Coping in chest pain patients with and without psychiatric disorders.

We first examined relations between psychiatric disorder and coronary heart disease (CHD) in 77 patients presenting with chest pain. The coping profiles of chest pain patients with and without psychiatric disorder and CHD were then compared. Psychiatric patients with no medical illness (n?=?129) were also studied. On the basis of previous research we hypothesized specific coping differences across the groups. As expected, chest pain patients without psychiatric disorder scored significantly higher on a problem-focused coping scale than chest pain patients with psychiatric disorder, who in turn scored higher on this scale than psychiatric patients with no medical illness. The opposite pattern occurred for a measure of wishful thinking. Scores of chest pain patients with psychiatric disorder were higher on a measure of avoidance and lower on a measure of seeking of social supports than those without psychiatric disorder. Scores on a self-blame measure were not different across the groups. The results are discussed in the context of illness behavior and somatization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders

BACKGROUND: The aim of this study was to explore patterns and clinical correlates of psychiatric comorbidity in patients with schizophrenia spectrum disorders and mood spectrum disorders with psychotic features. METHOD: Ninety-six consecutively hospitalized patients with current psychotic symptoms were recruited and included in this study. Index episode psychotic diagnosis and psychiatric comorbidity were assessed using the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Psychopathology was assessed by the SCID-P, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, and Hopkins Symptom Checklist. Awareness of illness was assessed with the Scale to Assess Unawareness of Mental Disorders. RESULTS: The total lifetime prevalence of psychiatric comorbidity in the entire cohort was 57.3% (58.1% in schizophrenia spectrum disorders and 56.9% in mood spectrum psychoses). Overall, panic disorder (24%), obsessive-compulsive disorder (24%), social phobia (17.7%), substance abuse (11.5%), alcohol abuse (10.4%), and simple phobia (7.3%) were the most frequent comorbidities. Within the group of mood spectrum disorders, negative symptoms were found to be more frequent among patients with psychiatric comorbidity than among those without comorbidity, while such a difference was not detected within the group of schizophrenia spectrum disorders. Social phobia, substance abuse disorder, and panic disorder comorbidity showed the greatest association with psychotic features. An association between earlier age at first hospitalization and comorbidity was found only in patients with unipolar psychotic depression. Patient self-reported psychopathology was more severe in schizophrenia spectrum patients with comorbidity than in those without, while such a difference was less pronounced in mood spectrum psychoses. CONCLUSION: These findings suggest that psychiatric comorbidity is a relevant phenomenon in psychoses and is likely to negatively affect the phenomenology of psychotic illness. Further studies in larger psychotic populations are needed to gain more insight into the clinical and therapeutic implications of psychiatric comorbidity in psychoses.     

Oesophageal dysfunction in male patients with angina-like pain

The value of betamethasone valerate by inhalation in the prophylactic therapy of severe childhood asthma has been established. To determine whether the efficacy of this drug is due to a local or a systemic action a double-blind crossover study of 28 days' treatment with oral betamethasone valerate and 28 days' treatment with inhaled steroid was carried out in 10 asthmatic children. Daily doses used were 1 mg orally and 800 mug by inhalation. Nine patients had fewer symptoms, higher peak expiratory flow rates, and a lower bronchodilator requirement on inhaled than on oral therapy. Exercise-induced bronchoconstriction was diminished on inhaled therapy. Five children requested early termination of the oral therapy period because of unacceptable symptoms. Nine parents stated a preference for the period of inhaled therapy. It is concluded that betamethasone valerate is highly effective by inhalation but that a comparable oral dose has no appreciable clinical effect.     

Biliary motility disorders

Incidental pituitary masses are commonly found during CT and MR imaging performed for a variety of reasons. Screening for hormone oversecretion by these tumors seems to be warranted. Patients with lesions greater than 1 cm should be screened for hypopituitarism. In the absence of visual field abnormalities or hypothalamic/stalk compression, it may be appropriate to observe such patients carefully with repeated MR imaging scans. A limited amount of data suggest that significant tumor enlargement occurs in less than 5% of patients with lesions smaller than 1 cm in diameter. However, all macroadenomas must start out as microadenomas, and thus periodic follow-up is indicated to assess for this possibility. Lesions larger than 1 cm in diameter by their very existence at the time of detection have already indicated a propensity for growth. Significant tumor growth occurs in just over one-quarter of such patients. Hemorrhage into such tumors is uncommon, but anticoagulation may predispose to this complication. When there is no evidence of visual field deficits, an attempt at medical therapy with a dopamine agonist or octreotide is reasonable, realizing that only 10% of such patients will respond with a decrease in tumor size. Alternatively, careful periodic observation without intervention may determine that the lesion is not growing. Surgery is indicated with evidence of tumor enlargement, especially when such growth is accompanied by compression of the optic chiasm, cavernous sinus invasion, or the development of pituitary hormone deficiencies.     

