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Sample records for chronically medicated schizophrenic

  1. Conversations with chronic schizophrenic patients.

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    Morgan, R

    1979-02-01

    An account is given of some of the topics discussed during a small informal weekly open group meeting of chronic schizophrenic patients, based on occasional notes compiled over eleven years. The main feature of the patients' condition as displayed was poverty--clinical, social, behavioural, material and financial--and certain features suggested an organic aetiology. Reasons are given for considering that the patients' condition was predominantly caused by schizophrenia rather than by institutionalism.

  2. Neurocortical electrical activity tomography in chronic schizophrenics

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    Veiga Heloisa

    2003-01-01

    Full Text Available Functional imaging of brain electrical activity was performed in 25 chronic medicated schizophrenics and 40 controls, analyzing the classical frequency bands (delta, theta, alpha, and beta of 19-channel EEG during resting state to identify brain regions with deviant activity of different functional significances, using LORETA (Low Resolution Tomography and SPM99 (Statistical Parametric Mapping. Patients differed from controls due to an excess of slow activity comprising delta + theta frequency bands (inhibitory pattern located at the right middle frontal gyrus, right inferior frontal gyrus, and right insula, as well as at the bilateral anterior cingulum with a left preponderance. The high temporal resolution of EEG enables the specification of the deviations not only as an excess or a deficit of brain electrical activity, but also as inhibitory (delta, theta, normal (alpha, and excitatory (beta activities. These deviations point out to an impaired functional brain state consisting of inhibited frontal and prefrontal areas that may result in inadequate treatment of externally or internally generated information.

  3. Positron CT findings of chronic schizophrenics

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    Toyoda, Junzo; Miyazaki, Chihiro; Sugai, Yuichi (National Musashi Research Institute for Mental and Nervous Disease, Kodaira, Tokyo (Japan)); Iio, Masaaki

    1983-12-01

    Positron CT images of 15 chronic schizophrenics (2 females and 13 males) were examined in contrast to 5 male controls. Average age of controls was 36 years and that of schizophrenics was 42 years. Schizophrenic cases were ill over 6 years, averaging 17 years. All were under antipsychotic drug therapy. Tracer compounds were /sup 11/C-CO/sub 2/ and /sup 11/C-glucose photosynthesised, the former being inhaled once just before and the latter being administered orally 10-15 minutes before examinations. On positron CT images of all normal controls, hyper-radioactivities in frontal regions were observed. Some asymmetries of activities were observed but not remarkable. There was no difference between the images with /sup 11/C-CO/sub 2/ and those with /sup 11/C-glucose. In schizophrenic cases, (1) 7 out of 15 cases showed hypo-activities in the frontal regions both with /sup 11/C-CO/sub 2/ and /sup 11/C-glucose. (2) With /sup 11/C-glucose, relative activities in the brain were lower than those in the soft tissues around the scalp, suggesting the lowered selective uptake of /sup 11/C-glucose by the brain. (3) With /sup 11/C-CO/sub 2/, 4 cases showed higher activities in the right temporal regions and their subcortex than the left. By consideration of relationships between these positron CT findings and clinical data such as present age, age of onset of illness, duration of illness, psychiatric symptoms, present drug amount, summed drug amount from administration, EEG and X-ray CT findings, significant correlation was recognized only between low frontal radioactivities and apathy-abulia as main symptom. Limitation on the explanation of the findings with the image alone was discussed.

  4. Mobilization of refractory chronic schizophrenics with haloperidol.

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    Psaras, M; Zissis, N P; Mouzakis, D; Lyketsos, G

    1980-01-01

    Adequate high doses of haloperidol have been administered to 24 chronic, refractory to standard antipsychotic treatment, schizophrenics (16 male, 8 female, mean age 32.9 years) to investigate the possibility of mobilizing and releasing these patients from the hospital. Treatment was started with 20 mg haloperidol and optimal doses were determined for each patient. The median daily optimal dose at the end of the trial was 100mg. All patients were followed up for 16 weeks. Evaluating criteria were the BPRS, the Discharge Readiness Questionnaire, a side-effect rating scale, a CGI scale and the number of patients able to leave the hospital. 3 patients were evaluated as able to leave the hospital. 87.4% of the patients were subjectively evaluated as improved. High doses of haloperidol did not correlate with a higher incidence of unwanted effects. On the contrary antiparkinson treatment was discontinued or decreased in 14 patients. It is concluded that nonresponsive chronic schizophrenics can profit from adequate high doses of haloperidol.

  5. Chronic pain and quality of life in schizophrenic patients

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    Jouce Gabriela de Almeida

    2013-03-01

    Full Text Available OBJECTIVE: To identify the prevalence and characteristics of chronic pain in schizophrenic patients and to compare the quality of life in patients with and without chronic pain. METHODS: Crossover design with a probablistic sample of 205 adult schizophrenic outpatients (80% paranoid schizophrenia. Socio-demographic, psychiatric disorder, pain and quality of life (WHOQOL- brief data were collected between June and September 2008. RESULTS: Mean age was 37 years, 65% were men, and the mean time spent in school was 9 years; 87% were single, 65% lived with parents and 25% had a job. Among patients with chronic pain, 70% did not receive treatment for pain. Regarding quality of life, patients with pain had more physical disabilities compared to those without pain (p < .001. There were no differences in other domains. Comparisons between patients with and without pain did not show any differences in how much they felt their mental health problems disabled them. Conclusion: Chronic pain was common in schizophrenic patients (similar to the general population of a similar age and decreased their quality of life. It is necessary to pay more attention to this co-morbidity.

  6. Neurocognitive performance in first-episode and chronic schizophrenic patients.

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    Moritz, Steffen; Andresen, Burghard; Perro, Christian; Schickel, Marc; Krausz, Micheal; Naber, Dieter

    2002-02-01

    Previous research on neuropsychological disturbances in first-episode and chronic schizophrenic patients has provided mixed results which can be partially attributed to methodological inconsistencies. For the present study, 70 schizophrenic patients (40 with chronic and 30 with first-episode schizophrenia) were compared to 30 healthy controls on a large battery of neuropsychological tests. Special attention was paid to potential confounds such as differences in psychopathology, age and educational level between the schizophrenic sub-samples. Healthy controls performed better than both first-episode and chronic patients in almost all cognitive domains (P < 0.01), while the patient samples did not differ in any of the tasks. Results were confirmed in a second series of analyses in which patient subgroups were equated for sociodemographic background variables. The present results confirm recent data collected in longitudinal studies, thus, lending further support for a neurodevelopmental model of schizophrenia. It is suggested that neuropsychological disturbances occur early in schizophrenia and do not worsen in the course beyond age-related decrement. Possible reasons why previous research has produced contradictory findings are discussed.

  7. Bilateral skin conductance, finger pulse volume, and EEG orienting response to tones of differing intensities in chronic schizophrenics and controls.

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    Bernstein, A S; Taylor, K W; Starkey, P; Juni, S; Lubowsky, J; Paley, H

    1981-08-01

    Skin conductance (SCOR), finger pulse volume (FPV-OR), and EEG orienting responses were examined to repeated tones of either 60- or 90-dB intensity in chronic schizophrenics, nonschizophrenic psychiatric patients, and normals. SCOR reaffirmed previous findings with schizophrenics displaying significantly more frequent nonresponsiveness to 60-dB tones, and faster habituation among patients who did respond. Increased stimulus intensity decreased the incidence of nonresponsiveness to the level of controls, but did not alter the rapid habituation of schizophrenics. These results generalized fully to the FPV-OR, despite the independence demonstrated between SCOR and FPV-OR, but did not generalize to EEG response. There were no significant differences between schizophrenics and controls in EEG reactivity-only in background activity, particularly in a slowing of dominant alpha frequency in schizophrenics. Schizophrenics displayed the same degree of bilateral asymmetry as controls in both SCOR and EEG; there was no evidence of a specifically schizophrenic asymmetry. Schizophrenics nonresponsive in either SCOR or FPV-OR showed significantly greater Conceptual Disorganization and Emotional Withdrawal, and significantly less Excitement than responders in blind clinical ratings on the Brief Psychiatric Rating Scale. None of the findings could be attributed to the effect of neuroleptics. Comparisons between medicated and nonmedicated patients showed no drug-associated effect on any OR variable under study. Drug effects were apparent only in skin conductance level (SCL). Neuroleptics were associated with a significant reduction in SCL in both schizophrenics and nonschizophrenics, together with a flattening of an otherwise incrementing SCL among schizophrenics.

  8. Computed tomographies of chronic schizophrenic patients following prefrontal lobotomy

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    Saito, Masahiko; Ogihara, Ryuji; Suzuki, Jiro

    1984-08-01

    To evaluate the long-term effects of prefrontal lobotomy, 70 chronic schizophrenic patients (male, 42; female, 28) who had undergone prefrontal lobotomy at the Tokyo Metropolitan Matsuzawa Hospital more than 25 years ago were studied by means of computed tomography (CT). The age of the subjects ranged from 51 to 83, averaging 63.9. All CT scans were performed with GE-CT/T. Cuts were made parallel to the orbito-meatal line at 10-mm intervals in all patients. CT scans of the coronal section were also obtained in some patients. There are 9 methods of lobotomy. Standard lobotomy and orbital lobotomy were most frequently found in our subjects. Corresponding to the lobotomy sites in the white matter of the frontal lobe, well-defined low-density areas were demonstrated in all the patients. The attenuation of these areas was identical with that of the cerebrospinal fluid. The location and the extent of these low-density areas were characteristic of each method of lobotomy. Except in the frontal lobe, there were no significant changes in the cerebrum compared with those of the non-lobotomized chronic schizophrenic patients who were selected as controls. (author).

  9. Subjective cognitive dysfunction in first-episode and chronic schizophrenic patients.

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    Moritz, S; Lambert, M; Andresen, B; Böthern, A; Naber, D; Krausz, M

    2001-01-01

    Previous studies indicate that first-episode and chronic schizophrenic patients do not differ regarding neuropsychological performance as assessed with standard cognitive tasks. For the present study, it was investigated whether first-episode and chronic schizophrenics report similar subjective cognitive deficits. The Frankfurt Complaint Questionnaire (FCQ), a scale devised for assessing subjective cognitive disturbances in schizophrenia, was administered to 20 first-episode and 36 chronic schizophrenic patients, as well as 20 healthy controls. The schizophrenic subsamples did not differ on any of the FCQ subscales or on a "lie scale," measuring illness denial. Psychopathological ratings were comparable for both groups. As expected, healthy subjects reported significantly less cognitive and perceptual problems than schizophrenic patients. In marked contrast to a Kraepelinian view of schizophrenia, the present data confirm previous studies conducted with objective neuropsychological tests that schizophrenia is a neurodevelopmental rather than a neurodegenerative disorder.

  10. Self-care actions of chronic schizophrenics associated with meeting solitude and social interaction requisites.

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    Harris, J L

    1990-10-01

    Solitude becomes a way of life and social interaction a scarce commodity for many chronic schizophrenics who are in institutional settings. This article describes the self-care actions associated with meeting solitude and social interaction requisites as reported by 10 institutionalized chronic schizophrenics. Eighteen solitude self-care actions and 10 social interaction self-care actions emerged from the interview data. The solitude self-care actions clustered around two distinct categories: distancing and organizing. The social interaction self-care actions clustered around one category, managing situations. The implications of this study extend to anyone who is in the position of providing care and support to an individual diagnosed as a chronic schizophrenic. Additional research is suggested to increase the generalizability of the findings of this study and to isolate conditions related to Orem's (1985) sets of actions for maintenance of a balance between solitude and social interaction.

  11. Skin-conductance orienting response in chronic schizophrenics: the role of neuroleptics.

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    Spohn, H E; Coyne, L; Wilson, J K; Hayes, K

    1989-11-01

    The primary aim of this study was to determine whether there is an association between neuroleptic treatment and skin-conductance orienting response (SCOR) nonresponding in chronic schizophrenics. In a design adapted to this purpose, we were unable to demonstrate a relationship between neuroleptics and nonresponding. Although inability to prove the null hypothesis precludes a claim that neuroleptic treatment and SCOR nonresponding are unrelated, internal evidence and prior studies strongly suggest that such a dissociation exists in most chronic schizophrenic nonresponders. We also found stable nonspecific and toxic skin conductance activity differences between SCOR "responders" and "nonresponders" on three occasions of testing. We interpret our results as bearing on state and trait issues in chronic schizophrenics.

  12. NEUROPSYCHOLOGICAL PERFORMANCE IN A SAMPLE OF INSTITUTIONALIZED CHRONIC SCHIZOPHRENIC PATIENTS

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    Luis Maia

    2010-12-01

    Full Text Available We study the results of a descriptive and exploratory study, with the intent to understand the results of a 21 male schizophrenic patients interned in a Portuguese Mental Health Care Centre, evaluated with neuropsychological test. We tried also to link these tests with variables such as schooling, family contact or lengh of internment. The assessment instruments were: Digits Series and Vocabulary Task, both from WAIS, Raven Progressive Matrices, Rey’s Complex Figures, Luria’s Series Neuropsychological Screening, Clock Task - Neuropsychological Screening and Visual Search and Attention Test. Results show that there is not an attention deficit clinically significant, even that data suggests light attention affection; also variables like family contact and schooling appear as protective factors of memory and also seems to be important for the planning / organization functions.

  13. Functionally aberrant electrophysiological cortical connectivities in first episode medication-naive schizophrenics from three psychiatry centers

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    Dietrich eLehmann‡

    2014-08-01

    Full Text Available Functional dissociation between brain processes is widely hypothesized to account for aberrations of thought and emotions in schizophrenic patients. The typically small groups of analyzed schizophrenic patients yielded different neurophysiological findings, probably because small patient groups are likely to comprise different schizophrenia subtypes. We analyzed multichannel eyes-closed resting EEG from three small groups of acutely ill, first episode productive schizophrenic patients before start of medication (from three centers: Bern N=9; Osaka N=9; Berlin N=12 and their controls. Low resolution brain electromagnetic tomography (LORETA was used to compute intracortical source model-based lagged functional connectivity not biased by volume conduction effects between 19 cortical regions of interest (ROIs. The connectivities were compared between controls and patients of each group. Conjunction analysis determined six aberrant cortical functional connectivities that were the same in the three patient groups. Four of these six concerned the facilitating EEG alpha 1 frequency activity; they were decreased in the patients. Another two of these six connectivities concerned the inhibiting EEG delta frequency activity; they were increased in the patients. The principal orientation of the six aberrant cortical functional connectivities was sagittal; five of them involved both hemispheres. In sum, activity in the posterior brain areas of preprocessing functions and the anterior brain areas of evaluation and behavior control functions were compromised by either decreased coupled activation or increased coupled inhibition, common across schizophrenia subtypes in the three patient groups. These results of the analyzed three independent groups of schizophrenics support the concept of functional dissociation.

  14. Adherence to depot versus oral antipsychotic medication in schizophrenic patients during the long-term therapy

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    Stanković Žana

    2013-01-01

    Full Text Available Background/Aim. There is a high rate of schizophrenic patients who do not adhere to their prescribed therapy, despite the implementation of antipsychotic long-acting injections and the introduction of atypical antipsychotics. The aim of this study was to investigate the differences in sociodemographic, clinical and medication adherence variables between the two groups of schizophrenic patients on maintenance therapy with depot antipsychotic fluphenazine decanoate and oral antipsychotics only as well as a correlation between the medication adherence and other examined variables. Methods. A total of 56 patients of both genders, aged < 60 years, with the diagnosis of schizophrenia (F20 (ICD-10, 1992 clinically stable for at least 6 months were introduced in this cross-sectional study. The patients from the depot group (n = 19 were on classical depot antipsychotic fluphenazine decanoate administering intramuscularly every 4 weeks (with or without oral antipsychotic augmentation and the patients from the oral group (n = 37 were on oral therapy alone with classical or atypical antipsychotics, either as monotherapy or combined. The Positive and Negative Syndrome Scale (PANSS was used to assess symptom severity. Item G12 of the PANSS was used to assess insight into the illness. The patients completed the Medical Adherence Rating Scale (MARS was used to assess adherence to the therapy. A higher MARS score indicates behavior [Medical Adherence Questionnaire (MAQ subscale] and attitudes toward medication [Drug Attitude Inventory (DAI subscale] that are more consistent with treatment adherence. The exclusion criteria were determined. The Pearson's χ2 test was used to compare categorical variables, Student's t-test to compare continuous variables and Pearson's correlation to test the correlation significance; p = 0.05. Results. Significant betweengroup differences in age, illness duration, chlorpromazine equivalents, PANSS score and DAI subscore were found

  15. A double-blind clinical investigation of cis(Z)-clopenthixol and clopenthixol in chronic schizophrenic patients.

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    Heikkilä, L; Karsten, D; Valli, K

    1981-01-01

    The therapeutic effect of the neuroleptic cis(Z)-clopenthixol has been compared with that of clopenthixol in mainly chronic schizophrenic patients in a double-blind 8-week trial. Forty-nine of the 54 patients in the trial received clopenthixol in the pre-trial period. Ratings with CGI and a single side effects form were done at weeks 0, 2, 4, 6, and 8. The registration of therapeutic effect at week 8 indicated a symptomatological status quo in both groups of patients while there was a tendency of slightly less interference by cis(Z)-clopenthixol with patient's functioning than by clopenthixol. The ratio of therapeutically equipotent cis(Z)-clopenthixol/clopenthixol doses was found to be 1:2. It is suggested that long-term treatment with clopenthixol advantageously may be replaced by cis(Z)-clopenthixol.

  16. Alexithymia and schizophrenic psychopathology.

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    Maggini, Carlo; Raballo, Andrea

    2004-04-01

    This research is an attempt to gain a comprehensive insight into alexithymia in schizophrenia. Previous studies offered clinically-descriptive and phenomenologically oriented suggestions regarding alexithymia putative contribution in shaping schizophrenic psychopathology. However, the factorial structure of the scales used to assess alexithymia had never been applied to a schizophrenic sample as a preliminary step to interpret results, thus assuming the purported dimensions of the alexithymia construct (i.e. difficulties identifying feelings, difficulties describing feelings, and externally oriented thinking) to be transnosographically stable. In order to explore the psychopathologic meaning and interrelations with other schizophrenic symptoms, we evaluated 76 chronic schizophrenic outpatients using the 20-item Toronto Alexithymia Scale, standardized measures of positive, negative, disorganized and depressive symptoms, social and physical anhedonia scales, and the Bonn Scale for the Assessment of Basic Symptoms. The principal component analysis ofTAS-20 items revealed a 4-factor structure with multiple correlations with psychotic, disorganized, depressive, anhedonic dimensions and basic symptoms. The data suggest that alexithymia in schizophrenia is more heterogeneous than was previously recognized, and has several components, some of which are more state-related, and others of which are more like trait features. Those components are specifically correlated with both overt and subjective dimensions of schizophrenic psychopathology.

  17. Schizophrenia and the paranormal: more psi belief and superstition, and less déjà vu in medicated schizophrenic patients.

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    Shiah, Yung-Jong; Wu, Yi-Zhen; Chen, Yueh-Hua; Chiang, Shih-Kuang

    2014-04-01

    The present study examined the relation between déjà vu experiences and paranormal beliefs in schizophrenic patients. A total of 522 participants (54.5% female; mean age=33.3, SD=16.02) were recruited, including 422 healthy adults (60.9% female; mean age=29.48, SD=15.07) and 100 medicated adult schizophrenic patients (27.3% female; mean age=48.98, SD=8.57). The Chinese version of the Inventory of Déjà-vu Experiences Assessment was created via back translation. Chinese versions of the Revised Paranormal Belief Scale (CRPB), Beck Anxiety Inventory (CBAI), and Perceived Stress Scale (CPSS) were also used. After controlling for age, gender, education, and anxiety, the results supported the following three hypotheses. Schizophrenic persons have fewer déjà vu experiences than normal persons. These experiences are positively related to paranormal beliefs in healthy adults but not in schizophrenic patients. Schizophrenic patients have higher scores than healthy adults on the psi and superstitious subscales of the CRPB. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Computerized EEG as a predictor of drug response in treatment resistant schizophrenics.

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    Itil, T M; Shapiro, D; Schneider, S J; Francis, I B

    1981-10-01

    Thirteen chronic schizophrenics were identified who failed to improve with physician's choice medication and 1 year of systematic treatment with a long acting phenothiazine. These patients were considered to be treatment resistant. Computer analyzed electroencephalogram (CEEG) or these treatment resistant schizophrenics was characterized by a large amount of alpha activity and less fast activity, in comparison with previous results from therapy responsive schizophrenics. The therapy resistant subjects did not display the typical neuroleptic CEEG profile following test dosages of four neuroleptics, and instead displayed CEEG profiles which more closely resembled the typical profile for psychostimulants. These findings may point to an altered metabolism, neurotransmitter defect, or other problem which alters the physiological and clinical response of therapy resistant schizophrenics to neuroleptic medication.

  19. Influence of systemic farming therapy on chronic schizophren-ic rehabilitation%系统化农疗对慢性精神分裂症患者康复的影响

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    刘建明; 何东东; 汤景文; 杨月友; 苏金哥

    2014-01-01

    Objective To explore the influence of systemic farming therapy on rehabilitation of long hospi-talized chronic schizophrenics .Methods Systemic farming therapy was given to 93 long hospitalized chro-nic schizophrenics at the same time of conventional rehabilitation treatment and nursing intervention for 12 months .Rehabilitation outcomes were assessed with the Nurses’ Observation Scale for Inpatient Evalua-tion (NOSIE) .Results After 6-month farming therapy their total positive factor ,social competence ,so-cial interest ,individual neat score of the NOSIE heightened significantly compared with pre-treatment (P<0 .05) ,did more significantly especially after 12 months (P<0 .01);after 6-month farming therapy their total negative factor ,irritation ,retardation and depression score lowered significantly (P<0 .05) , did more significantly especially after 12 months (P<0 .01) .Conclusion Systemic farming therapy could notably promote comprehensive rehabilitation of long hospitalized chronic schizophrenics .%目的:探讨系统化农疗对长期住院慢性精神分裂症患者康复的影响。方法对93例长期住院慢性精神分裂症患者在常规康复治疗及护理干预的同时予以系统化农疗,观察12个月。采用护士用住院病人观察量表评定康复效果。结果本组患者参加农疗6个月后护士用住院病人观察量表总积极因素及社会能力、社会兴趣、个人整洁因子分较农疗前显著升高(P<0.05),12个月后升高更显著( P<0.01);6个月后总消极因素及激惹、迟缓、抑郁因子分较农疗前显著下降(P<0.05),12个月后下降更显著(P<0.01)。结论系统化农疗能显著促进长期住院慢性精神分裂症患者的全面康复。

  20. Chronic Sorrow: Lived Experiences of Caregivers of Schizophrenic Patients in Butabika Mental Hospital, Kampala, Uganda.

    OpenAIRE

    2012-01-01

    Grief is a central experience by people diagnosed with mental illness, families, and friends. Chronic sorrow is defined as pervasive sadness and/or other emotional reactions commonly associated with grief that is permanent, periodic and potentially progressive in nature. It is viewed as a normal reaction to loss that may be to a single event or ongoing. During the experience of chronic sorrow, people feel emotional commotion, discomfort, & hopelessness. It may progress to pathological grief o...

  1. Emergency anaesthetic management of a severely anaemic, chronic schizophrenic patient with history of neuroleptic malignant syndrome

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    Shrividya Chellam

    2011-01-01

    Full Text Available Administering anaesthesia to a patient with chronic schizophrenia is a challenge due to the increased risk of various perioperative complications. Neuroleptic agents are highly effective drugs used for the treatment of psychiatric disorders, but are rarely associated with neuroleptic malignant syndrome (NMS. Here, we describe the successful anaesthetic management of a patient of chronic schizophrenia with past history of NMS who presented in emergency with active bleeding per rectum and haemoglobin of 3 gm%.

  2. Chronic Arsenic Poisoning Following Ayurvedic Medication

    National Research Council Canada - National Science Library

    Pinto, Benzeeta; Goyal, Palvi; Flora, S J. S; Gill, K D; Singh, Surjit

    2014-01-01

    .... Chronic arsenic poisoning following the use of ayurvedic medication, though reported, is rare.We describe three patients who presented with features of chronic arsenic poisoning following prolonged ayurvedic medication use...

  3. Movement disorder, memory, psychiatric symptoms and serum DHEA levels in schizophrenic and schizoaffective patients.

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    Harris, D S; Wolkowitz, O M; Reus, V I

    2001-04-01

    Reports of low levels of dehydroepiandrosterone (DHEA) or its sulphate (DHEA-S) in some schizophrenic patients and in some persons with poorer motoric and cognitive functioning led us to examine clinical correlates of serum DHEA and DHEA-S levels in schizophrenic patients. Ratings of abnormal movements, memory and psychiatric symptoms in 17 medicated chronic schizophrenic or schizoaffective inpatients at a state hospital were correlated with serum DHEA and DHEA-S levels, and their ratios with serum cortisol. Controlling for age, higher DHEA levels and/or higher DHEA/cortisol ratios were significantly correlated with lower symptom ratings on the Brief Psychiatric Rating Scale, better performance on some measures of memory, and lower ratings of parkinsonian symptoms. Relatively low DHEA levels or DHEA/cortisol ratios may identify a particularly impaired subgroup of medicated patients with chronic schizophrenia. Potential implications are discussed.

  4. HELPING THE CHRONIC SCHIZOPHRENIC AND THEIR FAMILIES IN THE COMMUNITY—INTIAL OBSERVATIONS1

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    Suman, C.; Baldev, S.; Murthy, R. Srinivasa; Wig, N. N.

    1980-01-01

    SUMMARY There is a growing interest in the problems of mentally ill persons in the community in order to understand and organize services for them. Schizophrenia continues to form the most important problems in the community. The present prospective study involved thirty patients with chronic schizophrenia and their families. The study involved the intensive understanding of the social problems of the patients and families as well as the interventions to manage the problems isolated. The study revealed the following areas to the source of problems of adjustment: (i) High expectations of the family, (ii) Excessive emotional involvement, (iii) Marital disturbances, (iv) Problems of employment and (v) Problems relating to long term treatment. The techniques employed in the management were, in addition to long-acting phenothiazines were: (i) periodic and regular home visits, (ii) family financial counselling, (iii) explanation about the illness to enhance treatment acceptance, and (iv) contact with social welfare agencies. The paper is largely descriptive and illustrations of cases are included to highlight the salient aspects of the experience. PMID:22058448

  5. Disfunção pré-frontoparietal durante o processamento de informação visuoauditiva em pacientes idosos com esquizofrenia crônica e efeitos da medicação Parieto-prefrontal dysfunction during visuo-auditory information processing in elderly, chronic schizophrenic patients and medication effects

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    Andrea Schmitt

    2009-01-01

    during acoustic and visual stimulation. The aim of this study was to investigate the prefronto-parietal network in elderly schizophrenia patients using the same paradigm. Additionally, we hypothesized favourable effects on brain activation by the atypical antipsychotic clozapine compared to typical neuroleptics. METHODS: We investigated 18 elderly, chronic schizophrenia patients and 21 elderly healthy controls. Nine schizophrenia patients had been medicated with clozapine and 9 had been receiving typical neuroleptics over decades. In addition to assessments with psychopathological and neuropsychological rating scales we used an acoustic and visual stimulation paradigm in a 1.5 Tesla MRI scanner to investigate BOLD-response in different brain areas. RESULTS: Compared to healthy controls schizophrenia patients showed decreased brain activation in the prefrontal and parietal cortex as well as medial anterior cingulate gyrus compared to healthy controls. In these regions, patients medicated with clozapine showed increased BOLD-response compared to patients treated with typical neuroleptics. DISCUSSION: Our study confirmed prefronto-parietal network disturbances in elderly schizophrenia patients thus pointing to the preservation of brain activation deficits and the influence of neurodevelopmental disturbances in chronic schizophrenia until old-age. CONCLUSION: The atypical antipsychotic clozapine seems to facilitate brain activation even in elderly, chronic schizophrenia patients.

  6. Comparison Of Effect Of Addition Of Fluvoxamine Or Risperidone To Clozapine In Chronic Partially Responsive Schizophrenic Patients On Clinical Response, QTc interval And Lipid profile

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    Sunil Mahakalkar

    2016-07-01

    Full Text Available Objective – To study & compare the augmentation effect of addition of fluvoxamine or risperidone in chronic partially responsive schizophrenic patients receiving clozapine on clinical and laboratory parameters.Methods - A prospective, randomized, parallel, open label 12 weeks study. The schizophrenic patients, aged 20-60 years, who followed the DSM-IV diagnostic criteria and receiving clozapine therapy, showing partial response to the treatment were recruited and the study was carried out from January 2007 to June 2008. Subjects were randomized into two groups: Group A (n=28: fluvoxamine (25-50mg/day was added to clozapine (25-200mg/day & Group B (n=27: risperidone (1-5mg/day was added to clozapine therapy. The effect of drugs was assessed by PANSS, BPRS scale and ECG and lipid profile were done at 6 and 12 weeks.Result - There was significant decrease in PANSS and BPRS score in both groups.Fluvoxamine + clozapine significantly reduced PANSS score as compared to risperidone + clozapine compared to baseline and between 6 and 12 weeks. Risperidone +clozapine prolonged QTc interval (at 12 weeks and elevated serum TG, VLDL, HDL significantly at 6 and 12 weeks.Conclusion – Although addition of fluvoxamine and risperidone to clozapine are effective in management of chronic partially responsive schizophrenia on clozapine, fluvoxamine is more effective as well as safer compared to Risperidone when compared for 6 and 12 weeks in these patients.

  7. Psycological Nursing on Medication Compliance of Schizophrenics%心理护理对精神分裂症患者服药依从性的影响

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    张淑艳; 高海英; 张继青; 高海江; 窦建军; 徐尔飞

    2011-01-01

    To evaluate the effect of psychological nursing on medication compliance of schizophrenics, 98 patients who were diagnosed schizophrenic according to the CCMD-3-the clinical schizophrenic diagnostic criteria in our hospital were included and divided into two groups,control group with 50 patients, which was applied with medicine, and treatment group with 48 patients, which was applied with medication and psychological nursing. The medication compliance of the two groups was observed for 1 year and compared. There is no statistical difference ( P>0.05) in drug compliance of the two group at the beginning of the research which were valued by The brief psychiatric rating scale(BPRS) , Psychological status examination(PSE) and Social Disability Screening Schedule(SDSS). But the significant difference was observed at the end of the research (P<0.01) , the drug compliance of treatment group was much better than control group. Psychological nursing could improve the medication compliance of the schizophrenics who were in remitted period.%探讨心理护理对精神分裂症缓解期患者服药依从性的影响.选取2008年1月至2009年12月在我院住院,符合精神分裂症临床诊断标准的精神分裂症患者98例,随机分为研究组(药物加心理护理)48例和对照组(药物治疗)5.例,进行为期1年的观察.入组时两组对治疗的依从性及BPRS,PSE,SDSS三种量表的评分差异无显著性(P>0.05),研究结束时,研究组患者BPRS,PSE,SDSS三种量表的评分与对照组比较均有显著性差异(P<0.01),研究组叶服药依从性优于对照组,差异有非常显著性(P<0.01).心理护理可以提高精神分裂症缓解期患者服药的依从性.

  8. Test-retest reliability of the Advanced Psychodiagnostic Interpretation (API) scoring system for the Bender Gestalt in chronic schizophrenics.

    Science.gov (United States)

    Aucone, E J; Wagner, E E; Raphael, A J; Golden, C J; Espe-Pfeifer, P; Dornheim, L; Seldon, J; Pospisil, T; Proctor-Weber, Z; Calabria, M

    2001-09-01

    This study assesses the test-retest reliability of the revised Advanced Psychodiagnostic Interpretation (API) scoring system for the Bender Gestalt Test (BGT). The API system identifies 207 possible distortions in a BGT protocol. Test-retest reliability for 40 schizophrenic patients tested twice with a mean interval of 6.4 years (SD=3.8 years) was good, ranging from .71 to .80. Further reliability and validity studies are needed to further demonstrate the effectiveness of the system.

  9. Reported Childhood Trauma and Suicide Attempts in Schizophrenic Patients

    Science.gov (United States)

    Roy, Alec

    2005-01-01

    Childhood traumas are associated with suicidal behavior but this aspect has not been examined in relation to schizophrenia. In this study, 50 chronic schizophrenic patients who had attempted suicide were compared with 50 chronic schizophrenic patients who had never attempted suicide for their scores on the 34-item Childhood Trauma Questionnaire…

  10. Altered balance in the autonomic nervous system in schizophrenic patients

    DEFF Research Database (Denmark)

    Nielsen, B M; Mehlsen, J; Behnke, K

    1988-01-01

    healthy subjects (32 +/- 7 years) served as controls. Immediate heart-rate responses to a single deep inspiration was used as a measure of parasympathetic function. Heart-rate response to standing was used as a measure of sympathetic function. Supine blood pressure, heart-rate and orthostatic changes...... in blood pressure did not differ between groups. Heart-rate response to standing was greater in both medicated and non-medicated schizophrenics compared to normal subjects (P less than 0.01). Heart-rate response to standing was greater in non-medicated compared to medicated schizophrenics (P less than 0.......05). Heart-rate response to inspiration was greater in non-medicated schizophrenics compared to normal subjects (P less than 0.05), whereas no difference was found between medicated and non-medicated schizophrenics. The results show that the balance in the autonomic nervous system is altered in schizophrenic...

  11. Dor crônica em pacientes esquizofrênicos: prevalência e características Chronic pain in schizophrenic patients: prevalence and characteristics

    Directory of Open Access Journals (Sweden)

    Jouce Gabriela de Almeida

    2010-03-01

    Full Text Available A prevalência de dor crônica entre pacientes com transtornos psiquiátricos é, possivelmente, no mínimo igual à encontrada entre a população geral. Para estimar a prevalência de dor crônica em pacientes com esquizofrenia, comparar os grupos com e sem dor crônica e caracterizar a dor foi realizado um estudo transversal, com uma amostra probabilística de 205 pacientes adultos, com diagnóstico de esquizofrenia (idade média 37 anos; 65% homens; média de escolaridade de nove anos; 87% sem companheiro(a; 65% residentes com os pais, atendidos em hospital público do Município de São Paulo, Brasil. A prevalência de dor foi de 36,6%; a dor foi mais presente no abdômen (30,7%, seguida da dor de cabeça, face e boca (24% e região lombar, sacra e cóccix (14,7%. Com relação à freqüência, 24% dos entrevistados referiram ter dor todos os dias. O tempo médio de dor foi de 41 meses, com intensidade moderada. A prevalência de dor crônica em pacientes esquizofrênicos foi semelhante à encontrada para a população geral, e o quadro álgico foi significativo em termos de duração, intensidade e freqüência dos episódios dolorosos.Chronic pain may be at least as prevalent in psychiatric patients as in the general population. To estimate the prevalence of chronic pain in schizophrenic patients, compare the groups with and without chronic pain, and characterize the pain, a cross-sectional study was performed on a probabilistic sample of 205 adult patients with a diagnosis of schizophrenia (mean age 37 years; 65% men; mean schooling nine years; 87% single; 65% living with parents, treated at a public hospital in the city of São Paulo, Brazil. Prevalence of pain was 36.6%, and the most frequent sites were abdomen (30.7%, head, face, and mouth (24%, and lower back (14.7%. Twenty-four percent of patients reported feeling pain every day. Mean duration of pain was 41 months, with moderate intensity. Prevalence of chronic pain in

  12. Evaluating the effectiveness of hospitalized occupational rehabilitation on social functioning in chronic schizophrenic patients%慢性精神分裂症患者院内职业康复社会功能疗效评估

    Institute of Scientific and Technical Information of China (English)

    卢苓; 马胜民; 翁永振; 崔仁祥

    2003-01-01

    AIM:To evaluate the effectiveness of hospitalized occupational rehabilitation for chronic schizophrenic patients in social functioning.METHODS:79 qualified cases were selected from chronic psychiatric inpatient departments,divided into two groups randomly,of which 45 cases of treatment group accepted hospitalized occupational rehabilitation,another 34 cases of control group accepted ordinary treatment.Social functioning was evaluated by the Scale of Social Skills of Chronic Schizophrenic In patients(SSSI). RESULTS:6 month course of research figured out that the rank of improvement of the total disability degree of the treatment was significantly larger than that of the control group(P< 0.05).Items of which rank of improvement of the treatment was significantly larger than those of the control group are participating in the occupational rehabilitation,social withdraw and concern and care about others (P< 0.01- 0.05).The level of disability of 55.6% of the treatment decreased more than that of the control (26.5% ) (P< 0.05) evaluated by SSSI.CONCLUSION:Hospitalized occupational rehabilitation is effective in improving social functioning of chronic schizophrenic patients,especially in improving items like participating in the occupational rehabilitation, social withdraw and concern and care about others.

  13. Chronic arsenic poisoning following ayurvedic medication.

    Science.gov (United States)

    Pinto, Benzeeta; Goyal, Palvi; Flora, S J S; Gill, K D; Singh, Surjit

    2014-12-01

    Ayurveda, Indian traditional system of medicine, is practiced commonly in South East Asia and in many parts of the world. Many ayurvedic drugs contain heavy metals and may lead to metal toxicity. Of these, chronic lead poisoning is the most common. Chronic arsenic poisoning following the use of ayurvedic medication, though reported, is rare. We describe three patients who presented with features of chronic arsenic poisoning following prolonged ayurvedic medication use. The diagnosis of chronic arsenic poisoning was confirmed by high arsenic levels in the blood, urine, hair, and nails in all the three patients and in ayurvedic drug in two patients. The ayurvedic medication was discontinued and treatment with D-penicillamine started. At 6 months after treatment, blood arsenic levels returned to normal with clinical recovery in all of them. Arsenic poisoning following ayurvedic medication is much less common than lead poisoning, though mineral ayurvedic medicines may lead to it. We used D-penicillamine as chelator and all of them recovered. Whether withdrawal of medication alone or D-penicillamine also played a role in recovery is unclear and needs to be assessed.

  14. 伴迟发性运动障碍的慢性精神分裂症患者临床特征分析%Analysis of clinical characteristics in chronic schizophrenic patients with tardive dyskinesia.

    Institute of Scientific and Technical Information of China (English)

    胡卫红; 陆光华; 谢帆; 江开达

    2013-01-01

    Objective To explore the clinical characteristics in chronic schizophrenic patients with tardive dyskinesia (TD). Methods A total of 126 chronic schizophrenic patients with TD were assessed with Abnormal Involuntary Movement Scale (AIMS) to evaluate their dyskinesia movement and the Positive and Negative Symptom Scale (PANSS) to evaluate their psychiatric symptoms. Their clinical characteristics were compared with 116 chronic schizophrenic patients without TD. Results Compared with those without TD, schizophrenic patients with TD showed older age, longer duration of illness, higher total score of PANSS, higher score of negative symptoms and higher score of general psychopathology (P <0. 01 or P <0.05). There was no significant correlation between severity of TD with age, gender, total duration of illness, smoking, clinical psychopathology. Conclusion Chronic schizophrenic patients with TD have different clinical characteristics such as older age, longer duration of illness, more severe clinical psychopathology when compared with those without TD.%目的 探讨伴迟发性运动障碍(tardive dyskinesia,TD)的慢性精神分裂症患者的临床特征.方法 采用异常不自主运动评定量表(AIMS)对126例伴TD的慢性精神分裂症患者的不自主运动进行评定,运用阳性和阴性综合征量表(PANSS)对精神症状进行评估,并与1 16例不伴TD的慢性精神分裂症患者相对照.结果 与非TD患者相比较,TD患者相对年龄更大、病程更长(P<0.01),具有更高的PANSS总分、阴性症状评分及一般病理评分(P<0.01或P<0.05).TD严重程度与年龄、性别、总病程、吸烟、临床精神病理无显著相关性(P>0.05).结论 伴TD与不伴TD的慢性精神分裂症患者有不一样的临床特征,伴TD的患者年龄更大,病程更长,具有更严重的临床精神病理.

  15. Medical management of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Dhiraj Yadav; Jonathan E. Clain

    2003-01-01

    慢性胰腺炎的临床表现包括疼痛、脂肪泻和糖尿病.在西方国家,慢性胰腺炎最常见的病因是酗酒.70%以上的病人在就诊时有疼痛的临床表现,而且,这些患者中又有75%以上会在几年之后出现疼痛减轻或完全消失.对于所有的慢性胰腺炎的病人来说,均应排除非胰源性疼痛和胆道梗阻、胰腺假性囊肿等胰腺局部并发症.应建议所有慢性胰腺炎病人戒烟、戒酒.阿片类镇痛剂仅应用于治疗疼痛严重的病人.尽管有报道认为胰酶替代治疗有助于止痛,但是,对于已经确诊的慢性胰腺炎病人来说,该疗法无效.激素类药物进行腹腔神经丛阻滞术可能有助于病人度过剧烈疼痛期.顽固性疼痛是进行胰液引流或胰腺切除的适应证.建议应用适量胰酶替代联合(或不联合)制酸剂治疗营养不良.慢性胰腺炎导致的糖尿病与原发性糖尿病的治疗原则相似.%The clinical presentation of chronic pancreatitis includes pain, steatorrhea and diabetes. The most common etiology in the western world is excess alcohol use. Pain is present in >70% patients at presentation and decreases in intensity or resolves over several years in up to 75% of patients. Non-pancreatic causes of pain and local complications, chiefly pseudocysts and biliary obstruction should be excluded in all patients. All patients should be advised to abstain from alcohol and smoking and opiates should be used only to control severe exacerbations of pain. Although pancreatic enzyme replacement is reported to be useful in the management of pancreatic pain, it is of little or no benefit in patients with established chronic pancreatitis. Celiac plexus block using steroids may be helpful to tide patients over an episode of severe pain. Intractable pain is an indication for surgery that includes pancreatic drainage procedure or pancreatic resection. For control of malabsorption, adequate pancreatic enzyme replacement with or

  16. [Impressibility of schizophrenic patients].

    Science.gov (United States)

    Bazhin, E F; Korneva, T V; Lomachenkov, A S

    1978-01-01

    The authors studied the abilities to identify emotional states according to the acustico-phonetical symptoms of speech in 160 schizophrenic patients and 80 normals. These studies were performed with the aid of a specially elaborated tape recorder test. It was established that difficulties in accomplishing these tasks were found in schizophrenic patients with paranoid symptomatology. Patients with other clinical states, including sufficiently expressed specific disturbances in the emotional sphere, extremely subtly differentiated the emotional state of the announcers. These data are considered as proof of preserved impressive abilities in the majority of schizophrenic patients. The significance of these factors for the organization of psychosocial influences are discussed.

  17. Chronic pain patients' perspectives of medical cannabis.

    Science.gov (United States)

    Piper, Brian J; Beals, Monica L; Abess, Alexander T; Nichols, Stephanie D; Martin, Maurice W; Cobb, Catherine M; DeKeuster, Rebecca M

    2017-07-01

    Medical cannabis (MC) is used for a variety of conditions including chronic pain. The goal of this report was to provide an in-depth qualitative exploration of patient perspectives on the strengths and limitations of MC. Members of MC dispensaries (N = 984) in New England including two-thirds with a history of chronic pain completed an online survey. In response to "How effective is medical cannabis in treating your symptoms or conditions?," with options of 0% "no relief" to 100% "complete relief," the average was 74.6% ± 0.6. The average amount spent on MC each year was $3064.47 ± 117.60, median = $2320.23, range = $52.14 to $52,140.00. Open-ended responses were coded into themes and subthemes. Analysis of answers to "What is it that you like most about MC?" (N = 2592 responses) identified 10 themes, including health benefits (36.0% of responses, eg, "Changes perception and experience of my chronic pain."), the product (14.2%, eg, "Knowing exactly what strain you are getting"), nonhealth benefits (14.1%), general considerations (10.3%), and medications (7.1%). Responses (N = 1678) to "What is it that you like least about MC?" identified 12 themes, including money (28.4%, eg, "The cost is expensive for someone on a fixed income"), effects (21.7%, eg, "The effects on my lungs"), the view of others (11.4%), access (8.2%), and method of administration (7.1%). These findings provide a patient-centered view on the advantages (eg, efficacy in pain treatment, reduced use of other medications) and disadvantages (eg, economic and stigma) of MC.

  18. Attitude of schizophrenics to computer videogames.

    Science.gov (United States)

    Samoilovich, S; Riccitelli, C; Schiel, A; Siedi, A

    1992-01-01

    We investigated the initial attitude of 10 chronic, defected schizophrenic patients to a computer videogame session. Six of them enjoyed the experience and wanted to repeat it. Cooperation and performance were compared by means of videogames and a standard psychometric test (WAIS). Videogame performance correlated with the execution test IQ more than with the verbal test IQ. Computer games could be useful in these patients for evaluation of attitudes and responses, psychologic testing, motivation and reward.

  19. 音乐疗法在慢性精神分裂症康复治疗中的作用%The effect of musical therapy on chronic schizophrenics rehabilitation

    Institute of Scientific and Technical Information of China (English)

    吴丽荣

    2000-01-01

    Objective:The purpose of this study was to investigation the effect of musical therapy in chronic schizophrenia,for there have been some data suggested that musical therapy may improve the negative symptoms,delay the deterioration of chronic schizophrenics.Methods:64 chronic schizophrenic patients were treated with musical therapy and the effect was assessed with BPRS,SANS and NOSIE before and after the treatment.Results:The results showed that the musical therapy increased the social function social interesting and activated affection of the patients,the activity lacking was improved significantly(P<0.01).The effect of initiative musical therapy was better than of passive musical therapy.The symptoms such as poorness of thought,thought disorder were not changed(P>0.05). Conclusion :The results suggest that musical therapy is an effective auxiliay treatment in the recovery of the chronic schizophrenic,so it should be applied for long period of time.%目的:利用音乐治疗改善慢性精神分裂症的阴性症状,延缓精神活动的衰退。方法:选取64例精神分裂症病人进行了音乐治疗前后对照研究,进行了BPRS、SANS、NOSIE的测定。结果:表明音乐治疗能提高慢性精神分裂症的社会功能、社会兴趣和活跃情绪,对缺乏活动的精神症状有改善作用(P<0.01)。主动性音乐治疗疗效优于被动性音乐治疗。但对思维贫乏、思维障碍等症状的改善作用欠佳(P>0.05)。结论:音乐治疗是慢性精神分裂症康复疗法中的一种有效的辅助治疗,应长期进行。

  20. [Conservative medical treatment of chronic pancreatitis].

    Science.gov (United States)

    Binek, J

    1998-05-13

    The conservative medical treatment of chronic pancreatitis entails dealing prevalently with exocrine and endocrine insufficiency, diet and pain. As steatorrhoea can cause malabsorption, it is advisable to reduce first the fat content of the diet and secondly to prescribe, where necessary, pancreatic enzymes. Several factors can lead to a poor therapeutic enzyme effect. Attention should be given to the pharmacological properties of the enzyme-preparation and to the secretion of acid in the stomach. An endocrine insufficiency is more difficult to treat compared to a classical diabetes mellitus, for lack of endocrine regulatory mechanisms. Pain is the consequence of several pathophysiological processes. Before initiating analgetic treatment, a minimal diagnostic program should be completed allowing the exclusion of those primary causes of pain which require an alternative approach such as interventional endoscopy or surgery.

  1. 慢性精神分裂症患者合并肺部感染临床资料分析%Analyses of clinical data of chronic schizophrenic with pulmo-nary infection

    Institute of Scientific and Technical Information of China (English)

    何莉萍

    2015-01-01

    Objective To explore clinical features of chronic schizophrenic with pulmonary infection (PI) .Methods Clinical data of 162 chronic schizophrenics with PI were retrospec‐tively analyzed .Results Among them 124 ones suffered from segmental pneumonia and 38 chronic pulmo‐nary infection .Acute pneumonia was common in middle‐aged young persons with course of psychosis 3 years ,lobus inferior pulmonis of two lungs ,basis pulmonalis and two sides of backbone were main infec‐tion sites ,cure rate was 71 .1% after symptomatic treatment ,and disappearance rate of clinical symptoms 28 .9% .Conclusion Pulmonary infection rate of schizophrenics is higher ,clinical symptoms are atypical , effective prevention and control measures should be made to reduce the development of infection .%目的:探讨慢性精神分裂症患者合并肺部感染的临床特征。方法对162例慢性精神分裂症合并肺部感染患者的临床资料进行回顾性分析。结果162例肺部感染者,其中节段性肺炎124例,慢性肺部感染38例。急性肺炎以中青年,精神病病程<3 a居多,感染部位以右肺中叶和左肺舌叶为主,对症治疗后均痊愈;慢性感染以中老年多见,精神病病程>3a,感染部位以两肺下叶、肺底及脊柱两旁慢性感染为主,对症治疗后痊愈率为71.1%,临床症状消失率为28.9%。结论精神分裂症患者合并肺部感染率较高,临床症状不典型,应制定有效的预防和控制对策,减少感染的发生。

  2. Schizophrenic patients treated with clozapine or olanzapine perform better on theory of mind tasks than those treated with risperidone or typical antipsychotic medications.

    Science.gov (United States)

    Savina, Ioulia; Beninger, Richard J

    2007-08-01

    Theory of mind (ToM), the ability to attribute mental states to others, is associated with medial prefrontal cortical (mPFC) activity and is impaired in schizophrenia. Olanzapine or clozapine but not typical antipsychotics or risperidone preferentially affect c-fos expression in mPFC in animals. We tested the hypothesis that schizophrenic patients treated with different antipsychotics would perform differently on ToM tasks. Groups receiving Typicals (n=23), Clozapine (n=18), Olanzapine (n=20) or Risperidone (n=23) and a Control group of healthy volunteers (n=24) were matched for age, gender, handedness and education. ToM functioning was assessed with picture sequence, second-order belief and faux-pas tests. Schizophrenic groups performed similarly to controls on non-ToM conditions. The Olanzapine and Clozapine groups performed similarly to Controls on ToM tasks. The Typicals and Risperidone groups performed worse than the other groups on ToM tasks. We concluded that ToM performance of schizophrenic patients is influenced by the antipsychotic they are taking. Our results suggest that olanzapine or clozapine but not typicals or risperidone may improve or protect ToM ability.

  3. Oriental Medical Treatment of chronic Acalculous Cholecystitis

    Directory of Open Access Journals (Sweden)

    Hae-Yeon Lee

    2004-12-01

    Full Text Available Chronic acalculous cholecystitis gets possession of about 12 to 13 percent of patients with chronic cholecystitis. Pathologically it is characterised by chronic inflammation and thickening of the gallbladder wall but doesn't come across stones. Clinical symptoms are vague and include abdominal discomfort and distension, nausea, flatulence and intolerance of fatty foods. A patient on chronic acalculous cholecystitis diagnosed from his clinical symtoms and abdominal ultrasonogram was treated by Geonbihwan, acupuncture and herbal acupuncture. Satisfactory symptomatic improvement was achieved and findings of abdominal ultrasonogram came also normal.

  4. Aspects of sexual self-perception in schizophrenic patients

    Directory of Open Access Journals (Sweden)

    Marija Vucic Peitl

    2009-03-01

    Full Text Available Objective: Self-perception is a complex, dynamic system and sexual self-perception is only one of the items in that complex system. Our goal was to establish whether the differences in sexual self-perception between schizophrenic patients and healthy individuals exist, and to establish possible differences in sexual self-perception between acute and chronic schizophrenic patients. Method: Bezinovic’s test for sexual self-perception was used because it assesses multiple aspects of sexual self-perception and provides thorough insight of that part of self. Results: Results revealed that schizophrenic patients, compared to healthy individuals, scored significantly higher on the aspects of negative emotionality and sexual incompetence and significantly lower on the aspect of sexual satisfaction. No statistically significant differences were established between acute and chronic schizophrenic patients. Conclusions: It can be concluded that the conscious part of libido organization in schizophrenic patients exhibits proper consciousness of own sexuality, normal readiness for sexual activity, normal sexual adventurism, significantly higher negative emotionality and sexual incompetence and significantly lower sexual satisfaction.

  5. Medical marijuana use for chronic pain: risks and benefits.

    Science.gov (United States)

    Greenwell, Garth T

    2012-01-01

    Questions from patients about medical marijuana use for chronic pain are becoming more common. The information in this report will help patients understand the potential risks and benefits of using this substance for painful conditions.

  6. Young Children of Schizophrenic Mothers: Difficulties of Intervention

    DEFF Research Database (Denmark)

    Grünbaum, Liselotte; Gammeltoft, Marie

    1993-01-01

    Casework by Danish local social agencies on behalf of 11 children og chronically ill schizophrenic mothers is retrospectively analyzed, along with documentation from psychiatric hospitals, consulting child specialists, and other health professionals. Findings point to a need for earlier and more...... precise assessment of the mother's parenting abilities as measured against the severity of her illness and the vulnerability of the child...

  7. Young children of schizophrenic mothers: difficulties of intervention

    DEFF Research Database (Denmark)

    Grünbaum, Liselotte Tang; Gammeltoft, Michele

    1993-01-01

    Casework by Danish local social agencies on behalf of 11 children of chronically ill schizophrenic mothers is retrospectively analyzed, along with documentation from psychiatric hospitals, consulting child specialists, and other health professionals. Findings point to a need for earlier and more...... precise assessment of the mother's parenting abilities as measured against the severity of her illness and the vulnerability of her child....

  8. Utopian visions of schizophrenic adolescents.

    Science.gov (United States)

    Crain, W C; Starace, J

    1976-09-01

    Twenty-four normal and 24 hospitalized schizophrenic adolescents described an ideal society for an imaginary island. The normals usually tried to establish a functional democracy. The schizophrenics seemed more sensitive to basic biological needs, but their main goal was to create a personal paradise, a place in which every need and desire would be met. In their search for paradise, the schizophrenics often introduced themes that had a Jungian, archetypal flavor - e.g., themes from antiquity, God, sex, homes, animals, opposites (such as love and hate), birth, and death.

  9. Application of Maslow's management mode in rehabilitation training of hospitalized chronic schizophrenics%马斯洛管理模式在住院慢性精神分裂症患者康复训练中的应用

    Institute of Scientific and Technical Information of China (English)

    熊玉芳; 邓克琴; 陈艳琼; 李留萍; 黄其春; 韩淑英; 张文秀

    2015-01-01

    Objective To explore the application of Maslow's management mode in rehabilitation training of hospitalized chronic schizophrenics .Methods Sixty chronic schizophrenics were randomly assigned to two groups of 40 ones each .Both groups received routine antipsychotic treatment ,routine nursing and rehabili‐tation training ,on this basis research group w as plus rehabilitation training according to M aslow's manage‐ment mode for 3 months .Rehabilitation outcomes were assessed with the Scale for the Assessment of Neg‐ative Symptoms (SANS) ,Nurses’ Observation Scale for Inpatient Evaluation (NOSIE) and Inpatient Psychiatric Rehabilitation Outcome Scale (IPROS) before and after treatment .Results After training the SANS and IPROS scores of both groups lowered more significantly compared with pretreatment (P<0 .01) ,so did those in research than in control group (P<0 .05 or 0 .01);the NOSIE score since the 1st month training in research group heightened more significantly compared with pretreatment (P<0 .01) ,so did those in research than in control group (P<0 .05 or 0 .01) .Conclusion The imple‐mentation of Maslow's management mode is beneficial to the improvement of negative symptoms of hospi‐talized chronic schizophrenics ,boost patients’ social adaptation ,and promote patients’ comprehensive re‐habilitation .%目的:探讨马斯洛管理模式的实施对住院慢性精神分裂症患者康复效果的影响。方法将80例住院慢性精神分裂患者随机分为两组,每组40例。两组均接受常规抗精神病药物治疗、常规护理及康复训练,研究组在此基础上采用马斯洛管理模式开展康复训练,观察3个月。于训练前后采用阴性症状量表、护士用住院病人观察量表及住院患者康复疗效评定量表评定康复效果。结果训练后两组阴性症状量表、住院患者康复疗效评定量表评分均较训练前显著下降(P<0.01),研究组较

  10. Study on the Effects of Music Therapy on Rehabilitation of Patients with Chronic Schizophrenic%音乐治疗对慢性精神分裂症患者康复疗效研究

    Institute of Scientific and Technical Information of China (English)

    朱华; 王凯; 李丽红; 宋平; 赵蓉; 谢延; 廖万威; 刘青

    2012-01-01

    目的 探讨音乐治疗对社区慢性精神分裂症患者的生活质量及抑郁焦虑情绪的影响.方法 将社区慢性精神分裂症患者随机分成音乐治疗组和常规精神科治疗组,分别为81例.音乐治疗组除精神科常规药物维持治疗外给予8周音乐治疗,两组治疗前后分别采用生活质量评定综合问卷(GQOLI - 74)评定2组患者的生活质量,用抑郁自评量表(SDS)和焦虑自评量表(SAS)评定2组患者的抑郁焦虑情绪.结果 经音乐治疗8周后,患者在除住房、社区服务、生活环境和经济状况外的其他16个因子分、躯体功能、心理功能、社会功能3个维度分和总分上,均明显高于音乐治疗前(P<0.05);在8周后与常规精神科治疗组比较,除住房、社区服务、生活环境、经济状况4个因子分和物质生活状态维度分外,其他各项得分均高于常规治疗组(P<0.05).结论 音乐治疗有利于社区慢性精神分裂症患者的生活质量的提高及缓解抑郁焦虑情绪.%Objective To explore the influence of music therapy on the quality of life, depression and anxiety of chronic schizophrenic patients in community. Methods A total of 162 chronic schizophrenic patients in the community of Futian District of Shenzhen were randomly divided into two groups, the music therapy group and the control group, with 81 cases for each group. The patients in the control group continued the psychiatric routine drug maintenance therapy, while those in the music therapy group received additional music therapy. Before and after 8 - week treatment, the quality of life of the patients were assessed by the General Quality of Life Inventory (GQOLI - 74), and the depression and anxiety were evaluated by the Self - rating Depression Scale ( SDS } and the Self-rating Anxiety Scale (SAS). Results After 8 -week treatment with music, compared with the same group before treatment or compared with the control group with 8- week routine treatment

  11. 农疗对慢性精神分裂症住院患者孤独感的影响%Influences of farming therapy on feeling of loneliness of hospitalized chronic schizophrenics

    Institute of Scientific and Technical Information of China (English)

    杨志辉; 刘惠秋; 孙录; 杜宝国; 侯丽华; 容东环

    2009-01-01

    Objective To explore the influences of farming therapy on feeling of loneliness of hospitalized chronic schizophrenics.Methods 80 chronic schizophrenics were randomly divided into two groups of 40 ones each,both groups receieved routine rehabilitation treatment and nursing intervention,research group was plus farming therapy for 6 months.Efficacies were assessed with the Brief Psychiatric Rating Scale(BPRS) and loneliness status with the UCLA Loneliness Scales(UCLA-LS) before treatment and at the end of the 2nd,4th,8th,16th and 24th week. Results BRPS and UCLA-LS total scores at each time-point were significantly lower in the research compared with pretreatment(P0.05);in control group,the BPRS total score at the end of the 8th week was significantly lower compared with pretreatment(P0.05). Conclusion Farming therapy has an active synergistic effect on rehabilitation and makes for lessening feeling of loneliness and rehabilitation of chronic schizophrenics.%目的 探讨开展农疗对慢性精神分裂症住院患者孤独感的影响. 方法 将80例慢性精神分裂症患者随机分为研究组与对照组各40例.两组均接受常规康复治疗及护理干预,在此基础上研究组联合农疗.观察6 mo.于治疗前及治疗第2 w、4 w、8 w、16 w、24 w末采用简明精神病量表评定临床效果,UCLA孤独量表评定孤独状况. 结果 研究组治疗后各时点简明精神病量表总分、UCLA孤独量表总分均显著低于治疗前(P<0.01),并且均显著低于对照组(P<0.05或0.01),但治疗后各时点评分均无显著性差(P>0.05);对照组除治疗8 w末简明精神病量表总分显著低于治疗前(P<0.05)外,其他时点评分治疗前后均无显著变化(P>0.05). 结论 开展农疗对疾病康复具有积极的协同作用,有利于减轻慢性精神分裂症患者的孤独感,有利于患者的康复.

  12. 家属培训对长期住院慢性精神分裂症患者康复的影响%Effects of training of family members on rehabilitation in long-term hospitalized chronic schizophrenic patients

    Institute of Scientific and Technical Information of China (English)

    赵涛; 张传海; 庄美芳; 徐华; 李君

    2012-01-01

    Objective To investigate the role of training family members in terms of psychological care and daily life care skills in rehabilitation of long-term hospitalized chronic schizophrenic patients. Methods A total of 126 long-term hospitalized chronic schizophrenic patients were randomized into a control group (n=60) and an intervention group (n = 66). We provided a skill-training program for the family members of the intervention group with regard to psychological care and daily life care, and then patients were discharged to home for 3 months. Patients in the control group were hospitalized for treatment. The Nurses Observation Scale for Inpatient Evaluation (NOSIE) and the Self-esteem Scale (SES) were employed to test before and after the intervention. Results The NOSIE score and SES score were significantly better in the intervention group than those in the control group after intervention (P<0. 01, P<0. 05). Conclusion The skill-training program on psychological care and daily life care provided for family members of long-term hospitalized chronic schizophrenic patients, can improve patients' social ability and daily life care skills, reduce negative emotions as irritability and depression, and promote self-esteem and quality of life.%目的 探讨家属心理护理、生活技能培训在长期住院的慢性精神分裂症患者康复治疗中的作用.方法 选取有家庭监护条件的长期住院的精神分裂症患者126例,将其随机分为干预组(66例)和对照组(60例).干预组由心理咨询师对患者家属进行心理护理、生活技能培训,然后对患者实施假出院3个月.对照组患者仍住院治疗.实施前后采用护士用住院患者观察量表(NOSIE)、自尊量表(SES)进行测试.结果 干预后干预组NOSIE及SES评分显著优于对照组(P<0.01,P<0.05).结论 家属心理护理、生活技能培训用于长期住院的慢性精神分裂症患者,可使其社会能力、生活技能提高,激惹、抑郁等消

  13. Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue.

    Science.gov (United States)

    McBeth, J; Tomenson, B; Chew-Graham, C A; Macfarlane, G J; Jackson, J; Littlewood, A; Creed, F H

    2015-12-01

    Chronic widespread pain and chronic fatigue share common associated factors but these associations may be explained by the presence of concurrent depression and anxiety. We mailed questionnaires to a randomly selected sample of people in the UK to identify participants with chronic widespread pain (ACR 1990 definition) and those with chronic fatigue. The questionnaire assessed sociodemographic factors, health status, healthcare use, childhood factors, adult attachment, and psychological stress including anxiety and depression. To identify persons with unexplained chronic widespread pain or unexplained chronic fatigue; we examined participant's medical records to exclude medical illness that might cause these symptoms. Of 1443 participants (58.0% response rate) medical records of 990 were examined. 9.4% (N=93) had unexplained chronic widespread pain and 12.6% (N=125) had unexplained chronic fatigue. Marital status, childhood psychological abuse, recent threatening experiences and other somatic symptoms were commonly associated with both widespread pain and fatigue. No common effect was found for few years of education and current medical illnesses (more strongly associated with chronic widespread pain) or recent illness in a close relative, neuroticism, depression and anxiety scores (more strongly associated with chronic fatigue). Putative associated factors with a common effect were associated with unexplained chronic widespread pain or unexplained chronic fatigue only when there was concurrent anxiety and/or depression. This study suggests that the associated factors for chronic widespread pain and chronic fatigue need to be studied in conjunction with concurrent depression/anxiety. Clinicians should be aware of the importance of concurrent anxiety or depression. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue☆

    Science.gov (United States)

    McBeth, J.; Tomenson, B.; Chew-Graham, C.A.; Macfarlane, G.J.; Jackson, J.; Littlewood, A.; Creed, F.H.

