scholarly journals The reasons for an unjustified visit by patients with somatoform disorders to general practitioners

2018 ◽  
Vol 10 (4) ◽  
pp. 40-45
Author(s):  
A. V. Pogosov ◽  
V. B. Laskov ◽  
Yu. V. Bogushevskaya
Keyword(s):  
Primary Care Physicians ◽  
Information Sources ◽  
Psychiatric Care ◽  
Comparison Group ◽  
Somatoform Disorders ◽  
Diagnostic Procedures ◽  
Outpatient Setting ◽  
Study Group ◽  
Behavioral Strategies ◽  
Health Care Need

Patients with somatoform disorders (SD) seek specialized psychiatric care late. Although many factors that prevent the timely visits by patients with SD for specialized psychiatric care are known, this problem requires further study.Objective: to analyze the role of information sources and iatrogenic factors in unreasonably selecting a specialist by patients with SD to visit him/her for primary medical advice.Patients and methods. Sixty-six women aged 19 to 40 years with new-onset SD (F 45.0) were examined. Two patient groups were identified: a study group of 41 patients (mean age, 31.5+1.2years) and a comparison group of 25 (mean age, 31.6+0.8years) (p>0.5). Primary care physicians had examined and treated the study group patients long (for 1 to 6 years) before their visit to a psychiatrist. The comparison group patients had been seen by a psychiatrist just in the first year of the disease.Anamnestic, clinical, andpsychopathological methods were used when examining the patients.Results and discussion. For their first visit, the patients with SD had selected a therapist and a neurologist more frequently and a cardiologist and an endocrinologist somewhat less frequently. This selection was also affected by the specialists' high titles, psychiatric consultation-avoiding behavior, and conversion mechanisms. Acquaintances' advice and Internet information as health information sources contribute to the unjustified revisits by these patients to primary medical specialists for a long time. Iatrogenic mechanisms were found to play a role in forming a false concept of a disease and destructive behavioral strategies leading to the chronization and progression of SD. Patients with SD who are long and ineffectively exposed to numerous diagnostic procedures and ineffective treatment in the primary health care need psychiatric counseling and psychotherapeutic support.Conclusion. The diagnosis of SD remains ineffective in an outpatient setting. There is a need for an educational program on SD within the continuing health education system.

scholarly journals Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care

2018 ◽  
Vol 25 (4) ◽  
pp. 550-564
Author(s):  
I.V.E. Carlier ◽  
D.H. Andree Wiltens ◽  
Y.R. van Rood ◽  
T. van Veen ◽  
J. Dekker ◽  
...  
Keyword(s):  
Psychiatric Care ◽  
Somatoform Disorders ◽  
Routine Outcome Monitoring ◽  
Outcome Monitoring ◽  
Monitoring Study

scholarly journals Characteristics of the course of gastric and duodenal ulcer disease concurrent with duodenal insufficiency

2017 ◽  
Vol 89 (12) ◽  
pp. 76-80
Author(s):  
M S Busygina ◽  
Ya M Vakhrushev
Keyword(s):  
Duodenal Ulcer ◽  
Electrical Activity ◽  
Comparison Group ◽  
Epigastric Pain ◽  
Empty Stomach ◽  
Study Group ◽  
Duodenal Ulcer Disease ◽  
Ulcer Disease ◽  
Ph Values ◽  
Duodenal Ph

Aim. To comprehensively study the course of gastric ulcer disease (GUD) and duodenal ulcer disease (DUD) concurrent with chronic duodenal insufficiency (CDI). Materials and methods. Ulcer disease (UD) was verified on the basis of the results of clinical and fibrogastroduodenoscopic examinations. The data of contrast duodenography and cavitary manometry were used to identify CDI. Gastroduodenal motor activity was investigated using the peripheral electrogastrograph EGG-4M. The results of pH measurements were employed to assess the state of gastric acid secretion and duodenal pH values. Results. A comprehensive examination was made in 106 patients with UD concurrent with CDI (a study group) and 30 UD patients without CDI (a comparison group). Epigastric pain was noted in the patients with GUD in the study and comparison groups (91.5 and 84.6%, respectively), but the pain was mainly aching in the patients with concomitant CDI and more intense (77.8%) in those without this condition. In the study group, heartburn was more common in patients with GUD and DUD (75.3 and 71.4%, respectively) than in those with UD in the comparison group (28.5 and 37.5%, respectively). Helicobacter pylori tests were positive in 23.8% of the patients in the study group and in 57.2% in the comparison group. Electrogastrography indicated that the patients with GUD and CDI had bradygastria and hypokinesis on an empty stomach; the electrical activity was reduced after eating. In the comparison group, tachygastria and hyperkinesis were detected on an empty stomach; these postprandial indicators were elevated. H. pylori tests were positive in 34.7% of the patients with DUD and CDI and in 63.6% of those with DUD without CDI. The postprandial electrical activity increased in patients with DUD and decreased in the comparison group. The specific features of changes in gastric and duodenal pH values in GUD and DUD concurrent with CDI in comparison with the isolated course of UD. Conclusion. The immediate and long-term follow-ups show that GUD and DUD concurrent with CDI run a more persistent course; the time of ulcer healing increases and the periods of remission decrease.