Seizure disorders presenting with psychiatric symptomatology

Seizure disorders can be mistaken for psychiatric disorders and, the two have a number of poorly understood interrelations. Disruptions of consciousness, motor activity, hallucinations, and abrupt mood and anxiety changes can all be seizure manifestations caused by cortical neuronal discharges. This article presents the classification and proposed psychopathology of seizure disorders. It then reviews the psychiatric conditions that frequently mimic elements of such seizure disorders, giving hints that will allow the clinician to correctly identify seizures that are creating psychiatric presentations. Finally, this article makes clear the situations in which anticonvulsant medications may be of value when nothing else seems to be working.     

A clinical study of substance dependence patients combined with other psychiatric disorders

The present study was conducted for clarifying the comorbidity of substance dependence and other psychiatric disorders in outpatients of four psychiatric hospitals in May, 1995. The results were as follows; 7.4% (N = 234) of the total 3155 psychiatric outpatients were diagnosed as substance dependence. Among those substance dependence patients, alcohol dependence accounted for 82.5% and the percentage of the other substance dependence were very small, i.e., methamphetamine dependence 6.4%, solvent dependence 1.7%, multiple substance dependence 9.4%, respectively. The percentage of comorbidity of substance dependence and psychiatric disorders was 23.9% (N = 56) of 234 substance dependence patients. The percentage of co-morbid alcohol dependence patients with affective disorder in all affective disorder patients was 5.0%; the percentage of comorbidity of alcohol dependence in neurotic patients 4.1%; the percentage of alcohol dependence comorbidity in schizophrenic patients 0.7%. In many cases, onsets of substance dependence and psychiatric disorders were within 2 years, which suggests the common backgrounds for substance dependence and psychiatric disorders, such as disruption of family and occupational life, stress and individual vulnerability, and substance use for self-medication. The study indicates that the percentages of diagnosed comorbidity of substance dependence and psychiatric disorders are generally smaller in Japan than in the U.S., which may be based on the differences of diagnostic standards between the two countries. Further studies are needed on the comorbidity of substance dependence and psychiatric disorders in other general hospital and psychiatric clinic patients.     

Orthotopic liver transplantation improves small bowel motility disorders in cirrhotic patients

Altered small intestinal motility has been observed in patients with liver cirrhosis. Its pathophysiology remains to be defined. Our aim was to investigate the effect of orthotopic liver transplantation on small intestinal dysmotility in patients with liver disease. Two patients were studied both before and after orthotopic liver transplantation. Abnormal migrating motor complex activity and prominent clustered contractions present preoperatively normalized within 6 months after the surgical procedure. This finding might represent an additional benefit of liver transplantation considering that altered motility may be involved in bacterial overgrowth and infections observed in these patients.     

Oesophageal acid clearance in patients with severe reflux oesophagitis

Previous studies examining oesophageal acid clearance have employed a variety of techniques to induce or simulate acid reflux. Clearance abnormalities have been deduced from abnormal standard motility studies, barium radiology or from 24-h pH recordings. In this study a 24-h pH and oesophageal motility recording system was used to study naturally occurring acid reflux episodes in control subjects and in two groups of patients with severe acid reflux disease (erosive oesophagitis and oesophageal stricture). Acid clearance was compared between the subject groups. Patients with oesophageal stricture were found to have poor oesophageal peristaltic ability and particularly poor oesophageal acid clearance. Those with erosive oesophagitis had normal peristaltic swallowing but abnormal acid clearance. This study has characterized, for the first time, the abnormalities in acid clearance during naturally occurring acid reflux episodes in patients with severe reflux disease. A more complete understanding of these clearance abnormalities could influence future medical and surgical strategies in the management of severe gastro-oesophageal reflux disease.     