    2015-01-01

    Objective Chronic widespread pain and chronic fatigue share common associated factors but these associations may be explained by the presence of concurrent depression and anxiety. Methods We mailed questionnaires to a randomly selected sample of people in the UK to identify participants with chronic widespread pain (ACR 1990 definition) and those with chronic fatigue. The questionnaire assessed sociodemographic factors, health status, healthcare use, childhood factors, adult attachment, and psychological stress including anxiety and depression. To identify persons with unexplained chronic widespread pain or unexplained chronic fatigue; we examined participant's medical records to exclude medical illness that might cause these symptoms. Results Of 1443 participants (58.0% response rate) medical records of 990 were examined. 9.4% (N = 93) had unexplained chronic widespread pain and 12.6% (N = 125) had unexplained chronic fatigue. Marital status, childhood psychological abuse, recent threatening experiences and other somatic symptoms were commonly associated with both widespread pain and fatigue. No common effect was found for few years of education and current medical illnesses (more strongly associated with chronic widespread pain) or recent illness in a close relative, neuroticism, depression and anxiety scores (more strongly associated with chronic fatigue). Putative associated factors with a common effect were associated with unexplained chronic widespread pain or unexplained chronic fatigue only when there was concurrent anxiety and/or depression. Discussion This study suggests that the associated factors for chronic widespread pain and chronic fatigue need to be studied in conjunction with concurrent depression/anxiety. Clinicians should be aware of the importance of concurrent anxiety or depression. PMID:26652592

  15. [Childhood of the schizophrenic patient].

    Science.gov (United States)

    Da Fonseca, D

    2009-01-01

    We are able to identify the different risk factors involved in the development of the disorder from a study of the childhood of a schizophrenic patient. More specifically, we will define the perinatal risk factors: season and place of birth, viral exposure during pregnancy and obstetric complications. Developmental factors will also be discussed. Socialisation, language, psychomotor and cognitive development disorders are all developmental difficulties seen during the childhood of the schizophrenic patient. Finally we will finish by discussing a few psychosocial risk factors.

  16. [Medical certification of chronic fatigue syndrome].

    Science.gov (United States)

    Hausotter, W

    2015-03-01

    Chronic fatigue or chronic fatigue syndrome (CFS) is not a new disease, yet in recent years it has become increasingly important as an evaluation problem. It coincides with the well-known clinical picture of neurasthenia, shows extensive overlap with symptoms of depression and, finally, to the current concept of "burnout". Regarding the etiology there is fierce controversy between the representatives of a somatic and a psychological etiology. As reviewers you will be guided by the assessment criteria for somatoform disorders, especially because objectified findings are lacking. CFS can be independently encoded as neurological diagnosis G 93.3 according to ICD-10, although never objectified neurological deficits were detected, as well as neurasthenia F 48.0 or accompanying physical symptoms as somatization disorder F 45.0.

  17. [Structural correlation of schizophrenic thought and language disorders with delusional perception and variations of intentionality].

    Science.gov (United States)

    Holm-Hadulla, R

    1988-01-01

    This study originated from a phenomenological and speech-act theoretical concept of schizophrenic concretism. An experimental study was performed showing a highly significant lack in the schizophrenic patients' ability to use metaphors correctly. Basing on the interpretation of proverbs, the hypothesis is rejected that false interpretations of schizophrenic patients are due to intermingling of personal conflicts. On the other hand, it could be shown that concretistic interpretations of proverbs represent an avoidance of conflicts. The concepts of "substitution" and "transfer" enabled us to measure pathological concreteness and "deconflictualisation". The differentiation between schizophrenic and nonpsychotic patients was found to be highly significant. In a complementary study it could be shown that the chronic schizophrenics' disability to transfer images of proverbs to an interpersonally relevant context does not differ significantly from that of patients with their first schizophrenic episode. Discussing our empirical findings, we try to show that the concretistic reduction of thought and speech is also a paradigma of delusion. The "incorrigibility" of schizophrenic delusion was seen to be based on reification of verbal signs and metaphors. After trying to show a connection between the concretistic "Lebensform" (Wittgenstein) and the disordered intentionality of schizophrenic patients, pointers towards psychotherapeutic implications are given.

  18. Medical cannabis and chronic opioid therapy.

    Science.gov (United States)

    Reisfield, Gary M

    2010-12-01

    Fourteen states and the District of Columbia have legalized the use of cannabis for medical purposes. A small, high-quality literature supports the efficacy of medical cannabis for the treatment of neuropathic pain. The smoked botanical product, however, is associated with a number of adverse medical and psychiatric consequences. Furthermore, experimental data indicate that acute use of cannabis results in impairment of every important metric related to the safe operation of a motor vehicle. Epidemiological data show associations between recent cannabis use and both psychomotor impairment and motor vehicle crashes, associations that are strengthened by the concomitant use of alcohol and other central nervous system depressants. Finally, data from pain clinics reveals an unusually high prevalence of cannabis use in nearly all age groups and an association between cannabis use and opioid and other substance misuse. Based on available data and expert opinion, concomitant use of cannabis and opioids is an absolute contraindication to the operation of a motor vehicle. In patients who use cannabis and are prescribed opioids, heightened vigilance for opioid- and other substance-related problems is warranted. It is appropriate to refrain from prescribing opioids to individuals using medical cannabis if there is reasonable suspicion that the combination will pose a risk to the patient or others.

  19. Pregnancy and delivery complications in the births of an unselected series of Finnish children with schizophrenic mothers.

    Science.gov (United States)

    Wrede, G; Mednick, S A; Huttunen, M O; Nilsson, C G

    1980-10-01

    Pregnancy, delivery and post partum conditions were coded from Helsinki Well Mother-Baby Clinics and Lying in hospitals for all deliveries to a birth cohort of Helsinki schizophrenic women. Greater difficulty was observed at all perinatal stages for the chronic and mild schizophrenic groups than for controls. These differences were heightened in the case of winter births.

  20. Association Between Patient-Centered Medical Homes and Adherence to Chronic Disease Medications: A Cohort Study.

    Science.gov (United States)

    Lauffenburger, Julie C; Shrank, William H; Bitton, Asaf; Franklin, Jessica M; Glynn, Robert J; Krumme, Alexis A; Matlin, Olga S; Pezalla, Edmund J; Spettell, Claire M; Brill, Gregory; Choudhry, Niteesh K

    2017-01-17

    Despite the widespread adoption of patient-centered medical homes into primary care practice, the evidence supporting their effect on health care outcomes has come primarily from geographically localized and well-integrated health systems. To assess the association between medication adherence and medical homes in a national patient and provider population, given the strong ties between adherence to chronic disease medications and health care quality and spending. Retrospective cohort study. Claims from a large national health insurer. Patients initiating therapy with common medications for chronic diseases (diabetes, hypertension, and hyperlipidemia) between 2011 and 2013. Medication adherence in the 12 months after treatment initiation was compared among patients cared for by providers practicing in National Committee for Quality Assurance-recognized patient-centered medical homes and propensity score-matched control practices in the same Primary Care Service Areas. Linear mixed models were used to examine the association between medical homes and adherence. Of 313 765 patients meeting study criteria, 18 611 (5.9%) received care in patient-centered medical homes. Mean rates of adherence were 64% among medical home patients and 59% among control patients. Among 4660 matched control and medical home practices, medication adherence was significantly higher in medical homes (2.2% [95% CI, 1.5% to 2.9%]). The association between medical homes and better adherence did not differ significantly by disease state (diabetes, 3.0% [CI, 1.5% to 4.6%]; hypertension, 3.2% [CI, 2.2% to 4.2%]; hyperlipidemia, 1.5% [CI, 0.6% to 2.5%]). Clinical outcomes related to medication adherence were not assessed. Receipt of care in a patient-centered medical home is associated with better adherence, a vital measure of health care quality, among patients initiating treatment with medications for common high-cost chronic diseases. CVS Health.

  1. Parents, Teachers, and Medical Personnel: Helping Children with Chronic Illness.

    Science.gov (United States)

    Mescon, Joan A. W.; Honig, Alice S.

    1995-01-01

    Reviews how chronic illness affects the psychosocial and cognitive development of ill children, using both Eriksonian and Piagetian theoretical rubrics. Explores family and child stress and coping with medical crises and manifestations of illness. Provides recommendations for enhancing parent and professional communication and educational…

  2. Patient-Centered Medical Home in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ortiz G

    2011-10-01

    Full Text Available Gabriel Ortiz1, Len Fromer21Pediatric Pulmonary Services, El Paso, TX; 2Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USAAbstract: Chronic obstructive pulmonary disease (COPD is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH, which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.Keywords: Patient-Centered Medical Home, chronic care model, chronic obstructive pulmonary disease, patient education, physician assistants, nurse practitioners

  3. Chronic pain and pain medication use in chronic obstructive pulmonary disease. A cross-sectional study.

    Science.gov (United States)

    Roberts, Melissa H; Mapel, Douglas W; Hartry, Ann; Von Worley, Ann; Thomson, Heather

    2013-08-01

    Pain is a common problem for patients with chronic obstructive pulmonary disease (COPD). However, pain is minimally discussed in COPD management guidelines. The objective of this study was to describe chronic pain prevalence among patients with COPD compared with similar patients with other chronic diseases in a managed care population in the southwestern United States (age ≥ 40 yr). Using data for the period January 1, 2006 through December 31, 2010, patients with COPD were matched to two control subjects without COPD but with another chronic illness based on age, sex, insurance, and healthcare encounter type. Odds ratios (OR) for evidence of chronic pain were estimated using conditional logistic regression. Pulmonary function data for 200 randomly selected patients with COPD were abstracted. Retrospectively analyzed recurrent pain-related utilization (diagnoses and treatment) was considered evidence of chronic pain. The study sample comprised 7,952 patients with COPD (mean age, 69 yr; 42% male) and 15,904 patients with other chronic diseases (non-COPD). Patients with COPD compared with non-COPD patients had a higher percentage of chronic pain (59.8 vs. 51.7%; P pain-related medications (41.2 vs. 31.5%; P Hispanic ethnicity, and comorbidities, patients with COPD had higher odds of chronic pain (OR, 1.56; 95% confidence interval [CI], 1.43-1.71), chronic use of pain-related medications (OR, 1.60; 95% CI, 1.46-1.74), and chronic use of short-acting or long-acting opioids (OR, 1.74; 95% CI, 1.57-1.92). Chronic pain and opioid use are prevalent among adults with COPD. This finding was not explained by the burden of comorbidity.

  4. Effects of plasma magnesium and prolactin on quantitative ultrasound measurements of heel bone among schizophrenic patients

    Directory of Open Access Journals (Sweden)

    Renn Jenn-Huei

    2010-02-01

    Full Text Available Abstract Background Osteoporosis is a bone disease that can reduce both bone mass and bone strength. It can cause serious fractures of bones, along with causing significant and even devastating physical, psychological and financial consequences for patients and their family members. Many reports have revealed that the prevalence of decreased bone density is higher in schizophrenic patients than in the non-psychological diseased population. The previous report of our group revealed that chronic schizophrenia patients have poorer BUA levels since they were young as compared to the general community population. Hyperprolactinemia and antipsychotics are reported to be among the risk factors for osteoporosis in chronic schizophrenic patients. Methods 93 schizophrenic patients with severely poor adjusted BUA values and 93 age and gender matched patients with normal adjusted BUA values from a previous survey study were selected. Data were collected via questionnaires and via reviews of antipsychotic medications. Blood samples were drawn, and serum levels of prolactin, estradiol, testosterone, magnesium, calcium, phosphate, osteocalcin, Cross-linked N-teleopeptide of type I collagen (NTX, thyroid hormone and parathyroid hormone were checked. The association between BUA levels and serum levels of the above items, along with the type of received antipsychotic medication, was evaluated. Results There was no significant association found between reduced BUA levels and serum prolactin, calcium, phosphate, osteocalcin, NTX, thyroid stimulating hormone and parathyroid hormone levels. There was also no association between BUA levels and types of currently received antipsychotics. There was no association between BUA levels and menstruation condition in female patients. Hypermagnesemia had a borderline association with classical and combined (classical and atypical antipsychotic medications in male patients. Nevertheless, hypermagnesemia is a significant

  5. Research of the quality of life of schizophrenic patients in Belgrade

    Directory of Open Access Journals (Sweden)

    Opalić Petar

    2008-01-01

    Full Text Available First of all, it was pointed to the specificity of the quality of life of psychiatric patients, primarily to the fact that the very poor mental state significantly reduces the life satisfaction. Then, an overview of results of general research of quality of life among schizophrenic patients was presented, in relation to their conditions of treatment, cultural setting, influence of socio-demographic and other factors. The very research was conducted on the sample of 80 subjects treated under the diagnosis of schizophrenia at the Institute of Mental Health in Belgrade - treated as out-patients in the day-hospital. The controls were 80 healthy subjects employed with a Health-care center in Belgrade. The statistical significance calculations of differences were related to replies to the instrument's questions - the instrument being a combination of Lancashire and Manchester Questionnaire. The questions referred to 15 features, classified according to five dimensions of quality of life (physical and medical; psychological and psychopathological; economic; relational and social; and axiological and transcendental dimension, and we arrived at the following: In terms of statistical significance, schizophrenic patients, in comparison to healthy controls confirmed taking medicaments significantly more often, that is, confirmed feeling as being chronic patients, suffering due to their bad disposition, fear and having hallucinations. The schizophrenic subjects, also confirmed something very interesting - that they were satisfied with their housing conditions and income. On the other hand, healthy controls, statistically speaking, replied significantly more often that they were satisfied with their sexual relations and relations with their friends, as well as that they were significantly more satisfied with their cultural and social activities. The results of our research were also commented on in relation to the social and other factors, and were compared

  6. Chronic Stress and Suicidal Thinking Among Medical Students

    Science.gov (United States)

    Rosiek, Anna; Rosiek-Kryszewska, Aleksandra; Leksowski, Łukasz; Leksowski, Krzysztof

    2016-01-01

    Introduction: The subject of chronic stress and ways of dealing with it are very broad. The aim of this study was to analyze stress and anxiety and their influence on suicidal thinking among medical students. Materials and Methods: The study was conducted in the years 2014 to 2015 in Poland, at the Medical University—Nicolaus Copernicus University, Collegium Medicum. The objective of this study was to assess chronic stress and suicidal thinking among students and how students cope with this huge problem. Descriptive statistics and chi-square analyses were conducted to detect differences. Results: Analyses showed that students’ life is full of stressors. Students toward the end of their education cope better with stress than students starting their university studies. Chronic stress has a strong impact on mental health and suicidal thinking among students. Conclusions: The results of the study confirmed that chronic stress and anxiety have a negative influence on mental health and also confirm a relation to suicidal thinking in medical students. Students cope with stress by listening to music, talking to relatives or people close to them, resting or engaging in sports, with cycling, running and swimming being the most common methods used to affect suicidal thinking. PMID:26891311

  7. Analysis of thriod hormones,blood liqid and blood glucose of chronic schizophrenics%慢性精神分裂症患者甲状腺激素及血脂血糖分析

    Institute of Scientific and Technical Information of China (English)

    潘利; 梅红彬; 阳胜秋; 刘欣

    2013-01-01

    ,the therapy of atypical antipsychotics,blood lipids,and blood glucose.To explore the impact of above factors on cardiovascular and cerebrovascular complications,as wel.Methods:70 chronic schizophrenics who had been in hospital more than half a year were involved in the study at ramdon.Their spiritual symptom and blood pressure had been controled stably.They had been treated with atypical antipsychotics.Then we used the PANSS scale to assess mental symptoms,and analyzed the data with the statistical methods of t test,correlation analysis and discriminant analysis by SPSS 17.0 software. Results:As to above 70 schizophrenics who had been treated with atypical antipsychotics,their thyroid dysfunction mainly showed higher TSH and lower T3.Dyslipidemia was mainly high triglycerid.Many of them had been with high blood glucose,especialy with postprandial 2-hour blood glucose.Their blood liqid and blood glucose were positively correlated with each other.Their thyroid stimulating hormones were negative correlation with T3 and T4,but it had no statistical significance.So we confirmed that thyroid stimulating hormone of schizophrenic was affected not only by the feedback regulation of thriod hormone but also by other factors.As to the schizophrenics who had been treated with new atypical antipsychotics,their thyroid stimulating hormones were negative correlation with thriod hormones.Their mental symptoms had some positive correlation with the thyroid stimulating hormone but the correlation had no statistical significance.As to those who had been treated with clozapine for more than half a year,their thyroid stimulating hormones had some positive correlation with clozapine dose but the correlation had no statistical significance.Conclusions:Patients with chronic schizophrenia exist the hypothalamus-pituitary-thyroid axis dysfunction.We should pay attention to its influence on the physical and mental diseases.When they have hypothyroidism and metabolic disorders,we should take measures to

  8. Effectiveness of Biomodulator in treating chronic pain and reducing medications pain and reducing medications

    Science.gov (United States)

    2017-01-12

    age and sex and mental component scores were slightly more favorable. In contrast, studies of both Canadian military veterans and Persian Gulf...chronic lower back pain: a randomized, double-blind, placebo- controlled study. Journal of international medical research. 2006 Mar 1;34(2):160-7. 10...Kaptchuk TJ, Goldman P, Stone DA, Stason WB. Do medical devices have enhanced placebo effects?. Journal of clinical epidemiology. 2000 Aug 31;53(8

  9. Unintentional Discontinuation of Chronic Medications for Seniors in Nursing Homes

    Science.gov (United States)

    Stall, Nathan M.; Fischer, Hadas D.; Wu, C. Fangyun; Bierman, Arlene S.; Brener, Stacey; Bronskill, Susan; Etchells, Edward; Fernandes, Olavo; Lau, Davina; Mamdani, Muhammad M.; Rochon, Paula; Urbach, David R.; Bell, Chaim M.

    2015-01-01

    Abstract Transitions of care leave patients vulnerable to the unintentional discontinuation of medications with proven efficacy for treating chronic diseases. Older adults residing in nursing homes may be especially susceptible to this preventable adverse event. The effect of large-scale policy changes on improving this practice is unknown. The objective of this study was to analyze the effect of a national medication reconciliation accreditation requirement for nursing homes on rates of unintentional medication discontinuation after hospital discharge. It was a population-based retrospective cohort study that used linked administrative records between 2003 and 2012 of all hospitalizations in Ontario, Canada. We identified nursing home residents aged ≥66 years who had continuous use of ≥1 of the 3 selected medications for chronic disease: levothyroxine, HMG-CoA reductase inhibitors (statins), and proton pump inhibitors (PPIs). In 2008 medication reconciliation became a required practice for accreditation of Canadian nursing homes. The main outcome measures included the proportion of patients who restarted the medication of interest after hospital discharge at 7 days. We also performed a time series analysis to examine the impact of the accreditation requirement on rates of unintentional medication discontinuation. The study included 113,088 adults aged ≥66 years who were nursing home residents, had an acute hospitalization, and were discharged alive to the same nursing home. Overall rates of discontinuation at 7-days after hospital discharge were highest in 2003–2004 for all nursing homes: 23.9% for thyroxine, 26.4% for statins, and 23.9% for PPIs. In most of the cases, these overall rates decreased annually and were lowest in 2011–2012: 4.0% for thyroxine, 10.6% for statins, and 8.3% for PPIs. The time series analysis found that nursing home accreditation did not significantly lower medication discontinuation rates for any of the 3 drug groups. From 2003

  10. Chronic Obstructive Pulmonary Disease Illness and Medication Beliefs are Associated with Medication Adherence.

    Science.gov (United States)

    Krauskopf, Katherine; Federman, Alex D; Kale, Minal S; Sigel, Keith M; Martynenko, Melissa; O'Conor, Rachel; Wolf, Michael S; Leventhal, Howard; Wisnivesky, Juan P

    2015-04-01

    Almost half of patients with COPD do not adhere to their medications. Illness and medication beliefs are important determinants of adherence in other chronic diseases. Using the framework of the Common Sense Model of Self-Regulation (CSM), we determined associations between potentially modifiable beliefs and adherence to COPD medications in a cohort of English- and Spanish-speaking adults with COPD from New York and Chicago. Medication adherence was assessed using the Medication Adherence Report Scale. Illness and medication beliefs along CSM domains were evaluated using the Brief Illness Perception Questionnaire (B-IPQ) and the Beliefs about Medications Questionnaire (BMQ). Unadjusted analysis (with Cohen's d effect sizes) and multiple logistic regression were used to assess the relationship between illness and medication beliefs with adherence. The study included 188 participants (47% Black, 13% Hispanics); 109 (58%) were non-adherent. Non-adherent participants were younger (p confidence interval: 0.36-0.75). In this cohort of urban minority adults, concerns about medications were associated with non-adherence. Future work should explore interventions to influence patient adherence by addressing concerns about the safety profile and long-term effects of COPD medications.

  11. Efficacy of medical therapy in treatment of chronic rhinosinusitis.

    Science.gov (United States)

    Young, Lee C; Stow, Nicholas W; Zhou, Lifeng; Douglas, Richard G

    2012-01-01

    Uncomplicated chronic rhinosinusitis (CRS) is generally treated with medical therapy initially and surgery is contemplated only after medical therapy has failed. However, there is considerable variation in the medical treatment regimens used and studies defining their efficacy are few. The aim of this study was to determine the proportion of patients treated medically who responded sufficiently well so that surgery was not required. Subgroup analysis to identify clinical features that predicted a favorable response to medical therapy was also performed. Eighty patients referred to the Otorhinolaryngology Clinic at North Shore Hospital were treated with a standardized medical therapy protocol (oral prednisone for 3 weeks, oral antibiotics and ongoing saline lavage and intranasal budesonide spray). Symptom scores were collected before and after medical therapy. Clinical features such as presence of polyps, asthma, and aspirin hypersensitivity were recorded. Failure of medical therapy was defined as the persistence of significant CRS symptoms, and those patients who failed medical therapy were offered surgery. Follow-up data were available for 72 (90%) patients. Of this group, 52.5%, (95% CI, 42.7%, 62.2%) failed to respond adequately to medical therapy and were offered surgery. The remaining patients (37.5%) were successfully treated with medical therapy and did not require surgery at the time of follow-up. The premedical therapy symptom scores were significantly higher than the postmedical therapy symptom scores (p < 0.01). The symptom scores of those patients postmedical therapy who proceeded to have surgery were significantly higher than the group who responded well to maximum medical therapy (MMT) and did not require surgery (p < 0.0001). There were no significant differences in the proportion of patients with asthma, aspirin sensitivity, or polyps between the groups failing or not failing MMT. In approximately one-third of patients with CRS, medical therapy

  12. Assessment of Living Skills in Schizophrenic Patients by Kohlman Evaluation

    Directory of Open Access Journals (Sweden)

    Leila Kazazi

    2012-09-01

    Full Text Available Background: The living skills of schizophrenic patients are disrupted due to cognitive, perceptual, sensory-motor, psychological, and psychosocial problems. Therefore, the identification of some aspects of living skills that require medical intervention is essential in these patients. Accordingly, in this study, the living skills of schizophrenic patients were investigated with the Kohlman Evaluation of Living Skills.Materials and Methods: This study was conducted by using the cross-sectional descriptive and analytic approach in which 35 hospitalized and 51 outpatient schizophrenic patients and 35 healthy individuals were compared and the areas of living skills that needed help were determined.Results: According to the Kruskal-Wallis test, there was a significant difference between the mean scores of healthy, hospitalized and outpatients subjects, whereas the difference in the means scores was not significant between the two groups of patients (p=0.693. Schizophrenic patients showed more than 50% requirement for help in the following subscales; appearance, awareness of dangerous household situations, appropriate action for sickness and accidents, obtaining and maintaining a source of income, budgeting their monthly income, and leisure activities. Employment had a direct effect on the living skills of the subjects and the test mean scores of employed people (2.409 was better than unemployed persons (7.083.Conclusion: The living skills of schizophrenic patients are damaged in some areas through the course of the disease and its symptoms. Based on the Kohlman Evaluation of Living Skills, these people require most help in self-care, safety health, money management, and leisure activities.

  13. [Intersubjectivity and interpersonal relations of schizophrenics].

    Science.gov (United States)

    Scharfetter, C

    2000-12-01

    Original accounts of an introspectively and linguistically highly gifted schizophrenic woman serve as a means to reflect about the meaning of the concept of intersubjectivity in the sense of Husserl, the constitution of self and world and its failure in the schizophrenic ego disorder. Concerning general psychopathology, there can be attempted to propose a typology of disordered intersubjectivity and consequently interpersonality. Psychotherapy of schizophrenics means reconstruction of intersubjectivity.

  14. 首发和慢性精神分裂症脑白质的弥散张量成像%Diffusion tensor imaging findings in first-episode and chronic schizophrenics

    Institute of Scientific and Technical Information of China (English)

    魏钦令; 康庄; 吴小立; 张晋碚; 李雷俊; 郑俩荣; 国效峰; 赵靖平

    2011-01-01

    Objective To investigate the integrity of white matters in first-episode and chronic schizophrenics. Methods For this study, 39 first-episode and 38 chronic schizophrenics, 69 healthy controls (age, gender and years of received education no significantly different from those of the patients)underwent diffusion weighted images with a single-shot echo planar imaging (EPI) sequence aligned to the straight axial plane. The fractional anisotropy (FA) images of three groups underwent one-way ANOVA with the methods of voxel-based morphometric (VBM) analysis. Results ( 1 ) There were three brain regions where the FA values of white matter were different among three groups: right caudate nucleus ( MNI:20, 12,14; cluster = 432 voxels; FA value :0. 36 ± 0. 18 vs 0. 35 ± 0. 24 vs 0. 38 ± 0. 17 ), left insula ( MNI: - 32,18, 2; cluster =204 voxels; FA value:0. 35 ±0.31 vs 0.33 ±0.24 vs 0.36 ±0.21) and right anterior cingulated( MNI: 16, 36, 12; cluster = 132 voxels;FA value:0. 35 ±0. 29 vs 0. 34 ±0. 31 vs 0. 37 ±0. 25).(2)The mean FA values of the three brain regions of two patients groups decreased versus those of healthy controls (P <0. 05 ). (3)The mean FA values of left insular region in chronic patients decreased versus those of the first-episode patients ( P < 0. 05 ). Conclusion The reduced integrity of white matter may play an etiological role in schizophrenia and the changes are probably progressive.%目的 分析首发精神分裂症和慢性精神分裂症脑白质完整性变化.方法 2009年8月至2011年2月在中山大学附属第三医院精神科住院部或门诊部就诊的39例首发精神分裂症患者、38例慢性精神分裂症患者和广告招募的69名健康对照进行脑磁共振弥散张量成像,3组图像以基于体素的分析方法进行单因素方差分析,提取阳性结果区平均FA值再进行多重比较.结果 (1)首发精神分裂症、慢性精神分裂症和健康对照在以下脑区的白质FA值存在

  15. Complementary and alternative medications for chronic pelvic pain.

    Science.gov (United States)

    Leong, Fah Che

    2014-09-01

    Chronic pelvic pain is common, but rarely cured, thus patients seek both second opinions and alternative means of controlling their pain. Complementary and alternative medicine accounts for 11.2% of out-of-pocket medical expenditures for adults for all conditions in the United States. Although there are many treatments, rigorous testing and well-done randomized studies are lacking. Dietary changes and physical modalities such as physical therapy have often been included in the category of alternative medicine, but their use is now considered mainstream. This article concentrates on other sources of alternative and complementary medicine, such as dietary supplementation and acupuncture.

  16. [Chronic medications in the preoperative period: should they be stopped?].

    Science.gov (United States)

    López-Álvarez, A; Román-Fernández, A; Fernández-Vieitez, M B; Fossati-Puertas, S

    2014-03-01

    As different specialists are becoming increasingly involved in the preoperative management of our patients (for two main reasons; Primary Care doctors have to perform minor surgical procedures, and as coordination between Primary Care and In-hospital Care is more and more necessary in order to improve their outcomes), we believe that an update is needed as regards the management of chronic medications in this period. We will try to review the current literature dealing with the recommendations about withdrawing or continuing these drugs. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  17. Chronic Obstructive Pulmonary Disease Illness and Medication Beliefs are Associated with Medication Adherence

    Science.gov (United States)

    Krauskopf, Katherine; Federman, Alex D; Kale, Minal S; Sigel, Keith M; Martynenko, Melissa; O’Conor, Rachel; Wolf, Michael S; Leventhal, Howard; Wisnivesky, Juan P

    2015-01-01

    Almost half of patients with COPD do not adhere to their medications. Illness and medication beliefs are important determinants of adherence in other chronic diseases. Using the framework of the Common Sense Model of Self Regulation (CSM), we determined associations between potentially modifiable beliefs and adherence to COPD medications in a cohort of English- and Spanish-speaking adults with COPD from New York and Chicago. Medication adherence was assessed using the Medication Adherence Report Scale. Illness and medication beliefs along CSM domains were evaluated using the Brief Illness Perception Questionnaire (B-IPQ) and the Beliefs about Medications Questionnaire (BMQ). Unadjusted analysis (with Cohen’s d effect sizes) and multiple logistic regression were used to assess the relationship between illness and medication beliefs with adherence. The study included 188 participants (47% Black, 13% Hispanics); 109 (58%) were adherent. Non-adherent participants were younger (p<0.001), more likely to be Black or Hispanic (p=0.001), to have reported low income (p=0.02), and had fewer years of formal education (p=0.002). In unadjusted comparisons, non-adherent participants reported being more concerned about their COPD (p=0.011; Cohen’s d=0.43), more emotionally affected by the disease (p=0.001; Cohen’s d=0.54), and had greater concerns about COPD medications (p<0.001, Cohen’s d=0.81). In adjusted analyses, concerns about COPD medications independently predicted non-adherence (odds ratio: 0.52, 95% confidence interval: 0.36–0.75). In this cohort of urban minority adults, concerns about medications were associated with non-adherence. Future work should explore interventions to influence patient adherence by addressing concerns about the safety profile and long-term effects of COPD medications. PMID:24960306

  18. Medical Transport of Children with Complex Chronic Conditions

    Directory of Open Access Journals (Sweden)

    Carlos F. Lerner

    2012-01-01

    Full Text Available One of the most notable trends in child health has been the increase in the number of children with special health care needs, including those with complex chronic conditions. Care of these children accounts for a growing fraction of health care resources. We examine recent developments in health care, especially with regard to medical transport and prehospital care, that have emerged to adapt to this remarkable demographic trend. One such development is the focus on care coordination, including the dissemination of the patient-centered medical home concept. In the prehospital setting, the need for greater coordination has catalyzed the development of the emergency information form. Training programs for prehospital providers now incorporate specific modules for children with complex conditions. Another notable trend is the shift to a family-centered model of care. We explore efforts toward regionalization of care, including the development of specialized pediatric transport teams, and conclude with recommendations for a research agenda.

  19. Can eHealth Reduce Medical Expenditures of Chronic Diseases?

    Science.gov (United States)

    Tsuji, Masatsugu; Taher, Sheikh Abu; Kinai, Yusuke

    2015-01-01

    The objective of this research is to evaluate empirically the effectiveness of eHealth in Nishi-aizu Town, Fukushima Prefecture, based on a mail survey to the residents and their receipt data of National Health Insurance from November 2006 to February 2007. The residents were divided into two groups, users and non-users, and sent questionnaires to ask their characteristics or usage of the system. Their medical expenditures paid by National Health Insurance for five years from 2002 to 2006 are examined. The effects were analyzed by comparison of medical expenditures between users and non-users. The interests are focused on four chronic diseases namely heart diseases, high blood pressure, diabetes, and strokes. A regression analysis is employed to estimate the effect of eHealth to users who have these diseases and then calculate the monetary effect of eHealth on reduction of medical expenditures. The results are expected to be valid for establishment of evidence-based policy such as reimbursement from medical insurance to eHealth.

  20. Interpreting chronic disorders of consciousness: medical science and family experience.

    Science.gov (United States)

    Edgar, Andrew; Kitzinger, Celia; Kitzinger, Jenny

    2015-06-01

    Chronic disorders of consciousness (CDoC) pose significant problems of understanding for both medical professionals and the relatives and friends of the patient. This paper explores the tensions between the different interpretative resources that are drawn upon by lay people and professionals in their response to CDoC. A philosophical analysis of data from 51 interviews with people who have relatives who are (or have been) in a vegetative or minimally conscious state. The medical specialist and the lay person tend to draw on two different interpretative frameworks: a medical science framework, which tends to construct the patient in terms of measurable physical parameters, and an interpretative framework that encompasses the uniqueness of the patient and the relative's relationship to them as a social being. These differences potentially lead to ruptures in communication between medical professionals and relatives such that that an increased self-consciousness of the framing assumptions being made will facilitate communication and enrich understanding of CDoCs. © 2014 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

  1. Chromosome X aneuploidy in Brazilian schizophrenic patients.

    Science.gov (United States)

    de Moraes, Leopoldo Silva; Khayat, André Salim; de Lima, Patrícia Danielle Lima; Lima, Eleonidas Moura; Pinto, Giovanny Rebouças; Leal, Mariana Ferreira; de Arruda Cardoso Smith, Marília; Burbano, Rommel Rodríguez

    2010-01-01

    The identification of cytogenetic abnormalities in schizophrenic patients may provide clues to the genes involved in this disease. For this reason, a chromosomal analysis of samples from 62 schizophrenics and 70 controls was performed with trypsin-Giemsa banding and fluorescence in situ hybridization of the X chromosome. A clonal pericentric inversion on chromosome 9 was detected in one male patient, and we also discovered mosaicism associated with X chromosome aneuploidy in female patients, primarily detected in schizophrenic and normal female controls over 40 years old. When compared with age-matched female controls, the frequency of X chromosome loss was not significantly different between schizophrenics and controls, except for the 40- to 49-year-old age group. Our findings suggest that the X chromosome loss seen in schizophrenic patients is inherent to the normal cellular aging process. However, our data also suggest that X chromosome gain may be correlated with schizophrenia in this Brazilian population.

  2. 社区综合康复对慢性精神分裂症的疗效及初步卫生经济学评价%Effect and Preliminary Health Economy of Comprehensive Community-based Rehabilitation for Chronic Schizophrenics

    Institute of Scientific and Technical Information of China (English)

    傅伟忠; 张明; 秦虹云; 陆林福; 王美珍; 陈颖; 卢瑛; 唐强; 方海平

    2013-01-01

    目的探讨社区综合康复对慢性精神分裂症患者疗效及卫生经济学价值。方法对80例社区慢性精神分裂症患者进行1年综合康复,随访观察1年。另80例社区患者为对照组。观察临床疗效及费用成本。结果康复组患者社会功能状况、治疗依从性、病情稳定率、家庭负担、生活满意度、症状评定、复发住院数7项指标均明显优于对照组(P<0.01),2年总费用低于对照组,主要表现为住院费用、维持药物治疗费用、照料者停工损失费、社区防治费用明显低于对照组(P<0.01)。结论社区综合康复可以改善慢性精神分裂症患者的预后,并减少成本。%Objective To explore the efficacy of comprehensive community-based rehabilitation on chronic schizophrenia and assess in the view of health economy. Methods 80 chronic schizophrenic patients accepted comprehensive community-based rehabilitation for 1 year and were followed up for 1 year. Other 80 chronic schizophrenics were as the controls. They were observed with outcome and the cost. Re-sults The social function, compliance, stability rate, burden on family caregiver, satisfaction of living, psychiatric symptoms, hospitalization were all better in the rehabilitation group than in the control group (P<0.01), and the total cost in the 2 years was less, especially that on hos-pitalization, maintenance treatment, work loss of caregivers, public prevention (P<0.01). Conclusion Comprehensive community-based re-habilitation can improve the outcome of chronic schizophrenics with less cost.

  3. Phenothiazine effects on cerebral-evoked potentials and eye movements in acute schizophrenics.

    Science.gov (United States)

    Rappaport, M; Hopkins, H K; Hall, K; Belleza, T

    1975-01-01

    An investigation was made of the effects of phenothiazine medication on the averaged visual-evoked potentials (AVEP) and on eye movements in hospitalized, young, acute schizophrenic patients. These results were compared with those of normal subjects who were not given medication. AVEP measures included maximum amplitude (Am), frequency of peaks (FOP'S), variability (V) and peak latencies for an early negative peak (N1) and a later positive peak (P6). Eye movement measures included percent of time looking at a stimulus slide, percent of time looking at a figure on the slide, the number of fixations and the percent of cells entered in which fixations occurred. For schizophrenics off and on phenothiazine medication, there were no consistently significant drug effects on any measure except frequency of peaks. Schizophrenics compared to normals had lower amplitudes, greater frequency of peaks, greater variability and lower eye movement scores.

  4. Are there schizophrenics for whom drugs may be unnecessary or contraindicated?

    Science.gov (United States)

    Rappaport, M; Hopkins, H K; Hall, K; Belleza, T; Silverman, J

    1978-01-01

    This study reports that there are schizophrenics who do relatively well long term without the routine or continuous use of antipsychotic medication. Specially selected young males undergoing an acute schizophrenic episode were followed, after hospitalization, for up to three years. While hospitalized they were assigned randomly to either placebo or chlorpromazine treatment. Many unmedicated-while-in-hospital patients showed greater long-term improvement, less pathology at follow-up, fewer rehospitalizations and better overall function in the community than patients who were given chlorpromazine while in the hospital. Factors related to post-hospital outcome were good premorbid history and short-lived paranoid characteristics. Considerations which may have an effect on the successful management of acute schizophrenic patients not on medication are mentioned. The findings underline the need for further study of how to utilize antipsychotic medication more selectively in the treatment of schizophrenia.

  5. Discriminating schizophrenics from borderline patients: study with the Holtzman Inkblot technique.

    Science.gov (United States)

    Leichsenring, F

    1991-01-01

    The present study tried to discriminate acute (n = 25) and chronic schizophrenics (n = 25) from borderline patients (BLP; n = 30) on the basis of deviant verbalizations as assessed by the Holtzman Inkblot Technique (HIT). A 30-card version of the HIT was used. It was possible to separate BLPs and schizophrenics with quite good results: 77% of the BLPs, 80% of the acute schizophrenics and 92% of the chronic schizophrenics could be classified correctly based on the less severe deviant verbalizations (DVs) which were more frequent in the BLPs and based on the most severe forms of DVs, i.e. Incoherence, neologism and Perseveration (which were more frequent in the schizophrenic patients). Furthermore, it could be demonstrated that BLPs can be separated from neurotics using the 30-card version of the HIT, the resulting scores being nearly as high as those on the basis of the 45-card version. In another comparison, neurotics (n = 30) were discriminated from normals (n = 35) using the less severe DVs, which were more frequent in the neurotics: here, 74% of the normals and 73% of the neurotics could be classified correctly.

  6. Smart medical stocking using memory polymer for chronic venous disorders.

    Science.gov (United States)

    Kumar, Bipin; Hu, Jinlian; Pan, Ning

    2016-01-01

    Proper level of pressure or compression generated by medical stocking or hosiery is the key element for successful treatment or management of chronic venous disorders such as oedema, leg ulcers, etc. However achieving the recommended compression level and, more importantly, sustaining it using stockings has been a major challenge to the health practitioners supervising the treatment. This work aims to investigate and design a smart compression stocking using shape-memory polymer that allows externally controlling the pressure level in the wrapped position on the leg. Based on thermodynamical rubber theories, we first derived several criteria that have to be satisfied simultaneously in order to achieve the controlled pressure adjustment using external heat stimuli. We then presented a case where such a stocking is developed using a blend yarn consists of selected shape-memory polyurethane and nylon filaments. Extensive experimental work has also been conducted to demonstrate the feasibility and explore the influencing factors involved.

  7. PSD对慢性精神分裂症患者共情能力和社会功能的影响研究%On the Influences of Psychological Sitcom on Empathy and Social Function of Chronic Schizophrenics

    Institute of Scientific and Technical Information of China (English)

    王莉; 肖玮

    2015-01-01

    Objective To explore the influences of psychological sitcom on empathy and social function of chronic schizophrenics. Method A total of 104 patients were randomly divided into observation group and control group,52 in each. Based on the original antipsychotic agents,the observation group was supplemented with psychological sitcom,3 months as a course. The effects of psychological sitcom were assessed by interpersonal reaction pointer Scale ( Chinese version) ( IRI-C) ,Rosenberg Self-Esteem Scale ( SES) ,Scale for Assessment of Negative Symptoms ( SANS) ,Scale of Social-Skills for Psychiatric Inpatients ( SSPI) before and after treatment. Results After treatment,the observation group exhibited significant higher score in IRI-C score of life (FS), perspective taking (PT),empathic concern (EC) than those in the control group (P<0. 05). And the assessment results of ESLI,TSBI,SANS,SES,SSPI of the patients in the observation group were much better than those in the control group ( P<0 . 05 ) . While the evaluation result of the observation group improved obviously after treatment (P<0. 05). Conclusion Psychological sitcom can improve CS patients’ empathy ability and social function,reduce their social loneliness.%目的:探讨心理情景剧( PSD)对慢性精神分裂症患者共情能力和社会功能的影响.方法选取精神分裂症患者104例,随机分为对照组和观察组,每组各52例.两组均给予精神药物治疗,观察组患者辅以PSD治疗,3个月为1个疗程.分别于治疗前后采用人际反应指针量表(中文版)( IRI-C)、情绪-社交孤独问卷( ESLI)、得克萨斯社交行为问卷( TSBI)、罗森伯格自尊量表( SES)、阴性症状量表( SANS)、住院精神病患者社会功能评定量表( SSPI)对两组患者进行测定.结果治疗后观察组IRI-C总分、幻想能力( FS)得分、观点采择( PT)得分、同情性关心(EC)得分均高于对照组,差异具有统计学意义(P<0.05).治疗后观察组患者ESLI

  8. Medical errors in hospitalized pediatric trauma patients with chronic health conditions

    Directory of Open Access Journals (Sweden)

    Xiaotong Liu

    2014-01-01

    Full Text Available Objective: This study compares medical errors in pediatric trauma patients with and without chronic conditions. Methods: The 2009 Kids’ Inpatient Database, which included 123,303 trauma discharges, was analyzed. Medical errors were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. The medical error rates per 100 discharges and per 1000 hospital days were calculated and compared between inpatients with and without chronic conditions. Results: Pediatric trauma patients with chronic conditions experienced a higher medical error rate compared with patients without chronic conditions: 4.04 (95% confidence interval: 3.75–4.33 versus 1.07 (95% confidence interval: 0.98–1.16 per 100 discharges. The rate of medical error differed by type of chronic condition. After controlling for confounding factors, the presence of a chronic condition increased the adjusted odds ratio of medical error by 37% if one chronic condition existed (adjusted odds ratio: 1.37, 95% confidence interval: 1.21–1.5, and 69% if more than one chronic condition existed (adjusted odds ratio: 1.69, 95% confidence interval: 1.48–1.53. In the adjusted model, length of stay had the strongest association with medical error, but the adjusted odds ratio for chronic conditions and medical error remained significantly elevated even when accounting for the length of stay, suggesting that medical complexity has a role in medical error. Higher adjusted odds ratios were seen in other subgroups. Conclusion: Chronic conditions are associated with significantly higher rate of medical errors in pediatric trauma patients. Future research should evaluate interventions or guidelines for reducing the risk of medical errors in pediatric trauma patients with chronic conditions.

  9. Medical therapy for chronic obstructive pulmonary disease in 2007.

    Science.gov (United States)

    Ingenito, Edward P

    2007-01-01

    Medical treatment for patients with stable chronic obstructive pulmonary disease (COPD) has evolved significantly over the past 2 decades. Current World Health Organization recommendations suggest a stepwise approach to therapy depending upon disease severity. As-needed use of short-acting bronchodilators is recommended for patients with mild disease. Scheduled dosing of bronchodilators is recommended for patients with more advanced disease. Inhaled beta-agonists and anti-cholinergic agents in combination have proved to be more effective than either agent alone. Long-acting preparations are associated with better disease control and have not been associated with tachyphylaxis. Inhaled corticosteroids are useful for reducing the frequency of exacerbations in patients who experience one or more episodes per year. Oxygen therapy is clearly beneficial in patients with advanced COPD and chronic respiratory failure, and its potential benefits in less severe disease are currently being studied. Pulmonary rehabilitation benefits patients with mild-to-severe disease, although the greatest benefits have been demonstrated in those with moderate COPD. New ultra-long-acting inhaled bronchodilators, phosphodiesterase inhibitors, protease inhibitors, and retinoids intended to promote tissue regeneration are currently being evaluated in clinical trials as future therapeutic agents.

  10. Medical Therapies for Adult Chronic Sinusitis: A Systematic Review.

    Science.gov (United States)

    Rudmik, Luke; Soler, Zachary M

    2015-09-01

    Chronic sinusitis is a common inflammatory condition defined by persistent symptomatic inflammation of the sinonasal cavities lasting longer than 3 months. It accounts for 1% to 2% of total physician encounters and is associated with large health care expenditures. Appropriate use of medical therapies for chronic sinusitis is necessary to optimize patient quality of life (QOL) and daily functioning and minimize the risk of acute inflammatory exacerbations. To summarize the highest-quality evidence on medical therapies for adult chronic sinusitis and provide an evidence-based approach to assist in optimizing patient care. A systematic review searched Ovid MEDLINE (1947-January 30, 2015), EMBASE, and Cochrane Databases. The search was limited to randomized clinical trials (RCTs), systematic reviews, and meta-analyses. Evidence was categorized into maintenance and intermittent or rescue therapies and reported based on the presence or absence of nasal polyps. Twenty-nine studies met inclusion criteria: 12 meta-analyses (>60 RCTs), 13 systematic reviews, and 4 RCTs that were not included in any of the meta-analyses. Saline irrigation improved symptom scores compared with no treatment (standardized mean difference [SMD], 1.42 [95% CI, 1.01 to 1.84]; a positive SMD indicates improvement). Topical corticosteroid therapy improved overall symptom scores (SMD, -0.46 [95% CI, -0.65 to -0.27]; a negative SMD indicates improvement), improved polyp scores (SMD, -0.73 [95% CI, -1.0 to -0.46]; a negative SMD indicates improvement), and reduced polyp recurrence after surgery (relative risk, 0.59 [95% CI, 0.45 to 0.79]). Systemic corticosteroids and oral doxycycline (both for 3 weeks) reduced polyp size compared with placebo for 3 months after treatment (P sinusitis. A short course of systemic corticosteroids (1-3 weeks), short course of doxycycline (3 weeks), or a leukotriene antagonist may be considered in patients with nasal polyps. A prolonged course (3 months) of macrolide

  11. Sensory gating deficits in parents of schizophrenics

    Energy Technology Data Exchange (ETDEWEB)

    Waldo, M.; Madison, A.; Freedman, R. [Univ. of Colorado Health Sciences Center, Denver, CO (United States)] [and others

    1995-12-18

    Although schizophrenia clusters in families, it is not inherited in Mendelian fashion. This suggests that there may be alternative phenotypic expressions of genes that convey risk for schizophrenia, such as more elementary physiological or biochemical defects. One proposed phenotype is impaired inhibitory gating of the auditory evoked potential to repeated stimuli. Normally, the amplitude of the P50 response to the second stimulus is significantly less than the response to the first, but this gating of response is generally impaired in schizophrenia. Clinically unaffected individuals within a pedigree who have both an ancestral and descendant history of schizophrenia may be useful for studying whether this physiological defect is a possible alternative phenotype. We have studied inhibitory gating of the auditory P50 response to pairs of auditory stimuli in 17 nuclear families. In 11, there was one parent who had another relative with a chronic psychotic illness, in addition to the schizophrenic proband. AR of the parents with family histories of schizophrenia had gating of the P50 response similar to their schizophrenia offspring, whereas only 7% of the parents without family history had gating of the P50 response in the abnormal range. These results support loss of gating of the auditory P50 wave as an inherited deficit related to schizophrenia and suggest that studies of parents may help elucidate the neurobiological expression of genes that convey risk for schizophrenia. 36 refs., 2 figs., 2 tabs.

  12. Basic symptoms in schizophrenic and affective psychoses.

    Science.gov (United States)

    Ebel, H; Gross, G; Klosterkötter, J; Huber, G

    1989-01-01

    The study compares schizophrenic and affective psychoses with regard to basic symptoms. 30 patients in schizophrenic pre-, intra-, and postpsychotic basic stages and 30 patients in endogenous-depressive phases were examined according to the Bonn Scale for the Assessment of Basic Symptoms. The most important result is that certain cognitive basic symptoms and cenesthesias which are decisive for the development of florid productive-psychotic phenomena are found more frequently in the group of schizophrenias.

  13. The impact of parents’ chronic medical condition on children

    NARCIS (Netherlands)

    Sieh, D.S.

    2012-01-01

    The results of this research suggests that latency-aged and adolescent children generally cope well with the parent’s chronic disease. In terms of parent attachment, coping skills, and salivary cortisol, adolescents with a chronically ill parent have similar scores as those who do not have a chronic

  14. Gene polymorphism of serotonin receptors and drug-induced hyperprolactinemia in schizophrenic patients

    NARCIS (Netherlands)

    Osmanova, D.Z.; Boiko, A.S.; Fedorenko, O.Y.; Pozhidaev, I.V.; Freidin, M.B.; Kornetova, E.G.; Ivanova, S.A.; Wilffert, B.; Loonen, A.J.M.

    2016-01-01

    Background: Antipsychotics have been used for more than 50 years in the treatment of schizophrenia and many other psychiatric disorders. Schizophrenic patients have to take antipsychotic medication for a long time, often throughout the life [1]. Hyper prolactinemia in these patients is a common and

  15. Complex gunshot injury to the heart as a consequence of suicide attempt in a schizophrenic patient

    Directory of Open Access Journals (Sweden)

    J. Konecny

    2016-01-01

    Conclusion: This case represents management of complex self-inflicted gunshot cardiac injury in a schizophrenic patient who discontinued antipsychotic medication. Liaison between themedical rescue service and high level trauma center essentially reduced injury-to-surgery time. Complex heart injury was successfully repaired on extracorporeal circulation.

  16. Establishing a research agenda for investigating alternative medical interventions for chronic pain.

    Science.gov (United States)

    Berman, B M; Swyers, J P

    1997-12-01

    This article describes the University of Maryland School of Medicine's Center for Complementary Medicine Research approach to developing an agenda for investigating alternative medical treatments for chronic pain syndromes. This agenda includes conducting extensive literature searches and analyses to form a knowledge base for making clinical decisions on which chronic pain syndromes are in greatest need of better therapies, as well as which alternative medical therapies offer the greatest therapeutic promise for these specific chronic pain syndromes. To date, the Center has identified back pain, arthritis, and fibromyalgia as the chronic pain syndromes that contribute the greatest clinical and economic burden to overall chronic pain statistics. Not coincidentally, patients with these diagnoses are the greatest users of alternative therapies. The Center has identified acupuncture, homeopathy, manual/manipulative therapies, and mind-body therapies as the alternative medical therapies offering the greatest clinical potential for these three general chronic pain diagnoses. Preliminary data from the Center's ongoing clinical trials programs are presented.

  17. Computerized tomography studies on schizophrenic diseases

    Energy Technology Data Exchange (ETDEWEB)

    Gross, G.; Huber, G.; Schuettler, R.

    1982-01-01

    Earlier clinical pneumoencephalographic studies showed a subgroup of schizophrenics that have small and dysplastic cerebral ventricles as well as a subgroup with a 'pure defect', i.e., a slight internal brain atrophy. In echoencephalograms of pure and mixed residual schizophrenic syndrome patients, a significantly higher average transverse diameter of the third ventricle was demonstrated compared to that in patients with complete remissions. Correlations cannot be expected between certain groups of disease, e.g., epilepsy, multiple sclerosis, or schizophrenia on the whole, and pneumoencephalographic (PEG) and CT findings. Only schizophrenics with distinct signs of pure defect that had persisted for at least 3 years revealed deviations from normal by CT and PEG, but those with irreversible fixed deformations of personality structure did not. In patients who were 50 years of age or less with psychic reactive and psychopathic personality disorders, CT showed an average third ventricle diameter of 4.2 mm (range 2-6 mm). Of 117 schizophrenics (average age 35.5 years), only 28% revealed pathological CT changes. However, of 36 schizophrenics with pure residual syndromes 69% showed pathological CT findings that always concerned the third ventricle, rarely the lateral ventricles, and in no case the cortex. The average transverse diameter of the third ventricle in this subgroup with pure defect was 7.6 mm, as compared to 4.6 mm in the subgroup of schizophrenics with complete remission. There was no increase in size with increasing years until the 50th year in schizophrenics, as well as in the control group of variations of psychic being (neuroses and psychopathic personality disorders).

  18. Monocytic HLA DR antigens in schizophrenic patients.

    Science.gov (United States)

    Krause, Daniela; Wagner, Jenny; Matz, Judith; Weidinger, Elif; Obermeier, Michael; Riedel, Michael; Gruber, Rudolf; Schwarz, Markus; Mueller, Norbert

    2012-01-01

    A genetic association of specific human leukocyte antigens (HLA) DR genes and schizophrenia has recently been shown. These HLA play a fundamental role in the control of immune responses. Furthermore infectious agents have been proposed to be involved in the pathogenesis of schizophrenia. In this study we investigated the rate of HLA DR positive monocytes in schizophrenic patients compared to controls with a special focus on the adaption to in vitro stimulation with toll-like receptor ligands. Patients with schizophrenia and matched controls were included. For each individual, we evaluated the rate of HLA DR positive monocytes (either incubated at 37 °C or after stimulation with lipopolysaccharide or Poly I:C). We found a significantly higher percentage of schizophrenic patients with elevated HLA DR positive cells (p=0.045) as compared to controls. The adjustment rate from baseline levels of monocytic HLA DR positive cells to stimulation with Poly I:C was significantly lower in schizophrenic patients (p=0.038). The increased monocytic HLA DR in schizophrenic patients and the maladjustment of their monocytic HLA DR levels to an infectious stimulus might be a sign for a disturbed monocytic immune balance in schizophrenic individuals.

  19. The impact of neuroleptic dosage and extrapyramidal side effects on schizophrenic basic symptoms.

    Science.gov (United States)

    Moritz, S; Krausz, M; Gottwalz, E; Andresen, B

    2000-01-01

    The impact of neuroleptic medication and extrapyramidal symptoms on abnormal subjective experiences in schizophrenia, also termed basic symptoms, as assessed with the Frankfurt Complaint Questionnaire (FCQ) was investigated in 40 schizophrenic patients medicated with conventional neuroleptics. Basic symptoms are thought to reflect the subjective side of schizophrenic vulnerability and to underlie schizophrenic symptomatology. It was expected that basic symptoms would inversely correlate with chlorpromazine equivalents, since neuroleptics not only improve acute schizophrenic symptoms but also have prophylactic properties. However, a significant positive correlation with neuroleptic dosage and extrapyramidal symptoms emerged, suggesting that basic symptoms as operationalized in the FCQ partly reflect neuroleptic-induced deficits. The results remained unchanged when global psychopathology was controlled for. In line with previous research, basic symptoms correlated with thought disorder but not with positive symptoms. However, when the effects of neuroleptic-induced disturbances were controlled for, thought disorder also insignificantly correlated with basic symptoms. Our findings confirm previous results that question the construct validity of the FCQ. Moreover, the need to control for confounding variables (such as medication) is emphasized by comparing different psychiatric groups.

  20. Mortality and causes of death in schizophrenic patients in Denmark

    DEFF Research Database (Denmark)

    Mortensen, P B; Juel, K

    1990-01-01

    A cohort consisting of 6178 people that were psychiatric inpatients with a clinical schizophrenia diagnosis in 1957 were followed up from 1957 through 1986, and their cause-specific mortality was determined. Mortality from cardiovascular diseases, lung diseases, gastrointestinal and urogenital...... disorders, accidents and suicide was increased, whereas mortality from cerebrovascular disorders was reduced. In the male patients cancer mortality was reduced whereas cancer mortality in the female patients was increased. Mortality from a number of causes that theoretically could be associated with side...... effects from neuroleptics was increased. Mortality from some causes of death used as a measurement of the quality of medical care was found to be slightly increased. Further studies of the quality of the medical care provided to schizophrenic patients and of the association between neuroleptic medication...

  1. The impact of parents’ chronic medical condition on children

    NARCIS (Netherlands)

    Sieh, D.S.

    2012-01-01

    The results of this research suggests that latency-aged and adolescent children generally cope well with the parent’s chronic disease. In terms of parent attachment, coping skills, and salivary cortisol, adolescents with a chronically ill parent have similar scores as those who do not have a

  2. Participation of chronic patients in medical consultations: patients’ perceived efficacy, barriers and interest in support.

    NARCIS (Netherlands)

    Henselmans, I.; Heijmans, M.; Rademakers, J.; Dulmen, S. van

    2015-01-01

    Aims: Chronic patients are increasingly expected to participate actively in medical consultations. This study examined (i) patients' perceived efficacy and barriers to participation in consultations, (ii) patients' interest in communication support and (iii) correlates of perceived efficacy and

  3. Psychosocial predictors of non-adherence to chronic medication: systematic review of longitudinal studies

    NARCIS (Netherlands)

    Zwikker, H.E.; Bemt, B.J.F van den; Vriezekolk, J.E.; Ende, C.H.M. van den; Dulmen, S. van

    2014-01-01

    OBJECTIVES: Several cross-sectional studies suggest that psychosocial factors are associated with non-adherence to chronic preventive maintenance medication (CPMM); however, results from longitudinal associations have not yet been systematically summarized. Therefore, the objective of this study was

  4. Psychosocial predictors of non-adherence to chronic medication: systematic review of longitudinal studies.

    NARCIS (Netherlands)

    Zwikker, H.E.; Bemt, B.J. van den; Vriezekolk, J.E.; Ende, C.H. van den; Dulmen, S. van

    2014-01-01

    Objectives: Several cross-sectional studies suggest that psychosocial factors are associated with non-adherence to chronic preventive maintenance medication (CPMM); however, results from longitudinal associations have not yet been systematically summarized. Therefore, the objective of this study was

  5. Psychosocial predictors of non-adherence to chronic medication: systematic review of longitudinal studies

    NARCIS (Netherlands)

    Zwikker, H.E.; Bemt, B.J.F van den; Vriezekolk, J.E.; Ende, C.H.M. van den; Dulmen, S. van

    2014-01-01

    OBJECTIVES: Several cross-sectional studies suggest that psychosocial factors are associated with non-adherence to chronic preventive maintenance medication (CPMM); however, results from longitudinal associations have not yet been systematically summarized. Therefore, the objective of this study was

  6. Modelling Estimates of Norovirus Disease in Patients with Chronic Medical Conditions

    OpenAIRE

    Thomas Verstraeten; Baoguo Jiang; John G Weil; Lin, Jennifer H.

    2016-01-01

    Background The burden of disease due to norovirus infection has been well described in the general United States population, but studies of norovirus occurrence among persons with chronic medical conditions have been limited mostly to the immunocompromised. We assessed the impact of norovirus gastroenteritis on health care utilization in US subjects with a range of chronic medical conditions. Methods We performed a retrospective cohort study using MarketScan data from July 2002 to December 20...

  7. The effect of control and self-medication of chronic gout in a developing country.

    NARCIS (Netherlands)

    Darmawan, John; Rasker, Hans J.; Nuralim, Hendri

    2003-01-01

    Objective:: We describe a 10 year observation of the effect of control of hyperuricemia compared with self-medication alone in patients with chronic gout. Methods: We studied 299 consecutively self-referred Malayo-Polynesian men with chronic gout, mean age 35 ± 14.3 SD years. Subjects comprised 228

  8. Web-based Distributed Medical Information System for Chronic Viral Hepatitis

    Science.gov (United States)

    Yang, Ying; Qin, Tuan-fa; Jiang, Jian-ning; Lu, Hui; Ma, Zong-e.; Meng, Hong-chang

    2008-11-01

    To make a long-term dynamic monitoring to the chronically ill, especially patients of HBV A, we build a distributed Medical Information System for Chronic Viral Hepatitis (MISCHV). The Web-based system architecture and its function are described, and the extensive application and important role are also presented.

  9. The interaction of polymorphisms of IL10 and DBH was associated with general symptoms of PANSS with TD in Chinese Han schizophrenic patients.

    Directory of Open Access Journals (Sweden)

    Hongqiang Sun

    Full Text Available OBJECTIVE: Tardive dyskinesia (TD is a human hyperkinetic movement disorder as a result of potentially irreversible long-term chronic first-generation antipsychotic medications. Unfortunately, mechanisms involved in the development of TD have been poorly understood. Previous studies have indicated that some genetic polymorphisms of immune system and dopamine beta-hydroxylase (DBH genes may be involved in the pathogenesis of TD. Rs1800872 and rs72393728 are located on the promoter of interleukin-10 (IL10 and DBH gene, respectively. The genetic association between the rs1800872 and TD is unclear. Previous studies have indicated that genetic variations of IL 10 and DBH are implicated in the positive and negative symptoms in schizophrenia. However, the interaction of two variations with severity of TD and symptoms of schizophrenic patients with TD has not been reported. The present study investigated whether these variations and their interaction were associated with clinical phenotypes of TD with schizophrenia in a genetically homogeneous northern Chinese Han population. METHODS: Rs1800872 and rs72393728 were genotyped in schizophrenic patients with TD (n = 372 and without TD (NTD; n = 412. The Abnormal Involuntary Movement Scale (AIMS and Positive and Negative Syndrome Scale (PANSS were applied to assess the severity of TD and psychopathology of schizophrenia, respectively. RESULTS: The allele and genotype frequencies of rs1800872 and rs72393728 did not significantly differ between TD and NTD patients (p>0.05. No significant difference was found in the AIMS total score among the genotypes of two loci (p>0.05. Interestingly, the interaction of rs1800872 and rs72393728 showed a significant association with the PANSS general score (p = 0.011, and a trend toward to the PANSS total score (p = 0.055. CONCLUSION: These findings suggest that the interaction of rs1800872 and rs72393728 variants may play a role in psychopathology of the general symptoms on

  10. Adherence to Medication Regimens among Low-Income Patients with Multiple Comorbid Chronic Conditions

    Science.gov (United States)

    Mishra, Shiraz I.; Gioia, Deborah; Childress, Saltanat; Barnet, Beth; Webster, Ramothea L.

    2011-01-01

    This qualitative study sought to explore facilitators and barriers to adherence to multiple medications among low-income patients with comorbid chronic physical and mental health conditions. The 50 focus group participants identified personal/contextual and health system factors as major impediments to adherence to multiple medications. These…

  11. Dopamine D2 receptor gene -141C Insertion/Deletion polymorphism in Turkish schizophrenic patients.

    Science.gov (United States)

    Kurt, Hulyam; Dikmen, Miris; Basaran, Ayşe; Yenilmez, Cinar; Ozdemir, Figen; Degirmenci, Irfan; Gunes, Hasan Veysi; Kucuk, Meral Urhan; Mutlu, Fezan

    2011-02-01

    Schizophrenia is a chronic and neuropsychiatric disease that affects about 0.5-1% of the world's population. An increase in dopamine and dopamine D2 receptor (DRD2) gene products has been well described in schizophrenic patients. Several groups have studied the relationship between dopaminergic hyperactivity and cellular communications have obtained discordant results. Studies searching for the relationship between the schizophrenia and DRD2 gene have gained more interest. Our objective was to determine the relationships among schizophrenic symptoms in schizophrenia subtypes and severity of symptoms in terms of DRD2 gene -141C Insertion/Deletion [Ins/Del; I/D] polymorphism by PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) assay method. Genomic DNA was prepared from peripheral blood by using salt extraction method. After amplification of genomic DNA, PCR products were digested with BstNI restriction enzyme for the detection of DRD2 gene -141C Ins/Del polymorphism in 73 schizophrenic patients and 60 healthy control subjects. The allelic frequencies of the DRD2 gene -141C Ins/Del polymorphism in case and control groups were 79.5 and 77.5% for I allele; 20.5 and 22.5% for D allele respectively. There was no significant difference in frequencies of genotypes and alleles between the two groups. In schizophrenic and control subjects, there were no significant relationship in severity of the disease and schizophrenia types among the -141C Ins/Del genotypes and alleles.

