摘要:

Many of the exciting conceptual and scientific advances in the field of psychosomatic medicine are not taught in United States medical schools. This article, based on the Presidential Address given at the Annual Meeting of the American Psychosomatic Society in Phoenix, Arizona in March 2003, reviews the rationale for integrating psychosomatic medicine into medical curricula, identifies educational needs, proposes a core curriculum, and suggests how American Psychosomatic Society members can be instrumental in curriculum development and implementation.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesThe purpose of this study was to explore the efficacy in a primary care setting of a telephone-based disease management program for the acute management of depression and/or at-risk drinking.Materials and MethodsVeterans (N= 97) with depression and/or at-risk drinking were identified by systematic screening and assessment. Eligible subjects received either telephone disease management (TDM) program or usual care based on random assignment of their clinician. The TDM program consisted of regular contacts with each subject by a behavioral health specialist (BHS) to assist in assessment, education, support, and treatment planning. Symptomatic outcomes were assessed at 4 months.ResultsOverall response rates favored those assigned to TDM compared with those assigned to usual care (39.1% responded vs. 17.6%,p= 0.022). Response rates within the separate diagnostic groups also favored TDM, but this was only significant for depressive disorders.ConclusionsAlthough the sample size was modest and the sample was limited to veterans, findings strongly suggest that a telephone-based disease management program can improve outcomes for patients with a behavioral health problem. Findings also suggest that a health specialist can focus and manage patients with different diagnoses, thus expanding the role beyond just depression care. TDM may be a viable, low-cost, model for primary care clinicians to deliver manual guideline-adherent behavioral health care, especially in a VA clinical setting.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThis report evaluates the effects of a depression relapse prevention program on disability outcomes among patients treated for depression at high risk for relapse.Materials and MethodsPrimary care patients initiating antidepressant treatment for depression were assessed 6 to 8 weeks after the initial prescription. Patients responding to initial treatment but at high risk for relapse were randomized to usual care or a relapse prevention intervention (N= 386). The 12-month relapse prevention program included systematic patient education, two psycho-educational visits with a depression prevention specialist, shared decision-making regarding maintenance pharmacotherapy, and ongoing monitoring of medication adherence and depressive symptoms via telephone and mail. Disability outcomes were assessed via blinded telephone assessments at 3, 6, 9, and 12 months using SF-36 and Sheehan Disability scales.ResultsUsual care patients and relapse prevention program patients had high rates of use of maintenance pharmacotherapy. Both relapse prevention and usual care patients showed improved functioning over the 12-month follow-up period. One of the three disability measures (the SF-36 Social Function scale) showed a significant intervention effect because of continuing improvement at 9 and 12 month follow-up, whereas the Sheehan Disability Scale showed a nonsignificant trend toward greater improvements in disability among relapse prevention patients than among usual care controls.ConclusionsModerate effects of a relapse prevention intervention on depressive symptoms were associated with modest and variable effects on disability outcomes. Inconsistent effects of the intervention for disability outcomes may be because of the high rates of maintenance pharmacotherapy among usual care patients, relatively mild levels of depressive symptoms among both intervention and control patients at baseline, the absence of a specific relapse prevention effect of the intervention, and the resultant modest differences in depressive symptoms between intervention and control patients in this trial.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo evaluate gender-related differences in quality of life (QOL) and cognitive function 1 year after coronary artery bypass surgery (CABG) after adjusting for known baseline differences.Materials and MethodsTwo hundred eighty patients (96 women and 184 men) underwent neurocognitive and QOL evaluation at baseline (preoperatively) and at 1 year after CABG. Multivariable linear regression was used to assess the relationship of gender to follow-up QOL and cognitive function. Measures used to evaluate QOL were IADL, DASI, work activities (SF-36), social activities, social support, general health perception (SF-36), CESD, STAI, and symptom limitations. Cognitive function was measured with a battery of performance-based neuropsychological tests, reduced to a four-cognitive domain scores with factor analysis, and a self-report measure of cognitive difficulties. Covariates in multiple regression models included age, years of education, marital status, Charlson Comorbidity Index, hypertension, diabetes, race, and baseline QOL/cognitive status.ResultsFemale patients showed significantly worse outcome than male patients at 1 year follow-up in several key areas of QOL. After adjusting for baseline differences, women are at greater risk for increased cognitive difficulties (p= 0.04) and anxiety (p= 0.03), as well as impaired DASI (p= 0.02), IADL (p= 0.03), and work activities (p= 0.02). Cognitive sequelae attributable to bypass surgery were similar between men and women.ConclusionsEven after adjusting for known risk factors for compromised QOL and cognitive functioning, women do not show the same long-term quality benefits of CABG surgery that men do.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

