摘要:

Objective:The objective of this study was to investigate the significance of emotional distress immediately after a myocardial infarction as a predictor of physical, psychological, and social outcomes and resource use.Methods:In an epidemiological survey, demographic and cardiological data were obtained for all patients from a defined geographical area who had had a myocardial infarction (according to diagnostic criteria of the Monitoring Trends and Determinants in Cardiovascular Disease [MONICA] trial). Hospital survivors were interviewed and were asked to complete self-report assessments on mental state and quality of life. Full replies were available at baseline for 347 subjects. Self-report follow-up questionnaire information was collected 3 months and 1 year later.Results:Fifteen percent of patients scored as probable cases of anxiety or depression. They were more likely than noncases to report preinfarct distress and poor adjustment (as indicated on the 36-item Medical Outcome Study short form). There was an improvement at 3 months, but there was little overall or individual change after that time. Anxiety and depression did not predict subsequent mortality but did significantly predict poor outcome at 1 year on all dimensions of the 36-item short form quality-of-life measure and on specific measures of everyday activity and reports of chest pain, use of primary care resources, and secondary prevention lifestyle changes.Conclusions:Subjects who are distressed in the hospital are at high risk of adverse psychological and quality-of-life outcomes during the ensuing year. Our findings strengthen the argument for in-hospital identification and treatment of patients with depression and anxiety after myocardial infarction.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The differential diagnosis of primary (idiopathic) vs. psychiatric hypersomnia is challenging because of the lack of specific clinical or laboratory criteria differentiating these two disorders and the frequent comorbidity of mental disorders in patients with primary hypersomnia. The aim of this study was to assess whether polysomnography aids in the differential diagnosis of these two disorders.Methods:After excluding patients taking medication and those with an additional diagnosis of sleep-disordered breathing, we compared the nocturnal and daytime sleep of 82 consecutive patients with a diagnosis of either primary hypersomnia (N= 59) or psychiatric hypersomnia (N= 23) and normal control subjects (N= 50).Results:During nocturnal sleep, patients with psychiatric hypersomnia showed significantly higher sleep latency, wake time after sleep onset, and total wake time and a significantly lower percentage of sleep time than patients with primary hypersomnia and control subjects (p< .05). In addition, the daytime sleep of patients with psychiatric hypersomnia was significantly higher in terms of sleep latency, total wake time, and percentage of light (stage 1) sleep and lower in terms of percentage of sleep time and stage 2 sleep than in patients with primary hypersomnia and control subjects (p< .05). The daytime sleep of patients with primary hypersomnia as compared with that of control subjects was characterized by lower sleep latency and total wake time and a higher percentage of sleep time (p< .05). Finally, a sleep latency of less than 10 minutes or a sleep time percentage greater than 70% in either of the two daytime naps was associated with a sensitivity of 78.0% and a specificity of 95.7%.Conclusions:Our findings indicate that psychiatric hypersomnia is a disorder of hyperarousal, whereas primary hypersomnia is a disorder of hypoarousal. Polysomnographic measures may provide useful information in the differential diagnosis and treatment of these two disorders.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Previous studies have not evaluated the clinical correlates of the electroencephalographic spectral profile in patients with insomnia. In the preliminary study described here, we evaluated the extent to which symptoms of stress and depression are associated with subjective sleep complaints and quantitative measures of sleep in individuals with chronic insomnia.Methods:Subjects were 14 healthy adults who met criteria for primary insomnia as specified in the fourth edition of theDiagnostic and Statistical Manual of Mental Disorders. Measures of stress, depression, and subjective sleep quality were collected before subjects participated in a two-night laboratory sleep series. We hypothesized that elevated symptoms of stress and depression would be associated with subjective sleep complaints and electroencephalographic evidence of hyperarousal during sleep. Hyperarousal during sleep was defined as decreases in delta power and elevations in alpha and beta power throughout non–rapid eye movement sleep, and symptoms of stress were defined as the tendency to experience stress-related intrusive thoughts and the interaction between intrusion tendency and the number of recent stressful events (subjective stress burden).Results:A stronger tendency to experience stress-related intrusive thoughts was associated with greater sleep complaints and a trend toward higher beta power, whereas increases in subjective stress burden were associated with decreases in delta power. In addition, elevations in subclinical symptoms of depression were associated with greater sleep complaints and elevations in alpha power.Conclusions:Observed relationships among symptoms of stress, depression, subjective sleep complaints, and electroencephalographic power may be relevant to the discrepancy between subjective and objective measures of sleep in patients with insomnia and may be more broadly applicable to sleep complaints in association with stressful life events and major depression.