  12. Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study

    DEFF Research Database (Denmark)

    Wilbrink, Leopoldine A; Teernstra, Onno Pm; Haan, Joost

    2013-01-01

    BACKGROUND: About 10% of cluster headache patients have the chronic form. At least 10% of this chronic group is intractable to or cannot tolerate medical treatment. Open pilot studies suggest that occipital nerve stimulation (ONS) might offer effective prevention in these patients. Controlled...... in medically intractable, chronic cluster headache patients of high- versus low-amplitude ONS. Primary outcome measure is the mean number of attacks over the last four weeks. After a study period of six months there is an open extension phase of six months. Alongside the randomised trial an economic evaluation...... study is performed. DISCUSSION: The ICON study will show if ONS is an effective preventive therapy for patients suffering medically intractable chronic cluster headache and if there is a difference between high- and low-amplitude stimulation. The innovative design of the study will, for the first time...

  13. [Pregnancy and labor complications--their significance in the development of schizophrenic psychoses].

    Science.gov (United States)

    Stöber, G; Franzek, E; Beckmann, H

    1993-10-01

    In a retrospective study of 80 chronic DSM III-R schizophrenics and 80 controls, the occurrence of obstetric complications (OCs) into the development of chronic schizophrenias was investigated using Leonhard's distinction in systematic schizophrenia (no obvious familial loading) and unsystematic schizophrenia (mainly genetically determined according to Leonhard). The Lewis & Murray and Fuchs scales were used for evaluation. In both scales, unsystematic schizophrenias did not differ from controls, but those with OCs were significantly (p schizophrenics had an increased frequency, severity and total score of OCs compared to controls in the Fuchs scale (p perinatal disturbances lead to an early onset of the disease, however, in systematic schizophrenias they seem to be of causal importance for the development of the disease.

  14. [Schizophrenic disorders: current etiologic and clinical knowledge].

    Science.gov (United States)

    Olié, Jean-Pierre; Krebs, Marie-Odile; Lôo, Henri

    2005-05-01

    Brain anomalies associated with schizophrenic disorders may be of a cognitive, neurophysiological or neurological nature [the latter being relatively minor and nonspecific]. Brain imaging has revealed early anomalies such as cortical-subcortical atrophy and abnormal gyration. These anomalies can also be present in relatives free of schizophrenic symptoms. This raises the question of what determines the transition from vulnerability to clinical onset. There is now evidence that schizophrenic disorders are true brain diseases. This is based on neuropathological studies, brain imaging and clinical findings such as "soft" neurological signs (pyramidal and extrapyramidal symptoms, coordination difficulties, etc.). Cognitive dysfunctions such as attention and memory disorders and abnormal verbal fluency have also been described. Oculomotor pursuit and auditive evoked potentials have identified specific neurophysiological disorders such as N300 and P50 wave modifications. Schizophrenic disorders can also be associated with neuronal abnormalities, notably affecting factors involved in synaptic transmission and plasticity. For example, BDNF protein deficit is linked to certain late-onset forms of schizophrenia. Genetic studies are no longer focusing on a possible disease genotype but rather on phenotypic characteristics determined by simpler genotypes (P50 wave modulation, COMT and BDNF genes). The ultimate objective is to identify high-risk subjects, in order to shorten the treatment delay and thereby improve long-term outcome. The benefit of primary prophylaxis remains to be determined, however.

  15. Comment on Differentiating Paranoid From Nonparanoid Schizophrenics

    Science.gov (United States)

    Calhoun, James F.

    1971-01-01

    Three methods of differentiating paranoid from nonparanoid schizophrenics were compared using 97 males from a Veterans Administration hospital. Official hospital diagnosis and behavior ratings were found to be significantly correlated, while self-report correlated with neither of the other two techniques. Implications for research are briefly…

  16. Behavioral activation therapy for remediating persistent social deficits in medication-responsive chronic depression.

    Science.gov (United States)

    Erickson, Gregory; Hellerstein, David J

    2011-05-01

    The purpose of this article is to explore the use of behavioral activation therapy in patients with medication-responsive chronic depression who continue to experience social and occupational deficits. The classification of chronic depression includes a variety of disorders that are both common and debilitating and that frequently leave patients socially impaired even after remission of mood symptoms. Medication is often only partially effective in remedying these social impairments. As a result, other interventions, including forms of psychotherapy, may be justified as an adjunct to medication to improve residual social impairment. Behavioral activation therapy is one such treatment that may be especially appropriate for such individuals. The authors offer a brief description of behavioral activation therapy and examine how to adapt this therapy for use in patients with medication-responsive chronic depression. Preliminary evidence suggests that the therapy can be easily implemented with few modifications to improve social and occupational difficulties.

  17. [The role of chronic gastritis in past medical history with NSAID administration in patients with osteoarthrosis].

    Science.gov (United States)

    Zak, M Iu

    2014-11-01

    122 patients with osteoarthrosis, who have in the past medical history verified chronic gastritis (50 males and 72 females) at the age from 42 to 64 have been examined. Control group was comprised of 40 patients with osteoarthrosis without gastroduodenal zone pathology in the past medical history. For arthralgia relief patients were prescribed meloxicam (average dose--12.5 - 1.39 mg daily) or nimesulide (average dose--150 ± 14.91 mg daily). As a result of this research it was determined that administration of selective NSAID (meloxicam and nimesulide) in patients with chronic gastritis in the past medical history raised the risk of NSAID gastropathy/dyspepsia 2.9 times (P 0.05) of erosive gastropathy. Patients with chronic gastritis in the past medical history when taking NSAID with the purpose of gastropathy prevention are recommended to undergo gastroprotective therapy.

  18. Medication overuse, healthy lifestyle behaviour and stress in chronic headache

    DEFF Research Database (Denmark)

    Westergaard, Maria Lurenda; Glümer, Charlotte; Hansen, Ebba Holme

    2016-01-01

    with and without medication overuse (prevalence 1.8% and 1.6%, respectively) had strong, graded associations with stress. Associations with daily smoking, physical inactivity, and obesity were significant only for MOH. Odds for MOH were highest among people who had all three factors compared to those who had none...... as having CH then further described as having medication-overuse headache (MOH) or CH without medication overuse. Associations between headache and daily smoking, physical inactivity, obesity, excessive drinking, illicit drug use, and high stress were analysed by logistic regression. RESULTS: CH...

  19. Frequency and content analysis of chronic fatigue syndrome in medical text books.

    Science.gov (United States)

    Jason, Leonard A; Paavola, Erin; Porter, Nicole; Morello, Morgan L

    2010-01-01

    Text books are a cornerstone in the training of medical staff and students, and they are an important source of references and reviews for these professionals. The objective of this study was to determine both the quantity and quality of chronic fatigue syndrome (CFS) information included in medical texts. After reviewing 119 medical text books from various medical specialties, we found that 48 (40.3%) of the medical text books included information on CFS. However, among the 129 527 total pages within these medical text books, the CFS content was presented on only 116.3 (0.090%) pages. Other illnesses that are less prevalent, such as multiple sclerosis and Lyme disease, were more frequently represented in medical text books. These findings suggest that the topic ofCFS is underreported in published medical text books.

  20. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care.

    Science.gov (United States)

    Weeks, Greg; George, Johnson; Maclure, Katie; Stewart, Derek

    2016-11-22

    A range of health workforce strategies are needed to address health service demands in low-, middle- and high-income countries. Non-medical prescribing involves nurses, pharmacists, allied health professionals, and physician assistants substituting for doctors in a prescribing role, and this is one approach to improve access to medicines. To assess clinical, patient-reported, and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care). We searched databases including CENTRAL, MEDLINE, Embase, and five other databases on 19 July 2016. We also searched the grey literature and handsearched bibliographies of relevant papers and publications. Randomised controlled trials (RCTs), cluster-RCTs, controlled before-and-after (CBA) studies (with at least two intervention and two control sites) and interrupted time series analysis (with at least three observations before and after the intervention) comparing: 1. non-medical prescribing versus medical prescribing in acute care; 2. non-medical prescribing versus medical prescribing in chronic care; 3. non-medical prescribing versus medical prescribing in secondary care; 4 non-medical prescribing versus medical prescribing in primary care; 5. comparisons between different non-medical prescriber groups; and 6. non-medical healthcare providers with formal prescribing training versus those without formal prescribing training. We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed studies for inclusion, extracted data, and assessed study quality with discrepancies resolved by discussion. Two review authors independently assessed risk of bias for the included studies according to EPOC criteria. We undertook meta-analyses using the fixed-effect model where studies were examining the same treatment effect and to account for small sample sizes. We compared

  1. Improving medication adherence of patients with chronic heart failure: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Shah D

    2015-07-01

    Full Text Available Deval Shah,1 Kim Simms,2 Debra J Barksdale,3 Jia-Rong Wu3 1Internal Medicine, Wake Forest Baptist Hospital, Winston-Salem, 2Duke University Hospital, Durham, 3School of Nursing, University of North Carolina, Chapel Hill, NC, USA Abstract: Heart failure is a chronic debilitating illness that affects 5.7 million Americans. The financial burden of heart failure in the US toppled $31 billion in 2012, which is one of the highest among all chronic medical conditions. Medication adherence is a major component of heart failure self-care behaviors. Therefore, medication non-adherence is associated with more emergency department visits, frequent rehospitalizations, and higher medical cost. Medication adherence rates have varied from 10% to 98% depending on the definition and measurement used to assess and analyze adherence. Many factors contribute to medication non-adherence such as lack of support, finances, absent of symptoms, cognitive decline, adverse reactions, depression, poor attention span, poor knowledge about medication, multiple medications, difficulty swallowing large pills, and inconveniences of urinary frequency with diuretics. Researchers have explored various strategies such as the use of pharmacists, nurses, telemedicine, and interdisciplinary teams to provide interventions to improve medication adherence in heart failure. Health care providers should continue to provide education, constantly reinforce the importance of taking medication as prescribed, and when feasible, utilize one of the successful evidence-based strategies to increase adherence. Keywords: pharmacy, tele-health, interdisciplinary, registered nurse, interventions

  2. Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse.

    Science.gov (United States)

    Gómez-Beldarrain, Marian; Carrasco, María; Bilbao, Amaia; García-Moncó, Juan C

    2011-08-01

    Chronic migraine patients are at risk of developing a medication overuse. Brain functional studies in these patients have demonstrated an orbitofrontal hypometabolism, persistent after overuse cessation. Orbitofrontal dysfunction is also present in addiction and thus could predispose migraineurs to medication overuse. The aim of this study was to investigate if orbitofrontal dysfunction can be demonstrated in patients with chronic migraine and medication overuse by performing a systematic neuropsychological evaluation focused on tests that assess frontal lobe function. Second, to establish whether it is related to the outcome of these patients. We prospectively studied 42 chronic migraine patients with medication overuse, 42 episodic migraineurs and 41 controls on a battery of neuropsychological tasks evaluating the orbitofrontal and dorsolateral functioning. Depression, anxiety, and personality traits were also assessed. Chronic migraineurs with medication overuse showed a significant impairment in orbitofrontal task performance and higher depression scores as compared to episodic migraineurs and controls. Dorsolateral dysfunction was present in both groups of migraneurs, who also had higher rates of anxiety as compared to controls. After 1 year of follow-up, migraine patient's outcome was classified according to their medication overuse status. A negative outcome that included persistent or new-onset medication overuse was present in 34% of migraineurs and was associated with baseline poor orbitofrontal task performance, and with mild dorsolateral dysfunction, higher rates of depression, anxiety and neuroticism-anxiety traits. Formal education and years with migraine did not influence outcome. Orbitofrontal dysfunction is present in patients with chronic migraine and medication overuse, and associates with a poor outcome at 1 year of follow-up. Neuropsychological evaluation in migraine may help to detect patients prone to overuse so that appropriate therapeutic

  3. Impact of medication adherence on absenteeism and short-term disability for five chronic diseases.

    Science.gov (United States)

    Carls, Ginger S; Roebuck, M Christopher; Brennan, Troyen A; Slezak, Julie A; Matlin, Olga S; Gibson, Teresa B

    2012-07-01

    To estimate the impact of medication adherence on absenteeism and short-term disability among employees with chronic disease. Cross-sectional analysis of administrative health care claims, absenteeism, and short-term disability data using multivariate regression and instrumental variable models for five cohorts of employees: diabetes, hypertension, congestive heart failure, dyslipidemia, and asthma/chronic obstructive pulmonary disease. Adherence was defined as possessing medication on at least 80% of days during follow-up. Adherent employees with diabetes, hypertension, dyslipidemia, and asthma/chronic obstructive pulmonary disease realized between 1.7 and 7.1 fewer days absent from work and between 1.1 and 5.0 fewer days on short-term disability. Absenteeism and short-term disability days by adherent employees with congestive heart failure were not significantly different from nonadherent employees with the condition in most specifications. Appropriate management of chronic conditions can help employers minimize losses due to missed work.

  4. Examining influential factors in providers’ chronic pain treatment decisions: a comparison of physicians and medical students

    OpenAIRE

    2015-01-01

    Background Chronic pain treatment guidelines are unclear and conflicting, which contributes to inconsistent pain care. In order to improve pain care, it is important to understand the various factors that providers rely on to make treatment decisions. The purpose of this study was to examine factors that reportedly influence providers’ chronic pain treatment decisions. A secondary aim was to examine differences across participant training level. Methods Eighty-five participants (35 medical st...

  5. Efficacy of group cognitive-behavioral treatment on rehabilitation of chronic schizophrenics in community%团体认知行为治疗对社区精神分裂症患者康复疗效的评估

    Institute of Scientific and Technical Information of China (English)

    吴迎春; 李俊英; 赵业华; 杨雅芬; 张铁; 谢春梅; 卢绍龙; 高婷婷

    2013-01-01

    Objective:To investigate the efficacy of group cognitive -behavioral therapy on rehabilitation of schizophrenia in communi-ty.Methods:60 schizophrenic patients in community rehabilitation were divided into two groups .the treatment group received group cogni-tive-behavioral therapy combined with drug treatment , the control group , only to the general community and disease follow -up guid-ance, using the Positive and Negative Syndrome Scale ( PANSS) , Morning -side rehabilitation status Scale ( MRSS) social Disability screening Schedule (SDSS) insight questionnaire (SAI) were used to assess the two group at pre -therapy ,12 weeks after ,and 38 weeks after intervention .Results:After treatment, the study group PANSS total score , MRSS and SDSS score decreased , lower than the control group ,and SIA scores statistically higher in intervention group than in control group (P <0.05, there are significant differences). Conclusion:the Group cognitive behavioral therapy could enhance the level of rehabilitation in schizophrenia in community .%目的:探讨团体认知行为治疗对社区精神分裂症患者的康复疗效。方法:将60例社区康复的精神分裂症患者分成2组,治疗组予以团体认知行为治疗联合药物治疗,对照组仅予一般的社区随访和疾病指导,采用阳性与阴性症状综合征量表(PANSS),Morning-side康复状态量表(MRSS),社会功能缺陷筛选量表(SDSS)及自知力问卷(SAI),分别于治疗前,12周,38周末进行评定。结果:治疗后2组比较,研究组的PANSS总分,MRSS总分及SDSS总分值均下降,低于对照组, SAI总分值高于对照组(P<0.05,有统计学差异)。结论:团体认知行为治疗对社区精神分裂症患者康复有促进作用。

  6. Quality of life in schizophrenic patients.

    Science.gov (United States)

    Bobes, Julio; Garcia-Portilla, Maria Paz; Bascaran, Maria Teresa; Saiz, Pilar Alejandra; Bousoño, Manuel

    2007-01-01

    In the last decades, there has been increased interest in the field of quality of life in mental disorders in general, and particularly in schizophrenia. In addition, the appearance of the atypical antipsychotic drugs (amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone) with different therapeutic and side-effect profiles, has promoted a greater interest in assessing the quality of life of schizophrenic patients. In this paper we will briefly summarize the difficulties in assessing quality of life in schizophrenic patients, as well as the results concerning their quality of life and the influence of psychopathology, especially negative and depressive symptoms, on it. We will also review data from recent clinical trials showing the impact ofantipsychotic treatments and their side effects upon quality of life.

  7. Chronic disorders of consciousness following coma: Part one: medical issues.

    Science.gov (United States)

    Luce, John M

    2013-10-01

    Increasing numbers of patients survive traumatic brain injury (TBI) and cardiopulmonary arrest and resuscitation and are admitted to the ICU in coma. Some of these patients become brain dead; others regain consciousness. Still others become vegetative or minimally conscious, conditions called chronic disorders of consciousness and ultimately are cared for outside the ICU. Comatose patients lack the wakefulness and awareness that distinguish consciousness from unconsciousness. Vegetative patients are awake in that they manifest sleep-wake cycles, but they are unaware of their environment and cannot respond to stimuli. Minimally conscious patients are awake, aware to a limited extent, and somewhat responsive. The diagnosis of the vegetative and minimally conscious states has been based largely on their behavioral and pathologic features, and it has been believed that vegetative patients remain in that condition permanently. Nevertheless, EEG and neuroimaging studies suggest that the traditional diagnostic approach is imprecise. Moreover, clinical investigations have revealed that some vegetative patients can become minimally conscious and that some minimally conscious patients can gain increased awareness. Few therapies for patients with chronic disorders of consciousness have been subjected to randomized trials. Furthermore, although a small number of patients have improved neurologically with or without treatment, their overall prognosis for neurologic recovery remains poor.

  8. Prevalence of chronic headache with and without medication overuse

    DEFF Research Database (Denmark)

    Westergaard, Maria Lurenda; Glümer, Charlotte; Hansen, Ebba Holme;

    2014-01-01

    with these headaches. This cross-sectional study examined the prevalence of CH in Denmark; possible associations between CH and education, work status, and income; and the health status of people with CH across socioeconomic strata. A total of 129,150 individuals aged ⩾16years were invited to the 2010 Danish National...... medication overuse (⩾20 or ⩾30 defined daily doses per month depending on the drug or drugs) were classified as having MOH. Associations between headache and SEP were analyzed by logistic regression, and associations between headache and health status scores, by linear regression. Physical and mental health...... composite scores (SF-12) were summarized per headache group, stratified by SEP, and compared to the sample mean. Analyses were adjusted for stratified sampling and nonresponse. The response rate was 53.1%. CH prevalence was 3.3% with 53.0% of cases having concurrent medication overuse (MOH prevalence 1...

  9. Liposuction for chronic medical diseases and noncosmetic conditions: review of the literature

    Directory of Open Access Journals (Sweden)

    Hamdy Abuelhassan El-Khatib

    2015-03-01

    Full Text Available The purpose of this systematic literature review was to evaluate the safety of liposuction techniques and to identify the cosmetic and noncosmetic application of liposuction. Liposuction can be used to improve the quality-of-life in patients with disabling medical conditions in addition to its use for cosmetic rejuvenation. An online search of the Cochrane Library, MEDLINE, Embase, and SciELO were conducted. Forty-seven original articles reported from 1982 to February 2014 were included in this review. The articles reported on the use as well as the limitations of liposuction for treatment of noncosmetic and disabling medical conditions. The criteria used for selection of articles were: large sample size and originality. The case reports were excluded. There was a broad agreement about the applicability and the efficacy of the liposuction for treatment of these chronic medical conditions, such as multiple systemic lipomatosis, dercum's disease, chronic lymphedema, and axillary hyperhidrosis. Literatures review confirmed that Liposuction technique has provided significant and stable cure for these chronic medical conditions. Liposuction is the most frequent esthetic procedure for adipose tissue reduction and treatment of lipedema worldwide. Apart from esthetic indications, liposuction can also be used to treat chronic medical diseases and noncosmetic conditions.

  10. Nightmare in schizophrenic and depressed patients

    Directory of Open Access Journals (Sweden)

    Celestine Okorome Mume

    2009-09-01

    Full Text Available Background and Objectives: Nightmare is a common sleep disorder. While a sleep disorder such as insomnia can readily be associated with psychiatric disorders, the same cannot be said of nightmare. The objective of this study was to determine the prevalence rate of nightmare in a sample of psychiatric patients, and to compare this rate with the rate obtained in age- and sex- matched healthy control subjects in order to determine if there is a significant difference in the rates of nightmare in the different groups. Methods: Ninety - four randomly selected psychiatric patients made up of 54 schizophrenic patients and 40 depressed patients were recruited into the study. One hundred and twenty - three age- and sex- matched randomly selected control subjects were also recruited into the study. A questionnaire determining the one year prevalence of nightmare was administered to all the subjects. Each of them was required to indicate whether he or she had experienced nightmare in the previous one year and if so to indicate the number of episodes experienced during the said period. Results: The results showed prevalent rates of nightmare of 4.9%, 16.7% and 17.5% respectively for the healthy control subjects, schizophrenic patients and depressed patients. There was an overall prevalence rate of 17% among the psychiatric patients (schizophrenic patients and depressed patients as against 4.9% in the healthy control subjects. Among those who experienced nightmare, the mean values for the number of episodes within the previous one year were, respectively 18 (sd = 6.6 for healthy control subjects (n = 6, 42.7 (sd = 6.3 for schizophrenic patients (n = 9 and 44.6 (sd = 5.9 for depressed patients (n = 7. Conclusions: The findings in this study provide support for a significant association between nightmare and schizophrenia as well as nightmare and depressive illness. In effect, there is a significant association between nightmare and psychopathology.

  11. The oxidative stress may be induced by the elevated homocysteine in schizophrenic patients.

    Science.gov (United States)

    Dietrich-Muszalska, Anna; Malinowska, Joanna; Olas, Beata; Głowacki, Rafal; Bald, Edward; Wachowicz, Barbara; Rabe-Jabłońska, Jolanta

    2012-05-01

    The mechanisms of oxidative stress in schizophrenic patients are not fully understood. In the present study, we investigated the effect of elevated level of homocysteine (Hcys) on some parameters of oxidative stress, namely thiobarbituric acid reactive substances (TBARS), an index of lipid peroxidation in plasma, the level of carbonyl groups in plasma proteins, as well as the amount of 3-nitrotyrosine in plasma proteins isolated from schizophrenic patients. Patients hospitalised in I and II Psychiatric Department of Medical University in Lodz, Poland were interviewed with special questionnaire (treatment, course of diseases, dyskinesis and other EPS). According to DSM-IV criteria all patients had diagnosis of paranoid type. They were treated with antipsychotic drugs (clozapine, risperidone, olanzapine). Mean time of schizophrenia duration was about 5 years. High-performance liquid chromatography was used to analyse the total level of homocysteine in plasma. Levels of carbonyl groups and 3-nitrotyrosine residues in plasma proteins were measured by ELISA and a competition ELISA, respectively. The lipid peroxidation in plasma was measured by the level of TBARS. Our results showed that in schizophrenic patients the amount of homocysteine in plasma was higher in comparison with the control group. We also observed a statistically increased level of biomarkers of oxidative/nitrative stress such as carbonyl groups or 3-nitrotyrosine in plasma proteins from schizophrenic patients. Moreover, our experiments indicate that the correlation between the increased amount of homocysteine and the oxidative stress exists. Considering the data presented in this study, we suggest that the elevated Hcys in schizophrenic patients may stimulate the oxidative stress.

  12. Reading in schizophrenic subjects and their nonsymptomatic first-degree relatives.

    Science.gov (United States)

    Roberts, Eryl O; Proudlock, Frank A; Martin, Kate; Reveley, Michael A; Al-Uzri, Mohammed; Gottlob, Irene

    2013-07-01

    Previous studies have demonstrated eye movement abnormalities during smooth pursuit and antisaccadic tasks in schizophrenia. However, eye movements have not been investigated during reading. The purpose of this study was to determine whether schizophrenic subjects and their nonsymptomatic first-degree relatives show eye movement abnormalities during reading. Reading rate, number of saccades per line, amplitudes of saccades, percentage regressions (reverse saccades), and fixation durations were measured using an eye tracker (EyeLink, SensoMotoric Instruments, Germany) in 38 schizophrenic volunteers, 14 nonaffected first-degree relatives, and 57 control volunteers matched for age and National Adult Reading Test scores. Parameters were examined when volunteers read full pages of text and text was limited to progressively smaller viewing areas around the point of fixation using a gaze-contingent window. Schizophrenic volunteers showed significantly slower reading rates (P = .004), increase in total number of saccades (P ≤ .001), and a decrease in saccadic amplitude (P = .025) while reading. Relatives showed a significant increase in total number of saccades (P = .013) and decrease in saccadic amplitude (P = .020). Limitation of parafoveal information by reducing the amount of visible characters did not change the reading rate of schizophrenics but controls showed a significant decrease in reading rate with reduced parafoveal information (P < .001). Eye movement abnormalities during reading of schizophrenic volunteers and their first-degree relatives suggest that visual integration of foveal and parafoveal information may be reduced in schizophrenia. Reading abnormalities in relatives suggest a genetic influence in reading ability in schizophrenia and rule out confounding effects of medication.

  13. Association between adherence to medications for COPD and medications for other chronic conditions in COPD patients

    Science.gov (United States)

    Dhamane, Amol D; Schwab, Phil; Hopson, Sari; Moretz, Chad; Annavarapu, Srinivas; Burslem, Kate; Renda, Andrew; Kaila, Shuchita

    2017-01-01

    Background Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD) medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications), may have an adverse impact on adherence to mCOPD medications. Objective The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients. Methods COPD patients were identified using a large administrative claims database. Selected patients were 40–89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date) during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC]) was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC <0.8) to mCOPD and non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics. Results A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38–1.78, all P<0.01). Conclusion Adherence to mCOPD medications is low. Non-adherence (or adherence) to mCOPD medications is positively related to non-adherence (or adherence) to non-COPD medications, implying that the need to take medications prescribed for comorbid conditions does not adversely impact adherence to m

  14. Association between adherence to medications for COPD and medications for other chronic conditions in COPD patients.

    Science.gov (United States)

    Dhamane, Amol D; Schwab, Phil; Hopson, Sari; Moretz, Chad; Annavarapu, Srinivas; Burslem, Kate; Renda, Andrew; Kaila, Shuchita

    2017-01-01

    Patients with COPD often have multiple comorbidities requiring use of multiple medications, and adherence rates for maintenance COPD (mCOPD) medications are already known to be suboptimal. Presence of comorbidities in COPD patients, and use of medications used to treat those comorbidities (non-COPD medications), may have an adverse impact on adherence to mCOPD medications. The objective of the study was to evaluate the association between non-adherence to mCOPD medications and non-COPD medications in COPD patients. COPD patients were identified using a large administrative claims database. Selected patients were 40-89 years old and continuously enrolled for 12 months prior to and 24 months after the first identified COPD diagnosis (index date) during January 1, 2009 to December 31, 2010. Patients were required to have ≥1 prescription for a mCOPD medication within 365 days of the index date and ≥1 prescription for one of 12 non-COPD medication classes within ±30 days of the first COPD prescription. Adherence (proportion of days covered [PDC]) was measured during 365 days following the first COPD prescription. The association between non-adherence (PDC non-adherence to non-COPD medications was determined using logistic regression, controlling for baseline patient characteristics. A total of 14,117 patients, with a mean age of 69.9 years, met study criteria. Of these, 40.9% were males and 79.2% were non-adherent to mCOPD medications with a mean PDC of 0.47. Non-adherence to mCOPD medications was associated with non-adherence to 10 of 12 non-COPD medication classes (odds ratio 1.38-1.78, all PAdherence to mCOPD medications is low. Non-adherence (or adherence) to mCOPD medications is positively related to non-adherence (or adherence) to non-COPD medications, implying that the need to take medications prescribed for comorbid conditions does not adversely impact adherence to mCOPD medications.

  15. Quality of Life in Schizophrenic Patients

    Directory of Open Access Journals (Sweden)

    Naema Khodadadi

    2012-03-01

    Full Text Available Background: Nowadays, quality of life (QoL is an important indicator of treatment outcome and it's evaluation in schizophrenic patients will be vital. So, this study is conducted to compare QoL in schizophrenic patients and healthy people in Rasht, Guilan.Materials and Method: This study is a cross-sectional descriptive survey that was done on 52 patients with schizophrenia referred to Shafa hospital with convenience sampling method and 153 healthy people of Rasht by cluster method. Data collection instrument was a 3 part questionnaire consisting demographic-social questionnaire, WHO QoL questionnaire, and mental status assessment form. Data gathered by interview and analyzed with SPSS software using descriptive and inferential statistics (χ2, ANOVA, independent-t test. Results: Our finding indicated that patients and healthy individuals QoL had overall statistically significant difference (p<0.0001, and it's general (p<0.006, physical (p<0.0001, psychiatric (p<0.001, and social relationship (p<0.015. Conclusion: According result, schizophrenic clients compare with healthy people had lower QoL level that need special attention to improve treatment and their post-discharge care with focus on social relationship in this group of patients.

  16. Regional cerebral blood flow in schizophrenics

    Energy Technology Data Exchange (ETDEWEB)

    Uchino, J.; Ohta, Y.; Nakane, Y.; Mori, H.; Hirota, N.; Yonekura, M.

    1987-01-01

    The present study on schizophrenics dealt with the relationship of regional cerebral blood flow (rCBF) to age, disease duration, and treatment length with chlorpromazine hydrochloride (CPZ). Regional cerebral blood flow in 28 cerebral regions of interest was measured by iv injection of /sup 133/X in 54 schizophrenic patients and 39 healthy volunteers. Neither age nor dosage of CPZ significantly influenced rCBF. All patients, including 11 treated for a short period of time (6 months or less), were characterized by having a decreased rCBF over the whole cerebrum. Thirty-four patients treated for a long period of time (2 years or more) had a varied rCBF distribution in the left hemisphere, with the most predominant feature being the decrease in rCBF in the frontal lobe (i.e., hypofrontality); however, there was no linear correlation between rCBF and disease duration. A decreased rCBE in the right occipital region was seen in patients with paranoid schizophrenia, suggesting that manifestations of symptoms may depend on disturbed regions. These results suggest that cerebral dysfunction in schizophrenic patients may not be restricted to the frontal lobe, but cover the whole cerebrum, and that nonuniform dysfunction in various regions of the cerebrum, including the frontal lobe, may be involved in manifestations of symptoms.

  17. Nicotine reduces antisaccade errors in task impaired schizophrenic subjects.

    Science.gov (United States)

    Larrison-Faucher, Abigail L; Matorin, Anu A; Sereno, Anne B

    2004-05-01

    Nicotine and/or smoking have been shown to reduce various cognitive deficits associated with schizophrenia. Here, we examine the effects of nicotine gum on repeated performance on a simple eye movement task. Eight schizophrenic subjects and eight controls participated in three days of testing on saccade (S) and antisaccade (AS) tasks. On each testing day, subjects participated in four testing sessions and received both of two nicotine gum treatments (4 and 6 mg) and both of two control conditions (placebo gum and no gum), each followed by a recovery period. Overall, schizophrenics showed significant impairments on the AS task. However, upon individual examination only four schizophrenics showed significant differences in AS errors or reaction times (RTs) when compared to controls. The other four schizophrenic subjects showed control level performance. All schizophrenic subjects showed normal and better than control level performance on the simple S task. Furthermore, no effects of nicotine were seen on the simple S task. There were significant treatment effects on the AS task. Nicotine treatment significantly decreased errors in the task impaired schizophrenic group and this effect was most pronounced at the 6 mg level. No nicotine effects were demonstrated for non-impaired schizophrenic subjects or controls. This study demonstrates a benefit of short exposure to nicotine in cognitively impaired schizophrenic subjects. These results support previous findings of cognitive benefits of nicotine in schizophrenics.

  18. Supporting Medical Research on Chronic Diseases using Integrated Health Monitoring Platform

    OpenAIRE

    Krukowski, Artur; Vogiatzaki, Emmanouela; Charalambides, Marios; Chouchoulis, Michalis

    2014-01-01

    This paper describes combined experiences in developing e-Health platforms and services with respect of supporting medical research into the causes and relationships among physiological parameters and health problems concerning different chronic diseases, from cardiovascular to stroke, epilepsy, and others. The Personal Health Records (PHR) is presented as new technological approaches aimed at standardizing electronic management of medical information between the patient and its physicians, a...

  19. Chronic medical conditions among jail detainees in residential psychiatric treatment: a latent class analysis.

    Science.gov (United States)

    Swartz, James A

    2011-08-01

    Studies of incarcerates with serious mental illnesses have found elevated rates of chronic medical conditions such as asthma and diabetes, and of infectious diseases such as tuberculosis compared with general population rates. This study explored the pattern of chronic medical conditions in a sample of adult detainees in psychiatric treatment in a large urban jail to develop a clinical profile encompassing the full range of medical conditions. A total of 431 male and female detainees were sampled with certainty from admissions to a residential psychiatric treatment program (overall recruitment rate = 67%). Interviews used the World Mental Health version of the Composite International Diagnostic Interview to assess psychiatric and substance use disorders per DSM-IV criteria and chronic medical conditions. Latent class analysis was conducted using 17 medical conditions as class indicators, yielding a 3-class model composed of: a latent class with a high to intermediate probability of multiple medical conditions (HMC; 12.5% of the sample); an intermediate class with a lower probability of having a smaller number of medical conditions (MMC; 43.2%); and a class with a low probability of any medical condition (44.3%). Those in the HMC class were more likely to report respiratory problems, severe headaches, musculoskeletal pain, hypertension, and arthritis, have greater functional impairment, and have a higher number of co-occurring psychiatric disorders. Being older (50+ years) and female were associated with higher odds of being in the HMC or MMC classes. The policy implications for providing medical care to incarcerates with complex mixtures of medical conditions and psychiatric disorders are considered.

  20. Examining influential factors in providers' chronic pain treatment decisions: a comparison of physicians and medical students.

    Science.gov (United States)

    Hollingshead, Nicole A; Meints, Samantha; Middleton, Stephanie K; Free, Charnelle A; Hirsh, Adam T

    2015-10-01

    Chronic pain treatment guidelines are unclear and conflicting, which contributes to inconsistent pain care. In order to improve pain care, it is important to understand the various factors that providers rely on to make treatment decisions. The purpose of this study was to examine factors that reportedly influence providers' chronic pain treatment decisions. A secondary aim was to examine differences across participant training level. Eighty-five participants (35 medical students, 50 physicians) made treatment decisions for 16 computer-simulated patients with chronic pain. Participants then selected from provided lists the information they used and the information they would have used (had it been available) to make their chronic pain treatment decisions for the patient vignettes. Frequency analyses indicated that most participants reported using patients' pain histories (97.6 %) and pain description (95.3 %) when making treatment decisions, and they would have used information about patients' previous treatments (97.6 %) and average and current pain ratings (96.5 %) had this information been available. Compared to physicians, medical students endorsed more frequently that they would have used patients' employment and/or disability status (p medical students wanted information on patients' use of illicit drugs and alcohol to make treatment decisions; while a greater proportion of physicians reported using personal experience to inform their decisions. This study found providers use patients' information and their own experiences and intuition to make chronic pain treatment decisions. Also, participants of different training levels report using different patient and personal factors to guide their treatment decisions. These results highlight the complexity of chronic pain care and suggest a need for more chronic pain education aimed at medical students and practicing providers.

  1. Differential modulation of gene expression in the NMDA postsynaptic density of schizophrenic and control smokers.

    Science.gov (United States)

    Mexal, S; Frank, M; Berger, R; Adams, C E; Ross, R G; Freedman, R; Leonard, S

    2005-10-03

    Nicotine is known to induce the release of multiple neurotransmitters, including glutamate and dopamine, through activation of nicotinic receptors. Gene expression in the N-methyl-d-aspartate postsynaptic density (NMDA-PSD), as well as other functional groups, was compared in postmortem hippocampus of schizophrenic and nonmentally ill smokers and nonsmokers utilizing a microarray and quantitative RT-PCR approach. The expression of 277 genes was significantly changed between all smokers and nonsmokers. Specific gene groups, most notably genes expressed in the NMDA-PSD, were prevalent among these transcripts. Analysis of the interaction between smoking and schizophrenia identified several genes in the NMDA-PSD that were differentially affected by smoking in patients. The present findings suggest that smoking may differentially modulate glutamatergic function in schizophrenic patients and control subjects. The biological mechanisms underlying chronic tobacco use are likely to differ substantially between these two groups.

  2. 多专业团队介入农疗训练对慢性精神分裂症患者康复疗效的影响%The effect of multi-professional team based agricultural skills training on rehabilitation in chronic schizophrenic patients

    Institute of Scientific and Technical Information of China (English)

    郝军锋; 王美; 刘联琦

    2014-01-01

    目的:探讨多专业团队(精神科医生、护士、心理咨询师、康复治疗师、社工)介入农疗训练对慢性精神分裂症患者康复疗效的影响。方法选取2010年8月~2013年7月期间先后在我院接受农疗训练的精神分裂症患者共80例并随机分为两组。其中对照组40例,除维持原有的药物治疗、生活护理及健康宣教外,予以农疗训练;研究组40例,除维持原有的药物治疗、生活护理及健康宣教外,予以多专业团队介入的农疗训练。用住院精神患者康复疗效量表(IPROS)对两组患者分别进行入组前及入组半年后评估。结果入组后半年,两组IPROS总分及五项因子分均有明显改善;研究组IPROS总分及五项因子分明显低于于对照组,差异有统计学意义。结论多专业团队介入农疗训练对慢性精神分裂症患者康复疗效显著,应大力推广。%Objective To explore the effect of multi-disciplinary team(including psychiatrists, nurses, psychologists, counselors, rehabilitation therapists, social workers) involved agricultural skills training on rehabilitation in chronic schizophrenic patients.Methods A total of 80 patients with chronic schizophrenic recruited in our hospital from August 2010 to July 2013 were randomly divided into two groups. Drug treatment, life care, health education and farming training had been applied for two groups. The control group received agricultural skills training. The research group also received multi-disciplinary team involved agricultural skills training. Inpatient psychiatric rehabilitation outcome scale(IPROS) had been used for two groups to evaluate the effects of rehabilitation at base line and up to 6 months. Results Up to 6 months, IPROS total score and its five factors were decreased in both two groups; IPROS total score and its five factors were significantly lower in the multi-disciplinary team involved agricultural skills training group

  3. Unintentional non-adherence to chronic prescription medications: How unintentional is it really?

    Directory of Open Access Journals (Sweden)

    Gadkari Abhijit S

    2012-06-01

    Full Text Available Abstract Background Unintentional non-adherence has been characterized as passively inconsistent medication-taking behavior (forgetfulness or carelessness. Our objectives were to: (1 study the prevalence and predictors of unintentional non-adherence; and (2 explore the interrelationship between intentional and unintentional non-adherence in relation to patients’ medication beliefs. Methods We conducted a cross-sectional survey of adults with asthma, hypertension, diabetes, hyperlipidemia, osteoporosis, or depression from the Harris Interactive Chronic Illness Panel. The analytic sample for this study included 24,017 adults who self-identified themselves as persistent to prescription medications for their index disease. They answered three questions on unintentional non-adherence (forgot, ran out, being careless, 11 questions on intentional non-adherence, and three multi-item scales assessing perceived need for medication (k = 10, perceived medication concerns (k = 6, and perceived medication affordability (k = 4. Logistic regression was used to model predictors of each unintentional non-adherence behavior. Baron and Kenny’s regression approach was used to test the mediational effect of unintentional non-adherence on the relationship between medication beliefs and intentional non-adherence. Bootstrapping was employed to confirm the statistical significance of these results. Results For the index disease, 62% forgot to take a medication, 37% had run out of the medication, and 23% were careless about taking the medication. Common multivariate predictors (p  Conclusions For our study sample, unintentional non-adherence does not appear to be random and is predicted by medication beliefs, chronic disease, and sociodemographics. The data suggests that the importance of unintentional non-adherence may lie in its potential prognostic significance for future intentional non-adherence. Health care providers may consider routinely

  4. Management of violent behaviour in acutely relapsed schizophrenics

    Directory of Open Access Journals (Sweden)

    L. Koen

    2004-09-01

    Full Text Available The management of aggressive behaviour has always been a criticai issue in psychiatry. Finding measures that can be used to accurately predict the likelihood of assaultative behaviour and thus ensure timeous appropriate pharmacological management remains a dilemma. The study objective was to investigate the naturalistic, pharmacological management of inpatient aggressive behaviour in a group of 50 schizophrenic subjects with a view to determine: (1 whether a presenting history of recent violence lead to altered pharmacological management and (2 whether the NOSIE could be regarded as a useful assessment tool with regards to inpatient behaviour management. No significant difference could be demonstrated between the 2 subsets of subjects (history of violence vs none with respect to total doses of medication administered. No statistical correlation could be found between the total NOSIE score and the dose of psychotropic medication used. The relationship between a subset of NOSIE-items and the total dose of medication was more complex and a clear linear relationship could be demonstrated for a total score of 0 to 5. In this particular ward setting a presenting history of recent violent behaviour did not influence the administration of medication and neither could the clinical judgement employed by the nursing staff to manage inpatient behaviour be captured by the NOSIE. However, a five-item subset of the NOSIE with questions relating to aggression and irritability warrants further scrutiny in this regard.

  5. Mediators for internalizing problems in adolescents of parents with chronic medical condition

    NARCIS (Netherlands)

    Sieh, D.S.; Oort, F.J.; Visser-Meily, J.M.A.; Meijer, A.M.

    2014-01-01

    Parents’ chronic medical condition (CMC) is related to internalizing problem behavior in adolescents. Following the transactional stress and coping (TSC) model of Hocking and Lochman, our study examines whether the effect of illness and demographic parameters on the child’s internalizing problems is

  6. Mediators for internalizing problems in adolescents of parents with chronic medical condition

    NARCIS (Netherlands)

    D.S. Sieh; F.J. Oort; J.M.A. Visser-Meily; A.M. Meijer

    2014-01-01

    Parents’ chronic medical condition (CMC) is related to internalizing problem behavior in adolescents. Following the transactional stress and coping (TSC) model of Hocking and Lochman, our study examines whether the effect of illness and demographic parameters on the child’s internalizing problems is

  7. Integrating the Chronic Care Model into a Novel Medical Student Course

    Science.gov (United States)

    Block, Robert C.; Tran, Bill; McIntosh, Scott

    2011-01-01

    Objective: To determine whether integration of the Chronic Care Model into undergraduate medical education is associated with anticipated use of the Model and whether student perceptions match actual integration of the Model into their community projects. Design: This was a cross-sectional study using qualitative and quantitative data. Setting: A…

  8. Medication overuse as a cause of chronic headache in shunted hydrocephalus patients

    DEFF Research Database (Denmark)

    Willer, Lasse; Jensen, R H; Juhler, M

    2010-01-01

    To highlight the group of hydrocephalus patients known to have a long history of shunt revisions and refractory chronic headache. When a shunt in perfect working order has no effect on headache, other causes of headache should be investigated. In this paper, patients with medication overuse...

  9. Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

    DEFF Research Database (Denmark)

    Ingebrigtsen, Truls S; Marott, Jacob L; Nordestgaard, Børge G;

    2015-01-01

    OBJECTIVE: We tested the hypothesis that use of and adherence to maintenance medication is low among individuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD. DESIGN AND PARTICIPANTS: We identified 5,812 individuals...

  10. Medication overuse as a cause of chronic headache in shunted hydrocephalus patients

    DEFF Research Database (Denmark)

    Willer, Lasse; Jensen, R H; Juhler, M

    2010-01-01

    To highlight the group of hydrocephalus patients known to have a long history of shunt revisions and refractory chronic headache. When a shunt in perfect working order has no effect on headache, other causes of headache should be investigated. In this paper, patients with medication overuse...

  11. Perception and attitudes of medical students toward communication, chronic disease and death

    Directory of Open Access Journals (Sweden)

    Baliram V. Ghodke

    2014-10-01

    Conclusion: Perception of students regarding caring of chronically ill-patients and death related issues needs improvement. We believe that integrating different teaching strategies and training programs regarding this issue should begin at early stages of undergraduate medical curriculum. [Int J Basic Clin Pharmacol 2014; 3(5.000: 854-859

  12. The Effects of Chronic Partial Sleep Deprivation on Cognitive Functions of Medical Residents

    Directory of Open Access Journals (Sweden)

    Sara Samadzadeh

    2010-06-01

    Full Text Available "n  "n Objective:Because of on-call responsibilities, many medical residents are subjected to chronic partial sleep deprivation, a form of sleep restriction whereby individuals have chronic patterns of insufficient sleep. It is unclear whether deterioration in cognitive processing skills due to chronic partial sleep deprivation among medical residents would influence educational exposure or patient safety. Method: Twenty-six medical residents were recruited to participate in the study. Participants wore an Actigraph over a period of 5 consecutive days and nights so their sleep pattern could be recorded. Thirteen participants worked on services that forced chronic partial sleep deprivation (<6 hours of sleep per 24h for 5 consecutive days and nights. The other thirteen residents worked on services that permitted regular and adequate sleep patterns. Following the 5-day sleep monitoring period, the participants completed the three following cognitive tasks: (a the Wisconsin Card Sorting Test (WCST to assess abstract reasoning and prefrontal cortex performance; (b the Time Perception Task (TPT to assess time estimation and time reproduction skills; and (c the Iowa Gambling Task (IGT to assess decision-making ability. "nResults: The results of independent samples t-tests found no significant differences between the group who was chronically sleep deprived and the group who rested adequately (all ps > .05. "nConclusion: These results may have emerged for several possible reasons: (a chronic partial sleep deprivation may have a lesser impact on prefrontal cortex function than on other cognitive functions; (b fairly modest chronic sleep restriction may be less harmful than acute and more significant sleep restriction; or (c our research may have suffered from poor statistical power. Future research is recommended.

  13. Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/chronic pelvic pain syndrome: Initial results.

    Science.gov (United States)

    Chopra, Sameer; Satkunasivam, Raj; Aron, Monish

    2016-01-01

    Four patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), met criteria for National Institute of Health (NIH) Category III prostatitis, failed multiple medicinal treatments and underwent robotic radical prostatectomy (RRP). Median operative time (range): 157 (127-259) min. Validated functional questionnaires responses and NIH CP symptom index (NIH-CPSI) score were collected for each patient's status at different time points pre- and post-operatively. Median decreases (range) were: International Prostate Symptom Score - 14 (1-19); Sexual Health Inventory for Men - 6 (-14-22); and NIH-CPSI total - 23.5 (13-33). Median length of follow-up (range) was 34 (24-43) months. RRP appears to be an option for carefully selected patients with medication-refractory CP/CPPS who understand that baseline sexual function may not be restored postoperatively.

  14. Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/chronic pelvic pain syndrome: Initial results

    Directory of Open Access Journals (Sweden)

    Sameer Chopra

    2016-01-01

    Full Text Available Four patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS, met criteria for National Institute of Health (NIH Category III prostatitis, failed multiple medicinal treatments and underwent robotic radical prostatectomy (RRP. Median operative time (range: 157 (127–259 min. Validated functional questionnaires responses and NIH CP symptom index (NIH-CPSI score were collected for each patient's status at different time points pre- and post-operatively. Median decreases (range were: International Prostate Symptom Score - 14 (1–19; Sexual Health Inventory for Men - 6 (−14–22; and NIH-CPSI total - 23.5 (13–33. Median length of follow-up (range was 34 (24–43 months. RRP appears to be an option for carefully selected patients with medication-refractory CP/CPPS who understand that baseline sexual function may not be restored postoperatively.

  15. Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia

    Directory of Open Access Journals (Sweden)

    Rowa Al-Ramahi

    2012-01-01

    Full Text Available To determine the medication prescribing patterns in hospitalized patients with chronic kidney disease (CKD in a Malaysian hospital, we prospectively studied a cohort of 600 patients in two phases with 300 patients in each phase. The first phase was carried out from the beginning of February to the end of May 2007, and the second phase was from the beginning of March to the end of June 2008. Patients with CKD who had an estimated creatinine clearance ≤ 50 mL/min and were older than 18 years were included. A data collection form was used to collect data from the patients′ medical records and chart review. All systemic medications prescribed during hospitalization were included. The patients were prescribed 5795 medications. During the first phase, the patients were prescribed 2814 medication orders of 176 different medications. The prescriptions were 2981 of 158 medications during the second phase. The mean number of medications in the first and second phases was 9.38 ± 3.63 and 9.94 ± 3.78 res-pectively (P-value = 0.066. The top five used medications were calcium carbonate, folic acid/vitamin B complex, metoprolol, lovastatin, and ferrous sulfate. The most commonly used medication classes were mineral supplements, vitamins, antianemic preparations, antibacterials, and beta-blocking agents. This study provides an overview of prescription practice in a cohort of hospitalized CKD patients and indicates possible areas of improvement in prescription practice.

  16. Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia.

    Science.gov (United States)

    Al-Ramahi, Rowa

    2012-03-01

    To determine the medication prescribing patterns in hospitalized patients with chronic kidney disease (CKD) in a Malaysian hospital, we prospectively studied a cohort of 600 patients in two phases with 300 patients in each phase. The first phase was carried out from the beginning of February to the end of May 2007, and the second phase was from the beginning of March to the end of June 2008. Patients with CKD who had an estimated creatinine clearance ≤ 50 mL/min and were older than 18 years were included. A data collection form was used to collect data from the patients' medical records and chart review. All systemic medications prescribed during hospitalization were included. The patients were prescribed 5795 medications. During the first phase, the patients were prescribed 2814 medication orders of 176 different medications. The prescriptions were 2981 of 158 medications during the second phase. The mean number of medications in the first and second phases was 9.38 ± 3.63 and 9.94 ± 3.78 respectively (P-value = 0.066). The top five used medications were calcium carbonate, folic acid/vitamin B complex, metoprolol, lovastatin, and ferrous sulfate. The most commonly used medication classes were mineral supplements, vitamins, antianemic preparations, antibacterials, and beta-blocking agents. This study provides an overview of prescription practice in a cohort of hospitalized CKD patients and indicates possible areas of improvement in prescription practice.

  17. What Features of Smartphone Medication Applications Are Patients with Chronic Diseases and Caregivers Looking for?

    Science.gov (United States)

    Liu, Yisi; Wang, Liuyu; Chang, Polun; Lamb, Karen V; Cui, Yanyan; Wu, Ying

    2016-01-01

    We explored the desired features of medication applications for patients with chronic disease and their caregivers with a questionnaire survey, 50 from patients and 50 from their caregivers. Although the majority of people (75%) are willing to use medication apps, the actual usage rate is quite low (11%). Worrying about privacy of personal information seems to be the main reason of not using applications. The overall score desired for use was 3.29 ± 1.02 (out of 5). Searching medications and diseases and assistance with making doctors' appointments are the most wanted categories. Online shopping for drugs and delivery were the least desired items. The main concerns for people who do not want certain features include: they are not useful, worrying about buying counterfeit drugs and reliability of content. Compared with patients, caregivers seems to be more concerned on nutrition tips for chronic illness, fall detection, and privacy protection (P < 0.05 for all).

  18. Pathways to schizophrenic psychosis: a LISREL-tested model of the unfolding of the schizophrenic prodrome

    NARCIS (Netherlands)

    Kampen, van D.

    2005-01-01

    In this article a literature-based model (the Schizotypic Syndrome Questionnaire [SSQ] model) is presented that gives a description of the temporal unfolding of the schizophrenic prodrome. As a guiding principle for the selection of the symptoms in the model, the hypothesis was held that the main pr

  19. Schizophrenic neologism versus aphasic neologism: characteristics in writings of Japanese schizophrenic patients.

    Science.gov (United States)

    Moriyama, N; Nakao, H

    1989-06-01

    Three cases of schizophrenia with ideographic neologisms in Japanese are presented and compared with aphasic neologisms reported in Japanese literature. Schizophrenic neologisms are different from aphasic neologisms in nature. The contrast becomes obvious when both are compared in Japanese writing based on the dual writing system of kanji (Chinese characters, ideogram) and kana (phonetic characters, syllabogram).

  20. Developing a generic, individualised adherence programme for chronic medication users

    Directory of Open Access Journals (Sweden)

    Herborg H

    2008-09-01

    Full Text Available Objective: The scope of this article is to describe the background for and content of an adherence counselling programme with a specific focus on an individualised, multi-dimensional adherence model for patients with a potential adherence problem (a so-called ‘individualised systems model’.Methods: An intervention programme based on WHO’s systems model for adherence was developed for implementation in primary health care and tested in a development project in Danish pharmacies in 2004-2005 in three pharmacies and 4 GP practices by 27 patients. Data were collected from the participants by registration forms, questionnaires, and focus groups. Since the programme was to support patients in the self-management process regarding choice and implementation of medication treatment, various strategies were used and different theoretical assumptions and choices made prior to setting up the study. These strategies include distinguishing between different types of non-adherence, a model for stages of change, self-efficacy, narratives, motivating interviewing strategies and coaching techniques. These strategic and theoretical choices are described in the article. Results: The strategies and theoretical reflections formed the platform for the creation of a counselling programme, which was tested in two forms, a basic and an extended version - provided by either a pharmaconomist or a pharmacist. The result section also describes a toolbox of instruments to enable pharmacy staff and GPs to tailor a counselling programme for patients individually called ‘Safe and effective use of medicines’. Besides, the results include a description of how the WHO-model is transformed into an individualised counselling model.

  1. Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions.

    Science.gov (United States)

    Fattori, A; Neri, L; Aguglia, E; Bellomo, A; Bisogno, A; Camerino, D; Carpiniello, B; Cassin, A; Costa, G; De Fazio, P; Di Sciascio, G; Favaretto, G; Fraticelli, C; Giannelli, R; Leone, S; Maniscalco, T; Marchesi, C; Mauri, M; Mencacci, C; Polselli, G; Quartesan, R; Risso, F; Sciaretta, A; Vaggi, M; Vender, S; Viora, U

    2015-01-01

    Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Participants (N = 1717) with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182-5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Our findings demonstrate that the burden on workers' quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions.

  2. Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions

    Science.gov (United States)

    Fattori, A.; Neri, L.; Aguglia, E.; Bellomo, A.; Bisogno, A.; Camerino, D.; Carpiniello, B.; Cassin, A.; Costa, G.; De Fazio, P.; Di Sciascio, G.; Favaretto, G.; Fraticelli, C.; Giannelli, R.; Leone, S.; Maniscalco, T.; Marchesi, C.; Mauri, M.; Mencacci, C.; Polselli, G.; Quartesan, R.; Risso, F.; Sciaretta, A.; Vaggi, M.; Vender, S.; Viora, U.

    2015-01-01

    Background. Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods. Participants (N = 1717) with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p < 0.01; SF-12 MCS: 59.4% versus 74.3%, p < 0.01). The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions. Our findings demonstrate that the burden on workers' quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions. PMID:26557692

  3. Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions

    Directory of Open Access Journals (Sweden)

    A. Fattori

    2015-01-01

    Full Text Available Background. Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods. Participants (N=1717 with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p<0.01; SF-12 MCS: 59.4% versus 74.3%, p<0.01. The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions. Our findings demonstrate that the burden on workers’ quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions.

  4. Guideline-Recommended Medications and Physical Function in Older Adults with Multiple Chronic Conditions.

    Science.gov (United States)

    McAvay, Gail; Allore, Heather G; Cohen, Andrew B; Gnjidic, Danijela; Murphy, Terrence E; Tinetti, Mary E

    2017-09-14

    The benefit or harm of a single medication recommended for one specific condition can be difficult to determine in individuals with multiple chronic conditions and polypharmacy. There is limited information on the associations between guideline-recommended medications and physical function in older adults with multiple chronic conditions. The objective of this study was to estimate the beneficial or harmful associations between guideline-recommended medications and decline in physical function in older adults with multiple chronic conditions. Prospective observational cohort. National. Community-dwelling adults aged 65 and older from the Medicare Current Beneficiary Survey study (N = 3,273). Participants with atrial fibrillation, coronary artery disease, depression, diabetes mellitus, or heart failure were included. Self-reported decline in physical function; guideline-recommended medications; polypharmacy (taking <7 vs ≥7 concomitant medications); chronic conditions; and sociodemographic, behavioral, and health risk factors. The risk of decline in function in the overall sample was highest in participants with heart failure (35.4%, 95% confidence interval (CI) = 26.3-44.5) and lowest for those with atrial fibrillation (20.6%, 95% CI = 14.9-26.2). In the overall sample, none of the six guideline-recommended medications was associated with decline in physical function across the five study conditions, although in the group with low polypharmacy exposure, there was lower risk of decline in those with heart failure taking renin angiotensin system blockers (hazard ratio (HR) = 0.40, 95% CI = 0.16-0.99) and greater risk of decline in physical function for participants with diabetes mellitus taking statins (HR = 2.27, 95% CI = 1.39-3.69). In older adults with multiple chronic conditions, guideline-recommended medications for atrial fibrillation, coronary artery disease, depression, diabetes mellitus, and heart failure were largely not associated with self

  5. Effects of common chronic medical conditions on psychometric tests used to diagnose minimal hepatic encephalopathy

    DEFF Research Database (Denmark)

    Lauridsen, M M; Poulsen, L; Rasmussen, C K

    2016-01-01

    Many chronic medical conditions are accompanied by cognitive disturbances but these have only to a very limited extent been psychometrically quantified. An exception is liver cirrhosis where hepatic encephalopathy is an inherent risk and mild forms are diagnosed by psychometric tests. The preferred....../15, p psychometrically measurable cognitive deficits, whereas those with ESRF or DMII had not. This adds to the understanding of the clinical consequences of chronic heart- and lung disease, and implies...... that the psychometric tests should be interpreted with great caution in cirrhosis patients with heart- or lung comorbidity....

  6. [Medical care for chronic disease: reflexions on methodologic procedures of a qualitative study].

    Science.gov (United States)

    Mercado, Francisco J; Alcántara Hernández, Elizabeth; Flores, Norma Lara; Sánchez, Adelita; Tejada Tayabas, Luz María

    2002-01-01

    Chronic diseases have been the focus of qualitative researchers. However, few studies have explained in depth the methodological options choOsed in the studies and their reasons. This paper presents some reflections on the methodological strategies and procedures used in a multisite, qualitative study whose focus are the individual's perspectives on chronic conditions and medical care. Such reflections are on the study's orientation, the selection of the area, the focus groups and the social relations among participants. We conclude stating that the methodological options and the strategies used, rather than being solely a technical issue, are deeply linked to the study's object, the social relations among participants and the context of research.

  7. [The information of the schizophrenic patient: actuality].

    Science.gov (United States)

    Palazzolo, J; Brousse, G; Favre, P; Llorca, P-M

    2005-01-01

    schizophrenia can come alive talking about things in the past before they became ill. It's as if their life grinded to halt when they became sick. I'm stuck in the mid seventies, and that's the music I like. Everybody I know with schizophrenia is quite isolated socially and I don't really know why. That is especially true for the older people in my age group. Younger people seem to be doing much better. Many still live with their parents. Most older people live alone. There is also the odd person who recovers well, returns to a career, and marries someone without schizophrenia. In cases where marriage predates the onset of schizophrenia, the outcome is often divorce although women are more likely to stick with their husbands with schizophrenia than vice versa, especially if there are already children. I hope the next generation who appears to be less disabled survives better than people of my age with schizophrenia. The goal of community integration is one that requires: more effective treatments and/or more financial support and/or a compassionate non-discriminating community. The combination of early diagnosis and atypical medications will change the face of schizophrenia. I'm not expecting more financial support from the government, but many more people with schizophrenia will start working again instead. Their social networks will develop but social networks are probably the hardest hit in schizophrenia. It's better that you never lose your friends in the first place". This testimony shows how the information of the schizophrenic patient is necessary, and underlines the importance of the relationships between the patient and his family. Our article insists on this theme, rarely developed in the literature.

  8. The Social Function of Effect of Agricultural Rehabilitation Treatment in Team on Chronic Male Schizophrenics%“小组式”农疗改善男性慢性精神分裂症患者社会功能的对照研究

    Institute of Scientific and Technical Information of China (English)

    张士巧; 崔卫东; 赵幸福; 金圭星

    2015-01-01

    Objective:To investigate effect of agricultural rehabilitation treatment in team on social function of chronic male schizophrenics.Methods:83 male schizophrenics meeting with criteria of the U. S.mental disorder diagnostic and the Statistical Manual Fourth Edition diagnostic were randomly divided into two groups.The study group(45 cases) was given agricultural rehabilitation treatment in team inclu-ding 2h farming work once every 2 days,while the control group(38 cases) was administered non-agri-cultural rehabilitation treatment.Personal and Social Performance scale( PSP) and the Nurses'Observation Scale for Inpatient Evaluation ( NOSIE ) were applied to respectively evaluate the social functions and states in hospital after treatment 6 month.Results:Before treatment,the scores of PSP and NOSIE between two groups had no significant differences.After treatment,the scores of PSP,social ability,social interest, positive factor,and general score in study group were improved compared with those in control group( t=-3.14,3.67,2.74,3.46,2.52;P<0.05).There were significant differences in the scores of PSP,social ability,social interest, individual tidy, irritation, depression, positive factor, negative factor and general score of study group between before and after training(t=-25.72,-14.18,-10.12,-10.73,2.66,3.27,-17.59,2.07,-12.79;P<0.05),and no difference in the scores of irritation,psychosis and retardation. Conclusion: The agricultural rehabilitation treatment in team can improve social functions of chronic schizophrenics,which should be promoted further if possible.%目的:探讨小组式“农疗”改善慢性精神分裂症患者社会功能的疗效。方法:收集符合美国精神障碍诊断与统计手册第四版( DSM-IV)诊断标准的83例长期住院的男性慢性精神分裂症患者,随机分为两组,“小组式”农疗组为研究组共45例,非农疗组为对照组共38例。“小组式”农疗包括每2天1次进行2

  9. Rehabilitation in an individual with chronic arsenic poisoning: medical, psychological, and social implications.

    Science.gov (United States)

    McFall, T L; Richards, J S; Matthews, G

    1998-04-01

    Although arsenic poisoning was a common cause of homicide in the past, it is seldom suspected today; thus there may be serious delays in diagnosis and treatment of arsenic ingestion. Rehabilitation specialists have traditionally dealt with the debilitating consequences of the classic arsenic-induced sensorimotor peripheral neuropathy; however, a knowledge of the presentation of acute toxicity combined with the effects of chronic exposure is essential for proper treatment, particularly in the event of ongoing exposure. This case report demonstrates the wide spectrum of medical complications associated with arsenic poisoning and briefly reviews its pathophysiology and treatment from both the medical and psychosocial perspective.

  10. [The medical perspective towards chronic pain: biomedical model and clinical practice].

    Science.gov (United States)

    Lima, Mônica Angelim Gomes de; Trad, Leny A Bomfim

    2007-11-01

    This study aimed to shed light on the meanings ascribed to chronic pain in medical discourse and clinical practice in two Pain Clinics located in University hospitals in Salvador (Bahia) and São Paulo, Brazil. An ethnographic approach used participant observation and semi-structuralized interviews with attending and managing physicians. Data analysis drew on the clinical models developed by Byron Good and the medical rationalities project formulated by Madel Luz. The meanings emerging from the study were the recognition of chronic pain by biomedicine as a disease rather than a symptom, its invisibility to physicians, and its non-communicability and inevitability. The informants suggested the need for valorization of the human encounter in the clinic, exercise of understanding as opposed to suspicion, and negotiation of sustainable therapeutic projects.

  11. Chronic migraine and medication overuse headache: clarifying the current International Headache Society classification criteria.

    Science.gov (United States)

    Sun-Edelstein, C; Bigal, M E; Rapoport, A M

    2009-04-01

    Despite the recent advances in the understanding and classification of the chronic daily headaches, considerable controversy still exists regarding the classification of individual headaches, including chronic migraine (CM) and medication overuse headache (MOH). The original criteria, published in 2004, were difficult to apply to most patients with these disorders and were subsequently revised, resulting in broader clinical applicability. Nonetheless, they remain a topic of debate, and the revisions to the criteria have further added to the confusion. Even some prominent headache specialists are unsure which criteria to use. We aimed to explain the nature of the controversies surrounding the entities of CM and MOH. A clinical case will be used to illustrate some of the problems faced by clinicians in diagnosing patients with chronic daily headache.

