Pain perception in patients undergoing bone marrow puncture--a pilot study

The objective of this study was to establish the relationship between the perception of pain, anxiety, and depressive tendency in performance of bone marrow puncture. 93 consecutive patients (62% men, 38% women) from a hematological oncology outpatient department ages 20 to 85 years (M age = 53.7, SD = 15.1) were questioned. On average, the patients had undergone 2.5 (+/- 2.6) punctures. The underlying disease was leukemia in 49%, malignant lymphoma in 41%, another malignant disease in 2%, and there was a benign condition in 8%. Depression and general anxiety were measured using the Hospital Depression and Anxiety Scale (HADS-D). Fear of puncture and perception of pain were registered with visual analog scales. Patients with increased scores of anxiety or depressive tendency on the HADS-D suffered significantly more severely from fear of puncture and pain than patients with normal scores. However, the puncture-related fear in the group as a whole correlated markedly more closely with the intensity and tolerability of pain than did general fear and depressive tendency. This finding must be considered when planning psychological interventions in this group of patients.     

Severity of injuries due to accidental fall across the life span: a retrospective hospital-based study

This retrospective study investigated injuries due to accidental fall across the life span for which 19,593 patients were admitted to the Emergency Unit of the Groningen University Hospital during the period 1990 through 1997. 64% of the accidental falls were found for those in the age range between 10 years and 59 years; however, the proportion of accidental falls with regard to other causes of injuries by age group were the highest in youngsters (infants up to 9 years old) and in elderly persons (over 60 years old), 43% or more of these patients having falls with injuries. The clinically treated patients had on the average a statistically greater Injury Severity Score (7.2) than the outpatients (2.4). The highest percentages of medically treated inpatients were the patients of 60 years and over. Their mean ISS score was about the same for elderly inpatients, but the percentage of clinical treatment increased with age as well as the mortality. 30% of the injuries were found in the lower extremities and 30% in the upper extremities. Bone fracture was statistically significantly the major (36%) injury followed by contusion (20%). 34% of the accidental falls occurred at home, and statistically significantly more females, 50 years of age and older, were injured than males.     

Behaviorally treated irritable bowel syndrome patients: a four-year follow-up

Nineteen of 27 patients suffering from Irritable Bowel Syndrome (IBS) who had completed a multicomponent treatment involving progressive muscle relaxation, thermal biofeedback, cognitive therapy and IBS education were located and evaluated 4 yr posttreatment. Seventeen of 19 (89.5, or 63% of the total original sample) rated themselves as more than 50% improved. Six of the 12 patients (50%) who submitted symptom monitoring diaries met our criteria for clinical improvement, i.e. achieving at least a 50% reduction in primary IBS symptom scores. The means on all measures at long-term follow-up were lower than those obtained prior to treatment. When follow-up symptom means were compared with pretreatment means, significant (P less than 0.05) reductions were obtained on abdominal pain/tenderness, diarrhea, nausea, and flatulence.     

An analysis of referrals to chaplains in a community hospital in New York over a seven year period

The study analyzed the pattern of referrals to chaplains in a suburban hospital over a 7-year period. Nurses made more than half of all the referrals to chaplains, with nursing accounting for 81.74% of referrals from staff members other than pastoral care workers and volunteers. Social workers and physicians made 11.74% and 4.08% of referrals, respectively. The number of referrals from social workers (r=.86, p<.05), nurses (r=.68, p<.10) and other staff (r=.69, p<.10) increased across years, with the exception of physicians. Three quarters of referrals were requests for chaplains to visit patients and one quarter were requests to visit with family or friends. A significant difference was found in the percentage of referrals made for patients and family/friends by staff members (p<.05), with social workers making a higher percentage of referrals for relatives and friends (34.1%), compared to nurses (26.74%) and physicians (27.27%). The most common presenting problems for which patients were referred to chaplains were anxiety, depression, and pregnancy loss. The rate of referrals for patients over the entire study period was 39.04 per 1000 patient stays.     

