Symptom changes in episodic and recurrent psychosis.

Abstract Background The symptoms of COVID-19 appear to be heterogenous, and the typical course of these symptoms is unknown. Our objectives were to characterize the common trajectories of COVID-19 symptoms and assess how symptom course predicts other symptom changes as well as clinical deterioration. Methods 162 participants with acute COVID-19 responded to surveys up to 31 times for up to 17 days. Several statistical methods were used to characterize the temporal dynamics of these symptoms. Because nine participants showed clinical deterioration, we explored whether these participants showed any differences in symptom profiles. Results Trajectories varied greatly between individuals, with many having persistently severe symptoms or developing new symptoms several days after being diagnosed. A typical trajectory was for a symptom to improve at a decremental rate, with most symptoms still persisting to some degree at the end of the reporting period. The pattern of symptoms over time suggested a fluctuating course for many patients. Participants who showed clinical deterioration were more likely to present with higher reports of severity of cough and diarrhea. Conclusion The course of symptoms during the initial weeks of COVID-19 is highly heterogeneous and is neither predictable nor easily characterized using typical survey methods. This has implications for clinical care and early-treatment clinical trials. Additional research is needed to determine whether the decelerating improvement pattern seen in our data is related to the phenomenon of patients reporting long-term symptoms, and whether higher symptoms of diarrhea in early illness presages deterioration.

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Understanding symptom appraisal and help-seeking in people with symptoms suggestive of pancreatic cancer: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2016-015682 ◽

2017 ◽

Vol 7 (9) ◽

pp. e015682 ◽

Cited By ~ 6

Author(s):

Katie Mills ◽

Linda Birt ◽

Jon D Emery ◽

Nicola Hall ◽

Jonathan Banks ◽

...

Keyword(s):

Pancreatic Cancer ◽

Help Seeking ◽

Survival Rates ◽

Initial Symptom ◽

Self Medication ◽

Gastrointestinal Conditions ◽

Symptom Appraisal ◽

Age Range ◽

Specific Symptoms ◽

Symptom Changes

ObjectivePancreatic cancer has poor survival rates due to non-specific symptoms leading to later diagnosis. Understanding how patients interpret their symptoms could inform approaches to earlier diagnosis. This study sought to explore symptom appraisal and help-seeking among patients referred to secondary care for symptoms suggestive of pancreatic cancer.DesignQualitative analysis of semistructured in-depth interviews. Data were analysed iteratively and thematically, informed by the Model of Pathways to Treatment.Participants and settingPancreatic cancer occurs rarely in younger adults, therefore patients aged ≥40 years were recruited from nine hospitals after being referred to hospital with symptoms suggestive of pancreatic cancer; all were participants in a cohort study. Interviews were conducted soon after referral, and where possible, before diagnosis.ResultsTwenty-six interviews were conducted (cancer n=13 (pancreas n=9, other intra-abdominal n=4), non-cancer conditions n=13; age range 48–84 years; 14 women). Time from first symptoms to first presentation to healthcare ranged from 1 day to 270 days, median 21 days. We identified three main themes. Initial symptom appraisal usually began with intermittent, non-specific symptoms such as tiredness or appetite changes, attributed to diet and lifestyle, existing gastrointestinal conditions or side effects of medication. Responses to initial symptom appraisal included changes in meal type or frequency, or self-medication. Symptom changes such as alterations in appetite and enjoyment of food or weight loss usually prompted further appraisal. Triggers to seek help included a change or worsening of symptoms, particularly pain, which was often a ‘tipping point’. Help-seeking was often encouraged by others. We found no differences in symptom appraisal and help-seeking between people diagnosed with cancer and those with other conditions.ConclusionsGreater public and healthcare professional awareness of the combinations of subtle and intermittent symptoms, and their evolving nature, is needed to prompt timelier help-seeking and investigation among people with symptoms of pancreatic cancer.

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Mood and Global Symptom Changes among Psychotherapy Clients with Depressive Personality

Depression Research and Treatment ◽

10.1155/2012/208435 ◽

2012 ◽

Vol 2012 ◽

pp. 1-12

Author(s):

Rachel E. Maddux ◽

Lars-Gunnar Lundh

Keyword(s):

Repeated Measures ◽

Mixed Model ◽

Psychological Symptoms ◽

Self Report ◽

Treatment Results ◽

Repeated Measures Analysis ◽

Depressive Personality ◽

Symptom Changes ◽

Psychotherapy Clients ◽

Over Time

The present study assessed the rate of depressive personality (DP), as measured by the self-report instrument depressive personality disorder inventory (DPDI), among 159 clients entering psychotherapy at an outpatient university clinic. The presenting clinical profile was evaluated for those with and without DP, including levels of depressed mood, other psychological symptoms, and global severity of psychopathology. Clients were followed naturalistically over the course of therapy, up to 40 weeks, and reassessed on these variables again after treatment. Results indicated that 44 percent of the sample qualified for DP prior to treatment, and these individuals had a comparatively more severe and complex presenting disposition than those without DP. Mixed-model repeated-measures analysis of variance was used to examine between-groups changes on mood and global severity over time, with those with DP demonstrating larger reductions on both outcome variables, although still showing more symptoms after treatment, than those without DP. Only eleven percent of the sample continued to endorse DP following treatment. These findings suggest that in routine clinical situations, psychotherapy may benefit individuals with DP.