  12. Quality of life, treatment adherence, and locus of control: multiple family groups for chronic medical illnesses.

    Science.gov (United States)

    López-Larrosa, Silvia

    2013-12-01

    The Multiple Family Groups (MFGs) approach for patients with a chronic medical illness and their families is a structured psychoeducational program that unfolds in six weekly 90-minute sessions. In the MFGs, patients and family members explore new ways to balance illness and nonillness priorities in family life (Steinglass, 1998; Steinglass, 2000 Cuadernos de Terapia Familiar, 44-45, 11; Steinglass, Ostroff, & Steinglass, 2011 Family Process, 50, 393). © FPI, Inc.

  13. Medication safety and chronic kidney disease in older adults prescribed metformin: a cross-sectional analysis

    OpenAIRE

    Huang, Deborah L.; Abrass, Itamar B; Young, Bessie A.

    2014-01-01

    Background Medication safety in patients with chronic kidney disease (CKD) is a growing concern. This is particularly relevant in older adults due to underlying CKD. Metformin use is contraindicated in patients with abnormal kidney function; however, many patients are potentially prescribed metformin inappropriately. We evaluated the prevalence of CKD among older adults prescribed metformin for type 2 diabetes mellitus using available equations to estimate kidney function and examined demogra...

  14. The cost-effectiveness of managed care regarding chronic medicine prescriptions in a selected medical scheme

    Directory of Open Access Journals (Sweden)

    K. Day

    1998-09-01

    Full Text Available The purpose of the study was to examine the cost-effectiveness of managed care interventions with respect to prescriptions for chronic illness sufferers enrolled with a specific medical scheme. The illnesses included, were epilepsy, hypertension, diabetes and asthma. The managed care interventions applied were a primary discount; the use of preferred provider pharmacies, and drug utilization review. It was concluded that the managed care interventions resulted in some real cost savings.

  15. Cannabis use and dependence among French schizophrenic inpatients

    Directory of Open Access Journals (Sweden)

    Michel eLejoyeux

    2014-07-01

    Full Text Available Background: To assess the prevalence of cannabis use and dependence in a population of schizophrenic inpatients and to compare schizophrenics with and without cannabis consumption. Methods: 101 schizophrenic patients were examined during their first week of hospitalization. They answered the PANNS scale of schizophrenia, the CAGE and the Fagerström questionnaire and the DSM-IV-TR criteria for cannabis, alcohol, opiates and nicotine use dependence were checked. We also assessed socio-demographic characteristics, the motive of cannabis consumption and the number of cannabis joints and alcoholic drinks taken.Results: The prevalence of cannabis consumption was 33.6% among schizophrenic inpatients. Schizophrenics consuming cannabis were younger than non-schizophrenics (33.3 vs 44.7 years pConclusion: 33.6 % of the schizophrenic patients hospitalized in psychiatry consume cannabis and most of them are dependent on cannabis and alcohol. Hospitalization in psychiatry may provide an opportunity to systematically identify a dependence disorder and to offer appropriate information and treatment

  16. Attachment in medical care: A review of the interpersonal model in chronic disease management.

    Science.gov (United States)

    Jimenez, Xavier F

    2017-03-01

    Objective Patient-physician interaction is continually examined in an era prioritizing patient-centered approaches, yet elaboration beyond aspects of communication and empathy is lacking. Major chronic conditions would benefit tremendously from understanding interpersonal aspects of patient-physician encounters. This review intends to provide a concise introduction to the interpersonal model of attachment theory and how it informs both the patient-physician interaction and medical outcomes in chronic care. Methods A narrative review of the theoretical, neurobiological, epidemiological, investigational, and clinical literature on attachment theory and its impact on medical outcomes was conducted, utilizing a variety of key words as searched on PubMed database. Studies and reviews included were of a variety of sources, including textbooks and peer-reviewed journals. Reports in languages other than English were excluded. Results Measurable, discrete attachment styles and behavioral patterns correlate with poor medical outcomes, including nonadherence in insecure dismissing attachment and care overutilization in insecure preoccupied attachment. Furthermore, insecure dismissing attachment is associated with significant mortality. These variables can be easily assessed, and their effects are reversible, as evidenced by collaborative care outcome data. Discussion Attachment theory is useful a model with application in clinical and investigational aspects of chronic illness care. Implications and guidelines are explored.

  17. Effects of breast cancer on chronic disease medication adherence among older women.

    Science.gov (United States)

    Santorelli, Melissa L; Steinberg, Michael B; Hirshfield, Kim M; Rhoads, George G; Bandera, Elisa V; Lin, Yong; Demissie, Kitaw

    2016-08-01

    The purpose of this study was to determine the effects of breast cancer on chronic disease medication adherence among older women. The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked data and a 5% random sample of Medicare enrollees were used. Stage I-III breast cancer patients diagnosed in 2008 and women without cancer were eligible. Three cohorts of medication users 66+ years were identified using diagnosis codes and prescription fill records: diabetes, hypertension, and lipid disorders. For each cohort, breast cancer patients were frequency matched to comparison women by age and geographic area. Medication adherence was measured by the proportion of days covered and medication persistence. During the post-baseline period, the percentage of breast cancer patients who were non-adherent was 26.2% for diabetes medication, 28.9% for lipid-lowering medication, and 14.2% for hypertension medication. Breast cancer patients experienced an increased odds of diabetes medication non-adherence [odds ratio (OR) = 1.44; 95% confidence interval (CI) = 1.07 to 1.95] and were more likely to be non-persistent with diabetes medication (hazard ratio = 1.31; 95%CI: 1.04 to 1.66) relative to women without cancer. The study failed to show a difference between breast cancer and comparison women in the odds of non-adherence to hypertensive (OR = 0.87; 95%CI: 0.71 to 1.05) or lipid-lowering medication (OR = 0. 91; 95%CI: 0.73 to 1.13) with a proportion of days covered threshold of 80%. Special attention should be given to the coordination of primary care for older breast cancer patients with diabetes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  18. CHRONIC MEDICAL CONDITIONS AND REPRODUCIBILITY OF SELF-REPORTED AGE AT MENOPAUSE AMONG COMMUNITY DWELLING WOMEN

    Science.gov (United States)

    de Vries, Heather F.; Northington, Gina M.; Kaye, Elise M.; Bogner, Hillary R.

    2011-01-01

    OBJECTIVE To examine the association between chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women. METHOD Age at menopause was assessed in a population-based longitudinal survey of 240 women twice, in 1993 and 2004. Women who recalled age at menopause in 2004 within one year or less of the age at menopause recalled in 1993 (concordant) were compared with women who did not recall of age at menopause in 2004 within 1 year of age at menopause recalled in 1993 (discordant). Type of menopause (surgical or natural) and chronic medical conditions were assessed by self-report. RESULTS One hundred and forty three women (59.6%) reported surgical menopause and 97 (40.4%) reported natural menopause. In all, 130 (54.2%) of women recalled age at menopause in 2004 within one year or less of recalled age at menopause in 1994 while 110 (45.8%) women did not recall age at menopause in 2004 within one year or less of recalled age at menopause in 1994. Among women with surgical menopause, women with three or more medical conditions were less likely to have concordant recall of age at menopause than women with less than three chronic medical conditions (adjusted odds ratio (OR) = 0.36, 95% confidence interval (CI) [0.15, 0.91]) in multivariate models controlling for potentially influential characteristics including cognition and years from menopause. CONCLUSIONS Among women who underwent surgical menopause, the presence of three or more medical conditions is associated with decreased reproducibility of self-reported age at menopause. PMID:21971208

  19. The effect of procedural skill training in the treatment of patients with chronic schizophrenic%程式化训练在治疗慢性精神分裂症中的作用

    Institute of Scientific and Technical Information of China (English)

    张敏; 李俊亚

    2012-01-01

    目的 探讨程式化训练在慢性精神分裂症患者治疗中的作用.方法 将88例慢性精神分裂症患者随机分成家属参与训练组和对照组各44例,对训练组进行8周的程式化训练,然后全部随访44周.选用阳性与阴性症状量表(PANSS)、自知力与治疗态度问卷(ITAQ)、Morningside康复状态量表(MRSS)进行评估.结果 训练组的PANSS总分、阴性症状分和一般精神病理分在第20、32、44周末均较对照组显著为低(t =2.42~11.19,均P<0.01),而阳性症状分在44周末两组差异有统计学意义(t=3.19,P<0.01);训练组的ITAQ评分在第20、32、44周末均明显高于对照组(t=3.13 ~8.32,均P<0.01);训练组MRSS评定中依赖性活动、能力缺乏、社交能力及目前症状和异常行为平均分在20周均明显低于对照组(t=1.67~4.31;2.374>t >1.664,P<0.05;t>2.374,P<0.01).随访1年,训练组复发2例(5.13%)少于对照组5例(14,71%)(x2 =0.87,P<0.05).结论 程式化训练可明显提高住院慢性精神分裂症的康复效果,明显降低慢性精神分裂症的复发率.%Objective To investigate the effect of programed training in the treatment of patients with chronic schizophrenia.Methods 88 patients with chronic schizophrenia were randomly divided into families involved in the training group and control group 44 cases,the training group for eight weeks of programmed training,and then all were followed up for 44 weeks.Positive and negative syndrome scale (PANSS),insight and treatment attitude questionnaire(ITAQ),Morningside Rehabilitation Status Scale(MRSS) were selected to assess.Results Total score of PANSS,negative symptoms and general psychopathology in The training group sub-section 20,32,44 weekend were cignificartly lower than in the control group(t =2.42 ~ 11.19,all P <0.01) ;positive symptoms points in 44 weekend the difference was significant(t =3.19,P < 0.01) ; training group ITAQ score the weekend of the first 20

  20. The Impact of a Telephone-Based Chronic Disease Management Program on Medical Expenditures.

    Science.gov (United States)

    Avery, George; Cook, David; Talens, Sheila

    2016-06-01

    The impact of a payer-provided telephone-based chronic disease management program on medical expenditures was evaluated using claims data from 126,245 members in employer self-ensured health plans (16,224 with a chronic disease in a group enrolled in the self-management program, 13,509 with a chronic disease in a group not participating in the program). A random effects regression model controlling for retrospective risk, age, sex, and diagnosis with a chronic disease was used to determine the impact of program participation on market-adjusted health care expenditures. Further confirmation of results was obtained by an ordinary least squares model comparing market- and risk-adjusted costs to the length of participation in the program. Participation in the program is associated with an average annual savings of $1157.91 per enrolled member in health care expenditures. Savings increase with the length of participation in the program. The results support the use of telephone-based patient self-management of chronic disease as a cost-effective means to reduce health care expenditures in the working-age population. (Population Health Management 2016;19:156-162).

  1. From lesion to metaphor: chronic pain in British, French and German medical writings, 1800-1914.

    Science.gov (United States)

    Hodgkiss, A

    2000-01-01

    This is the first monograph devoted to the history of chronic pain. A novel methodology is used. Examining responses to a problem that remained stable over time anchors a survey of shifting terms and theories and leaves the historical invariance of the clinical syndrome open to textual research. Writings by medical authors from a wide range of professional backgrounds are examined including surgeons, physicians, psychiatrists, neurophysiologists, neurologists and psychoanalysts. Early responses to the problem of chronic pain without structural lesion were the appearance of neuralgia, a neuro-anatomical rewriting of traditional sympathies, extension of the concept of lesion to embrace disturbance of function and appeals to cenesthesis. Later in the century distinctions were drawn between hysterical and neuralgic pain, and between ideogenic, psychogenic and neurogenic pain. Some argued for the physiological equivalence of chronic pain and melancholia, while pain was central to Freud's original notion of conversion. This evidence of continuous discussion of lesionless pain throughout the century challenges the orthodox historical view that the rise of neuroscience meant such pain was simply dismissed as imaginary. The historical invariance of a syndrome of chronic pain without lesion speaks against histories of lesionless syndromes premised on social constructionism. The historical findings are relevant to contemporary debates about the nosology and nature of chronic pain.

  2. Eye-tracking dysfunctions in schizophrenic patients and their relatives

    Energy Technology Data Exchange (ETDEWEB)

    Holzman, P.S.; Proctor, L.R.; Levy, D.L.; Yasillo, N.J.; Meltzer, H.Y.; Hurt, S.W.

    1974-08-01

    A simple test of smooth-pursuit eye movements disclosed a striking association between deviant eye tracking and clinically diagnosed schizophrenia. A high proportion of the schizophrenic patients' first-degree relatives who were not themselves clinically schizophrenic also showed deviant eye-tracking behavior. The relationship of poor eye tracking and schizophrenia is even stronger when specific psychological test evidence of thought disorder is used operationally to classify patients. The eye-tracking dysfunction may thus represent a genetic marker that can prove highly useful for studying the transmission of a vulnerability to schizophrenia. The findings suggest proprioceptive and interoceptive involvement in schizophrenic pathology. (auth)

  3. Clinical correlates of decreased anteroposterior metabolic gradients in positron emission tomography (PET) of schizophrenic patients

    Energy Technology Data Exchange (ETDEWEB)

    DeLisi, L.E.; Buchsbaum, M.S.; Holcomb, H.H.; Dowling-Zimmerman, S.; Pickar, D.; Boronow, J.; Morihisa, J.M.; van Kammen, D.P.; Carpenter, W.; Kessler, R.

    1985-01-01

    The finding in schizophrenic patients of a reversal of the normal frontal to posterior pattern of brain metabolic activity with positron emission tomography (PET) is of interest, but its relevance to psychopathology is unknown. Using PET, the authors studied 21 patients with chronic schizophrenia and 21 age- and sex-matched control subjects. Although eight of the 21 patients and only one of the control subjects showed a relatively lower anteroposterior metabolic gradient, no clinical correlates of this finding were noted. In addition, cerebral atrophy, as determined by CAT scan, was not associated with this aberrant metabolic pattern.

  4. Race and Ethnic Group Differences in Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Chronic Medical Conditions.

    Science.gov (United States)

    Watkins, Daphne C; Assari, Shervin; Johnson-Lawrence, Vicki

    2015-09-01

    This study tested whether race and ethnic group differences exist for lifetime major depressive disorder and/or general anxiety disorder with one or more chronic medical conditions. Data from the National Survey of American Life, which included 3570 African American, 1438 Caribbean Black, and 891 non-Hispanic White adults were analyzed. Outcomes included at least one and multiple chronic medical conditions, from a list of 14 medical conditions (e.g., arthritis, cancer, diabetes, kidney disease, stroke, heart disease, etc.). Logistic regressions were fitted to data to determine how the association between major depressive disorder, general anxiety disorder, and one or more chronic medical conditions vary across race and ethnicity. Lifetime major depressive disorder (but not lifetime general anxiety disorder) was associated with at least one chronic medical condition among African Americans and Caribbean Blacks, but not non-Hispanic Whites. Lifetime major depressive disorder was similarly associated with multiple chronic medical conditions among African Americans, Caribbean Blacks, and non-Hispanic Whites. For Caribbean Blacks, stronger associations were found between major depressive disorder and general anxiety disorder with one or more chronic medical conditions compared to African Americans and non-Hispanic Whites. Findings suggest that race and ethnicity may shape the links between comorbid psychiatric disorders and chronic medical conditions. Mental health screening of individuals with chronic medical conditions in primary health-care settings may benefit from tailoring based on race and ethnicity. More research is needed to understand why associations between physical and mental health vary among race and ethnic groups.

  5. Multicultural influences on pain medication attitudes and beliefs in patients with nonmalignant chronic pain syndromes.

    Science.gov (United States)

    Monsivais, Diane; McNeill, Jeanette

    2007-06-01

    The objective was to develop an integrated review of quantitative and qualitative research regarding the influence of patients' beliefs and attitudes toward pain medication prescribed for the treatment of nonmalignant chronic pain on use of the pain medication. Studies involving patients at least 18 years old with nonmalignant chronic pain were included. Studies of patients with acquired immune deficiency syndrome, cancer, and acute pain were excluded. Medline, CINAHL, PsychInfo, and Cochrane databases from 1985 to 2005 were searched. Reference lists were screened for relevant articles. Abstracts were screened for compliance with the study criteria, and the articles were obtained for those that met criteria. By using a systematic process, each article was subjected to repeated review and data abstracted to the collection sheets. Evidence tables were created to assist with data review. High levels of concern positively correlate with nonadherence, preconceived ideas about when the drug should start working can cause the patient to discontinue it before it begins to work, and patients may perceive that if medication is taken on a regular basis to control pain it may not be effective in the future if the pain increases. Research also showed that if patients perceived the benefits of taking the pain medication to be high, they were willing to risk the side effects.

  6. Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders.

    Science.gov (United States)

    Smith, Michael T; Huang, Mary I; Manber, Rachel

    2005-07-01

    Insomnia is a pervasive problem for many patients suffering from medical and psychiatric conditions. Even when the comorbid disorders are successfully treated, insomnia often fails to remit. In addition to compromising quality of life, untreated insomnia may also aggravate and complicate recovery from the comorbid disease. Cognitive behavior therapy for insomnia (CBT-I) has an established efficacy for primary insomnia, but less is known about its efficacy for insomnia occurring in the context of medical and psychiatric conditions. The purpose of this article is to present a rationale for using CBT-I in medical and psychiatric disorders, review the extant outcome literature, highlight considerations for adapting CBT-I procedures in specific populations, and suggest directions for future research. Outcome studies were identified for CBT-I in mixed medical and psychiatric conditions, cancer, chronic pain, HIV, depression, posttraumatic stress disorder, and alcoholism. Other disorders discussed include: bipolar disorder, eating disorders, generalized anxiety, and obsessive compulsive disorder. The available data demonstrate moderate to large treatment effects (Cohen's d, range=0.35-2.2) and indicate that CBT-I is a promising treatment for individuals with medical and psychiatric comorbidity. Although the literature reviewed here is limited by a paucity of randomized, controlled studies, the available data suggest that by improving sleep, CBT-I might also indirectly improve medical and psychological endpoints. This review underscores the need for future research to test the efficacy of adaptations of CBT-I to disease specific conditions and symptoms.

  7. [Validity of assessment of schizophrenic basic symptoms].

    Science.gov (United States)

    Mass, R; Hitschfeld, K; Wall, E; Wagner, H B

    1997-03-01

    A study on the concept and measurement of the basic disorders of schizophrenia is presented. A total of 151 male adult psychiatric inpatients (51 with a dual diagnosis of schizophrenia and alcoholism, 50 schizophrenics and 50 alcoholics) were included. The aims of this study were: (1) the replication of the previous finding that the Frankfurt Complaint Questionnaire (FBF) contains items that discriminate between schizophrenia and alcoholism; (2) an empirical comparison between FBF and the Bonn Scale for the Assessment of Basic Symptoms (BSABS); (3) testing the relationship between basic and negative versus positive symptoms, as measured by the Positive and Negative Syndrome Scale (PANSS). Regarding (1), the former result was replicated. Regarding (2), FBF subscales and BSABS categories were shown to be significantly but weakly related, even if identical symptoms were included in the inquiry. Regarding (3), FBF and BSABS were found to be more closely related to negative than to positive PANSS items. Theoretical implications and consequences for further research are discussed.

  8. An analysis of the skin conductance orienting response in samples of American, British, and German schizophrenics.

    Science.gov (United States)

    Bernstein, A S; Frith, C D; Gruzelier, J H; Patterson, T; Straube, E; Venables, P H; Zahn, T P

    1982-01-01

    The existing literature dealing with the phasic orienting response (OR) in schizophrenia, examining, for the most part, the skin conductance component (SCOR), reports conflicting results with divergent implications for the nature of the attentional dysfunction in these patients. The present authors have contributed to that literature and to its divergencies. The present report addresses this issue by applying a common set of response definitions and uniform statistical-analytic procedures to the previously gathered electrodermal data obtained independently in each author's laboratory. A total of 14 studies is involved, drawn from six laboratories in the U.S.A., the U.K., and West Germany. Collectively, these studies examine chronic and acute schizophrenics, males and females, those receiving neuroleptic drugs and those not receiving them, recording SCOR from either (or both) hands using a variety of instruments and somewhat differing instructions and conditions, to both auditory and visual stimuli of different intensities and rise-time properties. The authors' purpose is two-fold. First, to determine whether some 'universal' dysfunction can be demonstrated across laboratories, conditions, and samples. Given the heterogeneous origins of these data such a finding would offer fairly strong evidence of 'real' dysfunction in schizophrenia. Second, where disagreement exists, to describe the scope and nature of the disagreement, and to articulate more clearly the findings on each side of a disputed area. One such 'universal' dysfunction emerged. Consistently, schizophrenics displayed an abnormally high incidence of nonresponsiveness, involving nearly 50% of the schizophrenic sample on average. The next most common finding is that many of the schizophrenics who display an SCOR often habituate faster than do nonschizophrenic responders. This was seen in a majority of the studies and laboratories, but conflicting evidence was presented by a minority. Evidence for a

  9. Occipital nerve stimulation in medically intractable, chronic cluster headache. The ICON study: Rationale and protocol of a randomised trial

    NARCIS (Netherlands)

    Wilbrink, Leopoldine A.; Teernstra, Onno P.M.; Haan, Joost; Zwet, van Erik W.; Evers, Silvia M.A.A.; Spincemaille, Geert H.; Veltink, Peter H.; Mulleners, Wim; Brand, Ronald; Huygen, Frank J.P.M.; Jensen, Rigmor H.; Paemeleire, Koen; Goadsby, Peter J.; Visser-Vandewalle, Veerle; Ferrari, Michel D.

    2013-01-01

    Background: About 10% of cluster headache patients have the chronic form. At least 10% of this chronic group is intractable to or cannot tolerate medical treatment. Open pilot studies suggest that occipital nerve stimulation (ONS) might offer effective prevention in these patients. Controlled neurom

  10. The effect of control and self-medication of chronic gout in a developing country. Outcome after 10 years

    NARCIS (Netherlands)

    Darmawan, John; Rasker, Johannes J.; Nuralim, Hendri

    2003-01-01

    Objective:: We describe a 10 year observation of the effect of control of hyperuricemia compared with self-medication alone in patients with chronic gout. Methods: We studied 299 consecutively self-referred Malayo-Polynesian men with chronic gout, mean age 35 ± 14.3 SD years. Subjects comprised 228

  11. Situational reactivity of autonomic functions in schizophrenic patients.

    Science.gov (United States)

    Albus, M; Ackenheil, M; Engel, R R; Müller, F

    1982-06-01

    In a study designed to evaluate the state of arousal and the autonomic reactivity to experimental conditions in schizophrenic patients, 12 acute, unmedicated schizophrenic patients with paranoid hallucinatory symptomatology and 63 healthy normal control subjects were administered four standardized tasks: cold pressor test, noise, mental arithmetic, and active relaxation. Biochemical (norepinephrine and cortisol) and physiological (electromyogram, electroencephalogram, skin and conductance response, skin conductance level, finger pulse amplitude, finger temperature, heart rate, respiratory volume, pulse wave velocity, and electrogastrogram) parameters were measured simultaneously. Schizophrenic patients showed elevated levels of cortisol and norepinephrine, as well as heightened responsivity on measures of electromyographic activity, skin conductance level, and heart rate, throughout the trial, and reduced responsivity to conditions of stress. It is concluded that schizophrenic patients show higher nonspecific activation and reduced ability to react to external stimulation, perhaps induced by lack of inhibition of the reticular formation by the limbic system.

  12. Evaluation of dense collagen matrices as medicated wound dressing for the treatment of cutaneous chronic wounds.

    Science.gov (United States)

    Helary, Christophe; Abed, Aicha; Mosser, Gervaise; Louedec, Liliane; Letourneur, Didier; Coradin, Thibaud; Giraud-Guille, Marie Madeleine; Meddahi-Pellé, Anne

    2015-02-01

    Cutaneous chronic wounds are characterized by an impaired wound healing which may lead to infection and amputation. When current treatments are not effective enough, the application of wound dressings is required. To date, no ideal biomaterial is available. In this study, highly dense collagen matrices have been evaluated as novel medicated wound dressings for the treatment of chronic wounds. For this purpose, the structure, mechanical properties, swelling ability and in vivo stability of matrices concentrated from 5 to 40 mg mL(-1) were tested. The matrix stiffness increased with the collagen concentration and was associated with the fibril density and thickness. Increased collagen concentration also enhanced the material resistance against accelerated digestion by collagenase. After subcutaneous implantation in rats, dense collagen matrices exhibited high stability without any degradation after 15 days. The absence of macrophages and neutrophils evidenced their biocompatibility. Subsequently, dense matrices at 40 mg mL(-1) were evaluated as drug delivery system for ampicillin release. More concentrated matrices exhibited the best swelling abilities and could absorb 20 times their dry weight in water, allowing for an efficient antibiotic loading from their dried form. They released efficient doses of antibiotics that inhibited the bacterial growth of Staphylococcus Aureus over 3 days. In parallel, they show no cytotoxicity towards human fibroblasts. These results show that dense collagen matrices are promising materials to develop medicated wound dressings for the treatment of chronic wounds.

  13. Pharmaceutical care and home delivery of medication to patients with chronic myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Begoña San José Ruiz

    2015-01-01

    Full Text Available Objectives: To describe the implementation of a new model face to face and remote pharmaceutical care with home delivery of tyronsine kinase inhibitors medicines for patients with chronic myeloid leukemia. Methods: Patients with chronic myeloid leukemia were selected to start this new model of care. Four characteristics were taken into account for the choice: chronicity of the disease, frequency of doctor visits, pharmaceutical care value and conservation of tyronsine kinase inhibitors medicines at room temperature. Results: Out of 68 patients with chronic myeloid leukemia and treated with tyronsine kinase inhibitors, 42 were selected due to the frequency of their hematologist visits. An introductory letter and a questionnaire about their preferences were sent to these patients.Sixteen of them expressed their desire to participate. The legal department designed a confidentiality contract, as well as a model of informed consent. A logistic distribution model based on defined routes and timetables was established. Prior to inclusion, pharmaceutical care was performed in a face to face consultation and the communication way was established for the followings remote consultations. Home delivery had a monthly cost of 13.2 € (including VAT per patient. All the patients who started this program continue in it. To date, 5 deliveries per patient have been conducted Conclusions: It is possible to establish an alternative model of pharmaceutical care with home delivery of medication, keeping the pharmacist-patient relationship, avoiding travel, ensuring the confidentiality and rationalizing the stocks

  14. Effective chronic disease management: patients' perspectives on medication-related problems.

    Science.gov (United States)

    Gordon, Karen; Smith, Felicity; Dhillon, Soraya

    2007-03-01

    To examine medication-related problems from the perspective of patients with a chronic condition and to identify how they may be supported in managing their medication. Patients prescribed medication for cardiovascular disease were recruited through five general medical surgeries and four community pharmacies in south London. Data were collected in 98 face-to-face interviews in participants' own homes. Interviews were designed to enable a detailed and holistic exploration of medication-related problems from participants' perspectives. Data were audio-recorded and transcribed verbatim to allow qualitative analysis. Five broad categories of medication-related problem emerged which were examined in the context of patients' perspectives on, and experiences of, the use of medicines and health services. These were concerns about and management of side effects; differing views regarding the use of medicines; cognitive, practical and sensory problems; lack of information or understanding; and problems with access to, and organisation of, services. All categories of problem had potential implications for the success of therapy in that they created barriers to adherence, access to medication or informed decision-making. The study demonstrated how patients actively engage in decision-making about their medicines in the home, if not in the consultation. The five categories of problem provide a focus for interventions by health professionals to support patients in achieving optimal theory outcomes. They demonstrate the need for a comprehensive approach, spanning patient education to the systems of delivery of care. Within the NHS in Britain, policy and practice initiatives are being designed to achieve this end. Further research should focus on the evaluation of professional practices and service developments in supporting patients in the self-management of their medicines.

  15. Urinary tract infection complicated by urine retention presenting as pseudocyesis in a schizophrenic patient.

    Science.gov (United States)

    Yeh, Yi-Wei; Kuo, Shin-Chang; Chen, Chun-Yen

    2012-01-01

    Pseudocyesis is a rare condition wherein a nonpregnant woman shows signs and symptoms of pregnancy, such as abdominal enlargement, breast enlargement, pigmentation, cessation of menses, subjective sensation of fetal movement and labor pains at the expected delivery date. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, it is classified as a somatoform disorder, characterized by a false belief of being pregnant that is associated with objective signs of pregnancy. We report the case of a middle-aged female schizophrenic patient who developed pseudocyesis secondary to a urinary tract infection complicated by acute urine retention. The patient accepted that she had pseudocyesis after the causative medical condition resolved.

  16. PERSONAL ATTITUDES, PERCEIVED SOCIAL NORMS, AND HEALTH RISK BEHAVIOR AMONG FEMALE ADOLESCENTS WITH CHRONIC MEDICAL CONDITIONS

    Science.gov (United States)

    Kunz, Jennifer Hauser; Greenley, Rachel Neff; Mussatto, Kathleen A.; Roth-Wojcicki, Betsy; Miller, Tami; Freeman, Mary Ellen; Lerand, Sarah

    2015-01-01

    Purpose To examine whether perceived peer/parent norms or personal beliefs about adolescent substance use influence substance use among female adolescents with chronic medical conditions. Methods 68 females reported on substance use, personal beliefs, and perceived peer/parent norms. Results Personal beliefs and perceived peer/parent norms were associated with adolescent’s current and future substance use. Although perceived peer norms accounted for variance in current substance use, only personal beliefs accounted for variance in future alcohol use. Conclusions Targeting perceived peer norms may be effective for intervention efforts among adolescents endorsing current substance use, whereas alcohol use prevention efforts should target personal beliefs. PMID:23524992

  17. Update on Medical Management of Clinical Manifestations of Chronic Kidney Disease.

    Science.gov (United States)

    Quimby, Jessica M

    2016-11-01

    Dysregulation of normal kidney functions in chronic kidney disease (CKD) leads to several pathophysiologic abnormalities that have the potential to significantly clinically affect the CKD patient. This article discusses the clinical impact of hypertension, hypokalemia, anemia, dysrexia, nausea/vomiting, and constipation in the CKD patient and therapies for these conditions. These clinical manifestations of disease may not occur in every patient and may also develop later during the progression of disease. Therefore, monitoring for, identifying, and addressing these factors is considered an important part of the medical management of CKD. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. FEATURES OF THE CHRONIC PAIN SYNDROME IN PATIENTS WITH RHEUMATOID ARTHRITIS AND MEDICAL DIAGNOSTIC TACTICS

    Directory of Open Access Journals (Sweden)

    M. A. Gromova

    2016-01-01

    medical tactics for rheumatoid arthritis patients with a chronic pain syndrome in therapeutic practice based on pain strength gradation, assessment of chronic pain syndrome variations, definition of anxiety and depression signs. All this allows to validate consultation of medical specialists and to differentiate treatment. Conclusions. The integrated approach to diagnostics of a chronic pain syndrome for rheumatoid arthritis allows to estimate pain strengths in dynamics of disease development, to reveal existence of pain variations, anxiety and depression. It enables usage of patient maintenance tactics and increases efficiency of treatment in therapeutic practice. 

  19. Brain computed tomography findings of aged schizophrenics; Comparison with healthy aged controls and aged schizophrenics with a history of psychosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Oomori, Masao; Koshino, Yoshifumi; Murata, Tetsuhito; Murata, Ichirou; Tani, Kazuhiko; Horie, Tan; Isaki, Kiminori (Fukui Medical School, Matsuoka (Japan))

    1992-05-01

    Brain CT was performed in a total of 30 aged schizophrenic patients, consisting of 20 with no history of psychosurgery (lobotomy) and the other 10 lobotomized patients. The CT findings were compared with those from healthy aged persons. The group of schizophrenic patients had marked atrophy of the frontal lobe and dilatated Sylvian fissure as compared with the control group. There was no significant difference in ventricular factors between the two groups. These findings may have implications for the different mechanisms of the occurrence of atrophied brain surface and enlarged ventricle. The cerebral cortex involved in the occurrence of schizophrenia may be affected by aging-related cerebral atrophy, in addition to the morphological changes due to schizophrenia. Thus, schizophrenic cerebral atrophy was more noticeable than physiological aging-related atrophy. However, enlargement of the ventricle in the schizophrenic group progressed with aging in the same manner as that in the normal group. In comparing schizophrenic patients with or without a history of lobotomy, atrophy of the brain surface and enlargement of the ventricle were more marked in the lobotomized patients than the non-lobotomized patients. This confirmed that lobotomy, as well as surgical scar, is involved in the morphology of schizophrenic brain. (N.K.).

  20. Computed tomography (CT) findings of schizophrenic patients after long time from psychosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Naoto; Akashi, Toshio; Toyoda, Junzou; Murakami, Hiroshi; Ogashiwa, Motohide (National Center of Neurology and Psychiatry, Musashi Hospital, Kodaira, Tokyo (Japan))

    1991-11-01

    The CT findings on 20 chronic schizophrenic inpatients who had undergone psychosurgery 37 years ago (operated group) were compared to 20 chronic schizophrenic inpatients without psychosurgery (non-operated group). The subjects of non-operated group were selected by matched age, sex and duration of the illness. Operated group showed significant decrease in frontal lobe size (p<0.001), enlargement of frontal horns of the lateral ventricle (p<0.01), widening of interhemispheric fissure (p<0.05), and brain atrophy (p<0.001) in comparison with non-operated group. Size of surgical injury showed significant rank correlation to frontal lobe size (p<0.01) and brain atrophy (p<0.001). Regarding the horizontal level of injury, in comparison with non-operated group, the patients with deficit in higher frontal areas showed enlargement of lateral ventricles (p<0.01) and those with deficit in lower frontal areas showed widening of interhemispheric fissure (p<0.05). Regarding the laterality of injury, the patients with deficit in left hemisphere showed significantly widened sylvian fissure in comparison with non-operated group (p<0.05). (author).

  1. The effects of psychoactive drugs and neuroleptics on language in normal subjects and schizophrenic patients: a review.

    Science.gov (United States)

    Salomé, F; Boyer, P; Fayol, M

    2000-12-01

    The aim of this survey is to present an overview of research into psychopharmacology as regards the effects of different psychoactive drugs and neuroleptics (NL) on language in normal subjects and schizophrenic patients. Eighteen studies that have investigated the effects of different drugs (alcohol, amphetamines, secobarbital, L-dopa, psilocybin, ketamine, fenfluramine) and neuroleptics (conventional and atypical) on language are reviewed. There are no studies concerning the effects of neuroleptics on language in healthy subjects. The results of the effects of other molecules indicate that language production can be increased (alcohol, amphetamine, secobarbital), rendered more complex (d-amphetamine), more focused (L-dopa) or more unfocused (psilocybin) and clearly impaired (ketamine). For schizophrenic patients, most studies show that conventional neuroleptic treatments, at a therapeutic dosage and in acute or chronic mode, reduce language disorders at all levels (clinic, linguistic, psycholinguistic). In conjunction with other molecules, the classical NL, when administered at a moderate dosage and in chronic mode, modify language in schizophrenia, either by improving the verbal flow and reducing pauses and positive thought disorder (NL + amphetamine) or by inducing an impairment in the language measurements (NL + fenfluramine). Clinical, methodological and theoretical considerations of results are debated in the framework of schizophrenic language disorders.

  2. Chronic disease, medications and lifestyle: perceptions from a regional Victorian Aboriginal community

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    Deacon-Crouch M

    2016-09-01

    Full Text Available Background: Poor medication management may contribute to the increased morbidity and mortality of Aboriginal people in Australia. Yet while there is extensive literature about the perceptions of healthcare providers on this issue, there is limited information on the perceptions of Aboriginal people themselves. Objectives: To investigate the perceptions of a group of Aboriginal people attending a Victorian regional Aboriginal Health Service (AHS with diagnosed medical conditions requiring medications, of their lifestyle, disease management and medication usage. Methods: Data was collected through one to one in depth interviews using a semi-structured ‘yarning’ process. Twenty patients were invited to participate in the study and were interviewed by Aboriginal Health Workers in a culturally appropriate manner. The interviews were recorded and transcribed verbatim. The data were analysed using descriptive statistics. Results: Our results show that the majority of participants perceived that changes in lifestyle factors such as diet, exercise, and smoking cessation would help improve their health. Most patients reported having been counselled on their medicines, and while the majority reported adherence and acknowledgement of the efficacy of their medicines, there was a lack of clarity regarding long term maintenance on regimens. Finally, while the majority reported taking over the counter products, some did not see the need to inform their doctor about this, or chose not to. Conclusion: Chronic illness was perceived as common in families and community. Patients relied mostly on their health care professionals as sources for their drug information. Patients may have benefited from further counselling in the area of complementary and other over the counter medicines, as well as on the necessity of maintenance of regimes for chronic disease management. Finally, lifestyle changes such as dietary improvements and smoking cessation were identified as

  3. Overuse of symptomatic medications among chronic (transformed migraine patients: profile of drug consumption

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    Krymchantowski Abouch Valenty

    2003-01-01

    Full Text Available Chronic daily headache and chronic (transformed migraine (TM patients represent more than one third of the subjects seen in specialized headache centers. Most of these patients may overuse symptomatic medications (SM taken on a daily basis to relieve headache and associated symptoms. The conversion to the daily or near-daily pattern of headache presentation is thought to be related to the medication overuse. The aim of this study was to evaluate the profile of SM consumption among transformed migraine patients attending a tertiary center. One hundred thirty three consecutive patients (22 men and 111 women, ages 17 to 80 with TM and overuse of SM according to the proposed criteria of Silberstein et al (1994, 1996 were prospectively studied. None of the patients were under treatment for other conditions. Among them, 73 (54.9% were using one category of SM, while 55 (41.3% and 5 (3.8% patients were taking simultaneously two and three categories of SM respectively. The categories of overused symptomatic medications varied from simple analgesics to narcotics, triptans and combinations of ergot derivatives and caffeine and of analgesics and caffeine. The average intake per patient per day was of 3 to 4 tablets and mostly of the patients overused simple analgesics (isolated or in combination with other substances (75.2%, caffeine containing drugs (71.4%, drugs containing ergotamine derivatives (26.1%, triptans (alone or combined (15.5%, drugs with narcotics or ansiolitics (13% and anti-inflammatory drugs (3.7%. The mechanisms by which the overuse of symptomatic medications may play a role in this transformation are uncertain but despite of the necessity of controlled trials to demonstrate the real role of such compounds in the development of transformed migraine, this study emphasizes the necessity for more rigorous prescribing guidelines for patients with frequent headaches.

  4. [Economic burden for patients with chronic myelogenous leukemia--healthcare economics and medical governance of cancer].

    Science.gov (United States)

    Kodama, Yuko; Kami, Masahiro

    2010-04-01

    Due to the recent economic downturn, the economic burden of cancer patients has been further worsened. Specifically for chronic myelogenous leukemia patients, their annual income has decreased by 1, 500, 000 yen from 2000 to 2008, while the cost of their medications has increased from 1,000,000 yen to 1,200,000 yen due the advent of the new drug, Glivec, which was approved in 2001. The scores for psychological burden have increased 30% over the past 8 years before Glivec became available. The economic crisis among cancer patients is a consequence of structural problems with many anticancer drugs and cancer treatment. Especially, problems involving the cost of medical care and the system of drug pricing should be resolved by thorough discussion not only with cancer patients but also with the entire population. Discussion on the medical expense burden for CML patients has flourished through patients' spontaneous activities and information disclosure to a wider population through the internet. This methodology will be significant in establishing medical governance in cancer treatment in Japan.

  5. Effects of Modeling and Reinforcement on Adult Chronic Schizophrenics

    Science.gov (United States)

    Olson, R. Paul

    1971-01-01

    This study confirmed two general predictions: (1) the model contributes to new learning; and (2) neither the model nor reinforcement of the model adds significantly to motivation, beyond the effect that can be attributed to reinforcement of the subject himself. (Author/CG)

  6. NEUROPSYCHOLOGICAL PERFORMANCE IN A SAMPLE OF INSTITUTIONALIZED CHRONIC SCHIZOPHRENIC PATIENTS

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    Luis Maia

    2010-01-01

    Full Text Available Se analizan los resultados de un estudio descriptivo y exploratorio, con el propósito de comprender los resultados de 21 pacientes esquizofrenicos varones, evaluados con pruebas neuropsicológicas, internados en un centro portugués de salud mental. Se busca relacionar estas pruebas a variables tales como escolaridad, contacto familiar o duración de la internación. Los instrumentos del evaluación fueron: serie de dígitos y vocabulario del WAIS, las matrices progresivas de Raven, las figuras complejas de Rey, La serie gráfica neuropsicológica del screening de Luria, el Test del reloj y el test de búsqueda visual y atención. Los resultados de las pruebas sugieren que no hay un déficit de atención clínicamente significativo, aunque sugieren un defecto ligero de la atención. Las variables como contacto familiar y escolaridad aparecen como los factores protectores de memoria y también parecen ser significativos para las funciones de ejecutivas del cerebro como son la planificación y organización.

  7. Pharmacological treatment of ambulatory schizophrenic patients in Belgium

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    Reginster J-Y

    2006-05-01

    Full Text Available Abstract Background the objective of this study was twofold: 1 Describe the use of antipsychotic treatments in ambulatory patients suffering from schizophrenia in Belgium. 2 Evaluate to which extend antipsychotic treatment prescribing patterns are in accordance with published treatment guidelines. Method A cross-sectional survey was carried out in 16 Belgian hospitals selected from a sample of 67 hospitals. The hospitals were equally distributed between the north and south part of the country and were representative of Belgian practice. During 2 months, participating psychiatrists were asked to record the medication use as well as demographic parameters of all consecutive ambulatory patients seen at their consultation or attending a day-hospital. Data concerning 1000 ambulatory patients with schizophrenia or schizoaffective disorder were collected. Results In Belgium, the use of atypical antipsychotics is frequent (69% in ambulatory patients with schizophrenia. In the overall sample, 73% receive only one antipsychotic drug. The majority of patients are treated with drugs of only one antipsychotic drug group, either first- typical (29.8% or second-generation, atypical antipsychotics (53.2%. 15.8% of patients combine different types of antipsychotics. Antipsychotic dosing is adequate for the majority of patients but about one fifth receives a higher than recommended dose as per package inserts. Polypharmacy remains within reasonable limits. The use of concomitant medication varies according the antipsychotic treatment: patients who take second-generation antipsychotics only, receive the least additional drugs. Conclusion Atypical antipsychotics appear to be the first line treatment for schizophrenic psychosis. Psychiatrists working with ambulatory patients are well aware of treatment guidelines and follow them quite adequately.

  8. Motivating medical students to learn basic science concepts using chronic myeloid leukemia as an integration theme

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    Sara Teresinha Olalla Saad

    2015-02-01

    Full Text Available Objective: To report on the use of chronic myeloid leukemia as a theme of basic clinical integration for first year medical students to motivate and enable in-depth understanding of the basic sciences of the future physician. Methods: During the past thirteen years we have reviewed and updated the curriculum of the medical school of the Universidade Estadual de Campinas. The main objective of the new curriculum is to teach the students how to learn to learn. Since then, a case of chronic myeloid leukemia has been introduced to first year medical students and discussed in horizontal integration with all themes taught during a molecular and cell biology course. Cell structure and components, protein, chromosomes, gene organization, proliferation, cell cycle, apoptosis, signaling and so on are all themes approached during this course. At the end of every topic approached, the students prepare in advance the corresponding topic of clinical cases chosen randomly during the class, which are then presented by them. During the final class, a paper regarding mutations in the abl gene that cause resistance to tyrosine kinase inhibitors is discussed. After each class, three tests are solved in an interactive evaluation. Results: The course has been successful since its beginning, 13 years ago. Great motivation of those who participated in the course was observed. There were less than 20% absences in the classes. At least three (and as many as nine students every year were interested in starting research training in the field of hematology. At the end of each class, an interactive evaluation was performed and more than 70% of the answers were correct in each evaluation. Moreover, for the final evaluation, the students summarized, in a written report, the molecular and therapeutic basis of chronic myeloid leukemia, with scores ranging from 0 to 10. Considering all 13 years, a median of 78% of the class scored above 5 (min 74%-max 85%, and a median of 67

  9. Environmental Determinants of Chronic Disease and Medical Approaches: Recognition, Avoidance, Supportive Therapy, and Detoxification

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    Margaret E. Sears

    2012-01-01

    Full Text Available The World Health Organization warns that chronic, noncommunicable diseases are rapidly becoming epidemic worldwide. Escalating rates of neurocognitive, metabolic, autoimmune and cardiovascular diseases cannot be ascribed only to genetics, lifestyle, and nutrition; early life and ongoing exposures, and bioaccumulated toxicants may also cause chronic disease. Contributors to ill health are summarized from multiple perspectives—biological effects of classes of toxicants, mechanisms of toxicity, and a synthesis of toxic contributors to major diseases. Healthcare practitioners have wide-ranging roles in addressing environmental factors in policy and public health and clinical practice. Public health initiatives include risk recognition and chemical assessment then exposure reduction, remediation, monitoring, and avoidance. The complex web of disease and environmental contributors is amenable to some straightforward clinical approaches addressing multiple toxicants. Widely applicable strategies include nutrition and supplements to counter toxic effects and to support metabolism; as well as exercise and sweating, and possibly medication to enhance excretion. Addressing environmental health and contributors to chronic disease has broad implications for society, with large potential benefits from improved health and productivity.

  10. Efficacy of serial medical surveillance for chronic beryllium disease in a beryllium machining plant.

    Science.gov (United States)

    Newman, L S; Mroz, M M; Maier, L A; Daniloff, E M; Balkissoon, R

    2001-03-01

    There is limited information on the use of the blood beryllium lymphocyte proliferation test (BeLPT) at regular intervals in medical surveillance. Employees of a beryllium machining plant were screened with the BeLPT biennially, and new employees were screened within 3 months of hire. Of 235 employees screened from 1995 to 1997, a total of 15 (6.4%) had confirmed abnormal BeLPT results indicating beryllium sensitization; nine of these employees were diagnosed with chronic beryllium disease. Four of the 15 cases were diagnosed within 3 months of first exposure. When 187 of the 235 employees participated in biennial screening in 1997 to 1999, seven more had developed beryllium sensitization or chronic beryllium disease, increasing the overall rate to 9.4% (22 of 235). The blood BeLPT should be used serially in beryllium disease surveillance to capture new or missed cases of sensitization and disease. Beryllium sensitization and chronic beryllium disease can occur within 50 days of first exposure in modern industry.

  11. Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States.

    Science.gov (United States)

    Rasu, Rafia S; Vouthy, Kiengkham; Crowl, Ashley N; Stegeman, Anne E; Fikru, Bithia; Bawa, Walter Agbor; Knell, Maureen E

    2014-09-01

    Nonmalignant chronic pain (NMCP) is a public health concern. Among primary care appointments, 22% focus on pain management. The American Academy of Pain Medicine guidelines for NMCP recommend combination medication therapy (including analgesics, nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, antidepressants, and anticonvulsants) as a key component to effective treatment for many chronic pain diagnoses. However, there has been little evidence outlining the costs of pain medications in adult patients with NMCP in the United States, an area that necessitates further consideration as the nation moves toward value-based benefit design. To estimate the cost of pain medication attributable to treating adult patients with NMCP in the United States and to analyze the trend of outpatient pain visits. This cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) data from 2000-2007. The Division of Health Care Statistics, National Center for Health Statistics, and the Centers for Disease Control and Prevention conducted the survey. The study included patients aged ≥18 years with chronic pain diagnoses (identified by the ICD-9-CM codes: primary, secondary, and tertiary). Patients prescribed at least 1 pain medication were included in the cost analysis. Pain-related prescription medications prescribed during ambulatory care visits were retrieved by using NAMCS drug codes/National Drug Code numbers. National pain prescription frequencies (weighted) were obtained from NAMCS data, using the statistical software STATA. We created pain therapy categories (drug classes) for cost analysis based on national pain guidelines. Drug classes used in this analysis were opioids/opioid-like agents, analgesics/NSAIDs, tricyclic antidepressants, selective serotonin reuptake inhibitors, antirheumatics/immunologics, muscle relaxants, topical products, and corticosteroids. We calculated average prices based on the 3 lowest average wholesale prices reported in the

  12. Microbial biofilms: impact on the pathogenesis of periodontitis, cystic fibrosis, chronic wounds and medical device-related infections.

    Science.gov (United States)

    Mihai, Mara Madalina; Holban, Alina Maria; Giurcaneanu, Calin; Popa, Liliana Gabriela; Oanea, Raluca Mihaela; Lazar, Veronica; Chifiriuc, Mariana Carmen; Popa, Marcela; Popa, Mircea Ioan

    2015-01-01

    The majority of chronic infections are associated with mono- or polymicrobial biofilms, having a significant impact on the patients' quality of life and survival rates. Although the use of medical devices revolutionized health care services and significantly improved patient outcomes, it also led to complications associated with biofilms and to the emergence of multidrug resistant bacteria. Immunocompromised patients, institutionalized or hospitalized individuals, elderly people are at greater risk due to life-threatening septic complications, but immunocompetent individuals with predisposing genetic or acquired diseases can also be affected, almost any body part being able to shelter persistent biofilms. Moreover, chronic biofilm-related infections can lead to the occurrence of systemic diseases, as in the case of chronic periodontitis, linked to atherosclerosis, cardiovascular disease and diabetes. The more researchers discover, new unknown issues add up to the complexity of biofilm infections, in which microbial species establish relationships of cooperation and competition, and elaborate phenotypic differentiation into functional, adapted communities. Their interaction with the host's immune system or with therapeutic agents contributes to the complex puzzle that still misses a lot of pieces. In this comprehensive review we aimed to highlight the microbial composition, developmental stages, architecture and properties of medical biofilms, as well as the diagnostic tools used in the management of biofilm related infections. Also, we present recently acquired knowledge on the etiopathogenesis, diagnosis and treatment of four chronic diseases associated with biofilm development in tissues (chronic periodontitis, chronic lung infection in cystic fibrosis, chronic wounds) and artificial substrata (medical devices-related infections).

  13. Medication understanding among patients living with multiple chronic conditions: Implications for patient-reported measures of adherence.

    Science.gov (United States)

    Fredericksen, R J; Gibbons, L; Brown, S; Edwards, T C; Yang, F M; Fitzsimmons, E; Alperovitz-Bichell, K; Godfrey, M; Wang, A; Church, A; Gutierrez, C; Paez, E; Dant, L; Loo, S; Walcott, M; Mugavero, M J; Mayer, K; Mathews, W C; Patrick, D L; Crane, P K; Crane, H M

    2017-06-20

    Low health literacy is associated with poor medication adherence and poor health outcomes. Limited understanding of prescribed medications may decrease validity of patient-reported adherence measures. To assess knowledge of names and purposes of prescribed medications among patients with multiple chronic conditions. Individual interviews were conducted with a convenience sample of patients from six U.S. primary care clinics. Participants (n = 57) were English and/or Spanish-speaking patients prescribed 3+ medications for chronic conditions, for which non-adherence may lead to disability or death. In individual interviews, patients were asked to name their medications, explain the purpose of each, and to explain how they distinguish them from one another. Interviews were audio recorded, transcribed, and coded; coded content was quantified by 1) whether or not the patient could name medications; 2) method of categorizing medications; 3) whether or not the purpose of the medication was understood. Descriptive statistics were compiled using Fisher's exact test to determine the relationship between patient knowledge and medication characteristics. Thirty percent of patients could not name at least one of their medications; 19% did not know their purpose; 30% held misconceptions about the purpose of one or more medications. There was no significant difference in ability to name medications or state their medication's purpose between patients using medi-sets, pre-packaged rolls, or blister packs, and patients who stored pills in their original containers (p = 0.56 and p = 0.73, respectively), or across demographic groups (p = 0.085 to 0.767). Many patients demonstrated difficulty identifying the name and purpose of prescribed medications; this did not differ by demographic group or medication storage type. Patients may benefit from routine review of medications with their provider in order to improve health literacy, outcomes, and patient-reported adherence

  14. Complementary and alternative medical therapy utilization by people with chronic fatiguing illnesses in the United States

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    Jones Ann-Britt

    2007-04-01

    Full Text Available Abstract Background Chronic fatiguing illnesses, including chronic fatigue syndrome (CFS, pose a diagnostic and therapeutic challenge. Previous clinical reports addressed the utilization of health care provided to patients with CFS by a variety of practitioners with other than allopathic training, but did not examine the spectrum of complementary and alternative medicine (CAM therapies used. This study was designed to measure CAM therapy use by persons with fatiguing illnesses in the United States population. Methods During a random-digit dialing survey to estimate the prevalence of CFS-like illness in urban and rural populations from different geographic regions of the United States, we queried the utilization of CAM including manipulation or body-based therapies, alternative medical systems, mind-body, biologically-based, and energy modalities. Results Four hundred forty fatigued and 444 non-fatigued persons from 2,728 households completed screening. Fatigued subjects included 53 persons with prolonged fatigue, 338 with chronic fatigue, and 49 with CFS-like illness. Mind-body therapy (primarily personal prayer and prayer by others was the most frequently used CAM across all groups. Among women, there was a significant trend of increasing overall CAM use across all subgroups (p-trend = 0.003. All categories of CAM use were associated with significantly poorer physical health scores, and all but one (alternative medicine systems were associated with significantly poorer mental health scores. People with CFS-like illness were significantly more likely to use body-based therapy (chiropractic and massage than non-fatigued participants (OR = 2.52, CI = 1.32, 4.82. Use of body-based therapies increased significantly in a linear trend across subgroups of non-fatigued, prolonged fatigued, chronic fatigued, and CFS-like subjects (p-trend = 0.002. People with chronic fatigue were also significantly more likely to use body-based therapy (OR = 1.52, CI = 1

  15. Inhaler Costs and Medication Nonadherence Among Seniors With Chronic Pulmonary Disease

    Science.gov (United States)

    Rogers, William H.; Safran, Dana Gelb; Wilson, Ira B.

    2010-01-01

    Background: Chronic pulmonary diseases (CPDs) such as asthma and COPD are associated with particularly high rates of cost-related medication nonadherence (CRN), but the degree to which inhaler costs contribute to this is not known. Here, we examine the relationship between inhaler-specific out-of-pocket costs and CRN in CPD. Methods: Using data obtained in 2006 in a national stratified random sample (N = 16,072) of community-dwelling Medicare beneficiaries aged ≥ 65 years, we used logistic regression to examine the relationship between inhaled medications, various types of out-of-pocket costs, and CRN in persons with CPD. Results: The prevalence of CRN in Medicare recipients with CPD using inhalers was 31%. In multivariate models, the odds that respondents with CPD using inhalers would report CRN was 1.43 (95% CI, 1.21-1.69) compared with respondents without CPD who were not using inhalers. Adjustment for out-of-pocket inhaler costs—but not adjustment for total medication costs or non-inhaler costs—eliminated this excess risk of CRN (OR, 0.95; 95% CI, 0.71-1.28). Patients paying > $20 per month for inhalers were at significantly higher risk for CRN compared with those who had no out-of-pocket inhaler costs. Conclusions: Individuals with CPD and high out-of-pocket inhaler costs are at increased risk for CRN relative to individuals on other medications. Physicians should be aware that inhalers can pose a particularly high risk of medication nonadherence for some patients. PMID:20418367

  16. PRODH mutations and hyperprolinemia in a subset of schizophrenic patients.

    Science.gov (United States)

    Jacquet, Hélène; Raux, Grégory; Thibaut, Florence; Hecketsweiler, Bernadette; Houy, Emmanuelle; Demilly, Caroline; Haouzir, Sadeq; Allio, Gabrielle; Fouldrin, Gael; Drouin, Valérie; Bou, Jacqueline; Petit, Michel; Campion, Dominique; Frébourg, Thierry

    2002-09-15

    The increased prevalence of schizophrenia among patients with the 22q11 interstitial deletion associated with DiGeorge syndrome has suggested the existence of a susceptibility gene for schizophrenia within the DiGeorge syndrome chromosomal region (DGCR) on 22q11. Screening for genomic rearrangements of 23 genes within or at the boundaries of the DGCR in 63 unrelated schizophrenic patients and 68 unaffected controls, using quantitative multiplex PCR of short fluorescent fragments (QMPSF), led us to identify, in a family including two schizophrenic subjects, a heterozygous deletion of the entire PRODH gene encoding proline dehydrogenase. This deletion was associated with hyperprolinemia in the schizophrenic patients. In addition, two heterozygous PRODH missense mutations (L441P and L289M), detected in 3 of 63 schizophrenic patients but in none among 68 controls, were also associated with increased plasma proline levels. Segregation analysis within the two families harboring respectively the PRODH deletion and the L441P mutation showed that the presence of a second PRODH nucleotide variation resulted in higher levels of prolinemia. In two unrelated patients suffering from severe type I hyperprolinemia with neurological manifestations, we identified a homozygous L441P PRODH mutation, associated with a heterozygous R453C substitution in one patient. These observations demonstrate that type I hyperprolinemia is present in a subset of schizophrenic patients, and suggest that the genetic determinism of type I hyperprolinemia is complex, the severity of hyperprolinemia depending on the nature and number of hits affecting the PRODH locus.

  17. STEREOLOGICAL EVALUATION OF BRAIN MAGNETIC RESONANCE IMAGES OF SCHIZOPHRENIC PATIENTS

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    Amani Abdelrazag Elfaki

    2013-11-01

    Full Text Available Advances in neuroimaging have enabled studies of specific neuroanatomical abnormalities with relevance to schizophrenia. This study quantified structural alterations on brain magnetic resonance (MR images of patients with schizophrenia. MR brain imaging was done on 88 control and 57 schizophrenic subjects and Dicom images were analyzed with ImageJ software. The brain volume was estimated with the planimetric stereological technique. The volume fraction of brain structures was also estimated. The results showed that, the mean volume of right, left, and total hemispheres in controls were 551, 550, and 1101 cm³, respectively. The mean volumes of right, left, and total hemispheres in schizophrenics were 513, 512, and 1026 cm³, respectively. The schizophrenics’ brains were smaller than the controls (p < 0.05. The mean volume of total white matter of controls (516 cm³ was bigger than the schizophrenics’ volume (451 cm³, (p < 0.05. The volume fraction of total white matter was also lower in schizophrenics (p < 0.05. Volume fraction of the lateral ventricles was higher in schizophrenics (p < 0.05. According to the findings, the volumes of schizophrenics’ brain were smaller than the controls and the volume fractional changes in schizophrenics showed sex dependent differences. We conclude that stereological analysis of MR brain images is useful for quantifying schizophrenia related structural changes.

  18. "I'm just not that sick": pain medication and identity in Mexican American women with chronic pain.

    Science.gov (United States)

    Monsivais, Diane B; Engebretson, Joan C

    2012-09-01

    To describe the beliefs and attitudes about self-identity and pain medication in a sample of Mexican American women with chronic pain living in the El Paso, Texas, area. The findings are drawn from a larger qualitative study of 15 women describing the expression and communication of chronic pain symptoms, pain-related cultural beliefs, decision making, and treatment preferences of chronic pain. Participants who had chronic pain syndromes for at least 1 year were recruited from a pain clinic and fibromyalgia support group. In-depth, open-ended interviews, fieldwork, and participant observation were used to gather information using a focused clinical ethnographic approach. Interviews were audiotaped and transcribed verbatim. A shared central theme was controlling the use of pain medications to control perceived negative associations with pain medication. The negative associations resulted in women rejecting use of medication to preserve their legitimate identity. This perception can be destructive and can lead to poor pain control. Providing patients with anticipatory guidance about common barriers to taking pain medication may allow medication use consistent with improved pain control.

  19. Oral inflammation and infection, and chronic medical diseases: implications for the elderly.

    Science.gov (United States)

    Scannapieco, Frank A; Cantos, Albert

    2016-10-01

    Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.

  20. The contribution of negative reproductive experiences and chronic medical conditions to depression and pain among Israeli women.

    Science.gov (United States)

    Sarid, Orly; Segal-Engelchin, Dorit; Cwikel, Julie

    2012-01-01

    This study of 302 Israeli women sought to investigate the associations among stressful reproductive experiences (e.g. fertility problems, abortions, and traumatic births), chronic medical conditions, pain, and depression. The specific aims of the study were to examine (1) the effect of stressful reproductive experiences, chronic medical conditions, and pain on depressive symptoms and (2) the effect of stressful reproductive experiences, chronic medical conditions, and depressive symptoms on pain. Our findings corroborate with previous studies demonstrating that depression and pain are two interrelated, but different phenomena, which have both common and distinct risk factors. The findings are discussed in the light of stress and adaptation theories that point to the long-term effects of stressful life events on emotional and physiological aspects such as depression and pain.

  1. Chronic inflammatory diseases are stimulated by current lifestyle: how diet, stress levels and medication prevent our body from recovering

    Directory of Open Access Journals (Sweden)

    Bosma-den Boer Margarethe M

    2012-04-01

    Full Text Available Abstract Serhan and colleagues introduced the term "Resoleomics" in 1996 as the process of inflammation resolution. The major discovery of Serhan's work is that onset to conclusion of an inflammation is a controlled process of the immune system (IS and not simply the consequence of an extinguished or "exhausted" immune reaction. Resoleomics can be considered as the evolutionary mechanism of restoring homeostatic balances after injury, inflammation and infection. Under normal circumstances, Resoleomics should be able to conclude inflammatory responses. Considering the modern pandemic increase of chronic medical and psychiatric illnesses involving chronic inflammation, it has become apparent that Resoleomics is not fulfilling its potential resolving capacity. We suggest that recent drastic changes in lifestyle, including diet and psycho-emotional stress, are responsible for inflammation and for disturbances in Resoleomics. In addition, current interventions, like chronic use of anti-inflammatory medication, suppress Resoleomics. These new lifestyle factors, including the use of medication, should be considered health hazards, as they are capable of long-term or chronic activation of the central stress axes. The IS is designed to produce solutions for fast, intensive hazards, not to cope with long-term, chronic stimulation. The never-ending stress factors of recent lifestyle changes have pushed the IS and the central stress system into a constant state of activity, leading to chronically unresolved inflammation and increased vulnerability for chronic disease. Our hypothesis is that modern diet, increased psycho-emotional stress and chronic use of anti-inflammatory medication disrupt the natural process of inflammation resolution ie Resoleomics.

  2. ENDOSCOPIC AND HISTOPATHOLOGIC CHANGES IN CHILDREN WITH CHRONIC DYSPEPSIA IN A RURAL MEDICAL COLLEGE HOSPITAL IN MELMARUVATHUR- TAMILNADU

    OpenAIRE

    Padma K; Sumathi S.; Dinakaran Nagendram; Kannan C

    2016-01-01

    INTRODUCTION Chronic pain abdomen and dyspepsia is the most common presenting symptoms in the Paediatric Outpatient Department (OPD) after respiratory illnesses. It is increasing alarmingly both in the paediatric and adult population. We, therefore carried out a cross-sectional study among children with chronic dyspepsia aged between 5 to 15 years attending Paediatric OPD in a rural medical college hospital, Melmaruvathur, Tamilnadu, South India. OBJECTIVE To evaluate the ga...

  3. Quantification of endocannabinoids in postmortem brain of schizophrenic subjects.

    Science.gov (United States)

    Muguruza, Carolina; Lehtonen, Marko; Aaltonen, Niina; Morentin, Benito; Meana, J Javier; Callado, Luis F

    2013-08-01

    Numerous studies have implicated the endocannabinoid system in the pathophysiology of schizophrenia. Endocannabinoids have been measured in blood and cerebrospinal fluid in schizophrenic patients but, to the date, there are no published reports dealing with measurements of endocannabinoid levels in schizophrenics' brain tissue. In the present study, postmortem brain samples from 19 subjects diagnosed with schizophrenia (DSM-IV) and 19 matched controls were studied. In specific brain regions, levels of four endocannabinoids (2-arachidonoylglycerol (2-AG), arachidonoylethanolamine (anandamide, AEA), dihomo-γ-linolenoylethanolamine (LEA), and docosahexaenoylethanolamine (DHEA)) and two cannabimimetic compounds (palmitoyl-ethanolamine (PEA) and oleoyl-ethanolamine (OEA)) were measured using quantitative liquid chromatography with triple quadrupole mass spectrometric detection. Suffering from schizophrenia significantly affects the brain levels of 2-AG (pendocannabinoids in different brain regions of schizophrenic subjects. Furthermore, these data evidence the involvement of the endocannabinoid system in the pathophysiology of schizophrenia.

