Prevalence of Somatic Indicators of Distress in Diabetes Patients: Comparison to Psychiatric Patients and Community Nonpatients

1998 ◽  
Vol 28 (3) ◽  
pp. 265-272 ◽  
Author(s):  
James E. Aikens
Keyword(s):  
Psychiatric Patients ◽  
Screening Methods ◽  
Medical Illness ◽  
Medically Ill ◽  
Somatic Distress ◽  
Memory Problems ◽  
Insulin Dependent ◽  
Patient Groups ◽  
Case Classification ◽  
Diabetes Patients

Objective: Because psychiatric screening methods are usually developed using psychiatric samples but not medical samples, they often include distress indicators that overlap with medical illness. This potentially inflates psychopathology estimates for medically ill patient groups. The objective of this study was to determine whether somatic distress indicator base rates are elevated in diabetes patients. Method: The occurrence of Symptom Checklist 90-R (SLC-90-R) somatic symptoms was studied in fifty-six diabetes mellitus patients (27 insulin dependent, 29 non-insulin dependent) with non-elevated SLC-90-R profiles, as compared to both community nonpatient and psychiatric patient norms. Results: Of the fifteen SCL-90-R items rated by endocrinologists as most likely to be diabetes-related, nine were endorsed more frequently by diabetes patients than by nonpatients: faintness/dizziness (endorsed by 36% of diabetics), reduced libido (endorsed by 41%), anenergia (68%), memory problems (66%), trembling (18%), numbness (55%), weakness (39%), overeating (59%), and somatic concerns (41%). Anergia and faintness/dizziness were endorsed more frequently by psychiatric patients than diabetes patients, whereas numbness was endorsed more often by diabetes patients. Conclusions: Conservatism is warranted when applying these somatic indicators of distress to diabetes patients. Further studies are needed to determine whether such illness overlap biases case classification.

Screening for Depression in the Medically Ill: The Suggested Utility of a Cognitive-Based Approach

2001 ◽  
Vol 35 (4) ◽  
pp. 474-480 ◽  
Author(s):  
Gordon Parker ◽  
Gordon Parker ◽  
Therese Hilton ◽  
Dusan Hadzi-Pavlovic ◽  
Jatinder Bains
Keyword(s):  
Mood State ◽  
Depression Scale ◽  
Composite International Diagnostic Interview ◽  
Depressive Mood ◽  
Physical Symptoms ◽  
Diagnostic Interview ◽  
Medical Illness ◽  
Medically Ill ◽  
High Internal Consistency ◽  
Comparison Measures

Objective: There is a need for a valid measure of depression in the medically ill, and one that is independent of medical illness characteristics. As yet, there is no such widely accepted measure. We thus report on the early development of such a measure using cognitive constructs that define depressive mood state nuances. Method: We studied 67 patients with a significant medical illness, verbally administering a set of 81 provisional items. Sample members also alternatively completed one of two comparison measures: the Hospital Anxiety and Depression Scale (HADS) or the Beck Depression Inventory for Primary Care (BDI-PC). A psychiatrist interviewed a subset to determine severity of any depression and whether subjects met formalized caseness criteria for depression. The Composite International Diagnostic Interview (CIDI) was also administered during interviews to assess agreement with psychiatrist judgements about caseness. Results: A 16-item measure with high internal consistency was derived, with validation analyses suggesting it was distinctly superior to the HADS and somewhat superior to the BDI-PC measure. Conclusions: A cognitive-based approach (as used by both our measure and the BDI-PC) to screen for depression in medically ill groups appears to have distinct utility in identifying depressed patients, and in avoiding confounding influences of physical symptoms.

Disease burden and unmet needs for prevention of venous thromboembolism in medically ill patients in Europe show underutilisation of preventive therapies

2011 ◽  
Vol 106 (10) ◽  
pp. 600-608 ◽  
Author(s):  
Sharon Welner ◽  
Maria Kubin ◽  
Kerstin Folkerts ◽  
Sylvia Haas ◽  
Hanane Khoury
Keyword(s):  
Venous Thromboembolism ◽  
Care Delivery ◽  
Risk Groups ◽  
Considerable Proportion ◽  
Medical Illness ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
Medical Inpatients ◽  
Clear Identification