scholarly journals Influence of various treatment methods on the content of cytokines in saliva of patients with chronic sialadenitis

2018 ◽  
Vol 99 (4) ◽  
pp. 593-597
Author(s):  
S Z Aliev
Keyword(s):  
Comparison Group ◽  
Interleukin 2 ◽  
Interferon Γ ◽  
Interleukin 1Β ◽  
Comprehensive Treatment ◽  
Study Group ◽  
Local Immunotherapy ◽  
Chronic Sialadenitis ◽  
Cytokine Levels ◽  
Mixed Saliva

Aim. Study of the main cytokines (interleukin-1β and -2, interferon γ) in the mixed saliva from patients with chronic sialadenitis on the basic and comprehensive treatment dynamically. Methods. During the period of 2014 to 2017 we performed examination and treatment of patients with salivary gland diseases. Out of them we defined a group with chronic non-specific sialadenitis including 45 patients seen in the clinic in exacerbation. Patients in the comparison group received basic treatment. Patients in the study group additionally to conventional treatment were administered local immunotherapy. Measurement of cytokine levels in the oral fluid was performed in 45 patients with chronic sialadenitis in exacerbation and in 10 practically healthy subjects. Results. The level of interleukin-1β in saliva was found to be significantly increased before treatment (p <0.05). After the treatment interleukin-1β level in saliva decreased in both groups but most significantly this parameter decreased in the study group. After including local immunocorrection into the treatment complex dynamic decrease of interleukin-2 to 14.7±0.4 pg/ml was registered, which apparently is associated with stabilization of immune processes in the oral cavity. After the treatment conducted according to traditional scheme in the comparison group the level of interferon γ in saliva increased to 7.2±0.2 pg/ml which is 1.1 times higher than before treatment. Conclusion. In patients with chronic sialadenitis in exacerbation the level of interleukin-1β statistically significantly increases by 1. times (p <0.05), interleukin 2 - by 2.1 times (p <0.05) and the level of interferon γ decreases by 1.4 times (p <0.05) which is indicative of immunological signs of inflammatory reaction; use of local immunocorrection leads to more prominent decrease of interleukin-1β (by 20.3 vs 16.2% in comparison group; p <0.05), interleukin-2 (by 38.8 vs 26.6%; p <0.05) and increase of interferon γ (by 21.2 vs 12.5% in comparison group; p <0.05).

The Futility of Pretransplant Coronary Bypass Grafting in Asymptomatic Patients on Peritoneal Dialysis

1998 ◽  
Vol 18 (5) ◽  
pp. 485-488 ◽  
Author(s):  
S. Panduranga Rao ◽  
Susan Lenkei ◽  
Maggie Chu ◽  
Joanne M. Bargman
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Comparison Group ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Study Group ◽  
Bypass Grafting ◽  
Comorbid Disease ◽  
Dialysis Patients ◽  
Asymptomatic Patients

Objective To evaluate the validity of recommending coronary artery bypass grafting (CABG) in preparation for renal transplantation in asymptomatic peritoneal dialysis (PD) patients with evidence of reversible myocardial ischemia. Design Retrospective review in a single PD unit. Participants Ten asymptomatic PD patients who underwent CABG to be placed on the transplant list comprised the study group. Ten age-, sex-, and diseasematched PD patients who did not receive CABG were used as a comparison group. Measurements Clinical outcome from 1990 to the present. Results Only 1 patient in the study group has received a transplant. Seven patients (70%) have died or have been removed from the list because of comorbid illness. Only 2 patients are still on the waiting list. Conclusion As a result of the long waiting time for cadaveric renal transplant and the high risk of interim development of comorbid disease, only a minority of patients come to transplantation. The presence of coronary disease is likely a surrogate for more generalized cardiac and vascular disease in this population. In light of these findings, the policy of prophylactic revascularization in asymptomatic dialysis patients in preparation for renal transplantation needs to be reconsidered.