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:We tested whether low SES was associated with reduced central serotonergic responsivity in a community sample of adult men and women and the extent to which standardized measures of aggression and impulsivity mediate the association.Methods:A total of 270 adults who were enrolled in a clinical trial on the neurobehavioral effects of lipid lowering were given a neuropharmacologic challenge (plasma prolactin response to orally administered fenfluramine) to measure serotonergic responsivity. Measures of family income and educational attainment were standardized and summed to derive an overall index of SES. Scores from the Brown-Goodwin Life History of Aggression interview, the Barratt Impulsiveness Scale, and the Angry Hostility subscale from the NEO Personality Inventory were also standardized and summed to form an aggression/impulsivity score.Results:Low SES was correlated with low prolactin responses to the fenfluramine challenge in the full sample (r= .15) as well as in whites, men, and women evaluated separately. Although the standardized SES score was correlated inversely with aggression/impulsivity measure (r= −.19,p< .01), the association between SES and prolactin responses remained significant when statistical adjustments were made for age, gender, body mass index, and aggression/impulsivity scores.Conclusions:Blunted serotonergic responsivity is associated with low social class as measured by annual family income and educational attainment.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Past research has demonstrated that self-disclosure of traumatic or secretive information produces observable health benefits. Self-disclosure has also been linked, albeit less consistently, to improved psychological health. The present study examined the physiological and psychological consequences of children’s self-disclosure of their HIV/AIDS status to friends.Methods:Data were collected twice, one year apart, from 64 caregiver-child dyads in which all of the children were infected with HIV. Dependent variables included the child’s CD4%, self-concept, and level of behavioral problems.Results:Children who had disclosed their HIV+ diagnosis to friends during the 1-year course of the study had a significantly larger increase in CD4% than children who had told their friends before the study or those children who had not yet disclosed their HIV+ diagnosis to friends. This effect remained significant when the child’s age and level of medication (protease inhibitors) were statistically controlled. Self-disclosure to friends did not impact the child’s behavior or self-concept.Conclusions:This is the first study to investigate the effect of self-disclosure in children. The results were consistent with previous studies showing the positive health consequences of self-disclosure in adults, and suggest potentially important implications for professional and familial care givers of HIV/AIDS individuals.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Purpose:This study investigated the relationship between antagonistic behavior, dominance, attitudinal hostility, and coronary heart disease (CHD).Methods:One hundred one men and 95 women referred for thallium stress testing were administered the Structured Interview and the Cook-Medley Hostility Scale. The Hostile Behavior Index, derived from the Structured Interview and developed by Haney et al., served as an index of antagonism, and the frequency with which interviewees interrupted their interviewer served as a measure of dominance. On the basis of their medical history and thallium stress test results, patients were classified as having (N= 44) or not having (N= 99) CHD.Results and Conclusions:Multivariate logistic regressions (with age, gender, disease, and lifestyle risk factors in the model) revealed that both the Hostile Behavior Index and dominance were significant independent risk factors for CHD (relative risk [RR] = 1.22 and 1.47,p< .03). Of the two Hostile Behavior Index component scores, indirect challenge and irritability, only the latter correlated significantly with CHD (RR = 1.27,p< .03). Separate logistic regressions for men and women suggest that subtle, indirect manifestations of antagonism confer CHD risk in women and that more overt expressions of anger confer risk in men. A significant univariate correlation between hostility scale scores and CHD became not significant when we adjusted for socioeconomic status.