Comorbidity of DSM-IV Personality Disorders in unipolar and bipolar affective disorders: a comparative study

The aim of this study was to compare the prevalence of Personality Disorders assessed by Structured Clinical Interview for Axis-II in 155 inpatients diagnosed with Unipolar Disorder vs inpatients with Bipolar Disorder (39). The most frequent Axis II diagnoses among Unipolar inpatients were Borderline (31.6%), Dependent (25.2%), and Obsessive-Compulsive (14.2%) Personality Disorders. Among Bipolar inpatients, the most prevalent personality disorders were Borderline (41%), Narcissistic (20.5%), Dependent (12.8%), and Histrionic disorders (10.3%). Using chi squared analysis, few differences in distribution emerged between the two groups: Unipolar patients had more recurrent Obsessive-Compulsive Personality Disorder than Bipolar patients (chi(1)2=6.24, p<.005). Comorbid Narcissistic Personality Disorder was significantly more frequent in the Bipolar than in the Unipolar group (chi(1)2=6.34, P<.01). Considering the three clusters (DSM-IV classification), there was a significant difference between the groups, Cluster C (fearful, avoidant) diagnoses being more frequent in the Unipolar than in the Bipolar group (48.4% vs 20.5%, respectively). Cluster B (dramatic, emotionally erratic) diagnoses were found more frequently in patients with Bipolar Disorders (71.8% vs 45.2% in Unipolar patients, chi(2)2=10.1, p<.006). The differences in the distribution and prevalence of Personality Disorders between the two patient groups are discussed.     

Suicidal behavior among inpatients with schizophrenia and mood disorders in Chengdu, China

This study evaluated the characteristics of suicidal behavior (suicide attempt or suicidal ideation) among 230 consecutively admitted inpatients with schizophrenia and mood disorders in a university hospital in China. The rate of lifetime suicidal behavior was found to be significantly higher in patients with mood disorders (62.4%) than in patients with schizophrenia (38.6%). The rate of suicidal behavior was significantly higher in patients with major depressive disorder (86.8%) than those with bipolar disorders (42.6%). Patients with schizophrenia attempted suicide for the first time earlier in life than the patients with mood disorders. Mood disorder patients, especially those with major depressive disorder, had more and more serious suicide attempts than the patients with schizophrenia.     

冠心病多支血管病变完全血运重建的长期疗效观察

为分析冠心病多支血管病变(MVD)患者经皮冠状动脉介入治疗(PCI)进行完全血运重建术后长期的临床疗效,我们收集了2004年5月~2008年5月589例接受PCI的冠心病患者,其中实施完全性血运重建(CRV)461例(78.3%),不完全性血运重建(IRV)128例(21.7%),对比分析两组病例PCI术后随访1年以上的结果。结果显示IRV组患者中完全闭塞病变、3支血管病变的比例均高于CRV组(P0.01);CRV组PCI成功率明显高于IRV组(94.8%vs87.5%,P0.05)。提示多支冠状动脉病变完全性血运重建能够获得更好的长期临床疗效论。     

Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years

The purpose of this study was to determine the course of the psychosocial functioning of patients with borderline personality disorder (BPD) over 6 years of prospective follow-up. The psychosocial functioning of 290 patients meeting both DIB-R and DSM-III-R criteria for BPD and 72 patients meeting DSM-III-R criteria for another Axis II disorder (and neither criteria set for BPD) was assessed at baseline using a semistructured interview of demonstrated reliability. Over 94% of surviving patients were reinterviewed about their psychosocial functioning blind to all previously collected information at three distinct follow-up waves: 2-, 4-, and 6-year follow-up. The psychosocial functioning of borderline patients improved substantially over time, with the percentage meeting criteria for good overall psychosocial functioning increasing from 26% at baseline to 56% during the third wave of follow-up. Despite this improvement, borderline patients functioned significantly more poorly than Axis II comparison subjects, particularly in the area of vocational achievement. However, a more detailed examination revealed that borderline patients who had experienced a symptomatic remission during the course of the study functioned significantly better both socially and vocationally than never-remitted borderline patients. More specifically, they were significantly more likely to have a good relationship with a spouse/partner and at least one parent, good work/school performance, a sustained work/school history, a GAF score of 61 or higher (43% vs. 0% 6 years after their index admission), and to have good overall psychosocial functioning (66% vs. 27% at 6 year follow-up). Taken together, the results of this study suggest that psychosocial improvement is both common among borderline patients and strongly related to their symptomatic status.     