Effect of Pregnancy on Overall Survival After the Diagnosis of Early-Stage Breast Cancer

2001 ◽  
Vol 19 (6) ◽  
pp. 1671-1675 ◽  
Author(s):  
Shari Gelber ◽  
Alan S. Coates ◽  
Aron Goldhirsch ◽  
Monica Castiglione-Gertsch ◽  
Gianluigi Marini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Comparison Group ◽  
Early Stage ◽  
Pregnant Patient ◽  
Subsequent Pregnancy ◽  
Cox Proportional Hazards ◽  
Early Stage Breast Cancer ◽  
Study Group ◽  
The Impact

PURPOSE: To evaluate the impact of subsequent pregnancy on the prognosis of patients with early breast cancer. PATIENTS AND METHODS: One hundred eight patients who became pregnant after diagnosis of early-stage breast cancer were identified in institutions participating in International Breast Cancer Study Group (IBCSG) studies. Fourteen had relapse of breast cancer before their first subsequent pregnancy. The remaining 94 patients (including eight who relapsed during pregnancy) formed the study group reported here. A comparison group of 188 was obtained by randomly selecting two patients, matched for nodal status, tumor size, age, and year of diagnosis from the IBCSG database, who were free of relapse for at least as long as the time between breast cancer diagnosis and completion of pregnancy for each pregnant patient. Survival comparison used Cox proportional hazards regression models. RESULTS: Overall 5- and 10-year survival percentages (± SE) measured from the diagnosis of early-stage breast cancer among the 94 study group patients were 92% ± 3% and 86% ± 4%, respectively. For the matched comparison group survival was 85% ± 3% at 5 years and 74% ± 4% at 10 years (risk ratio, 0.44; 95% confidence interval, 0.21 to 0.96; P = .04). CONCLUSION: Subsequent pregnancy does not adversely affect the prognosis of early-stage breast cancer. The superior survival seen in this and other controlled series may merely reflect a healthy patient selection bias, but is also consistent with an antitumor effect of the pregnancy.

Effect of Lymphatic Mapping on the New Tumor-Node-Metastasis Classification for Colorectal Cancer

2003 ◽  
Vol 21 (4) ◽  
pp. 668-672 ◽  
Author(s):  
Anton J. Bilchik ◽  
Dean T. Nora ◽  
Leslie H. Sobin ◽  
Roderick R. Turner ◽  
Steven Trocha ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Comparison Group ◽  
Lymphatic Mapping ◽  
Tnm Classification ◽  
Prognostic Significance ◽  
Detection Methods ◽  
Blue Dye ◽  
Study Group ◽  
Tumor Node Metastasis ◽  
Node Metastasis

Purpose: Sensitive detection methods and accurate reporting are necessary to determine the prognostic significance of micrometastases (MM) and isolated tumor cells (ITCs) in lymph nodes that drain colorectal cancers (CRCs). This study examined the role of lymphatic mapping (LM) in the application of the new tumor-node-metastasis (TNM) classification for MM and ITC. Patients and Methods: All patients at the John Wayne Cancer Institute underwent LM immediately before standard resection of primary CRC between 1996 and 2001. Sentinel nodes (SNs) were identified using blue dye and/or radiotracer and were examined by hematoxylin-eosin (H&E) staining, cytokeratin immunohistochemistry, and multilevel sectioning. The comparison group comprised 370 patients whose primary CRCs were resected without LM during the same period at the same institution. Results: LM was successfully performed in 115 of 120 (96%) patients and correctly predicted the tumor status of the nodal basin in 110 of 115 (96%) patients. Thirty-seven patients (32%) were lymph node-positive by H&E; ITC and MM were found in 23 patients (29.4%) whose lymph nodes were negative by H&E. Tumor deposits were found in the SN only in 29 patients (50%). Nodal involvement was identified for 14.3%, 30%, 74.6%, and 83.3% of T1, T2, T3, and T4 tumors, respectively, in the study group, and for 6.8%, 8.5%, 49.3%, and 41.8% of T1, T2, T3, and T4 tumors, respectively, in the comparison group. The study group had a higher percentage of nodal metastases (53% v 36%; P < .01) and a higher incidence of MM and ITC (29.4% v 1.9%; P < .0001). The mean number of lymph nodes found in the study group (14) was also significantly more than the number found in the comparison group (10; P < .00001). Conclusion: Conventional examination of lymph nodes for CRC is inadequate for the detection of MM and ITC as described in the new TNM classification. Thus, LM and focused SN analysis should be considered to fully stage CRC.