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Psychological distress and seasonal symptom changes in community subjects with irritable bowel syndrome

Gastroenterology ◽

10.1016/0016-5085(95)27100-7 ◽

1995 ◽

Vol 108 (4) ◽

pp. A697 ◽

Cited By ~ 1

Author(s):

N.J. Talley ◽

P. Boyce ◽

B. Owen ◽

K. Paterson

Keyword(s):

Irritable Bowel Syndrome ◽

Psychological Distress ◽

Irritable Bowel ◽

Symptom Changes

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Evaluation indexes for symptom changes in Chinese medicine

Journal of Traditional Chinese Medicine ◽

10.1016/s0254-6272(14)60085-6 ◽

2014 ◽

Vol 34 (2) ◽

pp. 238-242

Author(s):

Yiguo Wang ◽

Mingzhu Yu ◽

Qiming Zhang

Keyword(s):

Chinese Medicine ◽

Evaluation Indexes ◽

Symptom Changes

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Symptom Changes and Ureaplasma urealyticum Reculture after Treatment with Broad-spectrum Antibiotics for Patients with Urinary Tract Infection

Korean Journal of Urology ◽

10.4111/kju.2008.49.4.360 ◽

2008 ◽

Vol 49 (4) ◽

pp. 360

Author(s):

Sang Wook Lee ◽

Kwang Woo Lee ◽

Min Eui Kim

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Broad Spectrum ◽

Ureaplasma Urealyticum ◽

Broad Spectrum Antibiotics ◽

Symptom Changes

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Symptom Changes at COPD Exacerbation

Chronic Obstructive Pulmonary Disease Exacerbations ◽

10.3109/9781420070873-8 ◽

2008 ◽

pp. 75-88

Keyword(s):

Copd Exacerbation ◽

Symptom Changes

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Patterns of Opioid Prescription, Use, and Costs Among Patients With Advanced Cancer and Inpatient Palliative Care Between 2008 and 2014

Journal of Oncology Practice ◽

10.1200/jop.18.00205 ◽

2019 ◽

Vol 15 (1) ◽

pp. e74-e83 ◽

Cited By ~ 3

Author(s):

Sriram Yennurajalingam ◽

Zhanni Lu ◽

Suresh K. Reddy ◽

EdenMae C. Rodriguez ◽

Kristy Nguyen ◽

...

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Symptom Assessment ◽

Patient Characteristics ◽

Opioid Prescription ◽

Patients With Cancer ◽

Edmonton Symptom Assessment Scale ◽

Symptom Assessment Scale ◽

Symptom Changes

PURPOSE: An understanding of opioid prescription and cost patterns is important to optimize pain management for patients with advanced cancer. This study aimed to determine opioid prescription and cost patterns and to identify opioid prescription predictors in patients with advanced cancer who received inpatient palliative care (IPC). MATERIALS AND METHODS: We reviewed data from 807 consecutive patients with cancer who received IPC in each October from 2008 through 2014. Patient characteristics; opioid types; morphine equivalent daily dose (MEDD) in milligrams per day of scheduled opioids before, during, and after hospitalization; and in-admission opioid cost per patient were assessed. We determined symptom changes between baseline and follow-up palliative care visits and the in-admission opioid prescription predictors. RESULTS: A total of 714 (88%) of the 807 patients were evaluable. The median MEDD per patient decreased from 150 mg/d in 2008 to 83 mg/d in 2014 ( P < .001). The median opioid cost per patient decreased and then increased from $22.97 to $40.35 over the 7 years ( P = .03). The median MEDDs increased from IPC to discharge by 67% ( P < .001). The median Edmonton Symptom Assessment Scale pain improvement at follow-up was 1 ( P < .001). Younger patients with advanced cancer (odds ratio [OR[, 0.95; P < . 001) were prescribed higher preadmission MEDDs (OR, 1.01; P < .001) more often in the earlier study years (2014 v 2009: OR, 0.18 [ P = .004] v 0.30 [ P = .02]) and tended to use high MEDDs (> 75 mg/d) during hospitalization. CONCLUSION: The MEDD per person decreased from 2008 to 2014. The opioid cost per patient decreased from 2008 to 2011 and then increased from 2012 to 2014. Age, prescription year, and preadmission opioid doses were significantly associated with opioid doses prescribed to patients with advanced cancer who received IPC.

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