  4. Comparative study on medical utilization and costs of chronic obstructive pulmonary disease with good lung function

    Directory of Open Access Journals (Sweden)

    Lim JU

    2017-09-01

    Full Text Available Jeong Uk Lim,1 Kyungjoo Kim,2 Sang Hyun Kim,3 Myung Goo Lee,4 Sang Yeub Lee,5 Kwang Ha Yoo,6 Sang Haak Lee,1 Ki-Suck Jung,7 Chin Kook Rhee,2 Yong Il Hwang7 1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul’s Hospital, 2Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 3Big Data Division, Health Insurance Review and Assessment Service, Wonju, 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, 5Department of Internal Medicine, Korea University, Anam Hospital, 6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Republic of Korea Introduction: Patients with mild to moderate chronic obstructive pulmonary disease (COPD are underdiagnosed and undertreated due to the asymptomatic nature of the disease. Previous studies on patients with mild COPD have focused on symptomatic patients. Therefore, in this study, we evaluated the treatment status of patients with early COPD in Korea.Materials and methods: We compared hospital visits, medical costs per person, and COPD medication use by patients with COPD screened from the general population and COPD cohort patients. Patients with COPD aged ≥40 years with the value of forced expiratory volume in 1 s (FEV1 ≥60% were selected from the 2007 to 2012 Korea National Health and Nutrition Examination Survey (KNHANES data. Data including the number of outpatient clinic visits, admission to hospitals, COPD-related medications, and medical

  5. The cross-sectional GRAS sample: A comprehensive phenotypical data collection of schizophrenic patients

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    Oestereich Cornelia

    2010-11-01

    Full Text Available Abstract Background Schizophrenia is the collective term for an exclusively clinically diagnosed, heterogeneous group of mental disorders with still obscure biological roots. Based on the assumption that valuable information about relevant genetic and environmental disease mechanisms can be obtained by association studies on patient cohorts of ≥ 1000 patients, if performed on detailed clinical datasets and quantifiable biological readouts, we generated a new schizophrenia data base, the GRAS (Göttingen Research Association for Schizophrenia data collection. GRAS is the necessary ground to study genetic causes of the schizophrenic phenotype in a 'phenotype-based genetic association study' (PGAS. This approach is different from and complementary to the genome-wide association studies (GWAS on schizophrenia. Methods For this purpose, 1085 patients were recruited between 2005 and 2010 by an invariable team of traveling investigators in a cross-sectional field study that comprised 23 German psychiatric hospitals. Additionally, chart records and discharge letters of all patients were collected. Results The corresponding dataset extracted and presented in form of an overview here, comprises biographic information, disease history, medication including side effects, and results of comprehensive cross-sectional psychopathological, neuropsychological, and neurological examinations. With >3000 data points per schizophrenic subject, this data base of living patients, who are also accessible for follow-up studies, provides a wide-ranging and standardized phenotype characterization of as yet unprecedented detail. Conclusions The GRAS data base will serve as prerequisite for PGAS, a novel approach to better understanding 'the schizophrenias' through exploring the contribution of genetic variation to the schizophrenic phenotypes.

  6. Refraction and eye anterior segment parameters in schizophrenic patients

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    Tongabay Cumurcu

    2015-06-01

    Full Text Available ABSTRACT Purpose: To evaluate the difference in terms of refractive errors and anterior segment parameters between schizophrenic patients and healthy volunteers. Methods: This study compared 70 patients (48 men who were diagnosed with schizophrenia with a control group of 60 (35 men who were similar in terms of age, gender, education, and socioeconomic level. Anterior segment examination was performed using a Scheimflug system. Axial length and lens thickness (LT were measured using optic biometry. The following tests were administered to the psychiatric patient group: Brief Psychiatric Rating Scale (BPRS, Scale for the Assessment of Negative Symptoms (SANS, and Scale for the Assessment of Positive Symptoms (SAPS. Results: Mild myopia was detected in both the schizophrenic and control groups, with no statistically significant difference (p>0.005. Corneal volume (CV, anterior chamber volume (ACV, anterior chamber depth (ACD, and central corneal thickness (CCT values were lower in the schizophrenic group, and there was a statistically significant between-group difference (p=0.026, p=0.014, p=0.048, and p=0.005, respectively. LT was greater in schizophrenics, and the difference was found to be statistically significant (p=0.006. A statistically significant negative correlation was found between SAPS and cylinder values (p=0.008. The axial eye length, cylinder value, pupil diameter, mean keratometric value, and anterior chamber angle revealed no statistically significant difference between the groups (p>0.05. Conclusion: No statistically significant difference was detected in terms of refraction disorders between schizophrenics and the healthy control group, while some differences in anterior chamber parameters were present. These results demonstrate that schizophrenics may exhibit clinical and structural differences in the eye.

  7. Medical Nutrition Therapy based on Nutrition Intervention for a Patient with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Seo, Seung Hee

    2014-07-01

    Chronic obstructive pulmonary disease (COPD) is a major cause of disability, and according to statistics from the World Health Organization, COPD is the fourth leading cause of death overall in the face of decades, and expected to be increased. In 2005, the reported prevalence of COPD in Korea was 17.2% of adults over the age of 45. Malnutrition is a common problem in papatients with COPD. And several nutritional intervention studies showed a significant improvement in physical and functional outcomes. According to the results of previous studies, the nutritional support is important. This is a case report of a patient with COPD who was introduced to a proper diet through nutrition education based on the medical nutrition therapy protocol for COPD.

  8. Vaccination of adolescents with chronic medical conditions: Special considerations and strategies for enhancing uptake

    Science.gov (United States)

    Hofstetter, Annika M; LaRussa, Philip; Rosenthal, Susan L

    2015-01-01

    Adolescents with chronic medical conditions (CMCs), a growing population worldwide, possess a wide array of preventive health care needs. Vaccination is strongly recommended for the vast majority of these adolescents given their increased risk of vaccine preventable infection and associated complications. Not only should they receive routine vaccines, but some also require additional vaccines. Despite these guidelines, evidence suggests that adolescents with CMCs often fail to receive needed vaccines. Many factors contribute to this under-immunization, including lack of knowledge among parents and providers and suboptimal coordination of primary and subspecialty care. This review describes current vaccination recommendations for these adolescents as well as recent data related to infection risk, vaccine efficacy and safety, vaccination coverage, and the unique multilevel factors impacting uptake in this population. It also discusses strategies for improving coverage levels and reducing missed vaccination opportunities, with a particular focus on technology-based interventions. PMID:26212313

  9. Serotonin function in schizophrenia: effects of meta-chlorophenylpiperazine in schizophrenic patients and healthy subjects.

    Science.gov (United States)

    Kahn, R S; Siever, L J; Gabriel, S; Amin, F; Stern, R G; DuMont, K; Apter, S; Davidson, M

    1992-07-01

    This study examined serotonin (5-hydroxytryptamine; 5HT) receptor responsivity in 22 chronic schizophrenic patients and 17 healthy control subjects. The 5HT agonist meta-chlorophenylpiperazine (MCPP) was used as a probe of serotonergic function. MCPP (0.35 mg/kg) or placebo was administered orally after a 3-week drug-free period in a randomized double-blind design. Hormonal (adrenocorticotropic hormone and prolactin), temperature, and behavioral responses and MCPP blood levels were assessed for 210 minutes after administration of the capsules. The schizophrenic patients had blunted temperature responses compared with those of the healthy control subjects: MCPP raised body temperature in the control subjects, but not in the patients. Behavioral responses also differed in the two groups: MCPP increased the total Brief Psychiatric Rating Scale (BPRS) score in the control subjects and tended to decrease it in the patients. In patients, MCPP decreased the BPRS psychosis subscore. Hormonal responses did not differ significantly in the two groups. These findings suggest that further exploration of 5HT function in schizophrenia is warranted.

  10. Chronic Medical Conditions and Negative Affect; Racial Variation in Reciprocal Associations

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    Shervin Assari

    2016-08-01

    Full Text Available Background: Black-White health paradox can be defined as a lower frequency of depression despite a higher prevalence of economic and social adversities as well as chronic medical conditions (CMC among American Blacks compared to American Whites. Based on this paradox, the CMC - depressive symptoms link is expected to be weaker among Blacks and Whites. We conducted a 10 year longitudinal study to compare Blacks and Whites for bidirectional associations between number of CMC and negative affect.Methods: We used data from the MIDUS (Midlife in the United States, a nationally representative longitudinal study of American adults. A total number of 7,108 individuals with age range 25 to 75 (N = 7,108 were followed for 10 years from 1995 to 2004. Age, gender, and socioeconomic status (education and income measured at baseline were controls. Negative affect and chronic medical conditions were measured at baseline and end of follow up. Race was the moderator. Linear regression analysis was used to test the moderating effect of race on the reciprocal associations between CMC and negative affect, net of covariates.Results: In the pooled sample, while baseline CMC was predictive of an increase in negative affect over time, baseline negative affect was also predictive of an increase in CMC. We found interactions between race and baseline CMC on change in depressive symptoms, as well as race with negative affect on CMC change. Conclusion: Blacks and Whites differ in reciprocal links between CMC and negative affect over time. This finding replicates recent studies on differential links between psychosocial outcomes and physical health based on race. Findings may help us better understand how Black - White health paradox develops across mid and later life.

  11. [Social inequality as a predictor of occupational reintegration of chronic back pain patients following medical rehabilitation].

    Science.gov (United States)

    Hofreuter, K; Koch, U; Morfeld, M

    2008-03-01

    The question of which factors influence return to work following medical rehabilitative measures in the case of chronic back pain is, in a social political context, of international significance. While psychosocial, socio-economic and demographic factors as well as subjective perceptions of working conditions are individually discussed, the role of social inequality has thus far received little attention. The present paper focuses on the occupational reintegration of patients with chronic dorsopathies following a medical rehabilitative intervention and aims to investigate the influence of predictor variables on successful reintegration. The re-analysis conducted was based on a three-year prospective controlled intervention study with three measurement sessions. The study comprised a sample of 289 patients aged 20 to 64 years who had undergone first-time intervertebral disc operations in the lumbar spine region. Data were collected between March 2002 and February 2005 using a standardized written questionnaire. Winkler's (1998) composite index comprising indicators of occupational position, income and education was employed as a measure of social inequality. Age and sex were also included as independent variables in a binary logistic regression analysis. Of individuals undergoing rehabilitation, those from lower social classes returned to work later than those from higher social classes. Age and sex did not prove to be significant predictors of successful return to work. The probability of successful reintegration into working life increases according to the position within the vertical structure of social class. In light of this result, it can be assumed that not only differential allocation of patients to rehabilitation interventions but also the specific contents of these interventions should be modeled on the basis of economic criteria.

  12. [Three-Dimensional Ultrasonic Gait Analysis in Schizophrenic Patients

    Science.gov (United States)

    Putzhammer, Albert; Heindl, Bernhard; Müller, Jürgen; Broll, Karin; Pfeiff, Liane; Perfahl, Maria; Hess, Linda; Koch, Horst

    2003-05-01

    Schizophrenic disorders as well as neuroleptic treatment can affect locomotion. The study assessed the influence of neuroleptic treatment on human gait via ultrasonic topometric gait analysis. In a control sample the test system proved high test-retest-reliability. Spatial and temporal gait parameters were assessed in schizophrenic patients without neuroleptic treatment (n = 12) and under treatment with conventional neuroleptics (n = 14) and re-assessed after treatment change to the atypical neuroleptic olanzapine in a repeated measures design. After switch from conventional neuroleptics to olanzapine patients showed an increase of gait velocity (p step length (p gait analysis.

  13. MODELING CHRONIC DISEASE PATIENT FLOWS DIVERTED FROM EMERGENCY DEPARTMENTS TO PATIENT-CENTERED MEDICAL HOMES.

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua; Kumar, Sameer; Britton, Bruce

    Chronic Disease is defined as a long lasting health condition, which can develop and/or worsen over an extended time, but which can also be controlled. The monetary and budgetary toll due to its persistent nature has become unsustainable and requires pressing actions to limit their incidence and burden. This paper demonstrates the utility of the System Dynamics approach to simulate the behavior of key factors involved in the implementation of chronic disease management. We model the patient flow diversion from emergency departments (ED) to patient-centered medical homes (PCMH), with emphasis on the visit rates, as well as the effect of insurance coverage, in an effort to assure continuity of quality care for Asthma patients at lower costs. The model is used as an evaluative method to identify conditions of a maintained health status through adequate policy planning, in terms of resources and capacity. This approach gives decision makers the ability to track the level of implementation of the intervention and generate knowledge about dynamics between population demands and the intervention effectiveness. The functionality of the model is demonstrated through the consideration of hypothetical scenarios executed using sensitivity analysis.

  14. Chronic Disease Management Strategies of Early Childhood Caries: Support from the Medical and Dental Literature.

    Science.gov (United States)

    Edelstein, Burton L; Ng, Man Wai

    2015-01-01

    An Institute of Medicine report places chronic disease management (CDM) as an intervention on a treatment spectrum between prevention and acute care. CDM commonly focuses on conditions in which patient self-care efforts are significant. Framing early childhood caries (ECC) as such a chronic condition invites dentistry to reconsider its approach to caries management and shift gears from a strictly surgical approach to one that also incorporates a medical approach. This paper's purpose was to explore the definition of and concepts inherent in CDM. An explanatory model is introduced to describe the multiple factors that influence ECC-CDM strategies. Reviewed literature suggests that early evidence from ECC-CDM interventions, along with results of pediatric asthma and diabetes CDM, supports CDM of ECC as a valid approach that is independent of both prevention and repair. Early results of ECC-CDM endeavors have demonstrated a reduction in rates of new cavitation, dental pain, and referral to the operating room compared to baseline rates. ECC-CDM strategies hold strong promise to curtail caries activity while complementing dental repair when needed, thereby reducing disease progression and cavity recurrence. Institutionalizing ECC-CDM will both require and benefit from evolving health care delivery and financing systems that reward positive health outcomes.

  15. Models of care for late-life depression of the medically ill: examples from chronic obstructive pulmonary disease and stroke.

    Science.gov (United States)

    Avari, Jimmy N; Alexopoulos, George S

    2015-05-01

    Depression worsens most treatment outcomes in medically ill older adults. Chronic medical illnesses weaken and demoralize patients and compromise their ability to adhere to treatments requiring consistency and effort. Acute medical illnesses create a psychosocial storm that finds patients and their ecosystem unprepared. We describe two intervention models that can be used to target and personalize treatment in depressed, chronically, or acutely medically ill older adults. The Personalized Adherence Intervention for Depression and COPD (PID-C) is a model intervention for depressed patients with chronic medical illnesses. It targets patient-specific barriers to treatment engagement and aims to shift the balance in favor of treatment participation. PID-C led to higher remission rates of depression, reduction in depressive symptoms, and reduction in dyspnea-related disability. The addition of problem-solving training enables patients to use resources available to them and hopefully improve their outcomes. Ecosystem-focused therapy (EFT) is a model intervention for depression developing in the context of an acute medical event. It was developed for patients with poststroke depression (PSD) and targets five areas, part of the "psychosocial storm" originating from the patient's sudden disability and the resulting change in the patient's needs and family's life. A preliminary study suggests that EFT is feasible and efficacious in reducing depressive symptoms and signs and disability in PSD.

  16. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis.

    Science.gov (United States)

    Hoffmeister, A; Mayerle, J; Beglinger, C; Büchler, M W; Bufler, P; Dathe, K; Fölsch, U R; Friess, H; Izbicki, J; Kahl, S; Klar, E; Keller, J; Knoefel, W T; Layer, P; Loehr, M; Meier, R; Riemann, J F; Rünzi, M; Schmid, R M; Schreyer, A; Tribl, B; Werner, J; Witt, H; Mössner, J; Lerch, M M

    2015-12-01

    Chronic pancreatitis is a disease of the pancreas in which recurrent inflammatory episodes result in replacement of pancreatic parenchyma by fibrous connective tissue. This fibrotic reorganization of the pancreas leads to a progressive exocrine and endocrine pancreatic insufficiency. In addition, characteristic complications arise, such as pseudocysts, pancreatic duct obstructions, duodenal obstruction, vascular complications, obstruction of the bile ducts, malnutrition and pain syndrome. Pain presents as the main symptom of patients with chronic pancreatitis. Chronic pancreatitis is a risk factor for pancreatic carcinoma. Chronic pancreatitis significantly reduces the quality of life and the life expectancy of affected patients. These guidelines were researched and compiled by 74 representatives from 11 learned societies and their intention is to serve evidence-based professional training as well as continuing education. On this basis they shall improve the medical care of affected patients in both the inpatient and outpatient sector. Chronic pancreatitis requires an adequate diagnostic workup and systematic management, given its severity, frequency, chronicity, and negative impact on the quality of life and life expectancy.

  17. Multipayer patient-centered medical home implementation guided by the chronic care model.

    Science.gov (United States)

    Gabbay, Robert A; Bailit, Michael H; Mauger, David T; Wagner, Edward H; Siminerio, Linda

    2011-06-01

    A unique statewide multipayer ini Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) guided by the Chronic Care Model (CCM) with diabetes as an initial target disease. This project represents the first broad-scale CCM implementation with payment reform across a diverse range of practice organizations and one of the largest PCMH multipayer initiatives. Practices implemented the CCM and PCMH through regional Breakthrough Series learning collaboratives, supported by Improving Performance in Practice (IPIP) practice coaches, with required monthly quality reporting enhanced by multipayer infrastructure payments. Some 105 practices, representing 382 primary care providers, were engaged in the four regional collaboratives. The practices from the Southeast region of Pennsylvania focused on diabetes patients (n = 10,016). During the first intervention year (May 2008-May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients. Transforming primary care delivery through implementation of the PCMH and CCM supported by multipayer infrastructure payments holds significant promise to improve diabetes care.

  18. Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital.

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    Lauren Lapointe-Shaw

    Full Text Available BACKGROUND: Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices. METHODS: We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI, angiotensin-converting enzyme (ACE inhibitor or angiotensin receptor blocker (ARB following hospital admission from April 1(st 2008-March 31(st 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class. RESULTS: The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47% for PPIs, $162 thousand (17% for ACE inhibitors and $14 thousand (4% for ARBs over the year following discharge. INTERPRETATION: In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.

  19. "Schizophrenic"嵌段共聚物多重胶束化的研究%Schizophrenic Micellization of Block Copolymers

    Institute of Scientific and Technical Information of China (English)

    张晓晖; 艾长军; 马敬红; 徐坚

    2011-01-01

    The schizophrenic micellization of block copolymers who can self-assembled into well-defined structures in aqueous solution in response to specific stimuli such as temperature, pH, ionic strength and light has draw much attention due to the attractive protential applications. A typical case in this new sub-field involved environmental-sensitive AB diblock copolymer synthesized by group transfer polymerization (GTP) or living radical polymerisation (ATRP or RAFT), allowing the formation of two distinct types of micelle structures ( A-core / Bcorona and B-core / A-corona structures) in response to external stimuli and the two structures can be reversibly converted into each other. This remarkable property was introduced by Armes and coworkers for ‘ smart' pHdependent micelles of poly [ 2- (diethylamino) ethyl methacrylate ] -block- poly [ 2- (N-morpholino) ethyl methacrylate]. Recent progress in synthesis and environmental-induced schizophrenic micellization of block copolymers,the morphology of aggregations self-assembled from schizophrenic block copolymers and fixed structure of micelles by crosslinker have been reviewed. Technical problems in synthesis and characterization of schizophrenic micellization are also discussed, including 1H-NMR spectra, zeta potential, light scattering, transmittance of the solution and stopped-flow spectrophotometric techniques. Furthermore, the problems in schizophrenic micellization those still should be resolved are pointed out ,and the direction of this research field is discussed.%在不同环境刺激下自组装形成多重胶束的"schizophrenic"嵌段共聚物由于诱人的潜在应用而引起广泛的关注.本文综述了各种刺激诱导形成多重胶束的"schizophrenic"嵌段共聚物研究情况,介绍了多重胶束化不同形态的影响因素和胶束稳定方面的进展.并对"schizophrenic"嵌段共聚物的合成与表征技巧进行了总结,最后讨论了当前研究中仍需解决的问题,并对其应用前景做了展望.

  20. Anti-hypertensive medications and cardiovascular events in older adults with multiple chronic conditions.

    Science.gov (United States)

    Tinetti, Mary E; Han, Ling; McAvay, Gail J; Lee, David S H; Peduzzi, Peter; Dodson, John A; Gross, Cary P; Zhou, Bingqing; Lin, Haiqun

    2014-01-01

    Randomized trials of anti-hypertensive treatment demonstrating reduced risk of cardiovascular events in older adults included participants with less comorbidity than clinical populations. Whether these results generalize to all older adults, most of whom have multiple chronic conditions, is uncertain. To determine the association between anti-hypertensive medications and CV events and mortality in a nationally representative population of older adults. Competing risk analysis with propensity score adjustment and matching in the Medicare Current Beneficiary Survey cohort over three-year follow-up through 2010. 4,961 community-living participants with hypertension. Anti-hypertensive medication intensity, based on standardized daily dose for each anti-hypertensive medication class participants used. Cardiovascular events (myocardial infarction, unstable angina, cardiac revascularization, stroke, and hospitalizations for heart failure) and mortality. Of 4,961 participants, 14.1% received no anti-hypertensives; 54.6% received moderate, and 31.3% received high, anti-hypertensive intensity. During follow-up, 1,247 participants (25.1%) experienced cardiovascular events; 837 participants (16.9%) died. Of deaths, 430 (51.4%) occurred in participants who experienced cardiovascular events during follow-up. In the propensity score adjusted cohort, after adjusting for propensity score and other covariates, neither moderate (adjusted hazard ratio, 1.08 [95% CI, 0.89-1.32]) nor high (1.16 [0.94-1.43]) anti-hypertensive intensity was associated with experiencing cardiovascular events. The hazard ratio for death among all participants was 0.79 [0.65-0.97] in the moderate, and 0.72 [0.58-0.91] in the high intensity groups compared with those receiving no anti-hypertensives. Among participants who experienced cardiovascular events, the hazard ratio for death was 0.65 [0.48-0.87] and 0.58 [0.42-0.80] in the moderate and high intensity groups, respectively. Results were similar in the

  1. Anti-hypertensive medications and cardiovascular events in older adults with multiple chronic conditions.

    Directory of Open Access Journals (Sweden)

    Mary E Tinetti

    Full Text Available Randomized trials of anti-hypertensive treatment demonstrating reduced risk of cardiovascular events in older adults included participants with less comorbidity than clinical populations. Whether these results generalize to all older adults, most of whom have multiple chronic conditions, is uncertain.To determine the association between anti-hypertensive medications and CV events and mortality in a nationally representative population of older adults.Competing risk analysis with propensity score adjustment and matching in the Medicare Current Beneficiary Survey cohort over three-year follow-up through 2010.4,961 community-living participants with hypertension.Anti-hypertensive medication intensity, based on standardized daily dose for each anti-hypertensive medication class participants used.Cardiovascular events (myocardial infarction, unstable angina, cardiac revascularization, stroke, and hospitalizations for heart failure and mortality.Of 4,961 participants, 14.1% received no anti-hypertensives; 54.6% received moderate, and 31.3% received high, anti-hypertensive intensity. During follow-up, 1,247 participants (25.1% experienced cardiovascular events; 837 participants (16.9% died. Of deaths, 430 (51.4% occurred in participants who experienced cardiovascular events during follow-up. In the propensity score adjusted cohort, after adjusting for propensity score and other covariates, neither moderate (adjusted hazard ratio, 1.08 [95% CI, 0.89-1.32] nor high (1.16 [0.94-1.43] anti-hypertensive intensity was associated with experiencing cardiovascular events. The hazard ratio for death among all participants was 0.79 [0.65-0.97] in the moderate, and 0.72 [0.58-0.91] in the high intensity groups compared with those receiving no anti-hypertensives. Among participants who experienced cardiovascular events, the hazard ratio for death was 0.65 [0.48-0.87] and 0.58 [0.42-0.80] in the moderate and high intensity groups, respectively. Results were similar

  2. Psychosocial predictors of non-adherence to chronic medication: systematic review of longitudinal studies

    Science.gov (United States)

    Zwikker, Hanneke E; van den Bemt, Bart J; Vriezekolk, Johanna E; van den Ende, Cornelia H; van Dulmen, Sandra

    2014-01-01

    Objectives Several cross-sectional studies suggest that psychosocial factors are associated with non-adherence to chronic preventive maintenance medication (CPMM); however, results from longitudinal associations have not yet been systematically summarized. Therefore, the objective of this study was to systematically synthesize evidence of longitudinal associations between psychosocial predictors and CPMM non-adherence. Materials and methods PUBMED, EMBASE, CINAHL, and PsychINFO databases were searched for studies meeting our inclusion criteria. The reference lists and the ISI Web of Knowledge of the included studies were checked. Studies were included if they had an English abstract, involved adult populations using CPMM living in Western countries, and if they investigated associations between psychosocial predictors and medication non-adherence using longitudinal designs. Data were extracted according to a literature-based extraction form. Study quality was independently judged by two researchers using a framework comprising six bias domains. Studies were considered to be of high quality if ≥four domains were free of bias. Psychosocial predictors for non-adherence were categorized into five pre-defined categories: beliefs/cognitions; coping styles; social influences and social support; personality traits; and psychosocial well-being. A qualitative best evidence synthesis was performed to synthesize evidence of longitudinal associations between psychosocial predictors and CPMM non-adherence. Results Of 4,732 initially-identified studies, 30 (low-quality) studies were included in the systematic review. The qualitative best evidence synthesis demonstrated limited evidence for absence of a longitudinal association between CPMM non-adherence and the psychosocial categories. The strength of evidence for the review’s findings is limited by the low quality of included studies. Conclusion The results do not provide psychosocial targets for the development of new

  3. Recommendations for the medical management of chronic venous disease: The role of Micronized Purified Flavanoid Fraction (MPFF).

    Science.gov (United States)

    Bush, Ronald; Comerota, Anthony; Meissner, Mark; Raffetto, Joseph D; Hahn, Steven R; Freeman, Katherine

    2017-04-01

    Scope A systematic review of the clinical literature concerning medical management of chronic venous disease with the venoactive therapy Micronized Purified Flavonoid Fraction was conducted in addition to an investigation of the hemodynamics and mechanism of chronic venous disease. Methods The systematic review of the literature focused on the use of Micronized Purified Flavonoid Fraction (diosmin) which has recently become available in the US, in the management of chronic venous disease. The primary goal was to assess the level of evidence of the role of Micronized Purified Flavonoid Fraction in the healing of ulcers, and secondarily on the improvement of the symptoms of chronic venous disease such as edema. An initial search of Medline, Cochrane Database for Systematic Reviews and Google Scholar databases was conducted. The references of articles obtained in the primary search, including a Cochrane review of phlebotonics for venous insufficiency, were reviewed for additional studies. Studies were included if patients had a diagnosis of chronic venous disease documented with Doppler and Impedance Plethysmography. Studies excluded were those that had patients with arterial insufficiency (Ankle Brachial Index chronic venous disease patients because of its favorable safety profile. The Working Group for chronic venous disease concurs with previous guidance by the International European Society for Vascular Surgery in 2015 which recommended the use of Micronized Purified Flavonoid Fraction for the healing of venous ulcers, alone and adjunctive to compression therapy, and for the reduction in symptoms of chronic venous disease such as edema.

  4. Predicting declines in physical function in persons with multiple chronic medical conditions: What we can learn from the medical problem list

    Directory of Open Access Journals (Sweden)

    Bayliss Martha S

    2004-09-01

    Full Text Available Abstract Background Primary care physicians are caring for increasing numbers of persons with comorbid chronic illness. Longitudinal information on health outcomes associated with specific chronic conditions may be particularly relevant in caring for these populations. Our objective was to assess the effect of certain comorbid conditions on physical well being over time in a population of persons with chronic medical conditions; and to compare these effects to that of hypertension alone. Methods We conducted a secondary analysis of 4-year longitudinal data from the Medical Outcomes Study. A heterogeneous population of 1574 patients with either hypertension alone (referent or one or more of the following conditions: diabetes, coronary artery disease, congestive heart failure, respiratory illness, musculoskeletal conditions and/or depression were recruited from primary and specialty (endocrinology, cardiology or mental health practices within HMO and fee-for-service settings in three U.S. cities. We measured categorical change (worse vs. same/better in the SF-36® Health Survey physical component summary score (PCS over 4 years. We used logistic regression analysis to determine significant differences in longitudinal change in PCS between patients with hypertension alone and those with other comorbid conditions and linear regression analysis to assess the contribution of the explanatory variables. Results Specific diagnoses of CHF, diabetes and/or chronic respiratory disease; or 4 or more chronic conditions, were predictive of a clinically significant decline in PCS. Conclusions Clinical recognition of these specific chronic conditions or 4 or more of a list of chronic conditions may provide an opportunity for proactive clinical decision making to maximize physical functioning in these populations.

  5. Obstetrical complications and trail making deficits discriminate schizophrenics from unaffected siblings and controls.

    Science.gov (United States)

    Kinney, D K; Yurgelun-Todd, D A; Waternaux, C M; Matthysse, S

    1994-04-01

    Numerous studies have reported that both obstetrical complications (OCs) and deficits on the Trail Making Test show elevated prevalences in schizophrenics. Trail Making deficits have also been reported to be more common in schizophrenics' relatives than in controls, suggesting poor Trail Making performance may be a behavioral indicator of a familial risk factor for schizophrenia. Few studies, however, have investigated how these two variables co-vary in samples of schizophrenics and non-schizophrenics. In this study, DSM-III-R diagnoses, OCs noted in birth records, and Trail Making performance were independently assessed in 30 subjects: 9 schizophrenics, 8 of their non-schizophrenic siblings, and 13 comparison subjects with neither a personal nor a family history of schizophrenia. Results supported two key predictions of a two-factor etiologic model of schizophrenia: (a) the combination of perinatal OCs and poor Trail Making performance discriminated schizophrenics extremely well from non-schizophrenics, including their own non-schizophrenic sibs, and (b) perinatal OCs and Trail Making errors manifested a significant inverse association among schizophrenics' non-schizophrenic sibs, but not among other subjects.

  6. Inappropriateness of medication prescriptions about chronic kidney disease patients without dialysis therapy in a Chinese tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Yang P

    2016-10-01

    Full Text Available Ping Yang, Na Chen, Rong-Rong Wang, Lu Li, Sai-Ping Jiang Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China Background: With the increasing incidence rate of chronic kidney disease (CKD, inappropriate use of medicine in CKD patients is an important issue, as it may cause adverse effects in patients and progression to chronic renal failure.Objective: The aim of this study is to assess the frequency of inappropriate medicine use among CKD patients.Methods: A cross-sectional study was conducted from November 1 to December 1, 2014 in a Chinese teaching tertiary hospital. All medication prescriptions for CKD patients with serum creatinine level above normal value were enrolled. The prescriptions, including unreasonable dosage, contraindicated, and cautiously used medicines in CKD patients, were evaluated and the related medications were also analyzed and classified.Results: Two hundred and two patients were included, and a total of 1,733 lines of medication prescriptions were evaluated. The prevalence of inappropriate medication prescriptions in CKD patients was 15.18%, of which, unreasonable dosage (n=56, contraindicated (n=46, and cautiously used medicines (n=161 accounted for 3.23%, 2.65%, and 9.29%, respectively. Spearman’s rank correlation coefficient implied that there was a significant correlation between the severity of renal insufficiency and frequency of inappropriate medication prescriptions (P=0.02, r=0.056. Among the inappropriate medication prescriptions, nutraceutical and electrolytes (n=65, 24.71%, cardiovascular drugs (n=61, 23.19%, and antimicrobial drugs (n=55, 20.91% represented the top three medicine categories in CKD patients.Conclusion: The study confirmed that inappropriate medication prescriptions were prevalent in CKD patients. Improving the quality of medication prescriptions in CKD patients is necessary. Keywords: inappropriateness of

  7. The Interface between Substance Abuse and Chronic Pain Management in Primary Care: A Curriculum for Medical Residents

    Science.gov (United States)

    Gunderson, Erik W.; Coffin, Phillip O.; Chang, Nancy; Polydorou, Soteri; Levin, Frances R.

    2009-01-01

    Objectives: To develop and assess a housestaff curriculum on opioid and other substance abuse among patients with chronic noncancer pain (CNCP). Methods: The two-hour, case-based curriculum delivered to small groups of medical housestaff sought to improve assessment and management of opioid-treated CNCP patients, including those with a substance…

  8. Diet and Exercise Adherence and Practices among Medically Underserved Patients with Chronic Disease: Variation across Four Ethnic Groups

    Science.gov (United States)

    Orzech, Kathryn M.; Vivian, James; Huebner Torres, Cristina; Armin, Julie; Shaw, Susan J.

    2013-01-01

    Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative ("n" = 71) and quantitative ("n" = 297) data collected in a 4-year, multimethod study…

  9. Medication overuse headache and chronic migraine in a specialized headache centre: field-testing proposed new appendix criteria

    DEFF Research Database (Denmark)

    Zeeberg, P; Olesen, Jes; Jensen, R

    2009-01-01

    The classification subcommittee of the International Headache Society (IHS) has recently suggested revised criteria for medication overuse headache (MOH) and chronic migraine (CM). We field tested these revised criteria by applying them to the headache population at the Danish Headache Centre and...

  10. [Evaluation of use of complementary and alternative medicine by schizophrenic patients].

    Science.gov (United States)

    Schmid, Gary Bruno; Brunisholz, Katharina

    2007-06-01

    Natural and alternative healing methods are becoming ever more popular in the USA and Europe. Nevertheless, objective data about the use of complementary and alternative medicine (CAM) by persons suffering from schizophrenic disturbances is scarce. To examine whether patients who had undergone or were undergoing stationary treatment for a schizophrenic disturbance preferred CAM and, if so, to what extent. Via a special questionnaire, 70 patients in the adult psychiatry wards of a public hospital in Switzerland were interviewed. Most patients were undergoing stationary treatment with neuroleptics. The questionnaire covered various types of standard medical treatment as well as treatments with CAM, and explored patient motivation for their respective use. CAM methods were quite popular: they were used by 82% of all women and 91% of all men for treatment of mental problems, and were further recommended by 93% of women and 80% of men. Sex, age, highest educational level, present vocational position and severity of illness had no significant influence upon popularity. Most popular CAM methods were preparations for ingestion, psychological and imaginative procedures, body-oriented psychotherapy, and treatments involving sensory perceptions. Motivation for use of CAM encompassed personal interest, friends, family and acquaintances as well as an overall wish for treatment complementary to main stream. CAM methods are used in addition to - not instead of - usual practices of established medicine, and are just as popular as standard methods. Accordingly, CAM can justifiably be regarded as belonging to the 'main stream' of the health-seeking public.

  11. A double blind comparison of zuclopenthixol acetate with haloperidol in the management of acutely disturbed schizophrenics.

    Science.gov (United States)

    Chin, C N; Hamid, A R; Philip, G; Ramlee, T; Mahmud, M; Zulkifli, G; Loh, C C; Zakariah, M S; Norhamidah, M S; Suraya, Y; Roslan, K A; Chandramohan, P; Cheah, Y C; Leonard, A O

    1998-12-01

    The aim of this study was to evaluate the efficacy and side effects of zuclopenthixol acetate compared with haloperidol in the management of the acutely disturbed schizophrenic patient. Suitable subjects diagnosed as having schizophreniform disorder or acute exacerbation of schizophrenia admitted to the psychiatric wards Hospital Kuala Lumpur were randomised to receive either zuclopenthixol acetate or haloperidol. They were rated blind for three consecutive days using the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and UKU Side Effects Scale. Apart from repeat injections of the same medication, no other anti-psychotic was given for the duration of the study. 50 subjects entered the study of which 44 completed. 23 were given zuclopenthixol acetate and 21 haloperidol. Both groups significantly reduced BPRS and CGI scores on all 3 days compared to the initial rating (p p > 0.05). More subjects on haloperidol than zuclopenthixol required more than 1 injection during the study. Both groups had minimal side effects. Zuclopenthixol acetate was effective in the management of the acutely disturbed schizophrenic.

  12. Interpersonal Nurse-Patient Relationship With a Young Schizophrenic Pregnant Woman

    Directory of Open Access Journals (Sweden)

    Renata Marques de Oliveira

    2016-12-01

    Full Text Available The objective of this study was to investigate elements of the personal and psychiatric history, as well as the challenges related to motherhood, of a young schizophrenic female, through person-centered therapeutic interaction. The investigation had an exploratory scope, undertaken in a teaching hospital and data were collected during nondirective interaction on the part of the nurse with a young schizophrenic woman who had been treated in the institution for 10 years. Thematic analysis of the content was undertaken, with emphasis on the nuclei of meaning, identification of the themes and definition of the categories. The patient, called L. in this study, was 30 years old, had a two-year-old child and was three months pregnant when data were collected. Her trajectory was characterized by doubts, fears and uncertainties. The episodes of hospitalization, the coexistence with other patients, and the medications promoted insight into the symptoms, and acceptance of the diagnosis. The main challenge was experiencing pregnancy and the puerperium concomitantly with the psychiatric treatment. The interpersonal relationship established evidenced that, the young woman felling understood and that her needs were attended, overcame several difficulties she had reported and felt fulfilled and integrated into her social environment.

  13. Electroencephalographic sleep in clinically stable schizophrenic patients: two-weeks versus six-weeks neuroleptic-free.

    Science.gov (United States)

    Nofzinger, E A; van Kammen, D P; Gilbertson, M W; Gurklis, J A; Peters, J L

    EEG sleep studies in schizophrenic patients are influenced by alterations in clinical state and medication status. The current study defines longitudinal alterations in electroencephalographic (EEG) sleep for 10 healthy men who were schizophrenic patients who remained relatively clinically stable during a double-blind neuroleptic withdrawal study. Clinical assessments and EEG sleep studies were performed at baseline on haloperidol, and then at 2-week and 6-week drug-free periods. Sleep continuity and rapid eye movement (REM) sleep measures declined not only between the haloperidol baseline and 2-week drug-free conditions, but continued to decline from 2-week to 6-weeks neuroleptic-free. Alterations in EEG sleep from the 2-week to 6-week haloperidol-free assessments did not correlate with changes in clinical symptoms suggesting effects related to drug-withdrawal or subclinical state changes. These results show that despite relative clinical stability over time, the EEG sleep of schizophrenic patients continues to change following withdrawal of a neuroleptic and is dependent on the duration of the drug-free interval.

  14. Sensory Integration and Ego Development in a Schizophrenic Adolescent Male.

    Science.gov (United States)

    Pettit, Karen A.

    1987-01-01

    A retrospective study compared hours spent by a schizophrenic adolescent in "time out" before and after initiation of treatment. The study evaluated the effects of sensory integrative treatment on the ability to handle anger and frustration. Results demonstrate the utility of statistical analysis versus visual comparison to validate effectiveness…

  15. Schizophrenic and Depressed Mothers: Relational Deficits in Parenting.

    Science.gov (United States)

    Goodman, Sherryl H.; Brumley, H. Elizabeth

    1990-01-01

    Studied schizophrenic, depressed, and well women to determine the quality of their parenting and its affect on their three-month to five-year-old's social and intellectual development. Mothers' parenting practices, not their diagnostic status, accounted for much of the children's intellectual and social competence. (RH)

  16. Medication regimen complexity and readmissions after hospitalization for heart failure, acute myocardial infarction, pneumonia, and chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Nada Abou-Karam

    2016-02-01

    Full Text Available Objectives: Readmission rate is increasingly being viewed as a key indicator of health system performance. Medication regimen complexity index scores may be predictive of readmissions; however, few studies have examined this potential association. The primary objective of this study was to determine whether medication regimen complexity index is associated with all-cause 30-day readmission after admission for heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease. Methods: This study was an institutional review board–approved, multi-center, case–control study. Patients admitted with a primary diagnosis of heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease were randomly selected for inclusion. Patients were excluded if they discharged against medical advice or expired during their index visit. Block randomization was utilized for equal representation of index diagnosis and site. Discharge medication regimen complexity index scores were compared between subjects with readmission versus those without. Medication regimen complexity index score was then used as a predictor in logistic regression modeling for readmission. Results: Seven hundred and fifty-six patients were randomly selected for inclusion, and 101 (13.4% readmitted within 30 days. The readmission group had higher medication regimen complexity index scores than the no-readmission group (p < 0.01. However, after controlling for demographics, disease state, length of stay, site, and medication count, medication regimen complexity index was no longer a significant predictor of readmission (odds ratio 0.99, 95% confidence interval 0.97–1.01 or revisit (odds ratio 0.99, 95% confidence interval 0.98–1.02. Conclusion: There is little evidence to support the use of medication regimen complexity index in readmission prediction when other measures are available. Medication regimen complexity index

  17. [The algorithm for the medical maintenance of the aircraft personnel suffering from chronic sensorineural impairment of hearing].

    Science.gov (United States)

    Pankova, V B; Skryabina, L Yu; Barkhatova, O A

    2016-01-01

    The present study was designed to systematize the causes underlying the development of chronic sensorineural impairment of hearing in the aircraft personnel engaged in commercial aviation of the Russian Federation. A detailed clinical and audiological picture of chronic sensorineural loss of hearing in the aircraft personnel is presented with special reference to the criteria accepted in the civil aviationfor the evaluation of professional suitability and occupational selection in terms of hearing conditions. The study has demonstrated the paramount importance of the aviation medical expertise for the flight safety control in civil aviation. We analyzed the results of the audiological examination of the aircraft personnel suffering from chronic sensorineural impairment of hearing and proposed the algorithm for the rehabilitation of such subjects taking into consideration the stage of the chronic process.

  18. Automating and estimating glomerular filtration rate for dosing medications and staging chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Trinkley KE

    2014-05-01

    Full Text Available Katy E Trinkley,1 S Michelle Nikels,2 Robert L Page II,1 Melanie S Joy11Skaggs School of Pharmacy and Pharmaceutical Sciences, 2School of Medicine, University of Colorado, Aurora, CO, USA Objective: The purpose of this paper is to serve as a review for primary care providers on the bedside methods for estimating glomerular filtration rate (GFR for dosing and chronic kidney disease (CKD staging and to discuss how automated health information technologies (HIT can enhance clinical documentation of staging and reduce medication errors in patients with CKD.Methods: A nonsystematic search of PubMed (through March 2013 was conducted to determine the optimal approach to estimate GFR for dosing and CKD staging and to identify examples of how automated HITs can improve health outcomes in patients with CKD. Papers known to the authors were included, as were scientific statements. Articles were chosen based on the judgment of the authors.Results: Drug-dosing decisions should be based on the method used in the published studies and package labeling that have been determined to be safe, which is most often the Cockcroft–Gault formula unadjusted for body weight. Although Modification of Diet in Renal Disease is more commonly used in practice for staging, the CKD–Epidemiology Collaboration (CKD–EPI equation is the most accurate formula for estimating the CKD staging, especially at higher GFR values. Automated HITs offer a solution to the complexity of determining which equation to use for a given clinical scenario. HITs can educate providers on which formula to use and how to apply the formula in a given clinical situation, ultimately improving appropriate medication and medical management in CKD patients.Conclusion: Appropriate estimation of GFR is key to optimal health outcomes. HITs assist clinicians in both choosing the most appropriate GFR estimation formula and in applying the results of the GFR estimation in practice. Key limitations of the

  19. Opisodic memory orientation in schizophrenics, their relatives and normal people

    Directory of Open Access Journals (Sweden)

    Gholamali Nikpour

    2017-03-01

    Full Text Available Introduction: Memory is what creates perseverance and continuity in human and everyone's idea about himself depends on the memory. Among different psychological ideas, cognitive psychology is only one which investigated and recognized the memory. It seems mental and spiritual statuses have effects on memory and lead to memory orientation toward specific systems. According to research findings, there are spatial distortions in schizophrenics patients which are equal with main signs of schizophrenia i.e. disorders in the thoughts of these patients. Orientation has basic role to create and process the data same as thoughts in schizophrenics and normal people. Assessing such memory orientation in selecting the direction against pleasant, unpleasant and neutral stimulants is the purpose of current research Methods:   Used data in current study is related to patients and normal people reactions against pleasant, unpleasant and neutral materials of William’s test. After gathering the data, mean, variance and standard deviation were firstly, estimated and were analyzed statistically by independent T test. Results: Findings showed that there was a meaningful relationship between two mean of patients and normal people in reaction against pleasant, unpleasant and neutral stimulants of William’s test. It meaned normal people selected more pleasant stimulants than schizophrenics. Indeed, normal people selected neutral stimulants with slightly more different than schizophrenics. There was not any meaningful difference between normal people and schizophrenics only in unpleasant stimulants. Conclusion: Ability and intellectual coherence lead to mental appropriate performance and will result those people remind all memories particularly unpleasant ones with more details. Therefore it seems that memory orientation process leads to psychological status controlled the individual.

  20. Chronic Pain

    Science.gov (United States)

    ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. × ... pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain. ...

  1. Medication cost problems among chronically ill adults in the US: did the financial crisis make a bad situation even worse?

    Directory of Open Access Journals (Sweden)

    Piette JD

    2011-04-01

    Full Text Available John D Piette1, Ann Marie Rosland1, Maria J Silveira1, Rodney Hayward1, Colleen A McHorney21Ann Arbor VA Healthcare System, Ann Arbor, MI, USA; 2US Outcomes Research, Merck and Co, Inc, North Wales, PA, USAAbstract: A national internet survey was conducted between March and April 2009 among 27,302 US participants in the Harris Interactive Chronic Illness Panel. Respondents reported behaviors related to cost-related medication non-adherence (CRN and the impacts of medication costs on other aspects of their daily lives. Among respondents aged 40–64 and looking for work, 66% reported CRN in 2008, and 41% did not fill a prescription due to cost pressures. More than half of respondents aged 40–64 and nearly two-thirds of those in this group who were looking for work or disabled reported other impacts of medication costs, such as cutting back on basic needs or increasing credit card debt. More than one-third of respondents aged 65+ who were working or looking for work reported CRN. Regardless of age or employment status, roughly half of respondents reporting medication cost hardship said that these problems had become more frequent in 2008 than before the economic recession. These data show that many chronically ill patients, particularly those looking for work or disabled, reported greater medication cost problems since the economic crisis began. Given links between CRN and worse health, the financial downturn may have had significant health consequences for adults with chronic illness.Keywords: medication adherence, cost-of-care, access to care, chronic disease

  2. Pros and Cons of Medical Cannabis use by People with Chronic Brain Disorders.

    Science.gov (United States)

    Suryadevara, Uma; Bruijnzeel, Dawn M; Nuthi, Meena; Jagnarine, Darin A; Tandon, Rajiv; Bruijnzeel, Adriaan W

    2017-01-01

    Cannabis is the most widely used illicit drug in the world and there is growing concern about the mental health effects of cannabis use. These concerns are at least partly due to the strong increase in recreational and medical cannabis use and the rise in tetrahydrocannabinol (THC) levels. Cannabis is widely used to self-medicate by older people and people with brain disorders such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer's disease (AD), Parkinson's disease (PD), bipolar disorder, and schizophrenia. This review provides an overview of the perceived benefits and adverse mental health effects of cannabis use in people with ALS, MS, AD, PD, bipolar disorder, and schizophrenia. The reviewed studies indicate that cannabis use diminishes some symptoms associated with these disorders. Cannabis use decreases pain and spasticity in people with MS, decreases tremor, rigidity, and pain in people with PD, and improves the quality of life of ALS patients by improving appetite, and decreasing pain and spasticity. Cannabis use is more common among people with schizophrenia than healthy controls. Cannabis use is a risk factor for schizophrenia which increases positive symptoms in schizophrenia patients and diminishes negative symptoms. Cannabis use worsens bipolar disorder and there is no evidence that bipolar patients derive any benefit from cannabis. In late stage Alzheimer's patients, cannabis products may improve food intake, sleep quality, and diminish agitation. Cannabis use diminishes some of the adverse effects of neurological and psychiatric disorders. However, chronic cannabis use may lead to cognitive impairments and dependence. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  3. Acute blood pressure changes are related to chronic effects of resistance exercise in medicated hypertensives elderly women.

    Science.gov (United States)

    Moreira, Sérgio R; Cucato, Gabriel G; Terra, Denize F; Ritti-Dias, Raphael M

    2016-05-01

    A previous study observed that the chronic effects of aerobic training on blood pressure (BP) are related to acute BP responses after a single bout of aerobic exercise. However, whether similar responses are observed with resistance exercise (RE) remains obscure. Thus, this study analysed the relationship between the acute BP responses to a single bout of RE and chronic changes in resting BP after a RE training in medicated hypertensive elderly women. Twenty medicated hypertensive women participated in the study. They underwent an acute RE bout where BP and heart rate (HR) were obtained at rest and for 60 min after the RE. Subsequently, the participants underwent a progressive RE training for 12 weeks at 60-80% of maximal strength test. Resting BP and HR were also obtained after the RE training. The chronic decreases in systolic and diastolic BP were significantly greater in the participants who experienced acutely decreased systolic and diastolic BP, respectively (Pexercise, BP responses to a single bout of RE are strongly related to chronic effects of RE training on BP in medicated hypertensive elderly women. © 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  4. Visit to general practitioners as a proxy for accessing chronic benefits by members of medical schemes, South Africa

    Directory of Open Access Journals (Sweden)

    Mncedisi M. Willie

    2012-02-01

    Full Text Available Background: Prescribed Minimum Benefits is a list of conditions that all medical schemes need to cover in full, and includes a select of chronic conditions. Chronic conditions affect people’s lifestyles and require ongoing management over a period of years for long-term survival. Objectives: This study examined the association between prevalence of selected chronic diseases and health service use, in particular visits to general practitioners (GPs by medical scheme members.Method: This was a retrospective study on medical schemes data. The median imputation method was employed to deal with missing and unreported chronic diseases prevalence. Multivariate logistic regression analysis was employed to assess effects of chronic disease prevalence, age stratum and scheme size on GP visits per annum.Results: The study showed that prevalence of asthma was significantly associated with more than three GP visits (OR = 1.081; 95% CI = 1.008–1.159, as was prevalence of type 2 diabetes (OR = 1.087; 95% CI = 1.027–1.152, whilst prevalence of hyperlipidaemia (OR = 0.92; 95% CI = 0.875–0.97 was more likely to be associated with less than three GP visits. Prevalence of hypertension was associated with more than three GP visits per year (OR = 1.132; 95% CI = 1.017–1.26.Conclusion: This study shows that scheme size, prevalence of chronic diseases such as asthma, type 2 diabetes, hyperlipidaemia and hypertension are related to GP visits. GPs and managed care programmes employed by schemes should give special attention to certain disease states with high prevalence rates in an effort to better manage them.

  5. Visit to general practitioners as a proxy for accessing chronic benefits by members of medical schemes, South Africa

    Directory of Open Access Journals (Sweden)

    Mncedisi M. Willie

    2012-10-01

    Full Text Available Background: Prescribed Minimum Benefits is a list of conditions that all medical schemes need to cover in full, and includes a select of chronic conditions. Chronic conditions affect people’s lifestyles and require ongoing management over a period of years for long-term survival.Objectives: This study examined the association between prevalence of selected chronic diseases and health service use, in particular visits to general practitioners (GPs by medical scheme members.Method: This was a retrospective study on medical schemes data. The median imputation method was employed to deal with missing and unreported chronic diseases prevalence. Multivariate logistic regression analysis was employed to assess effects of chronic diseaseprevalence, age stratum and scheme size on GP visits per annum.Results: The study showed that prevalence of asthma was significantly associated with more than three GP visits (OR = 1.081; 95% CI = 1.008–1.159, as was prevalence of type 2 diabetes (OR = 1.087; 95% CI = 1.027–1.152, whilst prevalence of hyperlipidaemia (OR = 0.92; 95%CI = 0.875–0.97 was more likely to be associated with less than three GP visits. Prevalence of hypertension was associated with more than three GP visits per year (OR = 1.132; 95% CI = 1.017–1.26.Conclusion: This study shows that scheme size, prevalence of chronic diseases such as asthma, type 2 diabetes, hyperlipidaemia and hypertension are related to GP visits. GPs and managed care programmes employed by schemes should give special attention to certain disease states with high prevalence rates in an effort to better manage them.

  6. Meta-analysis of non-medical treatments for chronic pain.

    Science.gov (United States)

    Malone, M D; Strube, M J; Scogin, F R

    1988-09-01

    A meta-analysis was conducted on 109 published studies which assessed the outcome of various non-medical treatments for chronic pain. Of these studies, 48 provided sufficient information to calculate effect sizes. The remainder were examined according to proportion of patients rated as improved. Studies were compared as a function of type of treatment, type of pain, and type of outcome variable. In general, effect sizes were positive and of modest magnitude indicating the short-term efficacy of most treatments for most types of pain. This finding suggests that the effectiveness of treatments may be attributable not to the differences between treatments, but to the features they have in common. Mood and number of subjective symptoms consistently showed greater responses to treatment than did pain intensity, pain duration, or frequency of pain, indicating the importance of using a multidimensional framework for pain assessment. This finding also suggests that the benefit of psychological approaches to pain management may lie in reducing the fear and depression associated with pain, rather than relieving the pain itself. The present study also highlights the advantages of meta-analytic reviews.

  7. Validity of Oxygen-Ozone Therapy as Integrated Medication Form in Chronic Inflammatory Diseases.

    Science.gov (United States)

    Bocci, Velio; Zanardia, Iacopo; Valacchi, Giuseppe; Borrelli, Emma; Travagli, Valter

    2015-01-01

    The state-of-the-art of oxygen-ozone therapy is now clarified and all the mechanisms of action of medical ozone are within classical biochemistry and molecular biology. The outcomes of standard treatments in peripheral arterial occlusive disease (PAOD) and dry-form of age-related macular degeneration (AMD) have been compared with the documented therapeutic results achieved with ozonated autohemotherapy (O-AHT). On the other hand, the clinical data of O-AHT on stroke remain indicative. As the cost of O-AHT is almost irrelevant, its application in all public hospitals, especially those of poor Countries, would allow two advantages: the first is for the patient, who will improve her/his conditions, and the second is for Health Authorities burdened with increasing costs. The aim of this paper is to report to clinical scientists that O-AHT is a scientific-based therapeutic approach without side effects. The integration of O-AHT with effective approved drugs is likely to yield the best clinical results in several chronic inflammatory diseases.

  8. ANALYTICAL STUDY OFDENTAL STATUS OFPATIENTSWITH CHRONIC GENERALIZED PERIODONTITIS DENTAL CLINIC OF KRASNOYARSK STATE MEDICAL UNIVERSITY

    Directory of Open Access Journals (Sweden)

    Marugina Tatyana Leonidovna

    2013-05-01

    Full Text Available To make distinct approaches in the diagnosis, treatment and prevention of chronic generalized periodontitis the analysis of case rate of the disease during the period of 2010-2012 years was carried out in the dental clinic of Krasnoyarsk State Medical Academy. In order to divide patients into several groups according to severity of the disease the review of case history of 4390 patients aged 20 to 65 was made. 684 patients (15.6 % were diagnosed with mild degree of the disease, 2608 (59.4% with an average degree and 1908 patients (25% with severe degree of the disease. The low percentage of number of patients with mild degree of the disease is the result of late diagnosis of the disease. During the analysis of the structure of providing periodontal care at the stages of examination, periodontal and surgical help the lack of an objective assessment of the condition ofalveolar mucosa isnoted. Therefore, during the initial examination, we suggest to use Schiller-Pisarev method. As a crucial step in the identification of early forms of periodontal disease is a health education outreach.

  9. A study about influence of slow repetitive transcranial magnetic stimulation on the level of serum prolactin in chronic schizophrenics.%低频重复经颅磁刺激对慢性精神分裂症患者血清催乳素水平的影响

    Institute of Scientific and Technical Information of China (English)

    高志勤; 余海鹰; 金梅; 孙剑; 杨春; 丁松柏; 赵斌; 邱旭萍; 钟爱芳

    2011-01-01

    目的 探讨低频重复经颅磁刺激(rTMS)治疗抗精神病药所致高催乳素血症的疗效及安全性.方法 将61例利培酮所致高催乳素血症的住院军人慢性精神分裂症患者随机分为两组,在原有利培酮剂量稳定不变的基础上,分别予以10 d的1Hz低频删S刺激(31例)及假rTMS刺激(30例).于刺激前、后对两组分别进行血清催乳素(PRL)测定及阳性和阴性症状量表(PANss)、17项汉密尔顿抑郁量表(HAMD-17)评定,同时观察高催乳素血症临床症状的变化情况,并于1个月后对研究组的血清PRL水平进行复测.结果 (1)研究组rTMS刺激后PRL水平[(27.9±7.1)μg/L]较治疗前[(101.5±41.2)μg/L]下降,差异有统计学意义(P<0.01);对照组治疗后PRL水平[(111.4±44.5)μg/L]与治疗前[(106.6±41.9)μg/L]比较,差异无统计学意义(P>0.05);研究组疗效明显优于对照组(F=22.3,P<0.01);研究组治疗1个月后复测PRL[(96.7±38.3)μg/L],已恢复至治疗前水平(P>0.05).(2)研究组男性乳房女性化消失(8/14),自发泌乳消失(11/17),月经恢复(4/7),对照组则均无改善.(3)与治疗前比较,治疗后研究组及对照组PANSS及HAMD-17评分变化均无统计学意义(均P>0.05).两组不良反应均较轻,除头痛研究组多于对照组外,其余不良反应发生率两组相近.结论 短期低频rTMS治疗可使慢性精神分裂症患者服用抗精神病药所致高催乳素血症的症状减轻,且安全性较好,但需进一步的rTMS维持治疗以巩固疗效.%Objective To explore the efficacy and tolerability of slow repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of hyperprolactinemia caused by antipsychotic.Methods A total of 61 chronic schizophrenic patients with hyperprolactinemia caused by risperidone were randomized into study group (31 cases) treated with active rTMS plus former dosage of risperidone and control group (31 cases) treated with sham rTMS plus former dosage of risperidone

  10. Report of chronic myeloid leukemia from Indira Gandhi Institute of Medical Sciences, Regional Cancer Center, 2002-2009.

    Science.gov (United States)

    Prasad, Rajiv Ranjan; Singh, Pritanjali

    2013-07-01

    Indira Gandhi Institute of Medical Sciences, Regional Cancer Center was established in 1993. It's one of the main Health-Care Institution in the state of Bihar. The data of 205 patients was presented in the ICON meeting and 98% of patients were diagnosed in chronic phase. Complete hematological response was seen in 91% of patients in 3 months. A total of 197 (96%) patients were alive at the time of analysis of which 179 (87%) were still in chronic phase with hematological remission.

  11. Prevalence of right-to-left shunts on transcranial Doppler in chronic migraine and medication-overuse headache

    DEFF Research Database (Denmark)

    Guo, Song; Shalchian, Sarvnaz; Gérard, Pascale

    2014-01-01

    BACKGROUND: It was suggested that right-to-left shunt (RLS) may be highly prevalent in chronic migraine (CM) patients, indicating that patent foramen ovale (PFO) might be an aggravating and chronifying factor of migraine. Since a high proportion of chronic migraineurs also have medication......-overuse headache (MOH), one may wonder if they have a more severe form of the disorder and more frequently a PFO. OBJECTIVE: The objective of this study is to determine the prevalence and grade of RLS in patients suffering from CM and MOH. METHODS: A cross-sectional multicenter study of air-contrast transcranial...

  12. Effect of the medical insurance on the quality of care for Chinese patients with chronic heart failure.

    Science.gov (United States)

    Fu, Rong; Bao, Han; Su, Shaofei; Wang, Xinyu; Zhang, Meiqi; Liu, Meina

    2016-12-01

    To assess the effect of medical insurance on the quality of care for patients with chronic heart failure (CHF). Seven quality indicators were used to assess the association between medical insurance and quality of care. Statistical analyses were conducted using multilevel logistic models for the total population and the subpopulation stratified by sex and age. In total, 1862 CHF patients who were admitted in 20 tertiary hospitals between 1 January 2009 and 31 October 2010. Of 1862 patients, 53.8% patients had basic medical insurance and 26.9% patients paid the hospital costs by themselves. After adjusting for confounding factors, patients with New Rural Cooperative Medical Scheme (NRCMS) were more likely to receive warfarin (odds ratios [OR], 3.89; 95% confidence interval [CI], 1.08-13.99; P = 0.038), but less likely to receive aldosterone receptor antagonist (OR, 0.21; 95% CI, 0.08-0.56; P = 0.002) than patients without any medical insurance. Urban Employee Basic Medical Insurance (UEBMI) and NRCMS were associated with more use of discharge instructions ([OR, 3.54; 95% CI, 2.44-5.13; P insurance (OR, 1.78; 95% CI, 1.06-2.98; P = 0.029). UEBMI and NRCMS could increase the adherence to quality indicators of CHF to some extent. Improving the medical insurance system is expected to achieve equality in medical security and improve the quality of care for CHF patients.

  13. Efficacy of the topical 5% lidocaine medicated plaster in the treatment of chronic post-thoracotomy neuropathic pain.

    Science.gov (United States)

    Sansone, Pasquale; Passavanti, Maria Beatrice; Fiorelli, Alfonso; Aurilio, Caterina; Colella, Umberto; De Nardis, Lorenzo; Donatiello, Valerio; Pota, Vincenzo; Pace, Maria Caterina

    2017-05-01

    To assess the efficacy of the topical 5% lidocaine medicated plaster (Versatis(®), Grünenthal GmbH, Aachen, Germany) in patients with post-thoracotomy neuropathic pain. Patients were randomized to receive the topical 5% lidocaine medicated plaster (n = 33) or non-medicated placebo plasters (n = 30) for 12 h every day for 8 weeks. Laser-evoked potentials (LEPs) were measured, and various questionnaires/scales completed. Numeric Rating Scale pain scores improved significantly (p plaster than in placebo recipients. The same was true for N2 and P2 LEP latency and amplitude, and other parameters. The study included neurophysiological findings and confirmed the efficacy of the topical 5% lidocaine medicated plaster in patients with chronic post-thoracotomy neuropathic pain.

  14. Patient vs provider reports of aberrant medication-taking behavior among opioid-treated patients with chronic pain who report misusing opioid medication.

    Science.gov (United States)

    Nikulina, Valentina; Guarino, Honoria; Acosta, Michelle C; Marsch, Lisa A; Syckes, Cassandra; Moore, Sarah K; Portenoy, Russell K; Cruciani, Ricardo A; Turk, Dennis C; Rosenblum, Andrew

    2016-08-01

    During long-term opioid therapy for chronic noncancer pain, monitoring medication adherence of patients with a history of aberrant opioid medication-taking behaviors (AMTB) is an essential practice. There is limited research, however, into the concordance among existing monitoring tools of self-report, physician report, and biofluid screening. This study examined associations among patient and provider assessments of AMTB and urine drug screening using data from a randomized trial of a cognitive-behavioral intervention designed to improve medication adherence and pain-related outcomes among 110 opioid-treated patients with chronic pain who screened positive for AMTB and were enrolled in a pain program. Providers completed the Aberrant Behavior Checklist (ABC) and patients completed the Current Opioid Misuse Measure (COMM) and the Chemical Coping Inventory (CCI). In multivariate analyses, ABC scores were compared with COMM and CCI scores, while controlling for demographics and established risk factors for AMTB, such as pain severity. Based on clinical cutoffs, 84% of patients reported clinically significant levels of AMTB and providers rated 36% of patients at elevated levels. Provider reports of AMTB were not correlated with COMM or CCI scores. However, the ABC ratings of experienced providers (nurse practitioners/attending physicians) were higher than those of less experienced providers (fellows) and were correlated with CCI scores and risk factors for AMTB. Associations between patient- and provider-reported AMTB and urine drug screening results were low and largely nonsignificant. In conclusion, concordance between patient and provider reports of AMTB among patients with chronic pain prescribed opioid medication varied by provider level of training.