SummaryMarriage confers health benefits for men, but the evidence for women is less consistent. Inconsistent findings may be attributed, in part, to the confounding of marital status and marital quality.ObjectivesThe authors examined whether women in satisfying marriages evidence lesser atherosclerosis relative to women in low-satisfying marriages and relative to unmarried women.Materials and MethodsThree hundred ninety-three women from the Healthy Women Study participated in this study. Marital status and quality were assessed at baseline when women were premenopausal. Cardiovascular risk factors were also assessed at baseline to determine potential mediators. Markers of atherosclerotic burden—B-Mode ultrasound measures of intima-media thickness and plaque in the carotid arteries and electron beam computed tomography assessments of calcification in the aorta and coronary arteries—were performed, on average, 11 years and 14 years later, respectively. A subset of women underwent a second ultrasound scan approximately 3 years after their first scan.ResultsWomen in satisfying marriages had the least atherosclerosis in the carotid arteries and aorta, especially relative to those in low-satisfying marriages. Women in satisfying marriages also tended to show less rapid progression of carotid atherosclerosis relative to women in low-satisfying marriages. Women who did not have a partner had intermediate levels of atherosclerosis. Risk factors measured at baseline contributed to the differences between the satisfied and low-satisfied groups, but not those between the satisfied and unmarried groups.ConclusionsHigh-quality marriages may protect against cardiovascular disease for women. Studies concerning marriage and cardiovascular health in women should, therefore, concurrently examine marital quality and marital status.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThis article reviews the prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease (COPD) as well as the impact of comorbid anxiety on quality of life in patients with COPD. Published studies on three types of treatments for anxiety are then reviewed: psychopharmacology, psychotherapy, and pulmonary rehabilitation programs.Materials and MethodsA PubMed search was conducted of the literature from 1966 through 2002 using the keywords anxiety, chronic obstructive pulmonary disease, respiratory diseases, obstructive lung diseases, and pulmonary rehabilitation. Any articles that discussed the prevalence of anxiety symptoms or anxiety disorders among patients with COPD, the impact of anxiety on patients with COPD, or the treatment of anxiety in COPD patients were included in this review.ResultsAnxiety disorders, especially generalized anxiety disorder (GAD) and panic disorder, occur at a higher rate in patients with COPD compared with the general population. Not surprisingly, anxiety has a significant and negative impact on quality of life of COPD patients. Nonetheless, few studies have examined pharmacological, psychotherapeutic, or pulmonary rehabilitation treatments for anxiety disorders in the context of COPD. Trials of nortriptyline, buspirone, and sertraline have been found to reduce symptoms of anxiety. Similarly, cognitive–behavioral programs that focus on relaxation and changes in thinking also produced declines in anxious symptoms. Finally, multicomponent pulmonary rehabilitation programs can also result in reductions in anxious symptoms.ConclusionsStudies examining the treatment of anxiety disorders in patients with COPD are promising, yet their efficacy needs to be established. The long-term effects of treatment of anxiety disorders on quality of life of COPD patients have yet to be explored.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThe significance of psychological factors in asthma is a subject of considerable dispute. This study addressed the little investigated question of the potential role of psychological factors in the initial onset of asthma.Materials and MethodsData on the validated, standardized Behavior Screening Questionnaire were obtained prospectively from 35 to 53 months for 150 atopic children who had asthma by age 53 months and for 115 who did not.ResultsAt each age, the children who had asthma by 53 months had more behavior problems. There was no evidence that the subsequent behavior of those children who had asthma became more problematic. However, for those children without asthma by 35 months, an elevated behavior problem score at that age was related to the subsequent onset of asthma by age 53 months. The behavior problem score added significantly to the prediction of asthma onset (OR adjusted: 1.15; 95% CI: 1.02–1.29) when known risk factors of asthma and IgE levels for grass pollen and house dust mite at age 17 months were taken into account.ConclusionsBehavior problems may precede asthma onset in young atopic children. In this age group, behavior problems are not secondary psychological reactions to asthma onset. They may act as a marker for stress in the child’s life. The presence of behavior problems should alert clinicians that the child may be at increased risk for transition from atopic dermatitis to asthma.