Non-drug rehabilitation of patients with chronic obstructive pulmonary disease concurrent with hypertension

2016 ◽  
Vol 88 (8) ◽  
pp. 19-24
Author(s):  
E V Sevostyanova ◽  
Yu A Nikolaev ◽  
N V Bogdankevich ◽  
V G Lusheva ◽  
E N Markova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Comparison Group ◽  
Clinical Manifestations ◽  
Chronic Obstructive ◽  
Study Group ◽  
Basic Drug ◽  
Obstructive Pulmonary Disease

Aim. To evaluate the efficiency of decimeter wave therapy and halotherapy, which were additionally added to basic therapy, in patients with chronic obstructive pulmonary disease (COPD) concurrent with hypertension at the inpatient stage. Subject and methods. 36 patients aged 20 to 75 years with Stages I—II COPD concurrent with Stages I—II, first-second grade hypertension were examined and treated. The clinical examination included collection of complaints and medical history data, clinical laboratory and instrumental (electrocardiography, spirography) studies, and health-related quality of life (using the SF-36 questionnaire). The patients were randomized into two groups: a study group and a comparison group. The study group patients received decimeter wave therapy and halotherapy in addition to basic drug treatment; the comparison patients had basic drug therapy. Results. Pre- and postoperative comparative analysis of the major clinical manifestations of comorbidities revealed more pronounced positive changes with the lower rate of clinical manifestations in the study group. It was also observed to have a more marked reduction in blood pressure (BP) with its goal levels achieved. The mean pulse BP decreased by 28% in the study group (p=0.000005) and did not statistically reduced in the comparison group. In the study group patients, the integral quality-of-life indicator after a package of medical rehabilitation measures became statistically significantly higher by 35%. This indicator in the comparison group was statistically significantly unchanged. Conclusion. The directionality of the proposed rehabilitation complex towards the common pathogenetic components of the development and progression of COPD and hypertension, as well as the high efficiency of the complex justify its appropriate inclusion in the combination treatment and rehabilitation of this category of patients.

Pre-clinical Medical Students as the Primary Longitudinal Provider of Psychiatric Care in the Outpatient Setting: A Novel Training Model

2017 ◽  
Vol 41 (4) ◽  
pp. 538-541
Author(s):  
Jesse Tobias C. Martinez ◽  
Rachel E. Fargason ◽  
James H. Meador-Woodruff
Keyword(s):  
Medical Students ◽  
Psychiatric Care ◽  
Training Model ◽  
Outpatient Setting

Personal and pathopsychological features of patients with somatoform disorders in primary care

2017 ◽  
Vol 41 (S1) ◽  
pp. S417-S418
Author(s):  
B. Tsygankov ◽  
A. Kulichenko
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Somatoform Disorders ◽  
Psychometric Evaluation ◽  
Personal Characteristics ◽  
Pain Disorder ◽  
Somatization Disorder ◽  
Obsessive Compulsive ◽  
Somatoform Pain Disorder

IntroductionSomatoform disorders are a therapeutic challenge for primary care physicians. Various studies show low efficacy of psychotherapy for these patients, and the need for differentiated approach to their treatment.ObjectiveExplore the differences between pathopsychological, personal characteristics of patients with somatoform disorders.MethodsIt was carried out psychometric evaluation of 108 patients with different clinical variants of somatoform disorders, using SCL-90-r, Leonhard questionnaire.ResultsPatient with somatization disorder (SD) had maximum values on the “somatization”, “depression”, “hostile”, “paranoid” scales; a high level of anxiety. Singularity personality structure of these patients defining feature of exaltation, excitability, emotivity. Patients with undifferentiated somatoform disorder (USD) also showed high levels of somatization, anxiety and obsessive-compulsive, interpersonal sensitivity, phobic anxiety. Patients with stable somatoform pain disorder (SPD), had high levels of depression, obsessive-compulsive. SPD formed in individuals with features of anxiety, seizing, high emotivity. The maximum values for the scales of anxiety (ANX, PHOB) recorded in patients with somatoform dysfunction of the autonomic nervous system (SDANS). Evaluation of coping strategies showed a preferential use of the “avoidance” strategy by patients with SD, USD, a rare use of social support strategies, responsibility. Patients with somatoform pain disorder often resorted to seek social support.ConclusionThe use of the questionnaire SCL-90-r has identified a number of clinical features of patients with different variants of the SFD. Typologically in all samples of patients revealed moderate accentuation on emotivity trait.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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