Sleep disorders presenting as psychiatric disorders

In summary, disordered sleep can present in a complex and atypical fashion in which the primary sleep-related component may not be immediately apparent. A high index of suspicion serves the clinician well in these cases. A careful and systematic evaluation of sleep often proves to be rewarding in terms of diagnostic accuracy and improved treatment outcome.     

Exercise therapy for patients with psychiatric disorders: Research and clinical implications.

There is now considerable evidence that regular exercise is (a) a viable, cost-effective, but underused treatment for mild to moderate depression that compares favorably to individual psychotherapy, group psychotherapy, and cognitive therapy, and (b) a necessary ingredient in effective behavioral treatments that reduce self-reported pain in individuals with chronic pain. Preliminary evidence also suggests that regular exercise deserves further attention as (a) a singular treatment for some anxiety disorders, for individuals suffering from body image disturbance, and for the reduction of problem behavior of developmentally disabled persons, and (b) an adjunct in treatment programs for schizophrenia, conversion disorder, and alcohol dependence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neurological disorders in dentistry: managing patients with Alzheimer's disease

Alzheimer's disease (AD) is the most prevalent type of dementing illness affecting over four million Americans. It typically occurs after age 60, and prevalence increases with advanced age. As the adult population increases, a greater number of patients with a diagnosis of AD will require dental care. This article reviews the oral and systemic clinical findings seen in AD patients and current medical treatment. Some general and specific suggestions for dental management are presented, including guidelines for restraint and sedation use. Finally, some helpful, adaptive oral devices are recommended for use by caregivers of patients unable to provide for their own daily oral hygiene. Dental providers can and should be willing to make oral care available to patients with a diagnosis of AD. Despite the difficulties involved, the need will continue to be great, and the gratification in caring for these patients makes it worth the effort.     

Assessing communication in children with psychiatric and communication disorders

This article presents issues related to the communication assessment of children with psychiatric and communication disorders. Challenges inherent in assessing this population are discussed. Frequently used assessment instruments and procedures are described. Consideration is given to the assessment of very young or low-functioning children and older or high-functioning children.     

Neurological and psychiatric predictors of mortality in patients with Alzheimer disease in California

OBJECTIVE: To determine whether neurological and psychiatric symptoms predict survival time among patients with Alzheimer disease (AD) after adjusting for the influence of sociodemographic variables, health conditions, and dementia severity separately for men and women. DESIGN: The sample consisted of 936 men and women diagnosed as having probable or possible AD at 1 of 7 Alzheimer's Disease Diagnostic and Treatment Centers throughout California from 1986 through 1990. Data on dementia severity, comorbid conditions, and demographic characteristics were collected at the time of AD diagnosis. Data on vital status and dates of death were obtained by linking the patient file to several administrative databases maintained by the California State and federal governments. The mean length of follow-up was 31 months. Data were analyzed with Kaplan-Meier survival curves and Cox proportional hazards models. RESULTS: Men had shorter survival times than did women (log-rank test, 30.93, P < .001). Among men, but not women, survival times were negatively associated with selected neurological and psychiatric symptoms. Among women, but not men, a history of cardiovascular conditions was associated with poorer survival. CONCLUSIONS: Patterns of survival and predictors of survival time among patients with AD differ by sex. Future studies of survival and progression of AD need to examine men and women separately.     

AIDS risk behavior in opioid dependent patients treated with community reinforcement approach and relationships with psychiatric disorders

This study examined the Community Reinforcement Approach's (CRA) effect on AIDS risk behaviors and the relationship between comorbid psychiatric disorders and the risk for AIDS behavior in opioid dependent patients entering methadone maintenance treatment. Additionally, we looked at AIDS risk behaviors as they related to the Addition Severity Index (ASI), Beck Depression Inventory, Symptom Checklist-90-Revised (SCL-90-R), and the Social Adjustment Scale-Self Report (SAS-SR). Subjects (N = 227) were drawn from a large clinical trial that examined the effectiveness of a Community Reinforcement Approach for treatment of opioid dependence. Both CRA and standard treatment demonstrated a significant effect on reduction of AIDS risk behaviors. There was no relationship found regarding comorbid psychiatric disorders with the risk for AIDS behavior. However, there were correlations with other psychiatric, social, and substance abuse variables. Multivariate analyses indicated that increased drug and legal ASI composite scores were the primary predictors of increased AIDS risk behavior.     