  15. Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes

    DEFF Research Database (Denmark)

    Melloni, Chiara; Cornel, Jan H; Hafley, Gail

    2016-01-01

    AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. METHODS...... disease vs. normal/mild chronic kidney disease were estimated. Platelet reactivity at 30 days was assessed in a subset of patients (n = 1947). The majority of patients were in the normal/mild chronic kidney disease group (67%), followed by moderate chronic kidney disease (29%) and severe chronic kidney.......26; 95% confidence interval 1.09-1.46; severe vs. normal/mild: hazard ratio 1.60; 95% confidence interval 1.25-2.04). Platelet reactivity was lower in patients treated with prasugrel compared with clopidogrel, across all three chronic kidney disease stages. CONCLUSIONS: Among medically managed acute...

  16. Association of serotonin transporter promoter gene polymorphism (5-HTTLPR) with depression in Costa Rican schizophrenic patients.

    Science.gov (United States)

    Contreras, Javier; Hernández, Sandra; Quezada, Paulina; Dassori, Albana; Walss-Bass, Consuelo; Escamilla, Michael; Raventos, Henriette

    2010-07-01

    Depression and suicidal behavior are frequently observed in patients with schizophrenia. The serotonin transporter protein regulates serotonergic signaling at synapses and is encoded by a single gene (SLC6A4; Locus Link ID: 6532), located at 17q11.1-q12 with two polymorphic variants (the short and the long allele). The short allele of serotonin transporter gene has been associated with depression and suicidality in individuals who suffered negative life events and with depression in individuals with chronic psychosis.. Subjects were recruited from a genetic study of schizophrenia conducted in Costa Rica. The authors replicated their previous research, using a more narrow phenotype (only schizophrenic subjects) and a more ethnically homogenous sample (only Costa Rican schizophrenic individuals who were not included in the previous study). The authors hypothesized that subjects with at least one copy of the serotonin transporter promoter gene polymorphism (5-HTTLPR) "s" allele would have a greater history of lifetime depression and suicidability rate than those who had an "l/l" genotype. The authors analyzed 155 subjects with a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of schizophrenia (73% male, age at interview 38.3, SD = 11.23). The genotype distribution was "ss" 58 (37%), "sl" 69 (45%), and "ll" 28 (18%). In the secondary analysis, the authors explored association of the "s" allele with lifetime history of suicide behavior in 173 subjects (18 more subjects than primary analysis because schizophrenic individuals were included regardless of history of depression). The authors found that subjects carrying at least one short allele had a significant increased lifetime risk for depressive syndromes (chi(2) = 5.4, df = 1, P = 0.02; odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.15-6.3). No association was found for suicidal behavior in the same sample (chi(2) = 0.928, P = 0.629). In conclusion, the genotype at the

  17. Unsuccessful Self-Enucleation in a Schizophrenic Patient

    Directory of Open Access Journals (Sweden)

    Noam Bar-Yaakov

    2014-01-01

    Full Text Available Self-enucleation is a very unusual form of self-mutilation directly linked to mental illness. In this case we present a 26-year-old schizophrenic patient who attempted to enucleate his eye with a rollerball pen. Antipsychotic therapy and emergency surgery saved the patient eye and emphasize the importance of quick response and good collaboration between psychiatric and ophthalmic teams.

  18. 慢性胰腺炎的内科治疗%Medical treatment of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    赖雅敏; 钱家鸣

    2011-01-01

    慢性胰腺炎(chronic pancreatitis,CP)是由于胰腺炎症导致胰腺组织不可逆的毁损,最终将导致胰腺内、外分泌功能的部分或全部丧失.CP治疗目标是减轻疼痛,改善胰腺脂肪泻及营养不良,治疗糖尿病等并发症,保持或改善病人生活质量等.缓解疼痛是最常见的临床问题,补充胰酶和适当使用镇痛药物是常用治疗方法.胰酶制剂能显著改善脂肪泻,而其使用剂量和使用方法非常重要.近年来内镜治疗的进步令人鼓舞,方法包括胰腺括约肌切开术,支架置入术和体外震波碎石术等.内镜技术的进步为CP病人提供了新的治疗希望,但长期疗效仍有待随访.此外,在生活方式上,戒烟酒对CP病人很可能有益,而低脂饮食因为可能导致脂溶性维生素的缺乏而不被推荐.%Chronic pancreatitis (CP) is an ongoing inflamatory disorder characterized by irreversible destruction of the pancreas associated with disabling chronic pain and permanent loss of exocrine and endocrine function. The treatment of patients with CP revolves around control of pain, diabetes and steatorrhea. Pain relief is the most common and most difficult problem. The initial approach should consist of non-opioid analgesics and supplementation with pancreatic enzymes containing high amounts of proteases. Enzymes significantly reduce fat excretion and stool frequency and improve fat absorption. Dosing and timing are important. Although the medical treatment of CP is frustrating in most cases and the role of pancreatic enzyme replacement therapy and anti-oxidants is uncertain,the benefit of pancreatic endotherapy for CP is encouraging. The modalities includepancreatic sphincterotomy, stenting and ESWL to break large calculi. With growing expertise in endoscopic techniques, refinements in equipment and promising results from uncontrolled studies, patients should be offered opportunities of endoscopic therapy before subjecting them to surgical treatment

  19. Chronic hepatitis C: Treat or wait? Medical decision making in clinical practice

    Institute of Scientific and Technical Information of China (English)

    Claus Niederau; Dietrich Hüppe; Elmar Zehnter; Bernd M(o)ller; Renate Heyne; Stefan Christensen; Rainer Pfaff

    2012-01-01

    AIM:To analyzes the decision whether patients with chronic hepatitis C virus (HCV) infection are treated or not.METHODS:This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon α2a/ribavirin,involving 434 physicians/institutions throughout Germany (377 in private practice and 57 in hospital settings).A structured questionnaire had to be answered prior to the treatment decision,which included demographic data,information about the personal life situation of the patients,anamnesis and symptomatology of hepatitis C,virological data,laboratory data and data on concomitant diseases.A second part of the study analyzes patients treated with pegylated interferon α2a.All questionnaires included reasons against treatment mentioned by the physician.RESULTS:Overall treatment uptake was 45%.By multivariate analysis,genotype 1/4/5/6,HCV-RNA ≤ 520 000 IU/mL,normal alanine aminotransferase (ALT),platelets ≤ 142 500/μL,age > 56 years,female gender,infection length > 12.5 years,concomitant diseases,human immunodeficiency virus co-infection,liver biopsy not performed,care in private practice,asymptomatic disease,and unemployment were factors associated with reduced treatment rate.Treatment and sustained viral response rates in migrants (1/3 of cohort) were higher than in German natives although 1/3 of migrants had language problems.Treatment rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were low.CONCLUSION:Some reasons against treatment were medically based whereas others were related to fears,socio-economical problems,and information deficits both on the side of physicians and patients.

  20. Efficacy of betamethasone valerate medicated plaster on painful chronic elbow tendinopathy: a double-blind, randomized, placebo-controlled trial.

    Science.gov (United States)

    Frizziero, Antonio; Causero, Araldo; Bernasconi, Stefano; Papalia, Rocco; Longo, Mario; Sessa, Vincenzo; Sadile, Francesco; Greco, Pasquale; Tarantino, Umberto; Masiero, Stefano; Rovati, Stefano; Frangione, Valeria

    2016-01-01

    to investigate the efficacy and safety of a medicated plaster containing betamethasone valerate (BMV) 2.25 mg in patients with chronic elbow tendinopathy. randomized, double-blind, placebo-controlled study with assignment 2:2:1:1 to BMV medicated plaster applied daily for 12 hours, daily for 24 hours or matched placebo. 62 patients aged ≥18 years with chronic lateral elbow tendinopathy were randomized. The primary efficacy variable was pain reduction (VAS) at day 28. Secondary objectives included summed pain intensity differences (SPID), overall treatment efficacy and tolerability. mean reduction in VAS pain score at day 28 was greater in both BMV medicated plaster groups, -39.35±27.69 mm for BMV12-h and -36.91±32.50 mm for BMV24-h, than with placebo, -20.20±27.32 mm. Considering the adjusted mean decreases, there was a statistically significant difference between BMV12-h and placebo (p=0.0110). Global pain relief (SPID) and overall treatment efficacy were significantly better with BMV. BMV and placebo plasters had similar local tolerability and there were few treatment-related adverse events. BMV plaster was significantly more effective than placebo at reducing pain in patients with chronic elbow tendinopathies. The BMV plaster was safe and well tolerated.

  1. Neurotrophic factors and the pathophysiology of schizophrenic psychoses.

    Science.gov (United States)

    Durany, Nuria; Thome, Johannes

    2004-09-01

    The aim of this review is to summarize the present state of findings on altered neurotrophic factor levels in schizophrenic psychoses, on variations in genes coding for neurotrophic factors, and on the effect of antipsychotic drugs on the expression level of neurotrophic factors. This is a conceptual paper that aims to establish the link between the neuromaldevelopment theory of schizophrenia and neurotrophic factors. An extensive literature review has been done using the Pub Med database, a service of the National Library of Medicine, which includes over 14 million citations for biomedical articles back to the 1950s. The majority of studies discussed in this review support the notion of alterations of neurotrophic factors at the protein and gene level, respectively, and support the hypothesis that these alterations could, at least partially, explain some of the morphological, cytoarchitectural and neurobiochemical abnormalities found in the brain of schizophrenic patients. However, the results are not always conclusive and the clinical significance of these alterations is not fully understood. It is, thus, important to further neurotrophic factor research in order to better understand the etiopathogenesis of schizophrenic psychoses and, thus, potentially develop new treatment strategies urgently needed for patients suffering from these devastating disorders.

  2. High prevalence of Human Herpesvirus 8 in schizophrenic patients.

    Science.gov (United States)

    Hannachi, Neila; El Kissi, Yousri; Samoud, Samar; Nakhli, Jaafar; Letaief, Leila; Gaabout, Samia; Ali, Bechir Ben Hadj; Boukadida, Jalel

    2014-05-15

    Many studies have reported an association between Herpes family viruses and an increased risk of schizophrenia, but the role of Human Herpesvirus 8 (HHV8) has never been investigated. This study aimed to assess HHV8 prevalence in schizophrenic patients as well as the possible association between HHV8 infection and schizophrenia clinical features. We consecutively enrolled 108 patients meeting fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria of schizophrenia and 108 age and sex matched controls. Data about a number of demographic characteristics and potential HHV8 risk factors of infection were collected. Standardized psychopathology measures, disease severity and functioning level were obtained using Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), Clinical Global Impressions (CGI) and Global Assessment of functioning (GAF). The presence of anti-HHV8 antibodies was analyzed using an indirect immunofluorescence assay. A higher prevalence of HHV8 infection in schizophrenic patients than in controls was found. Marital status, having children, sexual behavior and risk factors of blood transmission were not associated with HHV8 prevalence. However, among schizophrenic patients, HHV8 prevalence was statically associated with positive symptoms. To our knowledge, this would be the first report of a possible role of HHV8 in the pathogenesis of schizophrenia. To prove this hypothesis, further investigation of HHV8 in schizophrenia with larger samples is needed.

  3. John Nash, game theory, and the schizophrenic brain.

    Science.gov (United States)

    Capps, Donald

    2011-03-01

    This article focuses on John Nash, recipient of the Nobel Prize in Economics in 1994, and subject of the Award winning 2001 film A Beautiful Mind, who was diagnosed with paranoid schizophrenia in 1958 at the age of 29. After presenting an account of the emergence, course, and eventual remission of his illness, the article argues for the relevance of his contribution to game theory, known as the Nash equilibrium, for which he received the Nobel Prize, to research studies of the schizophrenic brain and how it deviates from the normal brain. The case is made that the Nash equilibrium is descriptive of the normal brain, whereas the game theory formulated by John van Neumann, which Nash's theory challenges, is descriptive of the schizophrenic brain. The fact that Nash and his colleagues in mathematics did not make the association between his contributions to mathematics and his mental breakdown and that his later recovery exemplified the validity of this contribution are noted and discussed. Religious themes in his delusional system, including his view of himself as a secret messianic figure and the biblical Esau, are interpreted in light of these competing game theories and the dysfunctions of the schizophrenic brain. His recognition that his return to normalcy came at the price of his sense of being in relation to the cosmos is also noted.

  4. Chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women.

    Science.gov (United States)

    de Vries, Heather F; Northington, Gina M; Kaye, Elise M; Bogner, Hillary R

    2011-12-01

    The aim of this study was to examine the association between chronic medical conditions and reproducibility of self-reported age at menopause among community-dwelling women. Age at menopause was assessed in a population-based longitudinal survey of 240 women twice, in 1993 and 2004. Women who recalled age at menopause in 2004 within 1 year or less of age at menopause recalled in 1993 (concordant) were compared with women who did not recall age at menopause in 2004 within 1 year of age at menopause recalled in 1993 (discordant). Type of menopause (surgical or natural) and chronic medical conditions were assessed by self-report. One hundred forty-three women (59.6%) reported surgical menopause, and 97 (40.4%) reported natural menopause. In all, 130 (54.2%) women recalled age at menopause in 2004 within 1 year or less of recalled age at menopause in 1994, whereas 110 (45.8%) women did not recall age at menopause in 2004 within 1 year or less of recalled age at menopause in 1994. Among the women with surgical menopause, the women with three or more medical conditions were less likely to have concordant recall of age at menopause than the women with less than three chronic medical conditions (adjusted odds ratio, 0.36; 95% CI, 0.15-0.91) in multivariate models controlling for potentially influential characteristics including cognition and years since menopause. Among women who underwent surgical menopause, the presence of three or more medical conditions is associated with decreased reproducibility of self-reported age at menopause.

  5. Comparison of serum BDNF levels in deficit and nondeficit chronic schizophrenia and healthy controls.

    Science.gov (United States)

    Valiente-Gómez, Alicia; Amann, Benedikt L; Mármol, Frederic; Oliveira, Cristina; Messeguer, Ana; Lafuente, Amalia; Pomarol-Clotet, Edith; Bernardo Arroyo, Miguel

    2014-12-15

    The aim of this study was to compare serum BDNF levels of chronic schizophrenic patients, with or without deficit syndrome, and healthy controls. A comparative study of serum BDNF levels, determined by ELISA, was performed in 47 chronic patients with schizophrenia matched with 47 healthy controls. A part of the chronic schizophrenic sample was further divided into patients with a deficit (n=14) and a nondeficit syndrome (n=20), according to the Proxy for the Deficit Syndrome Scale. A significant difference was observed in decreased serum BDNF levels between chronic schizophrenia and healthy controls. No statistical significant differences in BDNF levels between deficit and nondeficit chronic schizophrenic patients were found. Our study confirms differences of serum BDNF levels of chronic schizophrenia and healthy controls, which correspond to the clinical progression of the disease. Our results do not support a relation between deficit profile in chronic schizophrenia and lower serum BDNF levels.

  6. Over-Expression of Dopamine D2 Receptor and Inwardly Rectifying Potassium Channel Genes in Drug-Naive Schizophrenic Peripheral Blood Lymphocytes as Potential Diagnostic Markers

    Directory of Open Access Journals (Sweden)

    Ágnes Zvara

    2005-01-01

    Full Text Available Schizophrenia is one of the most common neuropsychiatric disorders affecting nearly 1% of the human population. Current diagnosis of schizophrenia is based on complex clinical symptoms. The use of easily detectable peripheral molecular markers could substantially help the diagnosis of psychiatric disorders. Recent studies showed that peripheral blood lymphocytes (PBL express subtypes of D1 and D2 subclasses of dopamine receptors. Recently, dopamine receptor D3 (DRD3 was found to be over-expressed in schizophrenic PBL and proposed to be a diagnostic and follow-up marker for schizophrenia. In this study we screened PBL of 13 drug-naive/drug-free schizophrenic patients to identify additional markers of schizophrenia. One of the benefits of our study is the use of blood samples of non-medicated, drug-naive patients. This excludes the possibility that changes detected in gene expression levels might be attributed to the medication rather than to the disorder itself. Among others, genes for dopamine receptor D2 (DRD2 and the inwardly rectifying potassium channel (Kir2.3 were found to be over-expressed in microarray analysis. Increased mRNA levels were confirmed by quantitative real-time PCR (QRT-PCR using the SybrGreen method and dual labeled TaqMan probes. The use of both molecular markers allows a more rapid and precise prediction of schizophrenia and might help find the optimal medication for schizophrenic patients.

  7. Over-expression of dopamine D2 receptor and inwardly rectifying potassium channel genes in drug-naive schizophrenic peripheral blood lymphocytes as potential diagnostic markers.

    Science.gov (United States)

    Zvara, Agnes; Szekeres, György; Janka, Zoltán; Kelemen, János Z; Cimmer, Csongor; Sántha, Miklós; Puskás, László G

    2005-01-01

    Schizophrenia is one of the most common neuropsychiatric disorders affecting nearly 1% of the human population. Current diagnosis of schizophrenia is based on complex clinical symptoms. The use of easily detectable peripheral molecular markers could substantially help the diagnosis of psychiatric disorders. Recent studies showed that peripheral blood lymphocytes (PBL) express subtypes of D1 and D2 subclasses of dopamine receptors. Recently, dopamine receptor D3 (DRD3) was found to be over-expressed in schizophrenic PBL and proposed to be a diagnostic and follow-up marker for schizophrenia. In this study we screened PBL of 13 drug-naive/drug-free schizophrenic patients to identify additional markers of schizophrenia. One of the benefits of our study is the use of blood samples of non-medicated, drug-naive patients. This excludes the possibility that changes detected in gene expression levels might be attributed to the medication rather than to the disorder itself. Among others, genes for dopamine receptor D2 (DRD2) and the inwardly rectifying potassium channel (Kir2.3) were found to be over-expressed in microarray analysis. Increased mRNA levels were confirmed by quantitative real-time PCR (QRT-PCR) using the SybrGreen method and dual labeled TaqMan probes. The use of both molecular markers allows a more rapid and precise prediction of schizophrenia and might help find the optimal medication for schizophrenic patients.

  8. Extrahepatic manifestations of chronic hepatitis C virus infection:297 cases from a tertiary medical center in Beijing, China

    Institute of Scientific and Technical Information of China (English)

    Cheng Zhaojing; Zhou Baotong; Shi Xiaochun; Zhang Yao; Zhang Lifan; Chen Limeng; Liu Xiaoqing

    2014-01-01

    Background Chronic hepatitis C virus (HCV) infection can affect multiple organ systems and cause a variety of extrahepatic manifestations (EMs).We sought to assess the constituent ratio of EMs in Chinese patients with chronic HCV infection and identify the clinical and biological factors associated with EM.Methods The medical records of 297 patients with chronic HCV infection were analyzed and demographic and epidemiological information was collected.The diagnosis of chronic HCV infection was based on positive anti-HCV combined with a positive HCV-RNA or at least two times of elevated aminotransferases attributable to HCV infection.Patients with HBV and/or HIV coinfection,autoimmune hepatitis,and history of alcohol abuse were excluded.Results Sixty-two percent (184/297) of the patients had at least one EM,including fatigue (29.4%),type 2 diabetes mellitus (28.2%),renal involvement (12.5%),lymphadenopathy (9.6%),fever (9.4%),thyroid dysfunction (8.1%),and arthralgia (7.4%).Neuropathy,sicca syndrome,B-cell lymphoma,Raynaud's phenomenon,and lichen planus were rare.The mean age of patients with EM was older compared with those without EM.Conclusions EMs were common in Chinese patients with chronic HCV infection,particularly fatigue,type 2 diabetes,renal impairment,lymphadenophy,fever,and thyroid dysfunction.Older age was associated with EMs.

  9. [Beyond suffering, schizophrenic improvisation and therapeutic challenges].

    Science.gov (United States)

    Bizot, Tatiana

    2016-01-01

    Led jointly by an actress and an occupational therapist, an 'improvisation' activity has been set up within the Sainte-Anne University Hospital SHU Sector 14 for hospitalised patients, on medical prescription. This containing environment provides psychological support and encourages patients with schizophrenia to explore their creativity and to 'let go' so as to discover new physical possibilities. The group thereby becomes a support for the relationship and the development of verbal and non-verbal communication.

  10. Screening and brief intervention for unhealthy substance use in patients with chronic medical conditions: a systematic review.

    Science.gov (United States)

    Timko, Christine; Kong, Calvin; Vittorio, Lisa; Cucciare, Michael A

    2016-11-01

    This systematic review describes studies evaluating screening tools and brief interventions for addressing unhealthy substance use in primary care patients with hypertension, diabetes or depression. Primary care is the main entry point to the health care system for most patients with comorbid unhealthy substance use and chronic medical conditions. Although of great public health importance, systematic reviews of screening tools and brief interventions for unhealthy substance use in this population that are also feasible for use in primary care have not been conducted. Systematic review. We systematically review the research literature on evidence-based tools for screening for unhealthy substance use in primary care patients with depression, diabetes and hypertension, and utilising brief interventions with this population. Despite recommendations to screen for and intervene with unhealthy substance use in primary care patients with chronic medical conditions, the review found little indication of routine use of these practices. Limited evidence suggested the Alcohol Use Disorders Identification Test and Alcohol Use Disorders Identification Test-C screeners had adequate psychometric characteristics in patients with the selected chronic medical conditions. Screening scores indicating more severe alcohol use were associated with health-risk behaviours and poorer health outcomes, adding to the potential usefulness of screening for unhealthy alcohol use in this population. Studies support brief interventions' effectiveness with patients treated for hypertension or depression who hazardously use alcohol or cannabis, for both substance use and chronic medical condition outcomes. Although small, the international evidence base suggests that screening with the Alcohol Use Disorders Identification Test or Alcohol Use Disorders Identification Test-C and brief interventions for primary care patients with chronic medical conditions, delivered by nurses or other providers, are

  11. Nonlinear dynamics of electroencephalography study in schizophrenic patients

    Institute of Scientific and Technical Information of China (English)

    CHEN Xing-shi; XU Yi-feng; TANG Yun-xiang; FANG Yi-ru; ZHANG Chen; ZHANG Ming-dao; LOU Fei-ying

    2013-01-01

    Background Few characteristic changes of linear electroencephalograph (EEG) have been reported in schizophrenia.The aim of the present study was to investigate the changes in temporal-spatial dimensional properties of EEG under different cognitive tasks in patients with schizophrenia.Methods EEG was recorded by using EEG-1518K system and mapping system (Nihon Kohden Tomioka Corporation,Japan) in 45 schizophrenic patients and 47 healthy adults (normal control,NC) under five states:eyes closed,eyes open,mental arithmetic test with eyes closed,memory test with eyes open,and number cancellation test.Correlation dimension (D2) and point-wise correlation dimension (PD2) were calculated for all EEG analyses.Results (1) There were no significant differences of D2 and PD2 between NC and schizophrenic patients under states of eyes open and closed.(2) Compared with NC,schizophrenic patients showed decreased performance of D2 in mental arithmetic test with eyes closed and number cancellation test (mental arithmetic test with eyes closed:Nc 5.9±0.6,Sch 3.0±0.8; number cancellation test:Nc 6.0±0.6,Sch 4.4±0.7; P <0.05 or P <0.01).(3) Schizophrenic patients also showed decrease performance of PD2 in mental arithmetic test with eyes closed,memory test with eyes open,and number cancellation test (mental arithmetic test with eyes closed:Nc 6.9±0.7,Sch 4.0±0.8; memory test with eyes open:Nc 6.6±0.8,Sch 5.0±0.9; number cancellation test:Nc 7.1±0.7,Sch 4.8±0.9; P <0.05 or P <0.01).Conclusions Nonlinear dynamic analysis provided a new approach in clinical investigation of EEG signals.It was helpful to further understand the cerebral mechanism in schizophrenic cognitive process.

  12. Can Chronic Pain Patients Be Adequately Treated Using Generic Pain Medications to the Exclusion of Brand-Name Ones?

    Science.gov (United States)

    Candido, Kenneth D; Chiweshe, Joseph; Anantamongkol, Utchariya; Knezevic, Nebojsa Nick

    2016-01-01

    According to the Food and Drug Administration (FDA) reports, approximately 8 in 10 prescriptions filled in the United States are for generic medications, with an expectation that this number will increase over the next few years. The impetus for this emphasis on generics is the cost disparity between them and brand-name products. The use of FDA-approved generic drugs saved 158 billion dollars in 2010 alone. In the current health care climate, there is continually increasing pressure for prescribers to write for generic alternative medications, occasionally at the expense of best clinical practices. This creates a conflict wherein both physicians and patients may find brand-name medications clinically superior but nevertheless choose generic ones. The issue of generic versus brand medications is a key component of the discussion of health payers, physicians and their patients. This review evaluates some of the important medications in the armamentarium of pain physicians that are frequently used in the management of chronic pain, and that are currently at the forefront of this issue, including Opana (oxymorphone; Endo Pharmaceuticals, Inc., Malvern, PA), Gralise (gabapentin; Depomed, Newark, CA), and Horizant (gabapentin enacarbil; XenoPort, Santa Clara, CA) that are each available in generic forms as well. We also discuss the use of Lyrica (pregabalin; Pfizer, New York, NY), which is currently unavailable as generic medication, and Cymbalta (duloxetine; Eli Lilly, Indianapolis, IN), which has been recently FDA approved to be available in a generic form. It is clear that the use of generic medications results in large financial savings for the cost of prescriptions on a national scale. However, cost-analysis is only part of the equation when treating chronic pain patients and undervalues the relationships of enhanced compliance due to single-daily dosing and stable and reliable pharmacokinetics associated with extended-duration preparations using either retentive

  13. The prevalence of strabismus in schizophrenic patients in Durban, KwaZulu Natal

    Directory of Open Access Journals (Sweden)

    D. Ndlovu

    2011-12-01

    Full Text Available Purpose:    The psychosocial implications of a strabismus have not received sufficient attention and yet may have a significantly negative effect on a person’s life.  Schizophrenia is the fourth leading cause of mental disability in the developed world.  Both schizophrenia and strabismus appear to share a genetic and neurological origin.  This study thus set out to assess the prevalence of strabismus in a sample of schizophrenic subjects. Setting:  The study was carried out in Durban, Kwazulu-Natal inSouth Africa specifically at the Durban and Coastal Mental Health Institution. Method:  Fifty schizophrenic subjects residing at the Durban and Coastal Mental Health (DMH Institution were assessedfor the presence of strabismus using the cover test and modified Krimsky test.  The inclusion criteria were all subjects diagnosed with schizophrenia, of both genders and any race.  The subjects werebetween fifteen to seventy years of age.  The exclusion criteria included any other mental illness, systemic disease or medication other than that usedon schizophrenic patients.  Results:   The prevalence of strabismus in this sample was found tobe 74% which was considerably higher than thatreported by other studies1,2.  There was a greater incidence of exotropia as opposed to esotropia.  The mean distance exotropia as detected with the cover test was 33 prism dioptres.  Similarly, the near cover test indicated a mean of 11 prism dioptres exotropia, and with the modified Krimsky test a mean of 9 prism dioptres exotropia.   Most of the strabismic subjects (86.5% presented with a strabismus when fixating a near target.  Generally the strabismus was found to be constant and unilateral and no gender bias was found.  Conclusion:There appears to be a strong relationship between strabismus and schizophrenia.  Health care professionals, especially those dealing with paediatric care, parents and the public should be made awareof this relationship

  14. ENDOSCOPIC AND HISTOPATHOLOGIC CHANGES IN CHILDREN WITH CHRONIC DYSPEPSIA IN A RURAL MEDICAL COLLEGE HOSPITAL IN MELMARUVATHUR- TAMILNADU

    Directory of Open Access Journals (Sweden)

    Padma K

    2016-09-01

    Full Text Available INTRODUCTION Chronic pain abdomen and dyspepsia is the most common presenting symptoms in the Paediatric Outpatient Department (OPD after respiratory illnesses. It is increasing alarmingly both in the paediatric and adult population. We, therefore carried out a cross-sectional study among children with chronic dyspepsia aged between 5 to 15 years attending Paediatric OPD in a rural medical college hospital, Melmaruvathur, Tamilnadu, South India. OBJECTIVE To evaluate the gastroduodenal morbidity in children presenting to the paediatric department of a rural medical college hospital with chronic dyspeptic symptoms. METHODS Forty six children between the age group of 5 to 15 years with chronic dyspeptic symptoms of at least one month duration were evaluated for their symptom profile, epidemiological profile, nutritional status, endoscopic appearance and histopathological changes. Data analysis was done using SPSS version 18. RESULTS Of the 46 children studied, 43% were between the age group of 5-10 years and 70% were female children. Pain abdomen lasting for more than at least one month was the most common finding (93% observed. Other common symptoms in the order of decreasing frequency were early satiety (87%, poor appetite (76%, nausea (57% and not thriving (57%. History of loss of appetite was significantly associated with chronic dyspepsia with an odds ratio of 68.9394 and 95% confidence interval 26.62 to 178.54, p value of <0.0001. Most of the children belonged to lower income group predominantly of a rural background. 33 (72% children had under nutrition as per IAP classification. 10 (30% Grade I, 15 (45% Grade II and eight (24% had Grade III malnutrition. 26 children (57% had abnormal endoscopic findings. Antral mucosal biopsy done showed chronic lymphocytic gastritis in 44 (96% cases. 38 of these 44 (86% were H. pylori positive. H. pylori positivity in chronic dyspepsia was highly statistically significant with a p value of 0

  15. Chronic pelvic pain syndrome: reduction of medication use after pelvic floor physical therapy with an internal myofascial trigger point wand.

    Science.gov (United States)

    Anderson, Rodney U; Harvey, Richard H; Wise, David; Nevin Smith, J; Nathanson, Brian H; Sawyer, Tim

    2015-03-01

    This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

  16. Efficacy and adverse effects of medical marijuana for chronic noncancer pain: Systematic review of randomized controlled trials.

    Science.gov (United States)

    Deshpande, Amol; Mailis-Gagnon, Angela; Zoheiry, Nivan; Lakha, Shehnaz Fatima

    2015-08-01

    To determine if medical marijuana provides pain relief for patients with chronic noncancer pain (CNCP) and to determine the therapeutic dose, adverse effects, and specific indications. In April 2014, MEDLINE and EMBASE searches were conducted using the terms chronic noncancer pain, smoked marijuana or cannabinoids, placebo and pain relief, or side effects or adverse events. An article was selected for inclusion if it evaluated the effect of smoked or vaporized cannabinoids (nonsynthetic) for CNCP; it was designed as a controlled study involving a comparison group, either concurrently or historically; and it was published in English in a peer-review journal. Outcome data on pain, function, dose, and adverse effects were collected, if available. All articles that were only available in abstract form were excluded. Synthesis A total of 6 randomized controlled trials (N = 226 patients) were included in this review; 5 of them assessed the use of medical marijuana in neuropathic pain as an adjunct to other concomitant analgesics including opioids and anticonvulsants. The 5 trials were considered to be of high quality; however, all of them had challenges with masking. Data could not be pooled owing to heterogeneity in delta-9-tetrahydrocannabinol potency by dried weight, differing frequency and duration of treatment, and variability in assessing outcomes. All experimental sessions in the studies were of short duration (maximum of 5 days) and reported statistically significant pain relief with nonserious side effects. There is evidence for the use of low-dose medical marijuana in refractory neuropathic pain in conjunction with traditional analgesics. However, trials were limited by short duration, variability in dosing and strength of delta-9-tetrahydrocannabinol, and lack of functional outcomes. Although well tolerated in the short term, the long-term effects of psychoactive and neurocognitive effects of medical marijuana remain unknown. Generalizing the use of medical

  17. Enterococcus and Streptococcus spp. associated with chronic and self-medicated urinary tract infections in Vietnam

    Directory of Open Access Journals (Sweden)

    Poulsen Louise

    2012-11-01

    Full Text Available Abstract Background Urinary tract infections (UTI are one of the most common infections among women worldwide. E. coli often causes more than 75% of acute uncomplicated UTI, however, little is known about how recurrent UTIs and indiscriminate use of antimicrobials affect the aetiology of UTIs. This study aimed to establish the aetiology of UTI in a population of recurrent and self-medicated patients referred from pharmacies to a hospital in Hanoi, Vietnam and to describe genotypes and antimicrobial susceptibility of the associated bacterial pathogens. The aetiology of bacterial pathogens associated with UTI (defined as ≥ 104 CFU/ml urine was established by phenotypic and molecular methods. Enterococcus faecalis isolates were typed by Multi Locus Sequence Typing (MLST, Pulsed-Field Gel Electrophoresis (PFGE and antimicrobial susceptibility testing. Methods Urine samples from 276 patients suffering symptoms of urinary tract infection were collected and cultured on Flexicult agar® allowing for detection of the most common urine pathogens. Patients were interviewed about underlying diseases, duration of symptoms, earlier episodes of UTI, number of episodes diagnosed by doctors and treatment in relation to UTI. All tentative E. faecalis and E. faecium isolates were identified to species level by PCR, 16S rRNA and partial sequencing of the groEL gene. E. faecalis isolates were further characterized by Multi Locus Sequence Typing and antimicrobial susceptibility testing. Results Mean age of 49 patients was 48 yrs (range was 11–86 yrs and included 94% women. On average, patients reported to have suffered from UTI for 348 days (range 3 days-10 years, and experienced 2.7 UTIs during the previous year. Cephalosporins were reported the second drug of choice in treatment of UTI at the hospital. E. faecalis (55.1%, E. coli (12.2% and Streptococcus gallolyticus subsp. pasteurianus (8.2% were main bacterial pathogens. MIC testing of E. faecalis showed

  18. Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

    DEFF Research Database (Denmark)

    Schiøtz, Michaela Louise; Price, Mary; Frølich, Anne

    2011-01-01

    As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison...... with care in Kaiser Permanente (KP), an integrated delivery system based in the United States. We investigated population rates of hospitalisation and readmission rates for ambulatory care sensitive, chronic medical conditions in the two systems....

  19. Catha edulis chewing effects on treatment of paranoid schizophrenic patients

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    Kotb El-Sayed MI

    2015-04-01

    Full Text Available Mohamed-I Kotb El-Sayed, Hatem-K Amin Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Helwan University, Ain Helwan, Helwan, Cairo, Egypt Background: The current study’s aim is to evaluate the possible interaction effects of khat chewing on treatment of paranoid schizophrenic patients.Patients and methods: In the study group, 42 male subjects suffered from paranoid schizophrenia and were classified according to their khat chewing habits into two subgroups: either khat-chewer subgroup (SKc; n=21; r=11, h=10 or non-khat-chewer subgroup (SNKc; n=21, r=11, h=10. Each subgroup was further subdivided according to type of treatment into r (risperidone and h (haloperidol. Healthy male subjects (37 were subdivided into healthy khat-chewer as positive controls (HKc, n=17 and healthy non-khat-chewer as negative controls (HNKc, n=20. Plasma dopamine, 3,4-dihydroxyphenylacetic acid (DOPAC, homovanillic acid, 5-hydroxytryptamine (serotonin, 5-hydroxyindoleacetic acid, epinephrine, and norepinephrine were estimated.Results: ANOVA and post hoc analysis showed that dopamine was illustrating significant elevation in all khat chewing groups. DOPAC was illustrating significant decrease in all khat chewing groups with an interesting outcome showing significant increase in DOPAC in SNKcr group due to risperidone effect. Homovanillic acid, serotonin, hydroxyindoleacetic acid, and norepinephrine were illustrating significant elevations in all khat chewing groups. Epinephrine was illustrating significant elevation in all chewers than non-chewers groups. Unexpected significant decrease in epinephrine in the SNKcr group indicated that risperidone drug is decreasing epinephrine through indirect mechanism involving calcium.Conclusion: Khat chewing in schizophrenic patients is contraindicated because it aggravates the disease symptoms, attenuates all used treatment medications, and deteriorates all biochemical markers of the patients. Keywords

  20. Rapid review: sinonasal surgery vs. medical therapy for asthma in patients with chronic rhinosinusitis with or without nasal polyps.

    Science.gov (United States)

    de Bruin, Rick Johan Matthies; Hage, Rene; van der Zaag-Loonen, Hester; van Benthem, Peter Paul Germain

    2016-09-01

    The objective of the study was to compare the effect of sinonasal surgery vs. medical treatment on asthma in patients with chronic rhinosinusitis with or without nasal polyps. We executed a PRISMA guidelines-based systematic search of the following databases: PubMed, CENTRAL, Embase, Scopus and CINAHL. The search ran from database inception until 26 Feb 2014. We included controlled clinical trials comparing surgical intervention with medical intervention in patients with chronic rhinosinusitis with or without nasal polyps. We included only English papers. We used a pre-defined data collection form. Two authors independently assessed study quality. We assessed directness of evidence and risk of bias using pre-defined criteria. Our search yielded 2004 original articles, six of which satisfied our inclusion criteria. One article was excluded from further review because no comparison could be made of the subgroup of operated asthmatic patients versus the non-surgical control group. Only one study used objective pulmonary function measurements in asthmatics undergoing sinonasal surgery and therefore had the highest directness of evidence. Also it had a low risk of bias. Patient characteristics, treatments and outcome measures varied across studies, as did the observed effect. Risk of bias was high in most studies. Patient characteristics, treatment and outcome measurement differed across studies, making a comparison of the effects difficult. There is a risk of publication language bias. There is insufficient evidence either for or against sinonasal surgery for asthma control as compared to medical treatment.

  1. Patterns of Dysfunction in Schizophrenic Patients on an Aphasia Test Battery

    Science.gov (United States)

    DiSimoni, Frank G.; And Others

    1977-01-01

    In a study comparing schizophrenic language performance with the language performance profiles characteristic of aphasia, apraxia of speech, generalized intellectual impairment, and confused language, 27 schizophrenic patients (20 to 67 years old) were tested with an aphasia test battery. (Author/IM)

  2. Divergent Thinking Abilities across the Schizophrenic Spectrum and Other Psychological Correlates

    Science.gov (United States)

    Rodrigue, Amanda L.; Perkins, David R.

    2012-01-01

    The literature on the connection between psychopathology and creativity is vast and recent research has focused on the relationship between the schizophrenic spectrum and creativity. The schizophrenic spectrum includes genetically related disorders that share certain symptom features. It has been suggested that schizotypal personality disorder, a…

  3. Prescribing Generic Medication in Chronic Musculoskeletal Pain Patients: An Issue of Representations, Trust, and Experience in a Swiss Cohort.

    Science.gov (United States)

    Piguet, Valérie; D'Incau, Stéphanie; Besson, Marie; Desmeules, Jules; Cedraschi, Christine

    2015-01-01

    Parallel to an ever stronger advocacy for the use of generics, various sources of information report concerns regarding substitution. The literature indicates that information regarding substitution is not univocal. The aim of this qualitative study was to explore patients' representations regarding generics in patients suffering from non-specific disabling chronic musculoskeletal pain, as these patients are confronted with the issue of the prescription and/or substitution of original formulations with generics. Qualitative methods were selected because the aim was to access the range of patients' representations and to consider their conceptions. Standardized face-to-face semi-structured interviews were used, and transcripts were submitted to content analysis. Patients' representations suggest that they might be confident in taking a generic medication: when he/she has an understanding of generics as resulting from a development process that has become part of the public domain; the generic medication is prescribed by the physician; each prescription is discussed, i.e., the patient is prescribed the generic version of a given medication and not a generic medication. Economic arguments are not sufficient to justify substitution, and may even raise issues calling upon cognitive dissonance. Even in non-life-threatening diseases, negative cues require attention and need be de-emphasized - in particular lower price as an indication of lower quality, and generic status as contradictory with advocating individualization of medication.

  4. Prescribing Generic Medication in Chronic Musculoskeletal Pain Patients: An Issue of Representations, Trust, and Experience in a Swiss Cohort.

    Directory of Open Access Journals (Sweden)

    Valérie Piguet

    Full Text Available Parallel to an ever stronger advocacy for the use of generics, various sources of information report concerns regarding substitution. The literature indicates that information regarding substitution is not univocal. The aim of this qualitative study was to explore patients' representations regarding generics in patients suffering from non-specific disabling chronic musculoskeletal pain, as these patients are confronted with the issue of the prescription and/or substitution of original formulations with generics.Qualitative methods were selected because the aim was to access the range of patients' representations and to consider their conceptions. Standardized face-to-face semi-structured interviews were used, and transcripts were submitted to content analysis.Patients' representations suggest that they might be confident in taking a generic medication: when he/she has an understanding of generics as resulting from a development process that has become part of the public domain; the generic medication is prescribed by the physician; each prescription is discussed, i.e., the patient is prescribed the generic version of a given medication and not a generic medication.Economic arguments are not sufficient to justify substitution, and may even raise issues calling upon cognitive dissonance. Even in non-life-threatening diseases, negative cues require attention and need be de-emphasized - in particular lower price as an indication of lower quality, and generic status as contradictory with advocating individualization of medication.

  5. Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations.

    Science.gov (United States)

    Davis, Karen D; Flor, Herta; Greely, Henry T; Iannetti, Gian Domenico; Mackey, Sean; Ploner, Markus; Pustilnik, Amanda; Tracey, Irene; Treede, Rolf-Detlef; Wager, Tor D

    2017-09-08

    Chronic pain is the greatest source of disability globally and claims related to chronic pain feature in many insurance and medico-legal cases. Brain imaging (for example, functional MRI, PET, EEG and magnetoencephalography) is widely considered to have potential for diagnosis, prognostication, and prediction of treatment outcome in patients with chronic pain. In this Consensus Statement, a presidential task force of the International Association for the Study of Pain examines the capabilities of brain imaging in the diagnosis of chronic pain, and the ethical and legal implications of its use in this way. The task force emphasizes that the use of brain imaging in this context is in a discovery phase, but has the potential to increase our understanding of the neural underpinnings of chronic pain, inform the development of therapeutic agents, and predict treatment outcomes for use in personalized pain management. The task force proposes standards of evidence that must be satisfied before any brain imaging measure can be considered suitable for clinical or legal purposes. The admissibility of such evidence in legal cases also strongly depends on laws that vary between jurisdictions. For these reasons, the task force concludes that the use of brain imaging findings to support or dispute a claim of chronic pain - effectively as a pain lie detector - is not warranted, but that imaging should be used to further our understanding of the mechanisms underlying pain.

  6. Evidence-based approach for disaster preparedness authorities to inform the contents of repositories for prescription medications for chronic disease management and control.

    Science.gov (United States)

    Brown, David W; Young, Stacy L; Engelgau, Michael M; Mensah, George A

    2008-01-01

    Chronic diseases are major causes of death and disability and often require multiple prescribed medications for treatment and control. Public health emergencies (e.g., disasters due to natural hazards) that disrupt the availability or supply of these medications may exacerbate chronic disease or even cause death. A repository of chronic disease pharmaceuticals and medical supplies organized for rapid response in the event of a public health emergency is desirable. However, there is no science base for determining the contents of such a repository. This study provides the first step in an evidence-based approach to inform the planning, periodic review, and revision of repositories of chronic disease medications. Data from the 2004 National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to examine the prescription medication needs of persons presenting to US hospital emergency departments for chronic disease exacerbations. It was assumed that the typical distribution of cases for an emergency department will reflect the patient population treated in the days after a public health emergency. The estimated numbers of prescribed drugs for chronic conditions that represent the five leading causes of death, the five leading primary diagnoses for physician office visits, and the five leading causes of disease burden assessed by disability-adjusted life years are presented. The 2004 NHAMCS collected data on 36,589 patient visits that were provided by 376 emergency departments. Overall, the five drug classes mentioned most frequently for emergency department visits during 2004 were narcotic analgesics (30.7 million), non-steroidal anti-inflammatory drugs (25.2 million), non-narcotic analgesics (15.2 million), sedatives and hypnotics (10.4 million), and cephalosporins (8.2 million). The drug classes mentioned most frequently for chronic conditions were: (1) for heart disease, antianginal agents/vasodilators (715,000); (2) for cancer, narcotic analgesics (53

  7. Obsessive-compulsive aspects as predictors of poor response to treatments in patients with chronic migraine and medication overuse.

    Science.gov (United States)

    Curone, M; D'Amico, D; Bussone, G

    2012-05-01

    Patients with chronic migraine (CM) and medication overuse (MO) have a high frequency of psychiatric comorbidity or psychopathological traits, the presence of which may have important implications for the course of the CM and the MO, both for response to treatment and possible relapses. Overuse of symptomatic drugs is regarded as one of the most important risk factor for the transformation of episodic migraine into CM and drug-seeking tendency due to fear of headache in chronic migraine patients shares with obsessive-compulsive disorder (OCD) the compulsive quality of the behavior. Aim of this study was to review the clinical history of a sample of CM patients with MO in which an obsessive-compulsive trait was identified, performing a comparison with a sample of patients without obsessive-compulsive trait. We selected 14 patients with positivity to Spectrum Project OBS (obsessive-compulsive disorder) questionnaire and other 14 patients with negativity to the same tool from among a sample of patients who were enrolled in a previous study on the psychopathological profile of patients suffering from CM with MO. According to data obtained from the clinical records referring to the previous 5 years, patients with OBS questionnaire positivity showed a worse clinical course and a tendency to early relapse in MO after symptomatic medication withdrawal. Our results show that the comorbidity of OCD should be always evaluated in patients with CM and MO as it may play a relevant role--particularly if not treated--among the risk factors favoring the progression of episodic migraine to the chronic form, and/or the tendency to a pathological behavior that prompts the overuse of symptomatic medications.

  8. Differential regulation of alpha7 nicotinic receptor gene (CHRNA7) expression in schizophrenic smokers.

    Science.gov (United States)

    Mexal, Sharon; Berger, Ralph; Logel, Judy; Ross, Randal G; Freedman, Robert; Leonard, Sherry

    2010-01-01

    The alpha7 neuronal nicotinic receptor gene (CHRNA7) has been implicated in the pathophysiology of schizophrenia by genetic and pharmacological studies. Expression of the alpha7* receptor, as measured by [(125)I]alpha-bungarotoxin autoradiography, is decreased in postmortem brain of schizophrenic subjects compared to non-mentally ill controls. Most schizophrenic patients are heavy smokers, with high levels of serum cotinine. Smoking changes the expression of multiple genes and differentially regulates gene expression in schizophrenic hippocampus. We examined the effects of smoking on CHRNA7 expression in the same tissue and find that smoking differentially regulates expression of both mRNA and protein for this gene. CHRNA7 mRNA and protein levels are significantly lower in schizophrenic nonsmokers compared to control nonsmokers and are brought to control levels in schizophrenic smokers. Sufficient protein but low surface expression of the alpha7* receptor, seen in the autoradiographic studies, suggests aberrant assembly or trafficking of the receptor.

  9. The short-term course of familial and nonfamilial schizophrenic-spectrum disorder.

    Science.gov (United States)

    Sautter, F J; McDermott, B E

    1994-01-01

    This study was designed to determine if familial and nonfamilial forms of schizophrenia show a different short-term illness course. Sixteen familial and 22 nonfamilial schizophrenics were evaluated on three occasions at regular 6-month intervals over an 18-month period. The familial and nonfamilial groups were compared for differences in positive and negative symptoms of psychosis and interpersonal and occupational role functioning. The data show that familial schizophrenics experience significantly higher levels of positive symptoms of psychosis and significantly worse occupational role functioning. Significant time by family history interactions indicates that the negative symptoms and interpersonal role functioning of the familial schizophrenics changed over the course of follow-up while remaining stable over time in the nonfamilial group. These data provide preliminary support for the hypothesis that familial schizophrenics show a higher degree of impairment during follow-up than nonfamilial schizophrenics.

  10. The Association of Health Literacy with Illness and Medication Beliefs among Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Kale, Minal S; Federman, Alex D; Krauskopf, Katherine; Wolf, Michael; O'Conor, Rachel; Martynenko, Melissa; Leventhal, Howard; Wisnivesky, Juan P

    2015-01-01

    Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD. We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ). Unadjusted analyses, with corresponding Cohen's d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs. We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (pillness ((p = 0.04, Cohen's d = 0.17). In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65-0.94). In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05-1.37) though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82-1.04). In this cohort of urban individuals with COPD, low health literacy was prevalent, and associated with illness beliefs that predict decreased adherence. Our results suggest that targeted strategies to address low health literacy and related illness and medications beliefs might improve COPD medication adherence and other self-management behaviors.

  11. Mortality and causes of death in first admitted schizophrenic patients

    DEFF Research Database (Denmark)

    Mortensen, P B; Juel, K

    1993-01-01

    of 9156 first admitted schizophrenic patients. Suicide accounted for 50% of deaths in men and 35% of deaths in women. Suicide risk was particularly increased during the first year of follow-up. Death from natural causes, with the exception of cancer and cerebrovascular diseases, was increased. Suicide...... risk during the first year of follow-up increased by 56%, with a 50% reduction on psychiatric in-patient facilities. The study confirms that mortality in schizophrenia is still markedly elevated, and the finding of an increasing suicide risk may be an indicator of some adverse effects...

  12. Personal attitudes, perceived social norms, and health-risk behavior among female adolescents with chronic medical conditions.

    Science.gov (United States)

    Kunz, Jennifer H; Greenley, Rachel N; Mussatto, Kathleen A; Roth-Wojcicki, Betsy; Miller, Tami; Freeman, Mary E; Lerand, Sarah

    2014-07-01

    To examine whether perceived peer/parent norms or personal beliefs about adolescent substance use influence substance use among female adolescents with chronic medical conditions. Sixty-eight females reported on substance use, personal beliefs, and perceived peer/parent norms. Personal beliefs and perceived peer/parent norms were associated with adolescent's current and future substance use. Although perceived peer norms accounted for variance in current substance use, only personal beliefs accounted for variance in future alcohol use. Targeting perceived peer norms may be effective for intervention efforts among adolescents endorsing current substance use, whereas alcohol use prevention efforts should target personal beliefs.

  13. Rapid visual information processing in schizophrenic patients: the impact of cognitive load and duration of stimulus presentation. A pilot study.

    Science.gov (United States)

    Cattapan-Ludewig, Katja; Hilti, Caroline C; Ludewig, Stephan; Vollenweider, Franz X; Feldon, Joram

    2005-01-01

    The inability to sustain attention has been proposed as a core deficit in schizophrenia. The Continuous Performance Task (AX-CPT) and the Rapid Visual Information Processing Task (RVP) are widely used neuropsychological tasks to measure sustained attention. The RVP displays numbers as stimuli, whereas the AX-CPT uses letters. Ten patients with chronic schizophrenia and 18 healthy control subjects were studied using four different versions of the RVP. The versions differed with regard to stimulus presentation time (600 vs. 1,200 ms) and the number of target sequences to be memorized: either one sequence (low cognitive load) or two sequences (high cognitive load). Schizophrenic patients showed a reduced number of hits only on the task version with 600 ms stimulus duration coupled with high cognitive load. The combination of high cognitive load and short stimulus duration created a critical performance breaking point for schizophrenic patients. This finding supports the hypothesis that patients have an impaired ability to coactivate different cognitive performances; thus the results favor the theory of impaired functional connectivity in schizophrenia.

  14. The Adherence Estimator: a brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease.

    Science.gov (United States)

    McHorney, Colleen A

    2009-01-01

    To conceptualize, develop, and provide preliminary psychometric evidence for the Adherence Estimator--a brief, three-item proximal screener for the likelihood of non-adherence to prescription medications (medication non-fulfillment and non-persistence) for chronic disease. Qualitative focus groups with 140 healthcare consumers and two internet-based surveys of adults with chronic disease, comprising a total of 1772 respondents, who were self-reported medication adherers, non-persisters, and non-fulfillers. Psychometric tests were performed on over 150 items assessing 14 patient beliefs and skills hypothesized to be related to medication non-adherence along a proximal-distal continuum. Psychometric tests included, but were not limited to, known-groups discriminant validity at the scale and item level. The psychometric analyses sought to identify: (1) the specific multi-item scales that best differentiated self-reported adherers from self-reported non-adherers (non-fulfillers and non-persisters) and, (2) the single best item within each prioritized multi-item scale that best differentiated self-reported adherers from self-reported non-adherers (non-fulfillers and non-persisters). The two rounds of psychometric testing identified and cross-validated three proximal drivers of self-reported adherence: perceived concerns about medications, perceived need for medications, and perceived affordability of medications. One item from each domain was selected to include in the Adherence Estimator using a synthesis of psychometric results gleaned from classical and modern psychometric test theory. By simple summation of the weights assigned to the category responses of the three items, a total score is obtained that is immediately interpretable and completely transparent. Patients can be placed into one of three segments based on the total score--low, medium, and high risk for non-adherence. Sensitivity was 88%--of the non-adherers, 88% would be accurately classified as medium

  15. Infants at risk for psychopathology: offspring of schizophrenic parents.

    Science.gov (United States)

    Walker, E; Emory, E

    1983-10-01

    The results of research on infants at high risk for schizophrenia (offspring of schizophrenic parents) are reviewed. The findings indicate that high-risk infants are not exposed to greater exogenous stress during the prenatal and perinatal periods, although subsequent caregiving provided by disturbed mothers may be nonoptimal. Several findings point to the existence of a constitutionally vulnerable subgroup of high-risk infants. Fetal and neonatal deaths, unrelated to obstetrical complications, may be more common among high-risk offspring, and neuromotor abnormalities are apparent in a subgroup of high-risk subjects across the life span. Moreover, there is evidence to suggest that offspring of schizophrenics are uniquely susceptible to obstetrical complications when they occur: Neuromotor deficits and other developmental deviations show a greater relationship with obstetrical complications among high-risk infants than controls. Taken together, the results lend support to the validity of interactional models of the etiology of schizophrenia and suggest that preventive intervention may be a realistic goal.

  16. An autopsy case of the schizophrenic 32 years after lobotomy.

    Science.gov (United States)

    Arai, Y; Tsutsui, Y; Shinmura, Y; Kosugi, T; Nishikage, H; Yamamoto, J

    2001-03-01

    An autopsy case is reported here of a 69-year-old patient with schizophrenia, who was known retrospectively to have had a prefrontal lobotomy 32 years previously. The patient was diagnosed as schizophrenic at the age of 24 and the lobotomy was undertaken 13 years later. The patient was recently found outside in a dehydrated condition and admitted to a general hospital, where he died of respiratory failure. Bilateral cystic lesions were found in the deep white matter of the frontal lobe. The cyst walls consisted of glial fibrous tissues, and severe demyelination with axonal destruction was diffusely observed in the white matter of the frontal lobe. In the thinner frontal cortex without arcuate fibers (U fibers) close to the cavities, cytoarchitectural abnormalities were observed. In the thalamic nuclei marked retrograde degeneration and astrocytic gliosis were observed. The detailed neuropathological findings of a lobotomized schizophrenic brain are reported here. It is proposed that one should be reminded of a lobotomized brain if bilateral cysts are found.

  17. Premorbid adjustment and previous personality in schizophrenic patients

    Directory of Open Access Journals (Sweden)

    José Juan Rodríguez Solano

    2005-12-01

    Full Text Available Psychosocial adjustment and premorbid personality are two factors that are frequently studied in order to elucidate the etiopathogenesis of schizophrenia. Premorbid adjustment alterations and personality disorders (principally those of the schizophrenia spectrum have been considered vulnerability elements or have been linked with the early manifestations of a disease that is still underdeveloped (hypothesis of neurodevelopment. In this paper we review the literature. We also studied the relationship between premorbid adjustment (PAS scale and previous personality disorders (SCID-II in a sample of 40 patients with schizophrenia (DSM-III-R, DSM-IV, CIE-10, and statistically correlated them. The results show that premorbid adjustment correlates with avoidant, schizotypal and schizoid personality disorders: the more personality pathology found, the poorer is the premorbid psychosocial adjustment. Premorbid adjustment positively correlates with histrionic personality traits. The pathological traits of schizotypal and schizoid personalities account for up to 77% of the variance of the total premorbid adjustment in schizophrenic patients. Conclusion: The degrees of premorbid adjustment in schizophrenia are related to the different premorbid personality disorders of schizophrenic patients, which are mainly those most genetically related with schizophrenia, that is, the spectrum of the schizophrenia.

  18. Short report : Chronic medical conditions and life satisfaction in the elderly

    NARCIS (Netherlands)

    Jelicic, M; Kempen, GIJM

    1999-01-01

    The aim of this study was to examine the effect of chronic disease on life satisfaction in community dwelling elderly. A total of 5279 research participants, mean age 69.57 (SD = 8.04) yrs, were asked to judge their life satisfaction on the Seven Point Satisfaction Rating Scale. They were also admin

  19. Short report : Chronic medical conditions and life satisfaction in the elderly

    NARCIS (Netherlands)

    Jelicic, M; Kempen, GIJM

    1999-01-01

    The aim of this study was to examine the effect of chronic disease on life satisfaction in community dwelling elderly. A total of 5279 research participants, mean age 69.57 (SD = 8.04) yrs, were asked to judge their life satisfaction on the Seven Point Satisfaction Rating Scale. They were also

  20. Physical and psychosocial functioning following motor vehicle trauma: relationships with chronic pain, posttraumatic stress, and medication use.

    Science.gov (United States)

    Clapp, Joshua D; Masci, Jarod; Bennett, Shira A; Beck, J Gayle

    2010-04-01

    Chronic pain and PTSD are known to hold substantial comorbidity following traumatic injury. Although pharmacological agents have been examined in the treatment of pain and PTSD individually, little is known regarding the relationship of medication use with functioning in patients with comorbid conditions. This research examined the relationships of pain, PTSD, and medication use across physical and psychosocial functioning in patients with chronic pain following motor vehicle injury (N=234). Separate analyses were conducted for opioids, SSRIs, and sedative/anxiolytics, respectively. Several relevant effects were noted: (1) Pain evidenced strong associations with reduced functioning across both physical and psychosocial domains, (2) Opioid use held interactive relationships with PTSD across both functioning domains. Specifically, opioids were associated with greater physical impairment in patients without comorbid PTSD. Opioids also were related to greater psychosocial impairment in patients without PTSD while PTSD was associated with greater impairment in patients not using opioids, (3) Opioid use evidenced a marginal interaction with pain on psychosocial functioning. Opioids were associated with greater psychosocial impairment among patients with high-pain, and high-pain was associated with greater impairment among opioid users, (4) SSRIs held a marginal interaction with PTSD such that PTSD was related to poorer psychosocial functioning only among individuals not using an SSRI, and (5) Anxiolytic use evidenced a marginal interaction with PTSD on physical functioning although no between-group differences were noted. These data suggest that PTSD symptomology may be an important consideration in determining treatment modality for patients experiencing pain subsequent to traumatic injury.

  1. EFFECTS OF RELIGIOUS VERSUS STANDARD COGNITIVE-BEHAVIORAL THERAPY ON OPTIMISM IN PERSONS WITH MAJOR DEPRESSION AND CHRONIC MEDICAL ILLNESS.

    Science.gov (United States)

    Koenig, Harold G; Pearce, Michelle J; Nelson, Bruce; Daher, Noha

    2015-11-01

    We compared the effectiveness of religiously integrated cognitive behavioral therapy (RCBT) versus standard CBT (SCBT) on increasing optimism in persons with major depressive disorder (MDD) and chronic medical illness. Participants aged 18-85 were randomized to either RCBT (n = 65) or SCBT (n = 67) to receive ten 50-min sessions remotely (94% by telephone) over 12 weeks. Optimism was assessed at baseline, 12 and 24 weeks by the Life Orientation Test-Revised. Religiosity was assessed at baseline using a 29-item scale composed of religious importance, individual religious practices, intrinsic religiosity, and daily spiritual experiences. Mixed effects growth curve models were used to compare the effects of treatment group on trajectory of change in optimism. In the intention-to-treat analysis, both RCBT and SCBT increased optimism over time, although there was no significant difference between treatment groups (B = -0.75, SE = 0.57, t = -1.33, P = .185). Analyses in the highly religious and in the per protocol analysis indicated similar results. Higher baseline religiosity predicted an increase in optimism over time (B = 0.07, SE = 0.02, t = 4.12, P depressive symptoms over time (B = -0.61, SE = 0.10, t = -6.30, P < .0001), both independent of treatment group. RCBT and SCBT are equally effective in increasing optimism in persons with MDD and chronic medical illness. While baseline religiosity does not moderate this effect, religiosity predicts increases in optimism over time independent of treatment group. © 2015 Wiley Periodicals, Inc.

  2. [Perioperative management of neuroleptic malignant syndrome in a schizophrenic patient scheduled to undergo operation for bowel obstruction].

    Science.gov (United States)

    Kotera, Atsushi; Kouzuma, Seiji; Miyazaki, Naoki; Hashimoto, Masahiro; Taki, Kenichiro; Esaki, Kimiaki

    2011-03-01

    Neroleptic malignant syndrome (NMS) is a serious side effect of antipsychotic medications. The risk factors for NMS are the patient's physiologic conditions such as dehydration, malnutrition, stress, and additional administration of sedative drugs including haloperidol. We report a case of 62-year-old schizophrenic man with bowel obstruction due to rectal cancer. Colostomy under general anesthesia was scheduled, and he had not taken oral medication. After intravenous injection of haloperidol for sedation, muscle rigidity, high fever, and an elevated serum level of creatine phosphokinase were observed. He was diagnosed as NMS, and sodium dantrolene was administered. After the improvement of NMS, colostomy was done. Dehydration and malnutrition of the patient were severe at the time of operation, and the possibility of NMS developing due to stress was thought to be very high. We administered sodium dantrolene to prevent NMS after the operation, and the management for prevention of NMS is discussed.

  3. Immunoassay-Based Drug Tests Are Inadequately Sensitive for Medication Compliance Monitoring in Patients Treated for Chronic Pain.

    Science.gov (United States)

    Snyder, Marion L; Fantz, Corrine R; Melanson, Stacy

    2017-02-01

    Enzyme immunoassays (EIA) have notable limitations for monitoring therapeutic compliance in pain management. Chromatography coupled with mass spectrometry provides definitive results and superior sensitivity and specificity over traditional EIA testing. To analyze and compare the sensitivity of EIA results together with known prescriptions to liquid chromatography-tandem mass spectrometry (LC-MS/MS) for monitoring drug use (and abuse) in patients treated for chronic pain. A total of 530 urine samples from patients being treated for chronic pain were studied. Pain management clinic in the United States. The samples were tested for a profile of chronic pain medications and illicit drugs with commercially available EIA kits followed by analysis with Agilent LC-MS/MS system. The EIAs exhibited poor sensitivity and high rates of false negative results in the pain management setting. For example, 21% of EIA for opiates show false negative results. Mass spectrometry methods were more sensitive, detected a broader range of drugs and metabolites, and could detect non-prescribed drug use and simulations in compliance. Patients do not always accurately report drug use information, and some drugs do not have EIA methods available for comparative purposes. Mass spectrometry is a more robust and reliable method for detection of drugs used in the pain management setting. Due to the extent of undisclosed use and abuse of medications and illicit drugs, LC-MS/MS testing is necessary for adequate and accurate drug detection. In addition, LC-MS/MS methods are superior in terms of sensitivity and number of compounds that can be screened, making this a better method for use in pain management. Key words: Pain management, enzyme immunoassays, mass spectrometry, urine drug testing, prescription status, compliance.