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Postnatal depression affects 10% to 15% of women after childbirth. Self-report rating instruments, such as the Edinburgh Postnatal Depression Scale (EPDS), have been developed and administered to postpartum women to facilitate early detection. Most postnatal depression screening scales, however, focus solely on depressive symptomatology. We hypothesized that applying two complementary rating scales of symptoms and functioning as a double test would significantly enhance the positive predictive value of screening.Methods:A prospective cohort study was conducted at the postnatal clinic of a university teaching hospital. One hundred forty-five Chinese women completed the EPDS and 12-item General Health Questionnaire (GHQ) 6 weeks after delivery. They were then interviewed by a psychiatrist, who used the Structured Clinical Interview for third revised edition of theDiagnostic andStatistical Manual of Mental Disorders, nonpatient version (SCID-NP), to validate the diagnoses.Results:The positive predictive value of the EPDS and GHQ, when administered independently, was 44% and 52%, respectively, at their respective optimal cutoff scores. When the EPDS-GHQ double test was administered, the positive predictive value was significantly increased to 78%.Conclusions:Simultaneous administration of the EPDS and GHQ can substantially improve identification of women with postnatal depression. This can potentially reduce unnecessary referrals to general practitioners and psychiatrists and may enhance the overall cost-effectiveness of population-wide screening.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:This report describes associations between body mass index (BMI; kg/m2), eating attitudes, and affective symptoms across pregnancy and the postpartum period in a sample of 64 women.Methods:As part of a larger study, women were recruited during pregnancy and followed prospectively to 14 months postpartum. Measures included self-reported prepregnancy and 4-month postpartum BMI as well as pregnancy, 4-month, and 14-month postpartum eating attitudes (EAT), depressive symptoms (CES-D), and anxiety symptoms (STAI).Results:During pregnancy, symptoms of depression or anxiety were not significantly correlated with concurrent eating attitudes or measures of BMI. However, at 14 months postpartum, measures of eating attitudes and both depression and anxiety symptoms were associated. Measures of BMI were associated with depressive and anxiety symptoms at both 4 and 14 months postpartum. Four-month eating attitudes and BMI predicted 14-month postpartum depressive symptoms, beyond pregnancy, and 4-month postpartum measures of affective symptoms. Results suggested that overweight women were at risk for elevated anxiety at 4 months and depressive symptoms at both 4 and 14 months postpartum.Conclusions:These results provide evidence for a significant, albeit moderate, relationship between BMI, eating attitudes, and symptoms of depression and anxiety in the postpartum period that are not present during pregnancy.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objectives:The objectives of this study were to assess the prevalence of depressive disorders and symptoms and their correlates in patients with amyotrophic lateral sclerosis (ALS) and caregiver spouses and to identify dimensions of resilience as well as distress.Methods:Fifty-six patients with ALS and 31 caregivers were interviewed on one occasion, and 20 patients were subsequently reinterviewed during a scheduled medical visit at an ALS center. Major measures included the Structured Clinical Interview for DSM-IV, the Beck Depression Inventory, the Schedule of Attitudes Toward Hastened Death, quality of life, spirituality, and degree of hopelessness. The ALS Functional Rating Scale, spirometry measures of forced vital capacity, and the Karnofsky Performance Index were used to assess physical status.Results:Neither patients nor caregivers displayed significant psychopathology with respect to either current depressive disorders or scores on symptom scales. Depressive symptoms and psychological distress were not related to time since diagnosis, degree of disability, or illness progression during the period of observation. More interest in hastened death was associated with greater distress, but willingness to consider assisted suicide was not. Among caregivers, perceived caregiver burden was significantly associated with finding positive meaning in caregiving. Concordance between patient and caregiver distress was high, suggesting that attention to the mental health needs of caregivers may alleviate the patient’s distress as well.Conclusions:Clinical depression or significant depressive symptomatology is not an inevitable or common outcome of life-threatening illness, even in the presence of major disability.

ISSN:0033-3174    

出版商:OVID    

年代:2000

数据来源: OVID