Stress situations of daily living in patients with obsessive-compulsive disorder: a retrospective case note study

About 40% of patients with obsessive-compulsive disorder (OCD) are said to have treatment-refractory symptoms and chronic course of illness in spite of cognitive-behavior therapy and pharmacotherapy. The present purpose was to investigate factors relevant to OCD patients' chronic course and disturbed daily functions in view of human basic needs based on Maslow's hierarchy of five basic needs. Case notes of 101 outpatients with OCD (47 men and 54 women who were 18 to 55 years old) and seen on a psychiatry unit of a general hospital were studied to explore their stressful situations and identify thwarted basic needs. 84 of the 101 patients had Love Needs, and Esteem Needs (n = 47) and Safety Needs (n = 45) were next. The Poor-functioning group mainly had histories with problems of Safety Needs (70.8%), while the Good-functioning group tended to mainly have problems of Esteem Needs (51.5%) rather than Safety Needs (33.3%). 57 patients (23 men and 34 women) who were treated for more than three months were divided into two groups according to their Global Assessment of Functioning score at the final assessment (cut-off point: 61); patients in the Good-functioning group tended to have problems of higher needs.     

A review of patient outcomes in pharmacological studies from the psychiatric literature, 1966–1993

A literature search was conducted on studies of new drugs used with patients with schizophrenia reported by U.S. and non-U.S. researchers from 1966–1993, yielding 41 U.S., and a total of 24 other non-U.S. studies, among them 11 British studies. Results of the U.S. and non-U.S. studies were pooled separately and compared. Among several comparable conditions discussed, the lack of any data on suicides in the U.S. studies was observed. For a second statistical analysis of suicide rates ‘person-years’ were calculated to adjust for differing washout durations. The results obtained include findings that the percentage of patients relapsing in U.S. studies was slightly lower (37.9%) than in non-U.S. studies (46%); the percentage of patients dropping out in U.S. studies (10.5%) was higher than in non-U.S. studies (7.6%); known location of dropout patients in U.S. studies was 1.7%, compared to 2.6% in non-U.S. studies. The most interesting finding was that no suicides were reported in U.S. studies, compared to 0.6% of patients reported in British studies. Some U.S. studies used ‘challenge doses’, such as amphetamines or L-dopa; no non-U.S. studies reported their use. Compared to U.S. studies, those by non-U.S., and particularly British, researchers appeared to report adverse events in their studies. ‘Challenge’ drugs were not used; suicides were reported. It is estimated that the probability that no patients suicided who participated in the U.S. is small—one in 500.     

局限期小细胞肺癌放疗中预防野照射和累及野照射的疗效分析

局限期小细胞肺癌综合治疗中采用三维适型或调强放疗技术,按不同照射范围分为累及野照射和预防野照射2个组进行比较,分析不同照射野对预后的影响。 67例局限期小细胞肺癌患者,随机分为累及野照射组37例和预防野照射组30例。累及野照射组照射范围包括化疗前CT所见肿瘤及转移淋巴结范围,预防野照射组照射范围包括原发灶、同侧肺门、纵隔及锁骨上淋巴引流区。两组均采用三维适形或调强技术,放疗剂量为DT50Gy～66Gy/5周～6周。结果全组总有效率为82.1%,局部复发率为29.9%,远处转移率为56.7%,1年、2年、3年生存率分别为68.7%、36.2%和20.1%,分组比较以上指标均无显著性差异（P＞0.05）。而两组病例急性放射性肺炎和食道炎发生率分别为5.4%、16.7%和2.7%、20.0%,累及野照射食管炎发生率显著低于预防野（P＜0.05）。     