SummaryIt was the aim of this review to assess the incidence of venous thromboembolism (VTE) and current practice patterns for VTE prophylaxis among medical patients with acute illness in Europe. A literature search was conducted on the epidemiology and prophylaxis practices of VTE prevention among adult patients treated in-hospital for major medical conditions. A total of 21 studies with European information published between 1999 and April 2010 were retrieved. Among patients hospitalised for an acute medical illness, the incidence of VTE varied between 3.65% (symptomatic only over 10.9 days) and 14.9% (asymptomatic and symptomatic over 14 days). While clinical guidelines recommend pharmacologic VTE prophylaxis for patients admitted to hospital with an acute medical illness who are bedridden, clear identification of specific risk groups who would benefit from VTE prophylaxis is lacking. In the majority of studies retrieved, prophylaxis was under-used among medical inpatients; 21% to 62% of all patients admitted to the hospital for acute medical illnesses did not receive VTE prophylaxis. Furthermore, among patients who did receive prophylaxis, a considerable proportion received medication that was not in accord with guidelines due to short duration, suboptimal dose, or inappropriate type of prophylaxis. In most cases, the duration of VTE prophylaxis did not exceed hospital stay, the mean duration of which varied between 5 and 11 days. In conclusion, despite demonstrated efficacy and established guidelines supporting VTE prophylaxis, utilisation rates and treatment duration remain suboptimal, leaving medical patients at continued risk for VTE. Improved guideline adherence and effective care delivery among the medically ill are stressed.

The Reporting of Recent Stress in the Lives of Psychiatric Patients

1970 ◽  
Vol 117 (541) ◽  
pp. 635-643 ◽  
Author(s):  
Richard W. Hudgens ◽  
Eli Robins ◽  
W. Bradford Delong
Keyword(s):  
Life Events ◽  
Psychiatric Illness ◽  
Psychiatric Patients ◽  
Causative Role ◽  
Causal Connection ◽  
Specific Question ◽  
Interpersonal Conflicts ◽  
Positive Evidence ◽  
Medically Ill ◽  
Psychiatric Illnesses

Physicians and patients frequently assume a causal connection between life events and subsequent episodes of psychiatric illness. It seems to ‘make sense’ that an illness which is to some extent manifested by disordered emotions could be caused in part by emotion-producing events. But plausibility alone is no proof of the truth of such an assumption. Realizing this, several investigators have conducted systematic studies of the interrelationships of life events and illnesses, both psychiatric and medical. Such work has been reported by Adamson and Schmale (1), Holmes, et al. (3, 7, 9, 10) Brown and Birley (2) Clayton, et al. (4) Morrison, et al. (11) Murphy, et al. (12, 13) and Hudgens, et al. (8). These authors differed regarding the specific question of whether illnesses may be caused by emotion-producing stress. The first six of the above papers presented positive evidence for such a cause-effect relationship. The last four papers reported that psychiatric patients had significantly more interpersonal conflicts than did well persons or medically ill persons, at least while their psychiatric illnesses were in progress; but the latter authors were unable to find evidence that any type of stress, interpersonal or otherwise, played a causative role in the illnesses. Disagreements among all these workers may be traced to differences in both theoretical approach and methodology.

The Correlates of Cortical Sulci Atrophy and Central Atrophy in a Cohort of Schizophrenia and Manic Subjects in Nigeria

1995 ◽  
Vol 40 (4) ◽  
pp. 200-204 ◽  
Author(s):  
Abiodun O. Adeyinka ◽  
Jude U. Ohaeri ◽  
Benjamin O. Osuntokun
Keyword(s):  
Brain Atrophy ◽  
Negative Symptoms ◽  
Psychiatric Patients ◽  
Normal Subjects ◽  
Developed Countries ◽  
Clinical Parameters ◽  
Parallel Study ◽  
Healthy Control ◽  
Patient Groups ◽  
The Relationship

The prevalence of brain cortical sulci atrophy and central (subcortical) atrophy among Nigerian psychiatric patients is highlighted and compared with findings from developed countries. The relationship between these indices of brain atrophy and clinical parameters is also examined. Visual ratings of cortical sulci atrophy and central (subcortical) atrophy, assessed on the computed tomography (CT) image console, were compared among 50 patients with schizophrenia, 14 patients with mania and 41 healthy control subjects. The patients with schizophrenia and the patients with mania had a significantly higher prevalence of brain atrophy than normal subjects. Among the patients with schizophrenia, indices of brain atrophy were not significantly associated with disease outcome, and the presence of negative symptoms. In view of the findings from a parallel study of the same patients that psychiatric patient groups showed other evidence of CT abnormalities, the findings of this study indicate that the so-called functional psychiatric states in developing countries — as in developed countries — are probably associated with some diffuse neuropathological process.

scholarly journals Risk of Severe Bleeding With Extended Rivaroxaban to Prevent Venous Thromboembolism in Acute Medically Ill Patients With Bronchiectasis