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveDhokalia, Parsons, and Anderson (Psychosom Med1998;60:33–37) found a positive correlation between a trait measure of negative affectivity (NA; neuroticism) and resting end-tidal fractional concentration of CO2(FetCO2) (fractional-concentration of end-tidal carbon dioxide) in a nonclinical sample. This contrasts sharply with studies reporting a negative association of FetCO2with state measures of NA and with studies reporting no or a negative relationship between FetCO2and trait NA. In two studies we aimed to clarify this paradox.Materials and MethodsIn the first study, 110 participants (83 women) completed the PANAS and a Checklist for Psychosomatic Symptoms in daily life. FetCO2was measured noninvasively during 5 minutes via a nose cannula connected to a capnograph. In the second study, FetCO2of high (N= 20, 10 men) and low (N= 20, 10 men) NA participants was sampled once with a nasal cannula and once while breathing through a mouthpiece for 6 minutes each during rest, completion of the NEO-PI-R questionnaire, and completion of a verbal knowledge test.ResultsThe first study found no association between trait NA and resting FetCO2after partialling out the effects of gender, menstrual phase, and use of oral contraceptives. The second study showed that FetCO2increased significantly in the high NA group only when the particpants filled out the questionnaires, regardless of its type.ConclusionsOverall, no association between dispositional NA and cross-situational FetCO2was observed. Apparently inconsistent findings may be caused by lack of control for hormonal status and mental load during testing.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivePrevious research has demonstrated links between low socioeconomic status (SES) and clinical asthma outcomes, as well as links between stress and asthma. The objective of this study was to test whether adolescents with asthma from different SES backgrounds differed in biological profiles relevant to asthma, including immune and cortisol measures. The second objective was to test whether psychological stress and control beliefs could explain these differences.Materials and MethodsAdolescents with persistent asthma from either low (N= 18) or high (N= 12) SES neighborhoods were interviewed about their stress experiences (chronic stress, acute life events, interpretations of ambiguous life events) and control beliefs. Blood was drawn to assess immune (cytokines, eosinophils, IgE) and neuroendocrine (cortisol) markers associated with asthma.ResultsAdolescents in the low SES group had significantly higher levels of a stimulated cytokine associated with a Th-2 immune response (IL-5), higher levels of a stimulated cytokine associated with a Th-1 immune response (IFN-&ggr;), and marginally lower morning cortisol values compared with the high SES group. Low SES adolescents also had greater stress experiences and lower beliefs about control over their health. Statistical mediational analyses revealed that stress and control beliefs partially explained the relationship between SES and IL-5/IFN-&ggr;.ConclusionOur finding that low SES was associated with elevations in certain immune responses (IL-5/IFN-&ggr;) in adolescents with asthma suggests the importance of further exploration into relationships between SES and Th-2/Th-1 responses in asthma. Our findings also suggest that psychological stress and control beliefs may provide one explanation for links between SES and immune responses in childhood asthma.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivePosttraumatic psychological stress may be associated with increases in somatic illness, including asthma, but the impact of the psychological sequelae of the September 11, 2001 terrorist attacks on physical illness has not been well documented. The authors assessed the relationship between the psychological sequelae of the attacks and asthma symptom severity and the utilization of urgent health care services for asthma since September 11.Materials and MethodsThe authors performed a random digit dial telephone survey of adults in the New York City (NYC) metropolitan area 6 to 9 months after September 11, 2001. Two thousand seven hundred fifty-five demographically representative adults including 364 asthmatics were recruited. The authors assessed self-reported asthma symptom severity, emergency room (ER) visits, and unscheduled physician office visits for asthma since September 11.ResultsAfter adjustment for asthma measures before September 11, demographics, and event exposure in multivariate models posttraumatic stress disorder (PTSD) were a significant predictor of self-reported moderate-to-severe asthma symptoms (OR = 3.4; CI = 1.2–9.4), seeking care for asthma at an ER since September 11 (OR = 6.6; CI = 1.6–28.0), and unscheduled physician visits for asthma since September 11 (OR = 3.6; CI = 1.1–11.5). The number of PTSD symptoms was also significantly related to moderate-to-severe asthma symptoms and unscheduled physician visits since September 11. Neither a panic attack on September 11 nor depression since September 11 was an independent predictor of asthma severity or utilization in multivariate models after September 11.ConclusionsPTSD related to the September 11 terrorist attacks contributed to symptom severity and the utilization of urgent health care services among asthmatics in the NYC metropolitan area.

ISSN:0033-3174    

出版商:OVID    

年代:2003

数据来源: OVID