Multimodal therapy in an inpatient setting

Inpatient Multimodal Therapy (imt) is a residential treatment program, lasting a maximum of 36 weeks, for patients with severe neurotic symptoms. A group of 44 chronic obsessive-compulsive patients and a group of 40 chronic phobic patients were treated in order to assess the outcome and the process of treatment and to identify prognostic factors associated with the effect. At follow-up—on average, eight months after discharge—it was found that 60% had improved, 32% had remained the same, and 8% had deteriorated, indicating that, in general, the treatment was beneficial. That these effects were long-lasting is supported by the fact that, at follow-up, 78% of all patients were no longer receiving treatment, 18% were receiving outpatient or day treatment, and 4% were receiving inpatient treatment. Phobic patients appear to have gained more from the multimodal approach than did obsessive-compulsive patients, as indicated by the fact that the severity of symptoms decreased as they improved in rational thinking, assertiveness, and arousal. By contrast, obsessive-compulsive patients relapsed more than phobic patients did. This was attributed to the fact that the former gained less from the rational-emotive training, denied problems with assertiveness, and did not practice the acquired relaxation skills. It further appeared that a favorable outcome could be induced in patients who (1) expressed relatively mild symptoms in this otherwise severe group, (2) reported relatively few additional complaints, (3) could clearly indicate interpersonal problems, and (4) did not use psychotropic drugs. These prognostic factors are so widespread that not much weight can be ascribed to them. Yet they are useful for indication ofimt until better predictors are found.     

女性原发性生殖道恶性黑色素瘤20例临床病理分析

探讨女性生殖道恶性黑色素瘤（MM）的临床病理特点、治疗及预后.对20例女性生殖道MM临床资料进行回顾性分析,显示女性生殖道MM占女性生殖道恶性肿瘤的0.53%,20例患者平均年龄（55.2±10.5）岁,绝经者占60%;HMB45、Melen-A、S-100阳性患者分别占92.3%、76.9%、69.2%;随访时间3个月～70个月,随访率70%,随访期间死亡率为42.9%;生存≥1年者100%,生存≥2年者63.6%,生存≥5年者9.1%.故女性生殖道MM发病率低,预后差,HMB45、Melen-A、S-100有助于病理诊断,手术是主要的治疗手段.     

Components of type A behavior and two-year prognosis of patients with acute coronary syndrome

We investigated prospectively the relationship of Type A behavior and its subcomponents with cardiac mortality and recurrent nonfatal cardiac events in a 2-yr. follow-up of 90 patients [69 men and 21 women, M age=56.4 yr., SD=8.4] after acute coronary syndrome. Type A behavior was assessed via the general Bortner Type A Index. Each patient completed the Bortner's scale before hospital discharge. During the first 2-yr. follow-up, there were 14 cardiac deaths among patients with myocardial infarction. 8 patients had recurrent cardiac events and were hospitalized, and 19 patients had an effort-induced angina pectoris. Patients with acute myocardial infarction who died during follow-up had a significantly lower Bortner score than patients with a secondary cardiac event. Bortner scores of patients with acute myocardial infarction who died indicated Type B behavioral patterns. Mortality was significantly higher in the patients classified as showing Type B (21.8%) behavior than in the patients classified as showing Type A (12.0%) behavior. Patients with a secondary cardiac event had more common Type A behavior patterns and higher Bortner scores than patients without a secondary cardiac event. The items on Bortner's scale "very competitive, ever rushed, tries to do too many things at once, fast in daily activities and expresses feelings" were inversely associated with cardiac deaths. These findings suggest that patients with acute coronary syndrome classified by scores on the Bortner scale as Type B behavior have a greater probability of death, and patients classified on the Bortner scale as Type A behavior have a greater probability of secondary cardiac events during follow-up. This finding may have implications for the treatment of patients with acute coronary syndrome. The inferior survival of patients with Type B personalities argues against attempts to modify Type A behavior in postinfarction patients.     