2021 ◽  
Vol 27 ◽  
pp. 107602962110533
Author(s):  
Concetta Lipardi ◽  
C. Gregory Elliott ◽  
Chiara L. Sugarmann ◽  
Lloyd Haskell ◽  
Alex C. Spyropoulos ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Pulmonary Hemorrhage ◽  
Severe Bleeding ◽  
Medical Illness ◽  
Medically Ill ◽  
Subcutaneous Enoxaparin ◽  
Pulmonary Bleeding ◽  
Post Hoc ◽  
Medically Ill Patients

Background: Bronchiectasis is a chronic inflammation of the bronchi with recurrent infections and hemoptysis. The MAGELLAN study compared oral rivaroxaban, 10 mg once daily (QD), for 35 ± 4 days with subcutaneous enoxaparin 40 mg QD for 10 ± 4 days followed by placebo for 25 ± 4 days to prevent venous thromboembolism in patients hospitalized with an acute medical illness. MAGELLAN included a subset of patients with bronchiectasis. In a post hoc analysis, we evaluated the incidence and severity of pulmonary bleeding in patients with bronchiectasis who were hospitalized for an acute medical illness. This analysis included MAGELLAN patients diagnosed with bronchiectasis at baseline. Patients were evaluated by treatment group for International Society on Thrombosis and Haemostasis major bleeding, non-major clinically relevant (NMCR) bleeding, and the composite of the 2 (ie, clinically relevant bleeding). Results: Medically ill patients with bronchiectasis were randomized to rivaroxaban (n = 60) or enoxaparin/placebo (n = 61). There were 2 fatal pulmonary bleeds and 1 fatal gastrointestinal bleed in the rivaroxaban arm and no fatal or major bleeding in the enoxaparin/placebo arm. The incidence of major bleeding was 5% in the rivaroxaban arm. One NMCR bleed occurred in the rivaroxaban arm and 2 NMCR bleeds occurred in the enoxaparin/placebo arm. The incidence of clinically relevant bleeding was 6.7% versus 3.3% in the rivaroxaban and enoxaparin/placebo groups, respectively (relative risk = 2.06 [95% confidence interval: 0.351-12.046]). Conclusion: In-patients hospitalized with bronchiectasis and an acute medical illness, clinically relevant bleeding, including fatal pulmonary hemorrhage, occurs more frequently with extended rivaroxaban thromboprophylaxis than with enoxaparin followed by placebo.

scholarly journals Appraisal and discernment of prevalent drug-drug interactions in patients with psychiatric disorders

2021 ◽  
Vol 10 (8) ◽  
pp. 1005
Author(s):  
Axa Jacob ◽  
Cristin Simon Thomas ◽  
Anay Deore ◽  
Prasanna Deshpande
Keyword(s):  
Drug Interactions ◽  
Hospital Admissions ◽  
Psychiatric Patients ◽  
Medical Complications ◽  
Medical Illness ◽  
Inclusion Criteria ◽  
Potential Ddis ◽  
Careful Monitoring ◽  
Mechanistic Approach ◽  
High Prevalence

Background: Drug-drug interactions (DDIs) contribute majorly to hospital admissions, treatment failures, avoidable medical complications and subsequent healthcare costs. Thus, we employ a mechanistic approach to prospectively investigate the incidence of potential DDIs in the psychiatric patients in a clinical setting.Methods: In this prospective, observational, multi centred study conducted for a span of 6 months, psychiatric inpatients (≥18 years) prescribed with 2 or more medications daily for any medical illness were included. The secured prescriptions of the inpatients selected in accordance to the inclusion criteria were then assessed for DDIs using Micromedex(TM) as a standard.Results: Of the total 400 enrolled participants, 383 (95%) of them showed at least one pDDI regardless of the severity. An average of 7.33 interactions per patient was also deduced. A high prevalence of pDDIs totalling to 2900 was recorded in our study with an average of 7.33 interactions per patient.  Most of the interactions were of major (56.52%) and moderate severity (39.07) followed by contraindicated (2.55) and minor (1.83). Cardiovascular system (41.77%) had the highest potential to be affected due to the pDDIs identified. Trihexyphenidyl, haloperidol, promethazine, amisulpride, risperidone, divalproex, trifluoperazine, olanzapine and clozapine where among the most commonly encountered drugs in these interactions.Conclusions: A high prevalence of pDDIs totalling to 2900 was recorded in our study with an average of 7.33 interactions per patient.  A significant association of the pDDIs with variables such as age, gender, diagnosis and total number of drugs used was identified. More studies are required to explore the overall pattern of DDIs in psychiatric patients along with their levels and correlation with different risk factors. Careful monitoring and documentation are necessary to prevent further complications thereby improving the therapeutic outcome.