  4. The effect of verbalization strategy on wisconsin card sorting test performance in schizophrenic patients receiving classical or atypical antipsychotics

    Directory of Open Access Journals (Sweden)

    Cavallaro Roberto

    2006-01-01

    Full Text Available Abstract Background A number of reports showed en encouraging remediation in some patients' executive deficits thanks to the use of 'information processing strategies'. Moreover the impact of antipsychotics on cognitive functions of the schizophrenics is an important issue, especially if an integrated psychosocial treatment is needed. The aim of this paper is to evaluate different executive performance and response to verbalization, a strategy of the Wisconsin Card Sorting Test (WCST remediation, in subjects on classical vs atypical antipsychotic (AP treatment. Methods Sixty-three schizophrenic subjects undertook the WCST under standard and modified (verbalization administration. Subjects were stratified by the kind of WCST response (i.e. good, poor and remediable and AP treatment (i.e. atypical vs. classical. Results Subjects on atypical APs showed a better performance than those on classical ones. More poor performers who did not remediate were seen in the sample with classical Aps while subjects who remediated the performance were seen in the subgroup with atypical APs only. An increase of perseverative and total errors was seen in poor performers subjects on classical APs. Conclusion Subjects on atypicals showed a better cognitive pattern in terms of WCST performance. Since the naturalistic assignment of medication we cannot draw conclusions about its effect on cognitive performance and its interaction with cognitive remediation potential. However the data lead us to hypothesize that subjects with potential room for remediation did so with the atypical APs.

  5. Abnormal temporal and parietal magnetic activations during the early stages of theory of mind in schizophrenic patients.

    Science.gov (United States)

    Vistoli, Damien; Brunet-Gouet, Eric; Lemoalle, Amelia; Hardy-Baylé, Marie-Christine; Passerieux, Christine

    2011-01-01

    Schizophrenia is associated with abnormal cortical activation during theory of mind (ToM), as demonstrated by several fMRI or PET studies. Electrical and temporal characteristics of these abnormalities, especially in the early stages, remain unexplored. Nineteen medicated schizophrenic patients and 21 healthy controls underwent magnetoencephalography (MEG) recording to measure brain response evoked by nonverbal stimuli requiring mentalizing. Three conditions based on comic-strips were contrasted: attribution of intentions to others (AI), physical causality with human characters (PCCH), and physical causality with objects (PCOB). Minimum norm localization was performed in order to select regions of interest (ROIs) within bilateral temporal and parietal regions that showed significant ToM-related activations in the control group. Time-courses of each ROI were compared across group and condition. Reduced cortical activation within the 200 to 600 ms time-window was observed in the selected regions in patients. Significant group by condition interactions (i.e., reduced modulation in patients) were found in right posterior superior temporal sulcus, right temporoparietal junction, and right inferior parietal lobule during attribution of intentions. As in healthy controls, the presence of characters elicited activation in patients' left posterior temporal regions and temporoparietal junction. No group difference on evoked responses' latencies in AI was found. In conclusion, ToM processes in the early stages are functionally impaired in schizophrenia. MEG provides a promising means to refine our knowledge on schizophrenic social cognitive disorders.

  6. Brain volumes in familial and non-familial schizophrenic probands and their unaffected relatives.

    Science.gov (United States)

    McDonald, Colm; Grech, Anton; Toulopoulou, Timothea; Schulze, Katja; Chapple, Ben; Sham, Pak; Walshe, Muriel; Sharma, Tonmoy; Sigmundsson, Thordur; Chitnis, Xavier; Murray, Robin M

    2002-08-08

    Structural brain abnormalities are consistently reported in schizophrenic subjects but the etiology of these abnormalities remains unclear. We tested the contribution of genetic predisposition and obstetric complications to the structural brain abnormalities found in schizophrenic probands and their relatives. MRI scans were carried out on 35 schizophrenic probands from families multiply affected with the disorder, and 63 of their unaffected relatives, including 10 parents who appeared to transmit genetic risk to their children; as well as 31 schizophrenic probands from families with no other affected members, 33 of their unaffected relatives; and finally 68 controls. Volumetric measurements of whole brain, lateral ventricles, third ventricle, cerebellum, and temporal lobes were completed for each subject. The impact of obstetric complications on brain structure was assessed across the gradient of presumed genetic predisposition. Both groups of schizophrenic probands displayed enlargement of the lateral and third ventricles, and there was a gradient of ventricular enlargement amongst the unaffected relatives in proportion to their likelihood of carrying schizophrenic genes. Ventricular enlargement was largely confined to males in both probands and unaffected relatives. Obstetric complications were associated with ventricular enlargement only in the familial probands. Non-familial probands displayed reduced volume of the temporal lobes bilaterally. In families with several schizophrenic members, ventricular enlargement is a marker for genetic liability, particularly in males. Individuals inheriting the susceptibility to schizophrenia appear particularly prone to develop ventricular enlargement in response to obstetric complications.

  7. [Self-experienced vulnerability, prodromic symptoms and coping strategies before schizophrenic and affective episodes].

    Science.gov (United States)

    Bechdolf, A; Halve, S; Schultze-Lutter, F; Klosterkötter, J

    1998-08-01

    For the first time, the present study explores self-experienced vulnerability, prodromal symptoms and coping strategies preceding schizophrenic and affective episodes. 33 schizophrenic and 29 depressive patients were assessed retrospectively for preepisodic alterations by means of the "Bonn Scale for the Assessment of Basic Symptoms- BSABS" after complete recovery from the acute episode. 97% of the schizophrenic and 93% of the depressive patients showed preepisodic alterations. In the schizophrenic group the first alteration occurred with a median of 10 weeks and in the depressive group with a median of 18 weeks before the onset of the acute episode. With regard to self-experienced vulnerability depressive cases were significantly less tolerant to stress, i.e work under time pressure or unusual, unexpected requirements. With regard to prodromal symptoms schizophrenics showed significantly more often interpersonal irritation and certain perception and thought disturbances, whereas depressive patients reported more often adynamia and certain disturbances of proprioception. 73% of the schizophrenic patients and 90% of the depressive patients reacted to early symptoms with coping strategies. The preepisodic alterations in schizophrenic patients could be described in terms of mild psychotic productivity, early symptoms of depressive patients could be described as a mild depressive syndrome. Prospective studies are necessary to show if assessment of mild psychotic productivity could be used for early diagnosis and early intervention in schizophrenia.

  8. Lack of influence of COMT and NET genes variants on executive functions in schizophrenic and bipolar patients, their first-degree relatives and controls.

    Science.gov (United States)

    Szöke, A; Schürhoff, F; Méary, A; Mathieu, F; Chevalier, F; Trandafir, A; Alter, C; Roy, I; Bellivier, F; Leboyer, M

    2006-07-05

    Abnormal dopaminergic function in the prefrontal cortex (PFC) may be a key factor in the etiopathogeny of schizophrenia and bipolar disorder. Both schizophrenic and bipolar subjects have executive functions (EF) deficits, thought to reflect abnormal PFC function. The main inactivation pathways for dopamine in the PFC are enzymatic cleavage by the Carboxy-O-Methyl-Transferase (COMT) and reuptake by the nor-epinephrine transporter (NET). Our aim in this study was to replicate previous studies that investigated influence of the COMT genotype on EF in schizophrenic subjects, their relatives and controls and extend their scope by including bipolar patients, and their relatives and by exploring NET gene polymorphisms influence on executive performances. We investigated one functional polymorphism of the COMT gene and two polymorphisms of the NET gene. EF were assessed by means of the Trail Making Test (TMT) and the Wisconsin Card Sorting Test (WCST). We assessed the effect of each of the three genotypes on EF for the whole sample (N = 318) and separately in schizophrenic (N = 66), bipolar (N = 94) and healthy subjects (i.e., relatives and controls N = 158). Separate analyses were performed because of the presence, in patients samples, of potentially confounding factors, especially medication. Genotype had no significant effect on the cognitive measures in any of the analyses (for the two EF measures, the three polymorphisms, and the four groups). In our sample we found no evidence in favor of a major effect of COMT or NET polymorphisms on the two tests of EF.

  9. Self-management of chronic illness: the role of 'habit' versus reflective factors in exercise and medication adherence.

    Science.gov (United States)

    Phillips, L Alison; Cohen, Joshua; Burns, Edith; Abrams, Jessica; Renninger, Steffi

    2016-12-01

    Non-adherence to health behaviors required for chronic illness self-management is pervasive. Advancing health-behavior theory to include behavioral initiation and maintenance factors, including reflective (e.g., belief- and feedback-based) and automatic (e.g., habit-based) mechanisms of adherence to different treatment-related behaviors could improve non-adherence prediction and intervention efforts. To test behavioral initiation and maintenance factors from an extended common sense self-regulation theoretical framework for predicting medication adherence and physical activity among patients with Type 2 diabetes. Patients (n = 133) in an in-person (n = 80) or online (n = 53) version of the study reported treatment-related (1) barriers, (2) beliefs and experiential feedback (reflective mechanisms of treatment-initiation and short-term repetition), and (3) habit strength (automatic mechanism of treatment-maintenance) for taking medication and engaging in regular physical activity at baseline. Behaviors were assessed via self-reports (n = 133) and objectively (electronic monitoring pill bottles, accelerometers; n = 80) in the subsequent month. Treatment-specific barriers and habit strength predicted self-reported and objective adherence for both behaviors. Beliefs were inconsistently related to behavior, even when habits were "weak". Experiential feedback from behavior was not related to adherence. Among patients with Type 2 diabetes diagnosis, medication and physical activity adherence were better predicted by their degree of automatic behavioral repetition than their beliefs/experiences with the treatment-actions. Habit strength should be an intervention target for chronic illness self-management; assessing it in practice settings may effectively detect non-adherence to existing treatment-regimens. However, future research and further refining of CS-SRM theory regarding the processes required for such habit development are needed.

  10. Multiprofessional teamwork in work-related medical rehabilitation for patients with chronic musculoskeletal disorders.

    Science.gov (United States)

    Schwarz, Betje; Neuderth, Silke; Gutenbrunner, Christoph; Bethge, Matthias

    2015-01-01

    Systematic reviews indicate the effectiveness of multimodal rehabilitation. In Germany this has been shown, in particular, for work-related medical rehabilitation. A recently published guideline on work-related medical rehabilitation supports the dissemination of these programmes. The feasibility of this guideline was examined in a multicentre study. This paper presents findings on the relevance of multiprofessional teamwork for the implementation of successful work-related medical rehabilitation. Focus groups were conducted with 7 inpatient orthopaedic rehabilitation teams and examined using qualitative content analysis. Multiprofessional teamwork emerged inductively as a meaningful theme. All teams described multiprofessional teamwork as a work-related medical rehabilitation success factor, referring to its relevance for holistic treatment of multifactorially impaired patients. Although similar indicators of successful multiprofessional teamwork were named, the teams realized multiprofessional teamwork differently. We found 3 team types, corresponding to multidisciplinary, interdisciplinary and transdisciplinary team models. These types and models constitute a continuum of collaborative practice, which seems to be affected by context-related factors. The significance of multiprofessional teamwork for successful multimodal rehabilitation was underlined. Indicators of ideal multiprofessional teamwork and contextual facilitators were specified. The contingency approach to teamwork, as well as the assumption of multiprofessional teamwork as a continuum of collaborative practice, is supported. Stronger consideration of multiprofessional teamwork in the work-related medical rehabilitation guideline is indicated.

  11. Insight and attitudes towards medication among inpatients with chronic schizophrenia in the US and China.

    Science.gov (United States)

    Mohamed, Somaia; Rosenheck, Robert; He, Hongbo; Yuping, Ning

    2014-07-01

    The impact of culture on insight on illness and attitudes towards medication among patients with schizophrenia has not been well studied. We compared inpatients in the US and in China (a culture that numerous studies have shown heavily stigmatizes mental illness and psychosis), on measures of insight and acceptance of medication, controlling for overall severity of schizophrenia symptoms. Clinical antipsychotic treatment for intervention effectiveness (CATIE) was a large study of pharmacotherapy of people with schizophrenia across the US. Insight was measured using the insight and treatment attitudes questionnaire (ITAQ) and attitudes towards medication by the drug attitude inventory (DAI) and symptoms of schizophrenia by the Positive and Negative Syndrome Scale (PANSS). These measures were applied to a sample of hospitalized patients diagnosed with schizophrenia at the Guangzhou Psychiatric hospital, the largest psychiatric hospital in Southern China. Mean ITAQ and DAI scores, net of total schizophrenia symptoms and other differences were compared at the time of admission using analysis of covariance. Both insight and favourable attitudes towards medication were significantly and substantially lower in the sample from Guangzhou on bivariate analysis even after adjusting for severity of overall schizophrenia symptoms on the PANSS. Inpatients in China had far lower scores on measures of insight and acceptance of their need for and benefits of medication, controlling for overall severity of schizophrenia symptoms, suggesting a significant impact of Chinese culture which is presumed to more heavily stigmatize mental illness and especially psychosis, although other explanations can not be ruled out.

  12. Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care

    OpenAIRE

    2011-01-01

    Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need for various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technolog...

  13. Facial, vocal and musical emotion recognition is altered in paranoid schizophrenic patients.

    Science.gov (United States)

    Weisgerber, Anne; Vermeulen, Nicolas; Peretz, Isabelle; Samson, Séverine; Philippot, Pierre; Maurage, Pierre; De Graeuwe D'Aoust, Catherine; De Jaegere, Aline; Delatte, Benoît; Gillain, Benoît; De Longueville, Xavier; Constant, Eric

    2015-09-30

    Disturbed processing of emotional faces and voices is typically observed in schizophrenia. This deficit leads to impaired social cognition and interactions. In this study, we investigated whether impaired processing of emotions also affects musical stimuli, which are widely present in daily life and known for their emotional impact. Thirty schizophrenic patients and 30 matched healthy controls evaluated the emotional content of musical, vocal and facial stimuli. Schizophrenic patients are less accurate than healthy controls in recognizing emotion in music, voices and faces. Our results confirm impaired recognition of emotion in voice and face stimuli in schizophrenic patients and extend this observation to the recognition of emotion in musical stimuli.

  14. Chronic Abdominal Pain in Children and Adolescents: Parental Threat Perception Plays a Major Role in Seeking Medical Consultations.

    Science.gov (United States)

    Calvano, Claudia; Warschburger, Petra

    2016-01-01

    Background. Pain symptoms, associated impairment, and parental perception of threat are reported to be predictors of health care utilization (HCU) in childhood chronic abdominal pain (CAP). However, mediating variables and their interrelations have not yet been systematically studied. Objectives. This study aims to identify mediating pathways of influence between child's abdominal pain and the number of pain-related medical visits. Methods. In a multicenter study, we recruited N = 151 parent-child dyads with children aged 6-17 years suffering from CAP. A composite measure of pain symptoms was defined as predictor and the number of pain-related medical visits as outcome variable. This relation was analyzed by serial mediation, including child- and parent-reported impairment and parental threat perception as mediators. Results. Only parental threat perception significantly linked child's pain symptoms to the number of medical visits. Measures of impairment did not have a significant effect. Conclusions. Parental pain-related threat perception is strongly related to health care seeking in childhood CAP. Addressing threat perception might be a fruitful parent-centered approach in clinical practice.

  15. Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness

    Science.gov (United States)

    Pearce, Michelle J.; Koenig, Harold G.; Robins, Clive J.; Nelson, Bruce; Shaw, Sally F.; Cohen, Harvey J.; King, Michael B.

    2015-01-01

    Intervention studies have found that psychotherapeutic interventions that explicitly integrate clients’ spiritual and religious beliefs in therapy are as effective, if not more so, in reducing depression than those that do not for religious clients. However, few empirical studies have examined the effectiveness of religiously (vs. spiritually) integrated psychotherapy, and no manualized mental health intervention had been developed for the medically ill with religious beliefs. To address this gap, we developed and implemented a novel religiously integrated adaptation of cognitive–behavioral therapy (CBT) for the treatment of depression in individuals with chronic medical illness. This article describes the development and implementation of the intervention. First, we provide a brief overview of CBT. Next, we describe how religious beliefs and behaviors can be integrated into a CBT framework. Finally, we describe Religiously Integrated Cognitive Behavioral Therapy (RCBT), a manualized therapeutic approach designed to assist depressed individuals to develop depression-reducing thoughts and behaviors informed by their own religious beliefs, practices, and resources. This treatment approach has been developed for 5 major world religions (Christianity, Judaism, Islam, Buddhism, and Hinduism), increasing its potential to aid the depressed medically ill from a variety of religious backgrounds. PMID:25365155

  16. [Pain sensitivity changes in schizophrenic patients and animal models--Part II].

    Science.gov (United States)

    Tuboly, Gábor; Horváth, Gyöngyi

    2009-05-30

    Diminished pain sensitivity in schizophrenic patients has been reported for more than 50 years, however little is known about the substrate and the basic mechanisms underlying altered pain sensitivity in this disease, therefore, relevant animal models are of decisive importance in the study of psychiatric diseases. The authors report a review consisting of two parts focusing on pain sensitivity changes in patients and in different animal models which proved the eligibility as schizophrenia models and pain sensitivities have also been determined. The second part of this article analyzed the results regarding knock out mice as schizophrenia models. These data proved that several genes have significant role in the pathomechanism of schizophrenia; therefore deficiency in one gene does not produce animals showing all signs of this disease. As regards the pain sensitivity changes, only a few data are available with controversial results. Data originated from complex chronic animal models indicate that they might be more adequate methods for studying the mechanisms of schizophrenia including the pain-sensitivity changes.

  17. Clozapine augments delta, theta, and right frontal EEG alpha power in schizophrenic patients.

    Science.gov (United States)

    Maccrimmon, D; Brunet, D; Criollo, M; Galin, H; Lawson, J S

    2012-01-01

    Objective. To explore the Quantitative EEG (QEEG) effects of established clozapine therapy regimes compared to those of previous ineffective antipsychotic regimes among 64 chronic (DSM-IV) schizophrenic patients. Methods. Data from 20 EEG channels referenced to linked ears were collected before and during maintenance clozapine therapy (mean duration 1.4 years). Absolute power was calculated in six frequency bands: delta (0.4-3.6 Hz), theta (4.2-7.8 Hz), alpha (8.2-11.8 Hz), beta1 (12.2-15.8 Hz), beta2 (16.2-19.8 Hz), and beta3 (20.2-23.8 Hz). Results. Clozapine augments power globally in the delta and theta bands, but this effect is more pronounced over frontal areas. Beta3 power was reduced. Alpha showed a frontal increase, more pronounced in the right, coupled with a posterior decrease with no net change in overall power. Conclusion. The demonstration of a significant clozapine-induced alpha topographic shift frontally and to the right is a novel discovery that may serve to encourage further investigations of subcortical structures in attempts to better understand the diverse aetiologies and optimal treatments of the schizophrenias.

  18. Contributions of societal and geographical environments to "chronic Lyme disease": the psychopathogenesis and aporology of a new "medically unexplained symptoms" syndrome.

    Science.gov (United States)

    Sigal, Leonard H; Hassett, Afton L

    2002-08-01

    Lyme disease is a relatively well-described infectious disease with multisystem manifestations. Because of confusion over conflicting reports, anxiety related to vulnerability to disease, and sensationalized and inaccurate lay media coverage, a new syndrome, "chronic Lyme disease," has become established. Chronic Lyme disease is the most recent in a continuing series of "medically unexplained symptoms" syndromes. These syndromes, such as fibromyalgia, chronic fatigue syndrome, and multiple chemical sensitivity, meet the need for a societally and morally acceptable explanation for ill-defined symptoms in the absence of objective physical and laboratory findings. We describe factors involved in the psychopathogenesis of chronic Lyme disease and focus on the confusion and insecurity these patients feel, which gives rise to an inability to adequately formulate and articulate their health concerns and to deal adequately with their medical needs, a state of disorganization termed aporia.

  19. [Evolution of the social autonomy scale (EAS) in schizophrenic patients depending on their management].

    Science.gov (United States)

    Leguay, D; Rouillon, F; Azorin, J-M; Gasquet, I; Loze, J-Y; Arnaud, R; Dillenschneider, A

    2010-10-01

    It is becoming clear to clinicians that functional prognosis is the issue that should be guiding their choice of therapeutic strategy offered to people with schizophrenic disorders. An individual's degree of social autonomy is one of the principal factors determining functional prognosis, and it has become essential to identify the variables that influence it. The ESPASS survey was set up to follow a cohort of 6000 schizophrenic patients in a naturalistic setting, and was conducted over six months by 1170 psychiatrists. Patients were required to meet DSM-IV TR criteria for schizophrenia, with the exception of those suffering from an acute psychotic episode, and to either need a change in their antipsychotic treatment or its initiation. Data collected included patients' sociodemographical characteristics, types of treatment (pharmacological and non-pharmacological), illness characteristics (as determined by the DSM-IV TR criteria), degree of social autonomy (EAS), effectiveness (IAQ scale), overall severity of the illness (CGI - S scale) and patient satisfaction with medical treatment (PASAP self-questionnaire). Concerning the non-pharmacological aspects of treatment that offer patients programmes to increase their autonomy, the survey made it possible to collect data describing real practices and to measure the actual availability of rehabilitation services. It has been verified that the sample of psychiatrists included in this survey, as well as the schizophrenic patients under evaluation, were representative of the French psychiatrist and patient populations. Most importantly, the survey made it possible to objectively evaluate the healthcare services available in France. It seems that the vast majority of public-service psychiatrists have access to hospital and ambulatory facilities for treatment (medical-psychological centers, day-care hospitals and rest centers), as well as access to facilities providing simulated real-life activities. Psychiatrists who are

  20. Ritanserin as add-on medication to neuroleptic therapy for patients with chronic or subchronic schizophrenia

    NARCIS (Netherlands)

    Den Boer, JA; Vahlne, JO; Post, P; Heck, AH; Daubenton, F; Olbrich, R

    2000-01-01

    The effect of ritanserin, a potent 5HT(2A/2C) receptor antagonist, used as an add-on medication to neuroleptic treatmentin patients with schizophrenia, was compared with that of placebo, in an international, double-blind, parallel-group study. Previously established neuroleptic therapy was maintaine

  1. The Association of Health Literacy with Illness and Medication Beliefs among Patients with Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Kale, Minal S.; Federman, Alex D.; Krauskopf, Katherine; Wolf, Michael; O’Conor, Rachel; Martynenko, Melissa; Leventhal, Howard; Wisnivesky, Juan P.

    2015-01-01

    Background Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD. Methods We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ). Unadjusted analyses, with corresponding Cohen’s d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs. Results We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (p<0.001), not be married (p = 0.006), and to have lower income (p<0.001) or education (p<0.001). In unadjusted analyses, patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen’s d = 0.42), and were more likely to be concerned about their illness ((p = 0.04, Cohen’s d = 0.17). In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65–0.94). In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05–1.37) though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82–1.04). Conclusions In this cohort of urban

  2. The Association of Health Literacy with Illness and Medication Beliefs among Patients with Chronic Obstructive Pulmonary Disease.

    Directory of Open Access Journals (Sweden)

    Minal S Kale

    Full Text Available Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD.We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ and Beliefs about Medications Questionnaire (BMQ. Unadjusted analyses, with corresponding Cohen's d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs.We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (p<0.001, not be married (p = 0.006, and to have lower income (p<0.001 or education (p<0.001. In unadjusted analyses, patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen's d = 0.42, and were more likely to be concerned about their illness ((p = 0.04, Cohen's d = 0.17. In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65-0.94. In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05-1.37 though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82-1.04.In this cohort of urban individuals with COPD, low health literacy was

  3. Medical nutrition therapy in chronic kidney disease; from dialysis to transplant: A case report

    Directory of Open Access Journals (Sweden)

    Gabriela Leal-Escobar

    2016-01-01

    Full Text Available Chronic kidney disease has direct implications in nutritional status, causing anorexia and muscular catabolism. These situations are frequent in kidney renal replacement therapy in which nutritional disorders and inflammatory mechanisms associated with therapy often lead to the development of protein-energy wasting. Nutrition therapy has shown an adequate therapeutic strategy to prevent and treat metabolic alterations, reducing surgical and nutritional complication risks in kidney transplantation patients. The current case reports nutritional intervention on a continuous ambulatory peritoneal dialysis patient who was subsequently prescribed to automatic peritoneal dialysis and, finally, kidney transplant from a living donor.

  4. Development and psychometric evaluation of the Self-efficacy for Appropriate Medication Use Scale (SEAMS) in low-literacy patients with chronic disease.

    Science.gov (United States)

    Risser, Jessica; Jacobson, Terry A; Kripalani, Sunil

    2007-01-01

    Medication nonadherence remains a significant obstacle to achieving improved health outcomes in patients with chronic disease. Self-efficacy, the confidence in one's ability to perform a given task such as taking one's medications, is an important determinant of medication adherence, indicating the need for reliable and valid tools for measuring this construct. This study sought to develop a self-efficacy scale for medication adherence in chronic disease management that can be used in patients with a broad range of literacy skills. The Self-efficacy for Appropriate Medication Use (SEAMS) was developed by a multidisciplinary team with expertise in medication adherence and health literacy. Its psychometric properties were evaluated among 436 patients with coronary heart disease and other comorbid conditions. Reliability was evaluated by measuring internal consistency and test-retest reliability. Principal component factor analysis was performed to evaluate the validity of the SEAMS. Reliability and validity analyses were also performed separately among patients with low and higher literacy levels. The final 13-item scale had good internal consistency reliability (Cronbach's alpha = 0.89). A two-factor solution was found, explaining 52.3% of the scale's variance. The scale performed similarly across literacy levels. The SEAMS is a reliable and valid instrument that may provide a valuable assessment of medication self-efficacy in chronic disease management, and appears appropriate for use in patients with low literacy skills.

  5. A study of theory of mind deficit in first-episode schizophrenic patients%首发精神分裂症患者心灵理论损伤的研究

    Institute of Scientific and Technical Information of China (English)

    汪永光; 汪凯; 朱春燕; 汪辉

    2006-01-01

    成绩呈显著正相关.结论 首发、未服药的精神分裂症患者存在心灵理论能力的损害,并且这种损害可能与其额叶功能的障碍有关.两种不同亚型的精神分裂症患者可能存在着不同形式的心灵理论的损害.%Background The disability of theory of mind (ToM) has been confirmed in chronic or acute medicated schizophrenic patients.The role of ToM ability in first-episode, drug-naive schizophrenic patients was investigated in this study.Methods ToM was assessed with the Eyes task and Faux pas task in first-episode, drug-naive schizophrenic patients( n =52)compared with healthy controls ( n =64). Verbal Fluency Test (VFT) and Digit Span Test (DST) were also examined in two groups. Psychiatric symptoms were evaluated by the Positive and Negative Syndrome Scale (PANSS).Results The tests that involved the ToM ability (I. E. Mind reading and Faux pas questions) were impaired in the schizophrenic group. The schizophrenia performed worse than the normal controls on the VFT. The schizophrenic negative subgroup performed worse than the positive subgroup in Mind reading and VFT. There was a significantly positive correlation between the performances of the tests that involved the ToM ability and the scores of VFT in schizophrenic patients. There was a significantly negative correlation between the performances of the tests that involved the ToM ability and negative symptom scores in the patients.Conclusions The patients with schizophrenia exhibit ToM deficit that is probably associated with the frontal lobe dysfunction.The performance of ToM dysfunction might be different between negative subjects and positive ones.

  6. Schizophrenic delusions in Seoul, Shanghai and Taipei: a transcultural study.

    Science.gov (United States)

    Kim, K; Hwu, H; Zhang, L D; Lu, M K; Park, K K; Hwang, T J; Kim, D; Park, Y C

    2001-02-01

    In this transcultural study of schizophrenic delusions among patients in Seoul, Shanghai and Taipei, we discovered that both the frequency and content of delusions differed among the three groups; and that these differences could perhaps be explained by varying sociocultural and political situations. Delusional themes that are sensitive to sociocultural or political situations include guilt, love/sex, religion, somatic damage, economy/business and politics. Delusions regarding longevity, love/sex, dysmorphophobia/dysosmophobia, religion or supernatural matters, and espionage/spy stories were most frequent in Seoul patients. Those in Taipei predominantly had delusions about possession, religion or supernatural matters, hypnotism, and mass media/computers. Shanghai patients often had delusions of poisons, being prickled by poisoned needles, their brain and viscera extracted and being a family member of political authorities.

  7. Common risk genes for affective and schizophrenic psychoses.

    Science.gov (United States)

    Maier, Wolfgang

    2008-06-01

    The familial-genetic relationship between affective and schizophrenic disorders is receiving a re-emergence of interest. The reasons are a series of cross-diagnostic molecular-genetic discoveries: specific alleles in the genes for dysbindin (DTNBP1), neuregulin (NRG1) and DAOA (G72/G30) reveal associations for each of both groups of disorders in the same direction in some but not all reported studies. These findings cannot just be false positives because of confirming metaanalyses. Furthermore there is some pathophysiological support: the mentioned genes are involved in biochemical pathways, which are contributing to both disorders partly in a similar and partly in a different manner. The new levels of evidence enrich the classical continuity/discontinuity debate on the relationship between both groups of disorders.

  8. PRODH gene is associated with executive function in schizophrenic families.

    Science.gov (United States)

    Li, Tao; Ma, Xiaohong; Hu, Xun; Wang, Yingcheng; Yan, Chengying; Meng, Huaqing; Liu, Xiehe; Toulopoulou, Timothea; Murray, Robin M; Collier, David A

    2008-07-05

    The aim of this study was to investigate the relationship between polymorphisms in the PRODH and COMT genes and selected neurocognitive functions. Six SNPs in PRODH and two SNPs in COMT were genotyped in 167 first-episode schizophrenic families who had been assessed by a set of 14 neuropsychological tests. Neuropsychological measures were selected as quantitative traits for association analysis. The haplotype of SNPs PRODH 1945T/C and PRODH 1852G/A was associated with impaired performance on the Tower of Hanoi, a problem-solving task mainly reflecting planning capacity. There was no significant evidence for association with any other neuropsychological traits for other SNPs or haplotypes of paired SNPs in the two genes. This study takes previous findings of association between PRODH and schizophrenia further by associating variation within the gene with performance on a neurocognitive trait characteristic of the illness. It fails to confirm previous reports of an association between COMT and cognitive function.

  9. [Severe and acute hyponatremia in a schizophrenic patient with potomania].

    Science.gov (United States)

    Macías Robles, M D; López Fonticiella, M P; Maciá Bobés, M; Fernández San Martín, A

    2009-01-01

    Acute and severe hyponatremia causes a metabolic encephalothy. It is physiopathologically based on the cerebral edema, and its fatal symptoms include seizures and coma. We present a case of an extreme hyponatremia of multifactorial etiology in a schizophrenic patient with potomania. Potomania does not usually cause hyponatremia, unless it coexists with other trigger factors. This patient had a syndrome of inappropriate antidiuretic hormone (SIADH), and a deep hypokaliemia, due to vomiting and a treatment with indapamida, which perpetuates the deficit of extracellular sodium. In the patient's treatment, aripiprazole was the only recently introduced drug with which cases of inappropriate vasopressin secretion have been reported. Management of a severe hyponatremia must be considered a vital emergency, independent of the cause, and 3% hypertonic saline must be administered. The increase of the sodium level must not be higher than 25 mmol/L in the first 24-48 hours, to avoid a secondary brain injury.

  10. Racial and Ethnic Disparities in Influenza Vaccination among Adults with Chronic Medical Conditions Vary by Age in the United States

    Science.gov (United States)

    Lu, Degan; Qiao, Yanru; Brown, Natalie E.; Wang, Junling

    2017-01-01

    Background People living with chronic health conditions exhibit higher risk for developing severe complications from influenza according to the Centers for Diseases Control and Prevention. Although racial and ethnic disparities in influenza vaccination have been documented, it has not been comprehensively determined whether similar disparities are present among the adult population with at least one such condition. Objective To study if racial and ethnic disparities in relation to influenza vaccination are present in adults suffering from at least one chronic condition and if such inequalities differ between age groups. Methods The Medical Expenditure Panel Survey (2011–2012) was used to study the adult population (age ≥18) who had at least one chronic health condition. Baseline differences in population traits across racial and ethnic groups were identified using a chi-square test. This was conducted among various age groups. In addition, survey logistic regression was utilized to produce odds ratios of receiving influenza vaccination annually between racial and ethnic groups. Results The total sample consisted of 15,499 adults living with at least one chronic health condition. The numbers of non-Hispanic whites (whites), non-Hispanic blacks (blacks), and Hispanics were 8,658, 3,585, and 3,256, respectively. Whites (59.93%) were found to have a higher likelihood of self-reporting their receipt of the influenza vaccine in comparison to the black (48.54%) and Hispanic (48.65%) groups (Pinfluenza vaccine coverage than the white population (59.22%, 77.89) (both P0.05). After controlling for patient characteristics, the difference in influenza vaccine coverage between whites and the minority groups were no longer significant for adults aged 50–64 years. However, the difference were still statistically significant for those aged ≥65 years. Conclusions In the United States, there are significant disparities in influenza vaccination by race and ethnicity for

  11. “Just Advil”: Harm reduction and identity construction in the consumption of Over-The-Counter medication for chronic pain Social Science & Medicine

    Science.gov (United States)

    2015-01-01

    Direct-to-consumer marketing has sparked ongoing debate concerning whether ads empower consumers to be agents of their own care or shift greater control to the pharmaceutical industry. Ads for over-the-counter (OTC) medications in particular portend to offer simple, harmless solutions for meeting the demands of social life. Rather than join the longstanding debate between consumer agency and social control in pharmaceutical advertising, I approach self-medication with over-the-counter (OTC) analgesics using Harm Reduction as a framework. From this perspective, consumption of OTC analgesics by chronic pain sufferers is a means of seeking some level of relief while also avoiding the stigma associated with prescription pain medication. Qualitative methods are used to analyze data from two sources: (1) semi-structured qualitative interviews with 95 participants in a trial examining the effectiveness of Traditional Chinese Medicine for Temporomandibular Disorders (TMD) from 2006 to 2011 in Tucson, AZ and Portland, OR; and (2) print, online, and television advertisements for three major brands of OTC pain medication. Participants described their use of OTC medications as minimal, responsible, and justified by the severity of their pain. OTC medication advertising, while ostensibly ambiguous and targeting all forms of pain, effectively lends support to the consumption of these medication as part of the self-projects of chronic pain sufferers, allowing them to reconcile conflicting demands for pain relief while being stoic and maintaining a positive moral identity. Describing OTC medication as “just over-the-counter” or “not real pain medication,” sufferers engage in ideological harm reduction, distinguishing themselves from “those people who like taking pain medication” while still seeking relief. Justifying one’s use of OTC medication as minimal and “normal,” regardless of intake, avoids association with the addictive potential of prescription pain

  12. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: is the whole greater than the sum of its parts?

    OpenAIRE

    Wee, HL; Cheung, YB; Li, SC; Fong, KY; Thumboo, J

    2005-01-01

    Abstract Background Diabetes mellitus (DM) is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1) evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL) (which could be additive, synergistic or subtractive); (2) to determine the extent to which the SF-6D (a single-index preference measure)...

  13. Chronic post-embolic pulmonary hypertension: a new target for medical therapies?

    Directory of Open Access Journals (Sweden)

    Marion Delcroix

    2013-09-01

    Full Text Available The rationale for the use of pulmonary arterial hypertension-targeted drugs in chronic thromboembolic pulmonary hypertension is based on four bundles of evidence, as follows: 1 the pathobiology of the disease, with a distal component of pre-capillary arteriopathy that is very similar to pulmonary arterial hypertension; 2 the inoperability of some patients, and the persistence or recurrence of pulmonary hypertension after pulmonary endarterectomy in others; 3 the short-term efficacy and safety of pulmonary arterial hypertension-targeted drugs in these patients; and 4 their potential effect on survival. Chronic thromboembolic pulmonary hypertension is essentially a surgical disease, curable by pulmonary endarterectomy, with acceptable procedural mortality in experienced centres. Patient selection for surgery is extremely complex and results in 30–50% of patients considered inoperable. A large clinical experience has been built up with endothelin receptor antagonists and phosphodiesterase-5 inhibitors, while evidence from controlled trials is running far behind schedule. More recently, a randomised controlled trial with the guanylate cyclase stimulator, riociguat, achieved its target and showed haemodynamic, as well as functional, improvements within 4 months of therapy. The place of this therapy in the therapeutic arsenal needs to be further defined, but should be strictly limited to inoperable patients.

  14. Enhanced redundancy gain in schizophrenics: a correlate of callosal dysfunction?

    Science.gov (United States)

    Florio, Vincenzo; Marzi, Carlo A; Girelli, Andrea; Savazzi, Silvia

    2008-09-01

    An abnormal pattern of hemispheric asymmetry, possibly as a result of disturbed interhemispheric communication, is widely, albeit by no means unanimously, held as a major cause of schizophrenia. To behaviourally test interhemispheric communication in schizophrenia we used a task that has been shown to be a reliable indicator of callosal functioning, namely, the redundant signals effect (RSE). It consists of the speeding of simple reaction time when responding to double as opposed to single visual stimuli. When the stimuli in a pair are presented to different hemispheres patients who underwent total commissurotomy or suffer from callosal agenesis show a paradoxically enhanced RSE with respect to healthy controls. Therefore, if schizophrenia patients have a callosal abnormality they ought to show a similar effect. In three experiments we tested a total of 55 patients with a diagnosis of schizophrenia and 51 healthy controls. In Experiment 1 we presented unilateral single stimuli and bilateral simultaneous double stimuli. The RSE was reliably larger in schizophrenics than in controls. In Experiment 2 the temporal interval between the two stimuli in a pair was varied. We found that while in controls the RSE disappeared with interstimulus intervals longer than 17ms, in schizophrenia patients there was a RSE only for simultaneous double stimuli. Finally, in Experiment 3 we found that there was no enhanced redundancy gain in schizophrenics when the double stimuli were presented to one and the same hemisphere, and therefore, with no need for callosal transmission. All in all, the present results provide evidence of a callosal dysfunction in schizophrenia that impairs interhemispheric integration.

  15. Knowledge and Adherence to Medications among Palestinian Geriatrics Living with Chronic Diseases in the West Bank and East Jerusalem

    Science.gov (United States)

    Najjar, Anas; Amro, Yazan; Kitaneh, Islam; Abu-Sharar, Salam; Sawalha, Maryam; Jamous, Abrar; Qiq, Muhannad; Makharzeh, Enas; Subb Laban, Bayan; Amro, Wafa; Amro, Ahmad

    2015-01-01

    Background Adequate patient knowledge about medications is essential for appropriate drug taking behavior and patient adherence. This study aims to assess and quantify the level of knowledge and adherence to medications among Palestinian geriatrics living with chronic diseases and to investigate possible associated socio-demographic characteristics. Methods and Findings We conducted a cross-sectional study during June 2013 and January 2014 among Palestinian geriatrics ≥60 years old living with chronic disease in the West Bank and East Jerusalem. A stratified random sample was selected and a questionnaire-assisted interview was applied for data collection. T-test was applied for bivariate analyzing and one-way ANOVA test was applied for multivariate analyses. Results A total of 1192 Palestinian geriatrics were studied. The average age was 70.3 (SD=8.58) years and ranged from 60-110 years. The sample comprised 659 (55.3%) females and 533 (44.7%) males. The global knowledge and global adherence scores were (67.57%) and (89.29%), respectively. Adequate levels of knowledge were 71.4%, and of adherence 75%, which were recorded for 705 (59.1%) and 1088 (91.3%) participants, respectively. Significant higher levels of global knowledge and global adherence were recorded for males, and for participants who hold a Bachelor’s degree, those who live on their own, and did physical activity for more than 40 hours/week (p-value <0.05). Furthermore, workers, participants with a higher monthly income, and non-smokers have a higher knowledge level with (p-value <0.05). We found positive correlation between participants’ global adherence and global knowledge (r=0.487 and p-value <0.001). Negative correlation was found between participants’ global knowledge and adherence with age (r= -0.236, p-value <0.001 and r= -0.211 and p-value <0.001, respectively. Negative correlation between global knowledge and the number of drugs taken (r= -0.130, p-value <0.001) was predicted

  16. Knowledge and Adherence to Medications among Palestinian Geriatrics Living with Chronic Diseases in the West Bank and East Jerusalem.

    Directory of Open Access Journals (Sweden)

    Anas Najjar

    Full Text Available Adequate patient knowledge about medications is essential for appropriate drug taking behavior and patient adherence. This study aims to assess and quantify the level of knowledge and adherence to medications among Palestinian geriatrics living with chronic diseases and to investigate possible associated socio-demographic characteristics.We conducted a cross-sectional study during June 2013 and January 2014 among Palestinian geriatrics ≥ 60 years old living with chronic disease in the West Bank and East Jerusalem. A stratified random sample was selected and a questionnaire-assisted interview was applied for data collection. T-test was applied for bivariate analyzing and one-way ANOVA test was applied for multivariate analyses.A total of 1192 Palestinian geriatrics were studied. The average age was 70.3 (SD = 8.58 years and ranged from 60-110 years. The sample comprised 659 (55.3% females and 533 (44.7% males. The global knowledge and global adherence scores were (67.57% and (89.29%, respectively. Adequate levels of knowledge were 71.4%, and of adherence 75%, which were recorded for 705 (59.1% and 1088 (91.3% participants, respectively. Significant higher levels of global knowledge and global adherence were recorded for males, and for participants who hold a Bachelor's degree, those who live on their own, and did physical activity for more than 40 hours/week (p-value < 0.05. Furthermore, workers, participants with a higher monthly income, and non-smokers have a higher knowledge level with (p-value < 0.05. We found positive correlation between participants' global adherence and global knowledge (r = 0.487 and p-value < 0.001. Negative correlation was found between participants' global knowledge and adherence with age (r = -0.236, p-value < 0.001 and r = -0.211 and p-value < 0.001, respectively. Negative correlation between global knowledge and the number of drugs taken (r = -0.130, p-value < 0.001 was predicted.We concluded that patients with a

  17. Knowledge and Adherence to Medications among Palestinian Geriatrics Living with Chronic Diseases in the West Bank and East Jerusalem.

    Science.gov (United States)

    Najjar, Anas; Amro, Yazan; Kitaneh, Islam; Abu-Sharar, Salam; Sawalha, Maryam; Jamous, Abrar; Qiq, Muhannad; Makharzeh, Enas; Subb Laban, Bayan; Amro, Wafa; Amro, Ahmad

    2015-01-01

    Adequate patient knowledge about medications is essential for appropriate drug taking behavior and patient adherence. This study aims to assess and quantify the level of knowledge and adherence to medications among Palestinian geriatrics living with chronic diseases and to investigate possible associated socio-demographic characteristics. We conducted a cross-sectional study during June 2013 and January 2014 among Palestinian geriatrics ≥ 60 years old living with chronic disease in the West Bank and East Jerusalem. A stratified random sample was selected and a questionnaire-assisted interview was applied for data collection. T-test was applied for bivariate analyzing and one-way ANOVA test was applied for multivariate analyses. A total of 1192 Palestinian geriatrics were studied. The average age was 70.3 (SD = 8.58) years and ranged from 60-110 years. The sample comprised 659 (55.3%) females and 533 (44.7%) males. The global knowledge and global adherence scores were (67.57%) and (89.29%), respectively. Adequate levels of knowledge were 71.4%, and of adherence 75%, which were recorded for 705 (59.1%) and 1088 (91.3%) participants, respectively. Significant higher levels of global knowledge and global adherence were recorded for males, and for participants who hold a Bachelor's degree, those who live on their own, and did physical activity for more than 40 hours/week (p-value < 0.05). Furthermore, workers, participants with a higher monthly income, and non-smokers have a higher knowledge level with (p-value < 0.05). We found positive correlation between participants' global adherence and global knowledge (r = 0.487 and p-value < 0.001). Negative correlation was found between participants' global knowledge and adherence with age (r = -0.236, p-value < 0.001 and r = -0.211 and p-value < 0.001, respectively. Negative correlation between global knowledge and the number of drugs taken (r = -0.130, p-value < 0.001) was predicted. We concluded that patients with a higher

  18. Self-reports of medication side effects and pain-related activity interference in patients with chronic pain: a longitudinal cohort study.

    Science.gov (United States)

    Martel, Marc O; Finan, Patrick H; Dolman, Andrew J; Subramanian, Subu; Edwards, Robert R; Wasan, Ajay D; Jamison, Robert N

    2015-06-01

    The primary purpose of this study was to examine the association between self-reports of medication side effects and pain-related activity interference in patients with chronic pain. The potential moderators of the association between reports of side effects and pain-related activity interference were also examined. A total of 111 patients with chronic musculoskeletal pain were asked to provide, once a month for a period of 6 months, self-reports of medication use and the presence of any perceived side effects (eg, nausea, dizziness, headaches) associated with their medications. At each of these time points, patients were also asked to provide self-reports of pain intensity, negative affect, and pain-related activity interference. Multilevel modeling analyses revealed that month-to-month increases in perceived medication side effects were associated with heightened pain-related activity interference (P effects were associated with heightened pain-related activity interference even after controlling for the influence of patient demographics, pain intensity, and negative affect. This study provides preliminary evidence that reports of medication side effects are associated with heightened pain-related activity interference in patients with chronic pain beyond the influence of other pain-relevant variables. The implications of our findings for clinical practice and the management of patients with chronic pain conditions are discussed.

  19. The season of birth of schizophrenic, neurotic and psychiatrically normal twins.

    Science.gov (United States)

    Kendler, K S

    1982-08-01

    The quarter of birth of 536 schizophrenic, 1,991 neurotic and 12,085 psychiatrically normal twin pairs from the National Academy of Sciences-National Research Council Twin Registry was compared. When either all twin pairs, or only monozygotic or dizygotic twin pairs, were considered, no significant differences were found in the quarter of birth between the 3 groups. No difference in quarter of birth was found for twin pairs concordant versus discordant for schizophrenia. Despite the increased risk for intrauterine and perinatal complications in twin births, schizophrenic twins appear (at least) to be no more vulnerable than schizophrenic singletons to the seasonal gestation and birth-related insults which probably underlie the seasonality in schizophrenic births. Controlling for season of birth probably has little effect on the results of twin studies of schizophrenia.

  20. Factored Scales for the Personal Health Survey with Schizophrenics, Alcoholics, Felons, Unmarried Mothers, and College Students

    Science.gov (United States)

    Pishkin, Vladimir; Thorne, Frederick C.

    1978-01-01

    Employed the Personal Health Survey (PHS) to study patterns of symptomology related to physical and mental health in a population of 730 Ss, which consisted of five groups: felons, hospitalized alcoholics, unmarried mothers, college students and institutionalized schizophrenics. (Editor)

  1. Dual hydrophilic and salt responsive schizophrenic block copolymers – synthesis and study of self-assembly

    NARCIS (Netherlands)

    Vasantha, Vivek Arjunan; Jana, Satyasankar; Lee, Serina Siew Chen; Lim, Chin-Sing; Teo, Serena Lay Ming; Parthiban, Anbanandam; Vancso, Julius G.

    2015-01-01

    A new class of dual hydrophilic diblock copolymers (BCPs) possessing poly(ethylene glycol) (PEG) and zwitterionic polysulfabetaine (PSB) was synthesized by reversible addition–fragmentation chain transfer (RAFT) polymerization. These BCPs formed schizophrenic micelles undergoing core–shell transitio

  2. The social negotiation of fitness for work: tensions in doctor-patient relationships over medical certification of chronic pain.

    Science.gov (United States)

    Wainwright, Elaine; Wainwright, David; Keogh, Edmund; Eccleston, Christopher

    2015-01-01

    The UK government is promoting the health benefits of work, in order to change doctors' and patients' behaviour and reduce sickness absence. The rationale is that many people 'off sick' would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacement of the 'sick note' with the 'fit note' and a national educational programme are intended to reduce sickness-certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies. Our findings highlight the limitations of naïve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note's focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listing.

  3. Effect of medical ozone therapy on renal blood flow and renal function of patients with chronic severe hepatitis

    Institute of Scientific and Technical Information of China (English)

    GU Xi-bing; YANG Xiao-juan; ZHU Hong-ying; XU Yue-qin; LIU Xia-ying

    2010-01-01

    Background Medical ozone therapy system was reported to have certain effects on the treatment of severe hepatitis,but its mechanism is not very clear. One of the causes of death of severe hepatitis is complication of renal damage or hepatorenal syndrome. The present study aimed to observe effects of medical ozone therapy system on plasma renin activity (PRA), angiotensin Ⅱ (AⅡ), aldosterone (ALD), renal blood flow and renal function of patients with chronic severe hepatitis and explore mechanisms of medical ozone therapy in the treatment of severe hepatitis.Methods Eighty-five cases with chronic severe hepatitis were randomly divided into ozone therapy group (43 cases)and control group (42 cases). The patients in the ozone therapy group were treated with basic treatments plus ozone therapy system. Basic autohemotherapy was used. One hundred milliliter venous blood was drawn from each patient,and was mixed with 100 ml (35 μg/ml) medical ozone and then was returned the blood to the patient intravenously, once every other day for 20 days. Only the basic treatments were given to the control group. PRA, All, ALD, renal blood flow and damage to renal function of the two groups before treatment and 20 days after treatment were compared. Survival rates were also compared.Results Twenty days after the treatment, in ozone therapy group, PRA was (1.31±0.12) ng·ml-1·h-1, All (111.25±17.35)pg/ml, ALD (251.31 ±22.60) pg/ml, which decreased significantly compared with those before treatment (PRA (2.23±0.13)ng·ml-1 ·h1, AⅡ (155.18±19.13) pg/ml, ALD (405.31±29.88) pg/ml, t=4.67-14.23, P <0.01), also lower than those of control group 20 days after the treatment (PRA (2.02±0.11) ng·ml-1·h-1, All (162.21±15.32) pg/ml, ALD (401.20±35.02) pg/ml,t=4.97-15.61, P <0.01); renal blood flow was (175.15±28.20) ml/min, which increased compared with that before the treatment ((125.68±21.25) ml/min) and was higher than that of control group 20 days after the treatment

  4. DIAGNOSIS AND MEDICAL AND SURGICAL MANAGEMENT OF CHRONIC INFECTIOUS FIBRINOUS PLEURITIS IN AN OKAPI (OKAPIA JOHNSTONI).

    Science.gov (United States)

    Franzen, Dana; Lamberski, Nadine; Zuba, Jeffery; Richardson, G Lynn; Fischer, A T; Rantanen, Norman W

    2015-06-01

    A 10-yr-old female okapi (Okapia johnstoni) at the San Diego Zoo Safari Park was evaluated for intermittent malaise, inappetence, occasional cough, abdominal splinting, and licking at both flanks. Physical examination revealed tachypnea, tachycardia, and fluid sounds on thoracic auscultation. Transthoracic ultrasound showed multiple uniform, anechoic filled structures in the right and left pleural space. Surgical exploration of the thoracic cavity revealed bilateral, mature, fibrous, compartmentalizing adhesions between the visceral and parietal pleura, confirming a diagnosis of chronic, infectious, fibrinous pleuritis. The suspected etiology was occult aspiration pneumonia secondary to historical episodes of regurgitation associated with general anesthesia. Culture of the pleural fluid and fibrous adhesions grew Trueperella (Arcanobacterium) pyogenes, Arcanobacterium haemolyticum, and few Fusobacterium species. Treatment consisted of chest-tube placement to establish drainage, thoracic lavage, unilateral surgical debridement, and long-term antibiotics. The animal made a complete clinical recovery over 7 mo.

  5. Differential Regulation of α7 Nicotinic Receptor Gene (CHRNA7) Expression in Schizophrenic Smokers

    OpenAIRE

    Mexal, Sharon; Berger, Ralph; Logel, Judy; Ross, Randal G.; Freedman, Robert; Leonard, Sherry

    2009-01-01

    The α7 neuronal nicotinic receptor gene (CHRNA7) has been implicated in the pathophysiology of schizophrenia by genetic and pharmacological studies. Expression of the α7* receptor, as measured by [125I]α-bungarotoxin autoradiography, is decreased in postmortem brain of schizophrenic subjects compared to non-mentally ill controls. Most schizophrenic patients are heavy smokers, with high levels of serum cotinine. Smoking changes the expression of multiple genes and differentially regulates gene...

  6. Dynamic magnetic resonance imaging in the assessment of chronic medical nephropathies with impaired renal function

    Energy Technology Data Exchange (ETDEWEB)

    Dalla-Palma, L.; Pozzi-Mucelli, R.S.; Cova, M.; Meduri, S. [Dept. of Radiology, University of Trieste (Italy); Panzetta, G.; Galli, G. [Hemodialysis Service, Ospedale Maggiore, Trieste (Italy)

    2000-02-01

    We examined the value of dynamic magnetic resonance imaging (MRI) in chronic renal disease with renal insufficiency. In 33 consecutive patients (21 vascular nephropathy, 12 glomerular nephropathy) MRI was performed using a 1.5-T unit and a body coil, with SE T1-weighted (TR/TE = 600/19 ms) and dynamic TFFE T1-weighted sequences (TR/TE = 12/5 ms, flip angle = 25 ) after manual bolus injection (via a cubital vein) of 0.1 mmol/kg Gd-DTPA-BMA. Morphological evaluation was performed in unblinded fashion by three radiologists, evaluating renal size, cortical thickness, and corticomedullary differentiation. Functional analysis was performed by one reviewer. Time-signal intensity curves, peak intensity value (P), time to peak intensity (T), and the P/T ratio were obtained at the cortex, medulla, and pyelocaliceal system of each kidney. The relationship of these parameters to serum creatinine and with creatinine clearance was investigated. A good correlation between morphological features of the kidneys and serum creatinine values was found. Morphological findings could not distinguish between vascular and glomerular nephropathies. A statistically significant correlation (P <0.01) between cortical P, cortical P/T, medullary P, and serum creatinine and creatinine clearance was found. A significant correlation (P <0.01) was also found between cortical T, medullary P/T, T of the excretory system, and creatinine clearance. The cortical T value was significantly higher (P <0.01) in vascular nephropathy than in glomerular nephropathy. Thus in patients with chronic renal failure dynamic MRI shows both morphological and functional changes. Morphological changes are correlated with the degree of renal insufficiency and not with the type of nephropathy; the functional changes seem to differ in vascular from glomerular nephropathies. (orig.)

  7. Emergency Medical Treatment Needs: Chronic and Acute Exposure to Hazardous Materials.

    Science.gov (United States)

    1982-06-01

    1979, a chlorine gas release resulting from a freight train derailment in Mississauga, Canada, led to the evacuation of nearly 250,000 residents of that...ZNO3ETHYLTIO3-, HYDROCHLORIDE 9 Ni - ACRTANILIDE9 4’ - CLORO -Z-I IETHYLI 2-1PYRROLIDINYL )ETHYL )AHIHO -, DINYOROCHLORIDE 10 Ni - ACETAHILIDE9 2%*6-DCLRO-Z...aldehyde The following medical procedures should be made o Appearance and odor: Colorless liquid or gas with a available to each employee who is exposed to

  8. Helping a boy with chronic medical problems get on friendly terms with his body and puberty.

    Science.gov (United States)

    Todd, Victoria

    2012-01-01

    "My mom wants me to shave off my facial hair, but I like it. I think it makes me look mature," said sixteen-year-old Alex as he proudly stroked the crop of hairs sprouting from his chin. I was speechless. Why? Because for years I had heard about all the medical things that were wrong with Alex's body. Then, when puberty arrived, his distress about his changing body was intense. So how did psychoanalysis help him get on friendly terms with body changes, even enjoying signs of growing up? We shall see.

  9. Cardiovascular safety of new inhaled medications for asthma and chronic obstructive pulmonary disease: a critical review from pharmacist perspective

    Directory of Open Access Journals (Sweden)

    Kwang Choon Yee

    2016-06-01

    Full Text Available Individuals with chronic respiratory disorder often have cardiovascular comorbidities and are more vulnerable to adverse effects from medication. Inhaler medications are effective in managing many respiratory diseases, but some have concern about its potential cardiovascular effect from long-term therapy and inappropriate use of these drugs. In the past few years, new members of inhaled long-acting beta-2 agonists and anticholinergics have become available. Based on the published data we reviewed, the adverse cardiovascular effects of these drugs are relatively low, and largely comparable to existing agents. However, most of the studies have very strict selection criteria for subjects, with limited study periods. Therefore, some level of concern remains with the clinical use of these agents, often in patients with substantial cardiovascular or other comorbidities, and are likely to use these drug for very long periods. Perhaps the monitoring of therapeutic efficacy and toxicity by laboratory methods needs to be further explored. [Int J Res Med Sci 2016; 4(6.000: 1814-1829

  10. The Debrisoft(®) Monofilament Debridement Pad for Use in Acute or Chronic Wounds: A NICE Medical Technology Guidance.

    Science.gov (United States)

    Meads, Catherine; Lovato, Eleonora; Longworth, Louise

    2015-12-01

    As part of its Medical Technology Evaluation Programme, the National Institute for Health and Care Excellence (NICE) invited a manufacturer to provide clinical and economic evidence for the evaluation of the Debrisoft(®) monofilament debridement pad for use in acute or chronic wounds. The University of Birmingham and Brunel University, acting as a consortium, was commissioned to act as an External Assessment Centre (EAC) for NICE, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC's findings and the final NICE guidance issued. The sponsor submitted a simple cost analysis to estimate the costs of using Debrisoft(®) to debride wounds compared with saline and gauze, hydrogel and larvae. Separate analyses were conducted for applications in home and applications in a clinic setting. The analysis took an UK National Health Service (NHS) perspective. It incorporated the costs of the technologies and supplementary technologies (such as dressings) and the costs of their application by a district nurse. The sponsor concluded that Debrisoft(®) was cost saving relative to the comparators. The EAC made amendments to the sponsor analysis to correct for errors and to reflect alternative assumptions. Debrisoft(®) remained cost saving in most analyses and savings ranged from £77 to £222 per patient compared with hydrogel, from £97 to £347 compared with saline and gauze, and from £180 to £484 compared with larvae depending on the assumptions included in the analysis and whether debridement took place in a home or clinic setting. All analyses were severely limited by the available data on effectiveness, in particular a lack of comparative studies and that the effectiveness data for the comparators came from studies reporting different clinical endpoints compared with Debrisoft(®). The Medical Technologies Advisory Committee made a positive recommendation for adoption of Debrisoft(®) and this has been published

  11. Illness Representations, Treatment Beliefs, Medication Adherence, and 30-Day Hospital Readmission in Adults With Chronic Heart Failure: A Prospective Correlational Study.

    Science.gov (United States)

    Turrise, Stephanie

    2016-01-01

    An estimated 5.1 million Americans have chronic heart failure, yet despite advances in its treatment, there has been no improvement in hospital readmissions among aging adult patients with chronic heart failure. The purpose of this study is to investigate the relationships among illness representations, treatment beliefs, medication adherence, and 30-day hospital readmission for heart failure exacerbation in aging adults with chronic heart failure. Using a prospective, correlational design, 96 older adults with a primary or secondary diagnosis of heart failure discharged to home from a hospital in the Southeastern United States participated in telephone surveys and follow-up telephone calls. Data analysis included correlation and logistic regression analyses. Participants were highly adherent to their medications. Individuals who did not believe their treatment was effective in controlling their HF were readmitted within 30 days of hospital discharge for HF exacerbation; that is, treatment control was inversely related to 30-day hospital readmission. In post hoc analyses, personal control was inversely related to dichotomized medication adherence and necessity-concern differential was directly related to dichotomized medication adherence. The necessity-concern differential, or the belief that medication necessity outweighed the concerns they had about their medicines, was a significant predictor of medication adherence. Nurses can use these study findings to help identify individuals who may be at risk of being nonadherent to their medications and hospital readmission. Recommendations for future research include replication with multiple sites, the addition of objective measures of medication adherence, investigation of both the cognitive and emotional pathways, and qualitative exploration of personal control in the context of medication adherence in HF.

  12. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications

    Science.gov (United States)

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service. PMID:27559474

  13. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications.

    Science.gov (United States)

    Abdallah, Nihad; Conn, Rory; Latif Marini, Abdel

    2016-01-01

    Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service.

  14. Old age and chronic disease: is the emergency medical system the appropriate provider for the elderly?

    Science.gov (United States)

    Mochmann, Hans-Christian; Arntz, Hans-Richard; Dincklage, Falk V; Rauch, Ursula; Schultheiss, Heinz P; Bobbert, Peter

    2014-04-01

    The use of emergency medical services increases with the age of patients. Some care providers hold on to the prejudice that these alarms are unnecessary or of a lower importance. We assessed the relation of age and age-dependent emergency characteristics, taking into consideration the ratings of emergency physicians on whether or not emergency cases were considered truly in need of emergency physician attendance. Emergency physicians dispatched by the Berlin Fire Department evaluated for each case the necessity of emergency physician attendance. Case characteristics such as the day of the week and location of the emergency as well as patient characteristics such as age, sex, prior status, and care dependency were recorded. In addition, whether or not the physician accompanied the patient to the hospital was recorded as a parameter for emergency severity. Analysis was performed using multiple logistic regression modeling. During the 6-month prospective study period, 2702 cases were evaluated. Emergency medical services are used more frequently by older individuals, especially octogenarians. Emergency cases in older individuals were significantly more often rated as in need of emergency physician attendance; however, the rate of patients accompanied by the emergency physician to the hospital did not differ between the age groups. The age of patients, the primary diagnosis, the day and location of the emergency, and the presence of pre-existing dementia showed a significant impact on the necessity of physician-attended emergency missions. Despite common prejudices, emergency cases in elder patients are rated more often as in need of emergency physician attendance compared with those involving younger patients.

  15. Methodology to Estimate the Longitudinal Average Attributable Fraction of Guideline-recommended Medications for Death in Older Adults With Multiple Chronic Conditions.

    Science.gov (United States)

    Allore, Heather G; Zhan, Yilei; Cohen, Andrew B; Tinetti, Mary E; Trentalange, Mark; McAvay, Gail

    2016-08-01

    Persons with multiple chronic conditions receive multiple guideline-recommended medications to improve outcomes such as mortality. Our objective was to estimate the longitudinal average attributable fraction for 3-year survival of medications for cardiovascular conditions in persons with multiple chronic conditions and to determine whether heterogeneity occurred by age. Medicare Current Beneficiary Survey participants (N = 8,578) with two or more chronic conditions, enrolled from 2005 to 2009 with follow-up through 2011, were analyzed. We calculated the longitudinal extension of the average attributable fraction for oral medications (beta blockers, renin-angiotensin system blockers, and thiazide diuretics) indicated for cardiovascular conditions (atrial fibrillation, coronary artery disease, heart failure, and hypertension), on survival adjusted for 18 participant characteristics. Models stratified by age (≤80 and >80 years) were analyzed to determine heterogeneity of both cardiovascular conditions and medications. Heart failure had the greatest average attributable fraction (39%) for mortality. The fractional contributions of beta blockers, renin-angiotensin system blockers, and thiazides to improve survival were 10.4%, 9.3%, and 7.2% respectively. In age-stratified models, of these medications thiazides had a significant contribution to survival only for those aged 80 years or younger. The effects of the remaining medications were similar in both age strata. Most cardiovascular medications were attributed independently to survival. The two cardiovascular conditions contributing independently to death were heart failure and atrial fibrillation. The medication effects were similar by age except for thiazides that had a significant contribution to survival in persons younger than 80 years. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Complementary and alternative medical therapies for chronic low back pain: What treatments are patients willing to try?