Objectifying the effect of autogenic training on disordered ventilation in bronchial asthma]

Forty-one persons suffering from asthma (aged 20 to 55; duration of disease: greater than or equal 2 years) were divided into 2 groups and participated in courses of instruction in autogenic training. The control group was comprised of 14 patients. The effects of autogenic training on the maximum rate of expiration as well as the limiting respiratory value were recorded. The control group showed a seasonal decrease in the maximum rate of expiration and the limiting respiratory value by 10 to 20% in the period extending from April through November. The autogenic-training patients showed a temporally similar increase in the maximum rate of expiration of 27 and 22%, respectively (the difference to the control group being 47 and 42%, respectively). In 35 patients the increase in the limiting respiratory value was equal to or greater than the effect produced by novodrine. Catamnesis after one year (n = 40): Absence from work in a twelve-month period was 663 days prior to autogenic training and 77 days (11.6%) subsequent to autogenic training. Accordingly, autogenic training may be considered to be an objectively effective component of a combination of therapeutical methods used in the treatment of bronchial asthma.     

A survey of the views of trainees in psychiatry regarding religious issues

Abstract

Although 94% of Americans believe in God, little is known about the religiosity of psychiatric residents and the role of religion in residents’ practice. We aimed to determine residents’ perceptions about (1) the importance of knowledge of religious beliefs, practices and priority of psychotherapy, psychopharmacology and general medical patients and (2) the relative difficulty religious issues presented compared with race, age, gender and sexuality.

All psychiatric trainees in one training program during two academic years were surveyed (n = 96). The 38 respondents (40%) reported a substantial degree of religiosity [high belief (74%), high practise (50%), high priority (71%)]. Significantly more residents reported that it was more important to know about the religiosity of psychotherapy patients than of psychopharmacology or general medical patients. Race was the only issue that the majority of residents reported as presenting more difficulty than religion.

In conclusion, the subgroup of residents who responded to the survey were more religious than expected, based on previous surveys of psychiatrists. They clearly differentiated psychotherapy patients from others when considering the importance of religion. That residents viewed religion to be a challenging issue underlines the need for further training and clinical focus on religion.     

心内科处理心理障碍患者治疗方案的可行性分析

为了探讨在心内科治疗心理障碍患者的可行性,我们应用汉密尔顿量表评估400例到心内科就诊的患者,对诊断为焦虑或抑郁状态的患者分为两组（心内科干预组,心理科治疗组）,随访半年,观察焦虑或抑郁状态的缓解情况。结果显示,本研究共入选符合心理障碍诊断者71例,占就诊人数的17．75％。到心理科治疗患者30例,在心内科门诊治疗患者41例,半年随访评估,治疗有效率分别为16．7％和79．4％（16．7％vs79．4％,P〈0．05）。因此,在心内科门诊对就诊的心理障碍患者进行治疗,是一种可行的方案。     

Intrinsic and extrinsic religiosity in preadolescence and adolescence: Effect on psychological adjustment

The aim of this study was to determine the prevalence of expectation of secondary gain among first-generation immigrant Turkish patients referred to a psychiatric hospital and whether this prevalence differs from that of Dutch outpatients. The study was carried out in the outpatient department of a Dutch psychiatric hospital. Expectation of secondary gain was assessed by directly asking the patients, via questionnaires whether they hoped to gain specific “benefits” from being in therapy. The study found that 31.7% of the Turkish patients reported holding expectations of secondary gain while being in therapy versus 42.2% of the Dutch patients. Our finding of a large proportion of Turkish patients with expectations of secondary gain is consistent with the results of an earlier study of Dutch patients. However, in contrast to the findings of empirical research, Turkish immigrants were not found more than Dutch patients to have expectations of secondary gain. In fact, such expectations were more common among Dutch patients.