Selected psychiatric symptoms associated with rate of cognitive decline in patients with Alzheimer''s disease

Endoscopy Sphincterotomy is an important therapeutic procedure in the treatment of some biliary and pancreatic disorders. In this paper, we report our experience over this subject. In our patients the main indication to perform this procedure was common bile duct stones; they were 83% of the total cases. In those cases, 67% were residual stones after cholecystectomy by laparotomy and laparoscopy. We performed sphincterotomy in 33% of patients with gallbladders in situ. In five patients (7.57%), we made the diagnosis of Oddi's sphincter dysfunction taken in account clinical, biochemical an radiological findings. No manometric measurements were done. We found some unusual cases, such as: choledococele and Sump syndrome. In five patients we had complications, 3 of them bled and the other two developed edematous pancreatitis. All these complications were solved with medical treatment.     

Incomitance patterns in different ocular motility disorders

Patients with severe trauma and illness were treated at our critical care medical center. Many of these patients have diabetes, anemia and other underlying conditions which sometimes lead to serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. A clinical study imipenem/cilastatin sodium (IPM/CS) was performed at our Medical Center. IPM/CS was administered to 30 patients with serious infections. Clinical results were excellent in 11, good in 5, fair in 9 and poor in 5 patients, thus an overall efficacy rate of 53.3% was obtained. Bacteriological efficacy rate was 50% with eradications in 11 cases and decreases in 3 cases out of 28 cases examined. No side effects were observed in any patients.     

Social role functioning by adolescents with psychiatric disorders

OBJECTIVE: To identify aspects of social role functioning that are impaired in adolescents with specific psychiatric disorders in order to improve the psychiatric taxonomy and clinical knowledge base. METHOD: Adolescents in four urban public schools were screened for mental health problems. Structured psychiatric interviews (National Institute of Mental Health Diagnostic Interview Schedule for Children Version 2.2) with 288 adolescents and their mothers were used to identify youths with psychiatric disorders, and 10 aspects of social role functioning were assessed. Aspects of social role functioning that discriminated between youths with and without psychiatric disorders and between those with emotional disorders and those with disruptive disorders were identified for boys and for girls. RESULTS: Boys with any type of disorder and all youths with disruptive disorders had significant, consistent impairment in academic performance and several other areas of functioning. Youths with emotional disorders, especially girls, demonstrated impairment in social activity participation and peer acceptance, but girls with disorders were not as consistently different from those without as were the boys with emotional disorders. CONCLUSIONS: Role functioning differs in important ways between youths with and without psychiatric disorders and between girls and boys with disorders. The results underscore the importance of investigating observable aspects of role behavior in order to improve the timely detection and effective management of psychiatric disorders in youth.     

Gallbladder motility and cholecystokinin release during long-term enteral nutrition in patients with Crohn's disease

BACKGROUND: Gallbladder bile stasis during long-term continuous enteral feeding may contribute to the high prevalence of gallstones in patients with Crohn's disease. We therefore examined the effects of continuous enteral nutrition on gallbladder motility and cholecystokinin (CCK) release in six patients. METHODS: Gallbladder volume was measured ultrasonographically for 12 h on days 1 (start), 8, 22 (6-h interruption of enteral feeding), 36, and 43 (end) of enteral feeding. Plasma CCK was assessed at several time points. RESULTS: Initial fasting gallbladder volume was 19.3 +/- 4.5 (mean +/- SEM) ml, which decreased to 4.9 +/- 3.6 ml after start of feeding. CCK increased from 1.5 +/- 0.3 to 3.9 +/- 1.1 pmol/l. On days 8 and 36 the gallbladder was almost completely contracted, and CCK increased to 7.5 +/- 2.7 and 8.3 +/- 2.6 pmol/l, respectively. On days 22 and 43 gallbladder volume increased, and CCK decreased rapidly to fasting concentrations after interruption of feeding. CONCLUSIONS: During continuous enteral nutrition the gallbladder is completely contracted, and CCK concentrations remain elevated. It is therefore unlikely that long-term enteral nutrition contributes to the increased prevalence of gallstones in patients with Crohn's disease.