Medical Illness in Psychiatric Patients

1982 ◽  
Vol 75 (8) ◽  
pp. 941-944 ◽  
Author(s):  
DONALD F. M. BUNCE ◽  
L. RALPH JONES ◽  
LEE W. BADGER ◽  
STEVEN E. JONES
Keyword(s):  
Psychiatric Patients ◽  
Medical Illness

scholarly journals Healthcare resource utilisation and cost associated with elevated potassium levels: a Danish population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026465 ◽  
Author(s):  
Kun Kim ◽  
Reimar Wernich Thomsen ◽  
Sia Kromann Nicolaisen ◽  
Lars Pål Hasvold ◽  
Eirini Palaka ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Costs ◽  
Healthcare Providers ◽  
Population Based ◽  
Secondary Outcome ◽  
Resource Utilisation ◽  
Healthcare Resource Utilisation ◽  
Before And After ◽  
Patient Groups ◽  
Diabetes Patients

ObjectivesTo investigate healthcare costs associated with hyperkalaemia (HK) among patients with chronic kidney disease (CKD), heart failure (HF) or diabetes.DesignBefore–after cohort study of patients with HK and matched patients without HK.SettingPopulation-based databases covering primary and secondary care for the entire of Northern Denmark.ParticipantsPatients with a first incident record of CKD (n=78 372), HF (n=14 233) or diabetes (n=37 479) during 2005–2011. Among all patients experiencing a first HK event (potassium level >5.0 mmol/L), healthcare costs were compared during 6 months before and 6 months after the HK event. The same cost assessment was conducted 6 months before and after a matched index date in a comparison cohort of patients without HK.Primary and secondary outcome measuresMean costs of hospital care, general practice and dispensed drugs converted to 2018 Euros.ResultsOverall, 17 747 (23%) CKD patients, 5141 (36%) HF patients and 4183 (11%) diabetes patients with a first HK event were identified. More than 40% of all HK patients across the patient groups had subsequent HK events with successively shorter times between the events. In CKD patients, overall mean costs were €5518 higher 6 months after versus before first HK, while €441 higher in matched CKD patients without HK, yielding HK-associated costs of €5077. Corresponding costs associated with a HK event were €6018 in HF patients, and €4862 in diabetes patients.ConclusionsAmong CKD, HF and diabetes patients, an incident HK event was common, and a large proportion of the patients experienced recurrent HK events. Substantial increase in healthcare costs associated with a HK event was observed in the HK patients compared with non-HK patients. These results are important to better understand the potential economic impact of HK among high-risk comorbid patients in a real-wold setting and help inform decision-making for clinicians and healthcare providers.

The influence of a fish oil enriched diet on CETP and LCAT activity in non-insulin dependent diabetes patients

1994 ◽  
Vol 109 (1-2) ◽  
pp. 244-245
Author(s):  
C.E. Friedberg ◽  
R.J. Heine ◽  
T. van Gent ◽  
L.M. Scheek ◽  
W. Deville ◽  
...  
Keyword(s):  
Fish Oil ◽  
Insulin Dependent Diabetes ◽  
Lcat Activity ◽  
Insulin Dependent ◽  
Diabetes Patients

scholarly journals Patient's experiences of involuntary hospital admission and treatment: A review of qualitative studies

2007 ◽  
Vol 16 (2) ◽  
pp. 172-178 ◽  
Author(s):  
Christina Katsakou ◽  
Stefan Priebe
Keyword(s):  
Psychiatric Patients ◽  
Small Sample ◽  
Qualitative Studies ◽  
Future Research ◽  
Involuntary Admission ◽  
Involuntary Treatment ◽  
Emerging Issues ◽  
Patient Groups ◽  
Perceived Impact ◽  
Small Sample Sizes

SUMMARYAims - This study aimed to explore psychiatric patients' experiences of involuntary admission and treatment by reviewing qualitative studies. Method - Qualitative studies investigating patients' experiences of involuntary treatment were identified. Relevant databases were searched and authors were contacted. Thematic analysis was applied for the synthesis of emerging issues. Results - Five studies fulfilled the inclusion criteria. The main areas that appear to be of importance are: patients' perceived autonomy and participation in decisions for themselves, their feeling of whether or not they are being cared for and their sense of identity. In these areas both negative and positive consequences from involuntary admission were mentioned. However, methodological weaknesses were also found, such as small sample sizes. Furthermore, it is not described whether these themes are mentioned by all participants as negative and positive aspects of their experience or whether they reflect views supported by distinct groups. Conclusions - Although the perceived impact of involuntary treatment is fairly clearly described, differences between distinct patient groups are not examined. Future research should investigate such differences in order to inform relevant policy decisions for particular groups.Declaration of Interest: None.

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