    Directory of Open Access Journals (Sweden)

    Erro Janet

    2004-07-01

    Full Text Available Abstract Background Although back pain is the most common reason patients use complementary and alternative medical (CAM therapies, little is known about the willingness of primary care back pain patients to try these therapies. As part of an effort to refine recruitment strategies for clinical trials, we sought to determine if back pain patients are willing to try acupuncture, chiropractic, massage, meditation, and t'ai chi and to learn about their knowledge of, experience with, and perceptions about each of these therapies. Methods We identified English-speaking patients with diagnoses consistent with chronic low back pain using automated visit data from one health care organization in Boston and another in Seattle. We were able to confirm the eligibility status (i.e., current low back pain that had lasted at least 3 months of 70% of the patients with such diagnoses and all eligible respondents were interviewed. Results Except for chiropractic, knowledge about these therapies was low. Chiropractic and massage had been used by the largest fractions of respondents (54% and 38%, respectively, mostly for back pain (45% and 24%, respectively. Among prior users of specific CAM therapies for back pain, massage was rated most helpful. Users of chiropractic reported treatment-related "significant discomfort, pain or harm" more often (23% than users of other therapies (5–16%. Respondents expected massage would be most helpful (median of 7 on a 0 to 10 scale and meditation least helpful (median of 3 in relieving their current pain. Most respondents indicated they would be "very likely" to try acupuncture, massage, or chiropractic for their back pain if they did not have to pay out of pocket and their physician thought it was a reasonable treatment option. Conclusions Most patients with chronic back pain in our sample were interested in trying therapeutic options that lie outside the conventional medical spectrum. This highlights the need for additional

  17. An Open-Label Study of an Herbal Topical Medication (QoolSkin for Patients with Chronic Plaque Psoriasis

    Directory of Open Access Journals (Sweden)

    Arnon D. Cohen

    2007-01-01

    Full Text Available QoolSkin is novel herbal topical medication indicated for the treatment of patients with psoriasis and we endeavored to determine the efficacy of QoolSkin in patients with chronic plaque psoriasis. In an open-label, parallel-group study conducted at four sites in Israel, patients with chronic plaque psoriasis were treated by application of QoolSkin two to three times per day, for a period of 16 weeks. Clinical assessment was performed using the Psoriasis Area and Severity Index (PASI and the Beer-Sheva Psoriasis Severity Score (BPSS. The study included 100 patients (48 men, 52 women; age 18–65 years. QoolSkin was well tolerated and there were no local or systemic side effects. There was a 19% reduction in PASI, from a mean of 9.8 ± 9.5 before treatment to 8.0 ± 9.6 after treatment (p = 0.09. There was a 20% reduction in BPSS, from a mean of 16.1 ± 9.8 before treatment to 12.8 ± 10.6 after treatment (p = 0.01. The reduction in PASI and BPSS was pronounced in women (32 and 31%, respectively as compared to men (9 and 11%, respectively. The reduction in PASI and BPSS was parallel to the length of time the patients were treated by QoolSkin. In patients treated by one of the investigators, who applied QoolSkin three times per day and for a long period of time (mean 101.1 days, the reduction in PASI was 32.0% and the reduction in BPSS was 37.8%. In patients with chronic plaque psoriasis, QoolSkin treatment was well tolerated. Application of QoolSkin was associated with a decrease in disease severity, as assessed by the patients and physicians. Application of QoolSkin three times per day for long period is associated with a better response to treatment.

  18. Intra-peritoneal chronic loculation in peritoneal dialysis patients - a new medical management approach.

    Science.gov (United States)

    Mitoiu, Dan; David, Cristiana; Peride, Ileana; Niculae, Andrei; Mureşan, Alin; Ciocâlteu, Alexandru; Geavlete, Bogdan Florin; Checheriţă, Ionel Alexandru

    2014-01-01

    Peritoneal dialysis (PD) limitation as renal replacement therapy is mostly due to peritonitis and complications. Formation and persistence of intra-abdominal loculations is often under-diagnosed. Encapsulated peritoneal sclerosis (EPS) is a life-threatening complication, but malnutrition, recurrent peritonitis and early membrane failure are insidious enemies that need to be emphasized. It is important to highlight the persistence of intra-abdominal fluid collection after clinical resolution of peritonitis in PD patients and to indicate a new medical management approach for an early diagnosis. During five years, we selected PD peritonitis cases followed by a six months interval free of infections. Ninety-seven subjects were followed at six months and one year after the first peritonitis. Tomography had been performed to patients presenting a positive inflammatory state without a specific infectious cause. Subjects presenting documented localized fluid collection (31 cases) were divided into: drug-treated group and those undergoing laparoscopy by a new surgery technique (seven patients); a comparison regarding the clinical state and biohumoral parameters was assessed in both groups. The prevalence of intra-abdominal loculation following an apparent resolved peritonitis was high (31.9%). The cases undergoing laparoscopy presented a better evolution - improved clinical status (p=0.001), higher hemoglobin values (p=0.06), significant lower doses of erythropoietin requirement (p=0.03), improved dialysis adequacy (p=0.005) and inflammatory state. In cases with confirmed fluid encapsulated loculation, an active attitude (screening imaging protocol and laparoscopic exploration) appears to be mandatory, decreasing the risk of EPS, a serious complication which pathology and treatment are incompletely understood.

  19. Health management of older persons with chronically medicated psychotic disorders: the results of a survey in France.

    Science.gov (United States)

    Arbus, Christophe; Clement, Jean-Pierre; Bougerol, Thierry; Fremont, Patrick; Lancrenon, Sylvie; Camus, Vincent

    2012-03-01

    The medical care of elderly patients with psychotic disorders is a matter of major concern. The aim of the study was to investigate health conditions and treatment of elderly patients with psychotic disorders in France. The SAGE (Schizophrenia AGEd) study (observational, cross-sectional) was a survey conducted among 123 physicians in France, regarding prescriptions of antipsychotic drugs in elderly patients (≥60 years) suffering from psychotic disorders. The survey was based on a questionnaire addressing the mental and somatic health management of the patients. Data from 930 patients (mean age: 70.4 years) were collected. Most patients (58.5%) suffered from schizophrenia, 20.8% had delusional disorder and 20.6% hallucinatory chronic psychosis (very-late-onset schizophrenia-like psychosis). 70.8% of them were outpatients, while 29.2% were inpatients. The severity of psychotic symptoms was assessed in 97.8% of patients, but cognitive function was only evaluated in 41.6%. Some 46.5% of patients were treated with atypical antipsychotics alone, 36.2% with classical antipsychotics alone and 17.3% received a combination of both, atypical and classical antipsychotics; 36.3% patients were given antiparkinsonian medication, of whom only 17.8% as preventive treatment; 51.1% of patients had somatic comorbidities, particularly cardiovascular disorders (34.0%). Evaluation of renal and/or liver function to adjust the dose of treatment was done in only 32.1% of patients. Over the previous 12 months, almost half of the patients had had no ECG, glycemia or creatininemia investigated and HDL-cholesterol and triglycerides were available for less than one-third of them. Antipsychotic and antiparkinsonian drug prescriptions in French aged psychotic patients follow only partially the clinical guidelines and recommendations of consensus conferences. Moreover, cognitive, cardiac and metabolic aspects are not fully managed as expected.

  20. Concentrations in plasma clozapine levels in schizophrenic and schizoaffective patients.

    Science.gov (United States)

    Iglesias García, Celso; Iglesias Alonso, Ana; Bobes, Julio

    2017-08-22

    There is great variability in plasma levels of clozapine. The objective of this study is to know the characteristics of patients treated with clozapine and the relationship between them and the variability of plasma levels. Descriptive, cross-sectional study of all patients currently treated with clozapine in a Psychiatric Service with a diagnosis of schizophrenic psychosis or schizoaffective disorder. The present study assessed physical situation, psychopathology and functionality of the patients and explored the associations and correlations between clinical variables and plasma levels. We studied 39 patients, predominantly men, with negative and depressive symptoms and cardiovascular risk factors (metabolic syndrome and smoking). Significant variability in dose and even greater in clozapine levels were observed. The levels of clozapine at equal doses/kg of body weight were higher in non-smokers, they had positive correlation with BMI and negative correlation with systolic BP, disruptive behaviors and number of cigarettes consumed. Plasma level monitoring clozapine is an important tool to avoid clozapine plasma levels monitoring and minimize undesirable clinical situations (metabolic syndrome, sedation, negative symptoms and functional impairment). It is also important to control the effects of a smoking habit for optimum drug bioavailability. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. [Validity of a social skills training program for schizophrenic patients].

    Science.gov (United States)

    Cirici Amell, R; Obiols Llandrich, J

    2008-01-01

    In the 1980's, Robert P. Liberman and his team from UCLA designed the Social Independent Living Skills Modules. Since then, their methods have spread throughout the world and their effectiveness has been demonstrated. It seems that the application of these methods is beginning to disappear and there are practically no publications that support the continuity of these treatments. In this article, the results of the Social Skills Training Program (SSTP) are presented in a sample of 57 schizophrenic patients. The results are evaluated with the Positive and Negative Symptoms Scale (PANSS) and the Social behavior Assessment Schedule (SBAS) scale and with the Social Interaction Self-Statements Test (SISST) and AI-F questionnaires. The negative symptoms of the patients improved after the therapeutic intervention. The patients acquired new social roles and their frequency of assertive behavior increased. Their relatives also improved their emotional burden and stress level. In any event, these improvements decreased at 6 months of follow-up without therapeutic intervention.

  2. The concept of basic symptoms in schizophrenic and schizoaffective psychoses.

    Science.gov (United States)

    Huber, G; Gross, G

    1989-12-01

    This paper presents the psychiatric aspects of the concept of basic symptoms (BS), especially history, actual position and tendencies of development of the doctrine of BS, phenomenology and clinical picture of basic stages, the Bonn Scale for the assessment of dynamic and cognitive basic deficiencies (BSABS) and the importance of this concept for early diagnosis, therapy, prevention and rehabilitation. The patients experience and communicate the BS as deficiencies and are able to cope with, adapt and compensate for them. The BS were termed as basic symptoms because they represent the basis of the productive-psychotic symptomatology. Follow-up studies of cases with the suspicion diagnosis "prodrome of schizophrenia" based on BSABS rating, revealed that the subgroup passing over in schizophrenic psychoses after an average of 6.3 years showed significantly higher scores of cognitive BS at the time of index investigation. It now seems possible to impede increase of cognitive BS already present in prepsychotic prodromal states before reaching the threshold of transition into productive-psychotic symptomatology. Long-term development is more favorable if therapy commences as early as possible including the prepsychotic basic stages and also taking into consideration BS which were, until now, disregarded in DSM-III. Summarizing our findings of the last 30 years we suggest that the BS-concept may be an approach to overcome the dichotomy of negative and positive psychopathology in schizophrenia.

  3. [Richard Arwed Pfeifer. Aesthetics of "schizophrenic art" and brain research].

    Science.gov (United States)

    Somburg, O; Steinberg, H

    2008-11-01

    This paper concentrates on two aspects of the work of Leipzig brain researcher Richard Arwed Pfeifer (1877-1957). It has been little known that Pfeifer, like Prinzhorn, collected paintings by his schizophrenic patients. In works about these paintings, he tried to decipher their specific attraction and the possibility of differentiating artworks of sane artists from those of insane ones. From experimental research he concluded that the "demonic element" was of utmost importance, which however could temporarily be brought about by sane artists too. Trained in medicine and psychology by Wundt, Flechsig, and Niessl von Mayendorf, Pfeifer was appointed as the first associate professor of brain research in Germany in 1927. Until now he has been appreciated for reestablishing the angioarchitecture of the brain, mainly due to his works on the distribution of capillaries in the brain achieved by a particular method of injection which he developed. Moreover he contributed new findings on the interrelations of the capillaries and thus finally disproved the existence of so-called terminal arteries of Cohnheim.

  4. Treatment, expressed emotion and relapse in recent onset schizophrenic disorders.

    Science.gov (United States)

    Linszen, D; Dingemans, P; Van der Does, J W; Nugter, A; Scholte, P; Lenior, R; Goldstein, M J

    1996-03-01

    The effect of in-patient and individual orientated psychosocial intervention (IPI) and in-patient and individual and family orientated intervention (IPFI) across levels of expressed emotion (EE) on relapse was compared in a group of patients with recent onset schizophrenic disorders. Patients were randomly assigned to an individual orientated psychosocial intervention programme or to an identical psychosocial programme plus a behavioural family intervention. Seventy-six patients were studied during a 12 month out-patient treatment period after an in-patient treatment programme in which parents followed a psychoeducational programme. Overall relapse rates during the out-patient interventions were low (16%). Adding family intervention to the psychosocial intervention did not affect the relapse rate. Patients in low EE families relapsed slightly more often during the psychosocial plus family intervention. In-patient treatment with psychoeducation for parents, followed by an out-patient psychosocial intervention programme, has a favourable impact on relapse. Additional family intervention may increase stress in low EE families, thus affecting relapse in their children.

  5. Evaluating the Use of the Wilbarger Intervention with Schizophrenic Patients

    Science.gov (United States)

    Stout, Janet; Mogge, Neil L.; Nesland, Anita; David Allen, G.

    2005-01-01

    Individuals with schizophrenia have difficulty processing sensory information. The authors hypothesized that the Wilbarger intervention, an occupational therapy technique successfully used to treat children with sensory integration deficits, might prove beneficial if used with schizophrenic patients. Thirty inpatients diagnosed with schizophrenia or schizoaffective disorders voluntarily participated. Each was evaluated using the sensory integration subscale of the Neurological Evaluation Scale (NES) both pre- and post-intervention. The Wilbarger was scheduled to be administered five times per day for seven days per week for four weeks. Participants averaged 19.5 days (mean) in the study (median=27.5 days) and received 80.4 (mean) (106.5 median) interventions.Those receiving 90 or more interventions improved significantly on the graphesthesia subtest (t(28)=2.498; p<0.019), the right/left confusion subtest (t(28)=2.373; p<0.025) and the post-total score (t(28)=2.184; p<0.037). Sensory subscales of the NES statistically improved after use of the Wilbarger intervention. Further studies are planned to determine the duration and clinical significance of the noted changes. PMID:21179643

  6. Building models for postmortem abnormalities in hippocampus of schizophrenics.

    Science.gov (United States)

    Benes, Francine M

    2015-09-01

    Postmortem studies have suggested that there is abnormal GABAergic activity in the hippocampus in schizophrenia (SZ). In micro-dissected human hippocampal slices, a loss of interneurons and a compensatory upregulation of GABAA receptor binding activity on interneurons, but not PNs, has suggested that disinhibitory GABA-to-GABA connections are abnormal in stratum oriens (SO) of CA3/2, but not CA1, in schizophrenia. Abnormal expression changes in the expression of kainate receptor (KAR) subunits 5, 6 and 7, as well as an inwardly-rectifying hyperpolarization-activated cationic channel (Ih3; HCN3) may play important roles in regulating GABA cell activity at the SO CA3/2 locus. The exclusive neurons at this site are GABAergic interneurons; these cells also receive direct projections from the basolateral amygdala (BLA). When the BLA is stimulated by stereotaxic infusion of picrotoxin in rats, KARs influence axodendritic and presynaptic inhibitory mechanisms that regulate both inhibitory and disinhibitory interneurons in the SO-CA3/2 locus. The rat model described here was specifically developed to extend our understanding of these and other postmortem findings and has suggested that GABAergic abnormalities and possible disturbances in oscillatory rhythms may be related to a dysfunction of disinhibitory interneurons at the SO-CA3/2 site of schizophrenics.

  7. Providing chronic pain management in the "Fifth Vital Sign" Era: Historical and treatment perspectives on a modern-day medical dilemma.

    Science.gov (United States)

    Tompkins, D Andrew; Hobelmann, J Greg; Compton, Peggy

    2017-04-01

    Over 100 million Americans are living with chronic pain, and pain is the most common reason that patients seek medical attention. Despite the prevalence of pain, the practice of pain management and the scientific discipline of pain research are relatively new fields compared to the rest of medicine - contributing to a twenty-first century dilemma for health care providers asked to relieve suffering in the "Fifth Vital Sign" era. This manuscript provides a narrative review of the basic mechanisms of chronic pain and history of chronic pain management in the United States - including the various regulatory, health system and provider factors that contributed to the decline of multidisciplinary pain treatment in favor of the predominant opioid treatment strategy seen today. Multiple non-opioid pain treatment strategies are then outlined. The manuscript concludes with three key questions to help guide future research at the intersection of pain and addiction. The assessment and treatment of chronic pain will continue to be one of the most common functions of a health care provider. To move beyond an over reliance on opioid medications, the addiction and pain research communities must unite with chronic pain patients to increase the evidence base supporting non-opioid analgesic strategies. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  8. Religious versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results

    Directory of Open Access Journals (Sweden)

    Harold G. Koenig

    2012-01-01

    Full Text Available This paper (1 reviews the physical and religious barriers to CBT that disabled medically ill-depressed patients face, (2 discusses research on the relationship between religion and depression-induced physiological changes, (3 describes an ongoing randomized clinical trial of religious versus secular CBT in chronically ill patients with mild-to-moderate major depression designed to (a overcome physical and religious barriers to CBT and (b compare the efficacy of religious versus secular CBT in relieving depression and improving immune and endocrine functions, and (4 presents preliminary results that illustrate the technical difficulties that have been encountered in implementing this trial. CBT is being delivered remotely via instant messaging, telephone, or Skype, and Christian, Jewish, Muslim, Buddhist, and Hindu versions of religious CBT are being developed. The preliminary results described here are particular to the technologies employed in this study and are not results from the CBT clinical trial whose findings will be published in the future after the study ends and data are analyzed. The ultimate goal is to determine if a psychotherapy delivered remotely that integrates patients’ religious resources improves depression more quickly than a therapy that ignores them, and whether religious CBT is more effective than conventional CBT in reversing depression-induced physiological changes.

  9. Medical resource utilization and costs among Australian patients with genotype 1 chronic hepatitis C: results of a retrospective observational study.

    Science.gov (United States)

    McElroy, Heather J; Roberts, Stuart K; Thompson, Alex J; Angus, Peter W; McKenna, Sarah Jane; Warren, Emma; Musgrave, Sharon

    2017-01-01

    To evaluate medical resource utilization (MRU) and associated costs among Australian patients with genotype 1 chronic hepatitis C (GT1 CHC), including both untreated patients and those receiving treatment with first-generation protease inhibitor-based regimens (telaprevir, boceprevir with pegylated interferon and ribavirin). Medical records were reviewed for a stratified random sample of GT1 CHC patients first attending two liver clinics between 2011-2013 (principal population; PP), supplemented by all GT1 CHC patients attending one transplant clinic in the same period (transplant population; TP). CHC-related MRU and associated costs are reported for the PP by treatment status (treated/not treated) stratified by baseline fibrosis grade; and for the TP for the pre-transplant, year of transplant and post-transplant periods. A total 1636 patients were screened and 590 patients (36.1%) were included. Comprehensive MRU data were collected for 276 PP patients (F0-1 n = 59, F2 n = 58, F3 n = 53, F4 n = 106; mean follow-up = 17.3 months). Thirty-eight (13.8%) were treatment-experienced prior to enrolment; 55 (19.9%) received triple therapy during the study. Data were collected for 112 TP patients (mean follow-up = 29.9 months), 33 (29.5%) received a transplant during the study, and 51 (45.5%) beforehand. The annual direct medical costs, excluding drug costs, were higher among treated PP vs untreated PP (AU$: $1,954 vs $1,202); and year of transplant TP vs pre-/post-transplant TP (AU$: pre-transplant $32,407, transplant $155,138, post-transplant $7,358). To aid interpretation of results, note that only patients with GT1 CHC who are actively managed are included, and MRU data were collected specifically from liver outpatient clinics. That said, movement of patients between hospitals is rare, and any uncaptured MRU is expected to be minimal. CHC-related MRU increases substantially with disease severity. These real-world MRU data for GT1 CHC will be

  10. Effects of chronic academic stress on mental state and expression of glucocorticoid receptor α and β isoforms in healthy Japanese medical students.

    Science.gov (United States)

    Kurokawa, Ken; Tanahashi, Toshihito; Murata, Akiho; Akaike, Yoko; Katsuura, Sakurako; Nishida, Kensei; Masuda, Kiyoshi; Kuwano, Yuki; Kawai, Tomoko; Rokutan, Kazuhito

    2011-07-01

    Chronic academic stress responses were assessed by measuring mental state, salivary cortisol levels, and the glucocorticoid receptor (GR) gene expression in healthy Japanese medical students challenging the national medical license examination. Mental states of 17 male and 9 female medical undergraduates, aged 25.0 ± 1.2 years (mean ± SD), were assessed by the State and Trait Anxiety Inventory (STAI) and the Self-Rating Depression Scale (SDS) 2 months before, 2 days before, and 1 month after the examination. At the same time points, saliva and blood were collected. STAI-state scores peaked 2 days before the examination. Scores on STAI-trait and SDS, and salivary cortisol levels were consistently higher during the pre-examination period. One month after the examination, all these measures had significantly decreased to baseline levels. Real-time reverse transcription PCR showed that this chronic anxious state did not change the expression of the functional GRα mRNA isoform in peripheral leukocytes, while it resulted in reduced expression of the GRβ isoform 2 days before the examination. Our results replicate and extend a significant impact of chronic academic stressors on the mental state of healthy Japanese medical students and suggest a possible association of GRβ gene in response to psychological stress.

  11. Cognitive impairments in first-episode drug-naive and chronic medicated schizophrenia: MATRICS consensus cognitive battery in a Chinese Han population.

    Science.gov (United States)

    Wu, Jing Qin; Chen, Da Chun; Tan, Yun Long; Xiu, Mei Hong; Yang, Fu De; Soares, Jair C; Zhang, Xiang Yang

    2016-04-30

    Cognitive deficits are a core feature of schizophrenia and we examined the cognitive profile of first-episode and chronic schizophrenia in a Chinese Han population using the MATRICS Consensus Cognitive Battery (MCCB). We recruited 79 first-episode drug-naïve (FEDN) schizophrenia, 132 chronic medicated schizophrenia inpatients and 124 healthy controls. We assessed patient psychopathology using the Positive and Negative Syndrome Scale (PANSS). MCCB total score (pMSCEIT) were significantly higher in FEDN than in chronic patients (all p<0.05). FEDN exhibited relative weakness in continuous performance, whereas chronic patients exhibited relative weakness in mazes. Multiple regression analysis confirmed that in FEDN and chronic patients, total score and negative symptom of PANSS were independent contributors to MCCB total score, respectively. Our results not only demonstrate the applicability of the MCCB as a sensitive measure of cognitive impairment for schizophrenia patients in a Chinese Han population, but also suggest that the compromised cognition is present in the early stage of schizophrenia, some of which could be more severe in the chronic stage of illness.

  12. Group art therapy as adjunct therapy for the treatment of schizophrenic patients in day hospital

    Directory of Open Access Journals (Sweden)

    Mandić-Gajić Gordana

    2013-01-01

    Full Text Available Introduction. The schizophrenics are frequently disinterested and resistant to standard care. Case report. We presented clinical observations of group art therapy of two schizophrenic patients during integrative therapy in Day Hospital. We modified the original “Synallactic collective image technique” (Vassiliou G, Vassiliou V.. The group is open, heterogeneous, meets once a week and discusses on exhibited drawings, drawn by free associations. The patients' drawings and group protocols showed clinical improvement by lowering depressive themes, more human figures and self-confidence. The obvious severity of markedly impairment on Clinical Global Impression (CGI and Global Assessment of Functioning (GAF scales on admission with minimal improvement at discharge was rated. Conclusion. Group art therapy enables visual expression of emotions, perceptions and cognitions, develops creative potentials and support within the group, thus facilitating the integrative therapeutic process of schizophrenics. It may be useful adjunctive therapy for schizoprenic patients.

  13. Detecting potential adverse reactions of sulpiride in schizophrenic patients by prescription sequence symmetry analysis.

    Directory of Open Access Journals (Sweden)

    Edward Chia-Cheng Lai

    Full Text Available PURPOSE: Previous studies have demonstrated sulpiride to be significantly more effective than haloperidol, risperidone and olanzapine in schizophrenic treatment; however, only limited information is available on the potential risks associated with sulpiride treatment. This study attempts to provide information on the potential risks of sulpiride treatment of schizophrenia, especially with regard to unexpected adverse effects. MATERIALS AND METHODS: Patients with schizophrenia aged 18 and older, newly prescribed with a single antipsychotic medication from the National Health Insurance Research Database of Taiwan in the period from 2003 to 2010 were included. A within-subject comparison method, prescription sequence symmetry analysis (PSSA was employed to efficiently identify potential causal relationships while controlling for potential selection bias. RESULTS: A total of 5,750 patients, with a mean age of 39, approximately half of whom were male, constituted the study cohort. The PSSA found that sulpiride was associated with EPS (adjusted SR, 1.73; 95% CI, 1.46-2.06 and hyperprolactinemia (12.04; 1.59-91.2. In comparison, EPS caused by haloperidol has a magnitude of 1.99 when analyzed with PSSA, and hyperprolactinemia caused by amisulpride has a magnitude of 8.05, respectively. Another finding was the unexpected increase in the use of stomatological corticosteroids, emollient laxatives, dermatological preparations of corticosteroids, quinolone antibacterials, and topical products for joint and muscular pain, after initiation of sulpiride treatment. CONCLUSIONS: We found sulpiride to be associated with an increased risk of EPS and hyperprolactinemia, and the potential risk could be as high as that induced by haloperidol and amisulpride, respectively. Additionally, our study provides grounds for future investigations into the associations between sulpiride and the increased use of additional drugs for managing adverse effects, including

  14. Screening of Patients with Chronic Medical Disorders in the Outpatient Department for Depression Using Handheld Computers as Interface and Patient Health Questionnaire-9 as a Tool.

    Science.gov (United States)

    Ingle, Vaibhav Kumar; Pandey, Ijya; Singh, Akash Ranjan; Pakhare, Abhijit; Kumar, Sanjeev

    2017-01-01

    Depression, especially in concurrence with chronic medical disorders, is highly prevalent worldwide. An average between 9.3% and 23% of patients with one or more chronic disease have co-morbid depression. This comorbid depression has the worst health scores of all the disease states. Despite this, patients with chronic medical disorders are not commonly screened for depression. Lack of objective screening by health-care providers as well as lack of infrastructure (time/space/personnel) probably contributes to gross underdiagnosis of depression. This issue can be addressed using short objective depression screening score (Patient Health Questionnaire-9 [PHQ-9]) (validated in native languages, e.g., Hindi) and paperless self-administered interface on handheld computer (tablet), which is the objective of the study. One hundred consecutive patients with chronic medical disorders visiting our medicine outpatient department were screened for depression using tablets with PHQ-9 Hindi on a self-administered interface. The overall prevalence of depression was found to be 25% (95% confidence interval 16.6-34.8). Nearly half of the patients with depression had moderate depression (PHQ-9 score 10-14) while rest had moderately severe or very severe depression (PHQ-9 score >14). Association of depression was not found to be statistically significant with age, duration of disease, gender, the type of disease, or the number of disease. Majority of patients rated ease of the use of tablet interface (on a visual analog scale) as very easy (approx 95%). All the patients were able to complete the tablet screener without assistance, answering all of the questions. The median time of completion with interquartile range was 4 (3-5) min. Majority of the patients (63%) completed the questionnaire within 5 min while rest completed it in 5-10 min. It is feasible to use tablets with PHQ-9 questionnaire in native language for screening depression in chronic medical disorders. With high

  15. Studies of the correlations between morphological brain changes on MRI and computerized EEG changes in schizophrenics

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Kouzou (Kagoshima Univ. (Japan). Faculty of Medicine)

    1992-06-01

    Twenty eight schizophrenic patients, who ranged in age from 21 to 39 years with a mean of 30.2, and 21 age- and sex-matched normal volunteers were studied by magnetic resonance (MR) imaging and electroencephalography (EEG). ALl subjects were given informed consent prior to the present study. They were all right-handed. Schizophrenic patients showed a significantly larger ventricular brain ratio (VBR) on the axial and coronal planes as compared with the control. The bilateral anterior horns, left body, left posterior horn of the lateral ventricle and the third ventricle were significantly larger in schizophrenic patients than the control. The middle half of the corpus callosum was smaller in schizophrenic patients than the control. Schizophrenia was more likely associated not only with delta and theta activities in the centro-parieto-occipital regions but also with beta 1 and beta 2 activities in the front-central regions. In schizophrenic patients, however, alpha 2 activity was markedly decreased in all regions. There were significant positive correlations between the total scores for brief psychiatric rating scale (BPRS) and the areas of the left anterior and posterior horns of the lateral ventricle. The total BPRS scores positively correlated with the area of the third ventricle. In addition, positive correlations were significant between delata activity and the area of the left anterior horn of the lateral ventricle, between delta activity and the area of the third ventricle, and between beta 1 activity and the area of left posteior horn of the lateral ventricle. These results suggest that a dilated third ventricle is associated with electrophysiological brain pathology and psychopathology in schizophrenic patients. (N.K.) 76 refs.

  16. [Deficit in suppression of interference in visual information processing by schizophrenic subjects].

    Science.gov (United States)

    Gagnon, J F; Everett, J; LaJeunesse, C; Gosselin, N; Lavoie, K

    2000-01-01

    Although many studies have indicated information processing deficits in schizophrenic patients, the precise nature and underlying causes of these deficits remain largely uncertain. One prominent hypothesis is that these patients show insufficient attentional inhibition. This deficit to inhibition has been linked to certain cognitive disorders in schizophrenic patients, including attention deficits, as well as to some clinical symptoms, especially those involving delusional thought, hallucinations,and poor contact with reality. The hypothesis of deficient attentional inhibition, although attractive in some ways, is difficult to work with, because it is not easy to directly measure "attentional inhibition". Several studies involving normal subjects have linked attentional inhibition with performance on a task demanding the suppression of distracting information: the presumption is that efficient attentional inhibition will permit rapid responses because the distracting information will be quickly suppressed, allowing undistracted processing of the target information. The present study measures schizophrenic patients' performance on a task demanding suppression of rapidly-presented visual information. An important methodological feature of this study is that performance is measured in terms of "percent correct responses" rather than the reaction time measures typically used in tasks demanding distractor suppression, such as Stroop-like selective attention tasks. Since reaction times are not considered, the results cannot be interpreted in terms of deficient response organization and execution. Schizophrenic (18) and normal (18) subjects underwent trials in which a visual target was the second of two stimuli presented in rapid succession. Interference produced by a non-target significantly impaired perception of the target for schizophrenic patients. This effect persisted longer in the schizophrenic subjects possibly because of deficient attentional inhibition.

  17. Factors Affecting the Readiness of Medical Doctors and Patients with Chronic Conditions toward the Usage of Smartphones in the Saudi Arabian Healthcare Sector

    OpenAIRE

    Bassam M Al-Mahadeen

    2015-01-01

    Numerous studies have reported the rapid increase in the number of individuals who use smartphones. However, smartphones appear to be increasingly used by healthcare workers, particularly physicians and nurses. Therefore, this study aims to investigate the readiness of medical doctors and patients with chronic conditions in using and adopting smartphones for communication. This study employs the Technology Acceptance Model to examine the behavior of people in using smartphones from the perspe...

  18. Relationships between repeated instruction on inhalation therapy, medication adherence, and health status in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Masaya Takemura

    2011-01-01

    Full Text Available Masaya Takemura1, Katsumi Mitsui2, Ryo Itotani1, Manabu Ishitoko1, Shinko Suzuki1, Masataka Matsumoto1, Kensaku Aihara1, Tsuyoshi Oguma1, Tetsuya Ueda1, Hitoshi Kagioka1, Motonari Fukui11Division of Respiratory Medicine, 2Division of Pharmacy, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Osaka, JapanPurpose: Adherence to inhalation therapy is a critical determinant of the success of chronic obstructive pulmonary disease (COPD management. However, in practice, nonadherence to inhalation therapy is very common in COPD patients. The effects of adherence to inhalation therapy in COPD have not been fully studied, and less is known about the relationship between medication adherence and quality of life in COPD. Our aim is to assess the factors that contribute to adherence to inhalation therapy and examine their correlation with quality of life.Patients and methods: A cross-sectional analysis of 88 COPD patients was performed using a self-reported adherence questionnaire with responses on a 5-point Likert scale.Results: Of the 88 patients who were potential participants, 55 (63% responded with usable information. The only significant factor associated with the overall mean adherence score was receiving repeated instruction about inhalation techniques (P = 0.032. Of the 55 respondents, 22 (40.0% were given repeated verbal instruction and/or demonstrations of inhalation technique by a respiratory physician. Significant correlations were found between the overall mean adherence score and the health-related quality of life score (St George’s Respiratory Questionnaire: total, r = −0.35, P = 0.023; symptoms, r = −0.43, P = 0.002; impacts, r = −0.35, P = 0.011. Furthermore, patients with repeated instruction showed better quality of life scores than those who did not receive instruction (total, P = 0.030; symptoms, P = 0.038; impacts, P = 0.019.Conclusions: Repeated instruction for inhalation techniques may contribute to adherence to

  19. Use of medications by people with chronic fatigue syndrome and healthy persons: a population-based study of fatiguing illness in Georgia

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    Jones James F

    2009-07-01

    Full Text Available Abstract Background Chronic fatigue syndrome (CFS is a debilitating condition of unknown etiology and no definitive pharmacotherapy. Patients are usually prescribed symptomatic treatment or self-medicate. We evaluated prescription and non-prescription drug use among persons with CFS in Georgia and compared it to that in non-fatigued Well controls and also to chronically Unwell individuals not fully meeting criteria for CFS. Methods A population-based, case-control study. To identify persons with possible CFS-like illness and controls, we conducted a random-digit dialing telephone screening of 19,807 Georgia residents, followed by a detailed telephone interview of 5,630 to identify subjects with CFS-like illness, other chronically Unwell, and Well subjects. All those with CFS-like illness (n = 469, a random sample of chronically Unwell subjects (n = 505, and Well individuals (n = 641 who were age-, sex-, race-, and geographically matched to those with CFS-like illness were invited for a clinical evaluation and 783 participated (48% overall response rate. Clinical evaluation identified 113 persons with CFS, 264 Unwell subjects with insufficient symptoms for CFS (named ISF, and 124 Well controls; the remaining 280 subjects had exclusionary medical or psychiatric conditions, and 2 subjects could not be classified. Subjects were asked to bring all medications taken in the past 2 weeks to the clinic where a research nurse viewed and recorded the name and the dose of each medication. Results More than 90% of persons with CFS used at least one drug or supplement within the preceding two weeks. Among users, people with CFS used an average of 5.8 drugs or supplements, compared to 4.1 by ISF and 3.7 by Well controls. Persons with CFS were significantly more likely to use antidepressants, sedatives, muscle relaxants, and anti-acids than either Well controls or the ISF group. In addition, persons with CFS were significantly more likely to use pain

  20. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: Is the whole greater than the sum of its parts?

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    Fong Kok-Yong

    2005-01-01

    Full Text Available Abstract Background Diabetes mellitus (DM is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1 evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL (which could be additive, synergistic or subtractive; (2 to determine the extent to which the SF-6D (a single-index preference measure captures the multidimensional information provided by the SF-36 (a profile measure. Methods Using data from a cross-sectional, population-based survey of Chinese, Malay and Indians in Singapore, we developed 9 separate multiple linear regression models, with each SF-36 scale or SF-6D index score being the dependent variable for one model. The influence of DM and a second chronic medical condition (hypertension (HTN, heart disease (HD, musculoskeletal illnesses (MS and their interactions were studied after adjusting for the influence of potential confounding variables. Results Among 5,224 subjects, the prevalence of DM, HTN, HD and MS were 5.9%, 10.7%, 2.4% and 26.6% respectively. DM lowered SF-36 scores by more than 2 points on 3 SF-36 scales and lowered SF-6D scores by 0.03 points. Subjects with DM and HTN, DM and HD or DM and MS experienced further lowering of SF-36 scores exceeding 2 points on at least 6 scales and further lowering of SF-6D scores by 0.05, 0.08 and 0.10 points respectively. Generally, DM and co-existing medical conditions exerted additive effects on HRQoL, with the exception of DM and heart disease, where a subtractive effect was noted. SF-6D index scores generally reflected the patterns of influence of DM and chronic medical conditions on SF-36 scores. Conclusion DM and chronic medical conditions generally reduced HRQoL in this multiethnic general population in an additive, rather than synergistic or subtractive fashion. In this study, the SF

  1. Increased concentration of. cap alpha. - and. gamma. -endorphin in post mortem hypothalamic tissue of schizophrenic patients

    Energy Technology Data Exchange (ETDEWEB)

    Wiegant, V.M.; Verhoef, C.J.; Burbach, J.P.H.; de Wied, D.

    1988-01-01

    The concentrations of ..cap alpha..-, ..beta..- and ..gamma..-endorphin were determined by radioimmunoassay in HPLC fractionated extracts of post mortem hypothalamic tissue obtained from schizophrenic patients and controls. The hypothalamic concentration of ..cap alpha..- and ..gamma..-endorphin was significantly higher in patients than in controls. No difference was found in the concentration of ..beta..-endorphin, the putative precursor of ..cap alpha..- and ..gamma..-endorphins. These results suggest a deviant metabolism of ..beta..-endorphin in the brain of schizophrenic patients. Whether this phenomenon is related to the psychopathology, or is a consequence of ante mortem farmacotherapy, remains to be established.

  2. [3-D ultrasound-assisted gait analysis of schizophrenic patients. Comparison between conventional neuroleptics and olanzapine].

    Science.gov (United States)

    Putzhammer, Albert; Heindl, Bernhard; Müller, Jürgen; Broll, Karin; Pfeiff, Liane; Perfahl, Maria; Hess, Linda; Koch, Horst

    2003-05-01

    Schizophrenic disorders as well as neuroleptic treatment can affect locomotion. The study assessed the influence of neuroleptic treatment on human gait via ultrasonic topometric gait analysis. In a control sample the test system proved high test-retest-reliability. Spatial and temporal gait parameters were assessed in schizophrenic patients without neuroleptic treatment (n = 12) and under treatment with conventional neuroleptics (n = 14) and re-assessed after treatment change to the atypical neuroleptic olanzapine in a repeated measures design. After switch from conventional neuroleptics to olanzapine patients showed an increase of gait velocity (p step length (p gait analysis.

  3. Assessment and analysis of influencing factors affecting the personal and social functioning of chronic schizophrenic inpatients%住院慢性精神分裂症患者个体和社会功能的评估及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    胡满基; 安孝群; 杜宇峰; 肖艳红; 陈优; 朱慧莉; 朱晓洁

    2014-01-01

    目的:分析住院慢性稳定期精神分裂症患者的个人和社会功能及其影响因素。方法:对120例住院慢性稳定期精神分裂症患者采用个人和社会功能量表中文版(PSP)、患者健康问卷(PHQ)及阳性和阴性症状量表(PANSS)等进行个人和社会功能及精神病性状的评估。并对结果进行分析。结果:个人和社会功能低下患者2例(1.7%),有不同程度的能力缺陷患者72例(60.0%),社会功能和人际交往无困难或有轻微困难患者46例(38.3%);患者的个人和社会功能与性别(r =0.568,P <0.01)及本次病程(r =-0.362,P <0.01)存在显著相关性,患者的干扰和攻击行为与其精神症状显著相关(r =0.30,P <0.01)。结论:住院慢性稳定期精神分裂症患者大部分存在不同程度的个人和社会能力缺陷;其中,社会中有用的活动及干扰和攻击行为与患者的精神症状、躯体症状群严重程度及抑郁症状群严重程度显著相关。%Objective:To analyze the personal and social function and their influence factors of inpatients with chronic stable schizophrenia. Method:One hundred and twenty cases were evaluated by Chinese version of personal and social performancescale(PSP-CHN),patient health questionaire(PHQ),and positive and negative symptoms scale(PANSS). The data was analyzed. Results:There was 2 cases(1. 7% )in personal and social dysfunction,72 cases(60. 0% )with varying degrees of functional defects,46 cases(38. 3% )without social dys-function or with minor damage. There was significant correlation between personal and social function and gender (r =0. 568,P <0. 01)and the course of the disease(r = -0. 362,P <0. 01),and between disturbing and aggres-sive behaviors and psychiatric symptoms of these patients(r = 0. 30,P < 0. 01). Conclusion:Most inpatient with chronic stable schizophrenia have different degree of personal and social ability defects. There are

  4. chronic psychotropic medication

    African Journals Online (AJOL)

    2006-08-31

    Aug 31, 2006 ... lack of exercise, obesity, substance misuse) and high autonomic arousal during ... heart; however, it might precipitate complete heart block in the presence of .... desipramine) may impact more on children and the elderly. .... ECG changes such as rate, rhythm, T waves and QT interval ... Type of abnormality.

  5. Investigating a TELEmedicine solution to improve MEDication adherence in chronic Heart Failure (TELEMED-HF: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Widdershoven Jos

    2011-10-01

    Full Text Available Abstract Background Frequent rehospitalisations and poorer survival chances in heart failure (HF patients may partly be explained by poor medication adherence. There are multiple medication-related reasons for suboptimal adherence, but psychological reasons may also be important. A novel TELEmonitoring device may improve MEDication adherence in HF patients (TELEMED-HF. TELEMED-HF is a randomized, controlled clinical intervention trial designed to examine (1 the efficacy and cost-efficiency of an electronic medication adherence support system in improving and monitoring HF patients' medication adherence; (2 the effect of medication adherence on hospitalizations and health care consumption; as well as on (3 clinical characteristics, and Quality of Life (QoL; and (4 clinical, sociodemographic, and psychological determinants of medication adherence. Methods/Design Consecutive patients with chronic, systolic HF presenting to the outpatient clinic of the TweeSteden Hospital, The Netherlands, will be approached for study participation and randomly assigned (1:1 following blocked randomization procedures to the intervention (n = 200 or usual care arm (n = 200. Patients in the intervention arm use the medication support device for six months in addition to usual care. Post-intervention, patients return to usual care only and all patients participate in four follow-up occasions over 12 months. Primary endpoints comprise objective and subjective medication adherence, healthcare consumption, number of hospitalizations, and cost-effectiveness. Secondary endpoints include disease severity, physical functioning, and QoL. Discussion The TELEMED-HF study will provide us a comprehensive understanding of medication adherence in HF patients, and will show whether telemonitoring is effective and cost-efficient in improving adherence and preventing hospitalization in HF patients. Trial registration number NCT01347528.

  6. Waiting for Treatment for Chronic Pain – a Survey of Existing Benchmarks: Toward Establishing Evidence-Based Benchmarks for Medically Acceptable Waiting Times

    Directory of Open Access Journals (Sweden)

    Mary E Lynch

    2007-01-01

    Full Text Available As medical costs escalate, health care resources must be prioritized. In this context, there is an increasing need for benchmarks and best practices in wait time management. In December 2005, the Canadian Pain Society struck a Task Force to identify benchmarks for acceptable wait times for treatment of chronic pain. The task force mandate included a systematic review and survey to identify national or international wait time benchmarks for chronic pain, proposed or in use, along with a review of the evidence upon which they are based. An extensive systematic review of the literature and a survey of International Association for the Study of Pain Chapter Presidents and key informants has identified that there are no established benchmarks or guidelines for acceptable wait times for the treatment of chronic pain in use in the world. In countries with generic guidelines or wait time standards that apply to all outpatient clinics, there have been significant challenges faced by pain clinics in meeting the established targets. Important next steps are to ensure appropriate additional research and the establishment of international benchmarks or guidelines for acceptable wait times for the treatment of chronic pain. This will facilitate advocacy for improved access to appropriate care for people suffering from chronic pain around the world.

  7. Validation and usefulness of the Danish version of the Pain Medication Questionnaire in opioid-treated chronic pain patients

    DEFF Research Database (Denmark)

    Højsted, J; Nielsen, P R; Kendall, S;

    2011-01-01

    Addiction is a feared complication of long-term opioid therapy for chronic pain patients. A screening tool to assess the potential risk of addiction may be helpful.......Addiction is a feared complication of long-term opioid therapy for chronic pain patients. A screening tool to assess the potential risk of addiction may be helpful....

  8. Intracranial Hypertension: Medication and Surgery

    Science.gov (United States)

    ... Intracraneal en Espanol. STORE Shop the IHRF Store Medication and Surgery Medication and Surgery Both drugs and surgery are used ... to treat the headache that accompanies chronic IH. Medications for chronic headache like tricyclic anti-depressants, beta- ...

  9. Relationship of coping and patterns of dependent behavior in patients with chronic pancreatitis of biliary and alcoholic etiology in aspect of differentiation of its medical and psychological support

    Directory of Open Access Journals (Sweden)

    Маріанна Владиславівна Маркова

    2015-08-01

    Full Text Available Choric pancreatitis is an actual medical and psychological problem in Ukraine. The aim of the work was to study the features of coping in patients with chronic pancreatitis of alcoholic and biliary etiology.Methods. For detecting coping-mechanisms the standard method WCQ Р of Lazarus was used. The study of addictive tendencies was carried out with the help of questionnaire AUDIT and UDIT-tests oriented on patterns of dependent behavior.Results. The study of features of coping-mechanisms and an addiction to dependent behavior in patients with chronic pancreatitis revealed intergroup and intragroup differences. Confrontation and low levels of self-control, responsibility and positive assessment were intrinsic for respondents with alcoholic etiology of pancreatitis. Women demonstrated the high addiction to the search of social support, men – to distancing. As to an addictive behavior there was revealed that the typical common tendencies were the consumption of coffee, alcohol, internet-dependence, the specific ones for women – TV, shopping-dependencies, for men – workaholism in patients with biliary and computer-addiction in patients with alcoholic chronic pancreatitis. Intergroup differences were demonstrated by an addiction to disorder of food behavior in patients with biliary and consumption of alcohol and smoking in respondents with alcoholic etiology of pancreatitis.Conclusions. The revealed differences in coping-strategies of patients with different nosological forms of chronic pancreatitis give important information for detecting the targets of medical and psychological influence and constructing of differentiated program of medical and psychological help to patients of this type

  10. A pet-type robot AIBO-assisted therapy as a day care program for chronic schizophrenia patients: A pilot study

    OpenAIRE

    Shin Narita; Nobuyo Ohtani; Chikako Waga; Mitsuaki Ohta; Jun Ishigooka; Kazuhiko Iwahashi

    2016-01-01

    Background AAT (Animal-assisted therapy) was developed to promote human social and emotional functioning as a day care program for psychiatric patients. Aims In this study, we performed AAT using a pet-type robot, AIBO for schizophrenic patients. Methods After obtaining informed consent, we performed the AIBO-assisted therapy for three schizophrenic (ICD-10, F20.x2) patients (male: 1, female: 2) whose medication did not change over the 8 weeks study period in a ward. Results...

  11. COSTS AND BENEFITS OF DAY TREATMENT WITH COMMUNITY CARE FOR SCHIZOPHRENIC-PATIENTS

    NARCIS (Netherlands)

    WIERSMA, D; KLUITER, H; NIENHUIS, FJ; RUPHAN, M; GIEL, R

    1991-01-01

    The feasibility of day treatment with community care for schizophrenic patients was tested by means of a longitudinal randomized experiment with 34 experimentals and 16 controls: 38 percent could be treated satisfactorily in a day program that included a very active ambulatory service. The new appro

  12. COSTS AND BENEFITS OF HOSPITAL AND DAY TREATMENT WITH COMMUNITY CARE OF AFFECTIVE AND SCHIZOPHRENIC DISORDERS

    NARCIS (Netherlands)

    WIERSMA, D; KLUITER, H; NIENHUIS, FJ; RUPHAN, M; GIEL, R

    1995-01-01

    Background. A randomised controlled trial of day treatment with community care for patients with schizophrenic and affective disorders, referred for in-patient psychiatric treatment, was conducted to evaluate patterns of treatment and the course of illness with its psychosocial consequences over a p

  13. Self-experienced vulnerability, prodromal symptoms and coping strategies preceding schizophrenic and depressive relapses.

    Science.gov (United States)

    Bechdolf, Andreas; Schultze-Lutter, Frauke; Klosterkötter, Joachim

    2002-11-01

    For the first time, the present study explores pre-episodic disturbances, i.e. self-experienced vulnerability and prodromal symptoms, and related coping strategies preceding schizophrenic and depressive relapses. After complete recovery from the acute episode, 27 patients with recurrent schizophrenic and 24 patients with recurrent depressive episodes were assessed retrospectively for pre-episodic disturbances and related coping strategies with the "Bonn scale for the assessment of basic symptoms-BSABS". All (100%) of the schizophrenic and 23 (96%) of the depressive patients showed pre-episodic disturbances. Patients with schizophrenia showed significantly more often an increased emotional reactivity and certain perception and thought disturbances. Depressive patients reported significantly more often an impaired tolerance to certain stress and disorders of emotion and affect. Sixty-three percent of the schizophrenics and 87% of the depressives reacted to pre-episodic disturbances with coping strategies. The pre-episodic disturbances in patients with schizophrenia could be described in terms of mild psychotic productivity, those in depressives in terms of mild depressive syndrome. Future studies will have to show if these findings can be replicated in first episode or initial prodromal state samples and if the assessment of mild psychotic productivity and mild depressive syndrome can be used for early diagnosis and early intervention in schizophrenia and depression.

  14. Niacin skin flushing in schizophrenic and depressed patients and healthy controls

    NARCIS (Netherlands)

    Bosveld-van Haandel, Linda; Knegtering, Rikus; Kluiter, Herman; van den Bosch, Robert J.

    2006-01-01

    This study compares the skin reactions to the niacin flushing test of 16 schizophrenic patients with those of 17, depressed patients and 16 healthy controls. Methyl nicotinate (niacin) in a concentration of 0.1 M was applied to the forearm for 5 min. Significant differences could be observed between

  15. Increased lipid peroxidation and neuron specific enolase in treatment refractory schizophrenics.

    Science.gov (United States)

    Medina-Hernández, V; Ramos-Loyo, J; Luquin, S; Sánchez, L F Cerdán; García-Estrada, J; Navarro-Ruiz, A

    2007-10-01

    It is well-known that increased lipid peroxidation and failure of antioxidant mechanisms leads to neuronal damage in schizophrenic patients. However, this neurodegenerative mechanism has not been studied in treatment refractory schizophrenics (TRS). Therefore, the main purpose of this study was to determine neuronal damage in TRS in comparison to non-refractory schizophrenics (NRS) by means of quantitative analysis of lipid peroxidation and neuron specific enolase (NSE) related to the psychopathology severity. Two groups of paranoid schizophrenics, TRS and NRS, and a group of healthy controls (CO) were assembled (n=13). Lipid peroxidation was analyzed through spectrophotometry for quantification of malonaldehyde (MDA) and 4-hydroxynonenal (4-HNE) serum concentrations. As well, serum NSE was quantified by radioimmunoassay (ELSA). Psychopathology was evaluated using the brief psychiatric rating scale (BPRS) and the positive and negative symptoms scale (PANSS). TRS showed significant higher concentrations of lipoperoxides by-products and NSE, than NRS and CO. Clinical scores also revealed a more severe pathology in TRS, than in NRS. Raised lipoperoxidation correlated with higher delusions and emotional withdrawal symptoms, and increased NSE correlated with a lower flow of the conversation and lack of spontaneity. All these results together suggest that TRS patients suffer a greater lipid peroxidation and neuronal damage than NRS, apparently related to worsening of some of the psychiatric symptoms.

  16. Internalized Stigma of Mental Illness among Schizophrenic Patients and Their Families (Comparative Study)

    Science.gov (United States)

    Mahmoud, Sahar; Zaki, Rania A.

    2015-01-01

    This study was a comparative study aiming to assess the extent of internalized stigma of mental illness among patients with schizophrenia & identify stigma as perceived by family members caring schizophrenic patients. The study was conducted in two settings 1st clinic was outpatient clinic for psychiatric patient affiliated to Abbasia…

  17. GABAA receptor subunit gene expression in human prefrontal cortex: comparison of schizophrenics and controls

    Science.gov (United States)

    Akbarian, S.; Huntsman, M. M.; Kim, J. J.; Tafazzoli, A.; Potkin, S. G.; Bunney, W. E. Jr; Jones, E. G.; Bloom, F. E. (Principal Investigator)

    1995-01-01

    The prefrontal cortex of schizophrenics is hypoactive and displays changes related to inhibitory, GABAergic neurons, and GABAergic synapses. These changes include decreased levels of glutamic acid decarboxylase (GAD), the enzyme for GABA synthesis, upregulation of muscimol binding, and downregulation of benzodiazepine binding to GABAA receptors. Studies in the visual cortex of nonhuman primates have demonstrated that gene expression for GAD and for several GABAA receptor subunit polypeptides is under control of neuronal activity, raising the possibility that similar mechanisms in the hypoactive prefrontal cortex of schizophrenics may explain the abnormalities in GAD and in GABAA receptor regulation. In the present study, which is the first of its type on human cerebral cortex, levels of mRNAs for six GABAA receptor subunits (alpha 1, alpha 2, alpha 5, beta 1, beta 2, gamma 2) and their laminar expression patterns were analyzed in the prefrontal cortex of schizophrenics and matched controls, using in situ hybridization histochemistry and densitometry. Three types of laminar expression pattern were observed: mRNAs for the alpha 1, beta 2, and gamma 2 subunits, which are the predominant receptor subunits expressed in the mature cortex, were expressed at comparatively high levels by cells of all six cortical layers, but most intensely by cells in lower layer III and layer IV. mRNAs for the alpha 2, alpha 5, and beta 1 subunits were expressed at lower levels; alpha 2 and beta 1 were expressed predominantly by cells in layers II, III, and IV; alpha 5 was expressed predominantly in layers IV, V, and VI. There were no significant changes in overall mRNA levels for any of the receptor subunits in the prefrontal cortex of schizophrenics, and the laminar expression pattern of all six receptor subunit mRNAs did not differ between schizophrenics and controls. Because gene expression for GABAA receptor subunits is not consistently altered in the prefrontal cortex of

  18. Medical nutrition therapy in adults with chronic kidney disease: integrating evidence and consensus into practice for the generalist registered dietitian nutritionist.

    Science.gov (United States)

    Beto, Judith A; Ramirez, Wendy E; Bansal, Vinod K

    2014-07-01

    Chronic kidney disease is classified in stages 1 to 5 by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative depending on the level of renal function by glomerular filtration rate and, more recently, using further categorization depending on the level of glomerular filtration rate and albuminuria by the Kidney Disease Improving Global Outcomes initiative. Registered dietitian nutritionists can be reimbursed for medical nutrition therapy in chronic kidney disease stages 3 to 4 for specific clients under Center for Medicare and Medicaid Services coverage. This predialysis medical nutrition therapy counseling has been shown to both potentially delay progression to stage 5 (renal replacement therapy) and decrease first-year mortality after initiation of hemodialysis. The Joint Standards Task Force of the American Dietetic Association (now the Academy of Nutrition and Dietetics), the Renal Nutrition Dietetic Practice Group, and the National Kidney Foundation Council on Renal Nutrition collaboratively published 2009 Standards of Practice and Standards of Professional Performance for generalist, specialty, and advanced practice registered dietitian nutritionists in nephrology care. The purpose of this article is to provide an update on current recommendations for screening, diagnosis, and treatment of adults with chronic kidney disease for application in clinical practice for the generalist registered dietitian nutritionist using the evidence-based library of the Academy of Nutrition and Dietetics, published clinical practice guidelines (ie, National Kidney Foundation Council on Renal Nutrition, Renal Nutrition Dietetic Practice Group, Kidney Disease Outcomes Quality Initiative, and Kidney Disease Improving Global Outcomes), the Nutrition Care Process model, and peer-reviewed literature.

  19. Disordered semantic representation in schizophrenic temporal cortex revealed by neuromagnetic response patterns

    Directory of Open Access Journals (Sweden)

    Silberman Yaron

    2006-05-01

    Full Text Available Abstract Background Loosening of associations and thought disruption are key features of schizophrenic psychopathology. Alterations in neural networks underlying this basic abnormality have not yet been sufficiently identified. Previously, we demonstrated that spatio-temporal clustering of magnetic brain responses to pictorial stimuli map categorical representations in temporal cortex. This result has opened the possibility to quantify associative strength within and across semantic categories in schizophrenic patients. We hypothesized that in contrast to controls, schizophrenic patients exhibit disordered representations of semantic categories. Methods The spatio-temporal clusters of brain magnetic activities elicited by object pictures related to super-ordinate (flowers, animals, furniture, clothes and base-level (e.g. tulip, rose, orchid, sunflower categories were analysed in the source space for the time epochs 170–210 and 210–450 ms following stimulus onset and were compared between 10 schizophrenic patients and 10 control subjects. Results Spatio-temporal correlations of responses elicited by base-level concepts and the difference of within vs. across super-ordinate categories were distinctly lower in patients than in controls. Additionally, in contrast to the well-defined categorical representation in control subjects, unsupervised clustering indicated poorly defined representation of semantic categories in patients. Within the patient group, distinctiveness of categorical representation in the temporal cortex was positively related to negative symptoms and tended to be inversely related to positive symptoms. Conclusion Schizophrenic patients show a less organized representation of semantic categories in clusters of magnetic brain responses than healthy adults. This atypical neural network architecture may be a correlate of loosening of associations, promoting positive symptoms.

  20. Metabolic syndrome in Thai schizophrenic patients: a naturalistic one-year follow-up study

    Directory of Open Access Journals (Sweden)

    Charnsilp Chawanun

    2007-04-01

    Full Text Available Abstract Background Not only the prevalence, but also the progress of metabolic abnormalities in schizophrenic patients is of importance for treatment planning and policy making. However, there have been very few prospective studies of metabolic disturbance in schizophrenic patients. This study aimed to assess the progress of metabolic abnormalities in Thai individuals with schizophrenia by estimating their one-year incidence rate of metabolic syndrome (MetS. Methods We screened all schizophrenic patients who visited our psychiatric clinic. After the exclusion of participants with MetS at baseline, each subject was reassessed at 6 and 12 months to determine the occurrence of MetS. The definition of MetS, as proposed by the International Diabetes Federation (IDF, was applied. Results Fifty-seven participants (24 males and 33 females had a mean of age and duration of antipsychotic treatment of 37.5 years old and 8.4 years, respectively. At baseline, 13 subjects met the MetS definition. Of 44 subjects who had no MetS at baseline, 35 could be followed up. Seven of these 35 subjects (20.0% had developed MetS at the 6- or 12-month visit, after already having 2 MetS components at baseline. The demographic data and characteristics of those developing and not developing MetS were not different in any respect. Conclusion Thai schizophrenic patients are likely to develop MetS. Their metabolic abnormalities may progress rapidly and fulfill the MetS definition within a year of follow-up. These findings support the importance of assessing and monitoring metabolic syndrome in schizophrenic patients.

  1. Chronic diseases and multimorbidity among elderly patients admitted in the medical wards of a Nigerian tertiary hospital

    Directory of Open Access Journals (Sweden)

    Paul Osemeke Nwani, MBBS, MSc, FMCP, FWACP

    2016-09-01

    Conclusion: The high frequency of occurrence of multiple chronic diseases in the same individual highlights the challenges awaiting the current healthcare delivery system in developing countries as the populations in these parts of the world grow older.

  2. Investigation and Analysis of Associated Factors of Chronic Constipation in Medical Staff in Shanghai%上海地区医务人员慢性便秘调查及其相关因素分析

    Institute of Scientific and Technical Information of China (English)

    袁春英; 袁蕙芸

    2015-01-01

    Background:With the increase in pace and pressure of modern life,the aging of population,the change in dietary pattern and the challenge of social psychological problems,the overall prevalence of chronic constipation is increasing in general population in recent decades. Aims:To investigate the prevalence and associated factors of chronic constipation in medical staff. Methods:A total of 1 000 medical staffs were enrolled at random in Shanghai Ren Ji Hospital for fulfilling a questionnaire on associated factors of chronic constipation. Diagnosis of chronic constipation met the Rome Ⅲ criteria. Chi-square test and Logistic regression model analysis were performed to screen the potential risk factors for chronic constipation. The statistically significant variables revealed by chi-square test were taken into the Logistic regression model. Results:Nine hundred and eighty-six medical staffs completed the questionnaire,of them 115 were diagnosed as chronic constipation with a prevalence of 11. 7% . Multivariate Logistic regression analysis revealed that reading/ playing cell phone when defecation,working pressure,anxiety,and depression were the risk factors,which might increase the prevalence of chronic constipation;while regular life style,regular diet,drinking water,and regular bowel movement were the protective factors,which might decrease the prevalence of chronic constipation. Conclusions:Chronic constipation is prevalent in medical staff in Shanghai. Psychological factors,dietary pattern and life style,etc. are considered to be implicated in the pathogenesis of chronic constipation. Favorable life style,dietary pattern,bowel habit and mental status are associated with the reduced risk of chronic constipation.

  3. Why are some evidence-based care recommendations in chronic obstructive pulmonary disease better implemented than others? Perspectives of medical practitioners

    Directory of Open Access Journals (Sweden)

    Johnston KN

    2011-12-01

    Full Text Available Kylie N Johnston1, Mary Young2, Karen A Grimmer-Somers1, Ral Antic3, Peter A Frith41International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia; 2Transitional and Community Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 3Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 4Respiratory, Allergy and Sleep Services, Repatriation General Hospital and Flinders University Adelaide, South Australia, AustraliaBackground: Clinical guidelines for management of patients with chronic obstructive pulmonary disease (COPD include recommendations based on high levels of evidence, but gaps exist in their implementation. The aim of this study was to examine the perspectives of medical practitioners regarding implementation of six high-evidence recommendations for the management of people with COPD.Methods: Semi-structured interviews were conducted with medical practitioners involved with care of COPD patients in hospital and general practice. Interviews sought medical practitioners' experience regarding implementation of smoking cessation, influenza vaccination, pulmonary rehabilitation, guideline-based medications, long-term oxygen therapy for hypoxemia and plan and advice for future exacerbations. Interviews were audiotaped, transcribed verbatim and analyzed using content analysis.Results: Nine hospital-based medical practitioners and seven general practitioners participated. Four major categories were identified which impacted on implementation of the target recommendations in the care of patients with COPD: (1 role clarity of the medical practitioner; (2 persuasive communication with the patient; (3 complexity of behavioral change required; (4 awareness and support available at multiple levels. For some recommendations, strength in all four categories provided significant enablers supporting implementation. However, with regard to

  4. 5% Lidocaine-medicated plaster for the treatment of chronic peripheral neuropathic pain: complex regional pain syndrome and other neuropathic conditions.

    Science.gov (United States)

    Calderón, Enrique; Calderón-Seoane, María Eloísa; García-Hernández, Rafael; Torres, Luis Miguel

    2016-01-01

    Chronic neuropathic pain and chronic complex regional pain syndrome (CRPS), in particular, are debilitating and difficult-to-treat conditions that have a strong impact on patient's quality of life. The aim of this study was to evaluate the effectiveness of 5% lidocaine-medicated plaster as add-on therapy in patients with chronic peripheral neuropathic pain conditions, including CRPS. This was a single-center, prospective, observational study set in a specialized pain unit of a tertiary hospital in Spain. A total of 56 patients with long-standing peripheral neuropathic pain, ten of them with CRPS, received 5% lidocaine-medicated plaster as add-on analgesic therapy for 6 months. After 6 months of treatment, a ≥50% reduction in pain intensity was attained by 75% of patients, as measured by numeric rating scale (NRS) for pain. The average NRS score was reduced by 61% (4.7 points), from a baseline mean score of 7.8 to an end point mean score of 3.1. Marked improvements were also observed in the CRPS group: six out of ten patients achieved a ≥50% reduction in NRS score, and the average NRS score for patients with CRPS was reduced by 51% (4.0 points), from a baseline mean score of 7.9 to an end point mean score of 3.9. The improvements in pain intensity were partially translated into a decrease in disability index and in anxiety levels. 5% Lidocaine-medicated plaster may be useful as add-on therapy for a number of peripheral neuropathic pain conditions, including CRPS.

  5. Electroconvulsive in a Schizophrenic Patient With Neuroleptic Malignant Syndrome and Rhabdomyolysis.

    Science.gov (United States)

    San Gabriel, Maria Chona P; Eddula-Changala, Bharathi; Tan, Yonghong; Longshore, Carrol T

    2015-09-01

    We present the case of a middle-aged man with a chronic history of schizoaffective disorder, depressed type, stable on a second-generation antipsychotic. Psychotic symptoms recurred contingent to medication noncompliance necessitating hospitalization. Treatment was complicated by the development of neuroleptic malignant syndrome (NMS). In addition, subsequent medication rechallenges failed because of recurrent rhabdomyolysis and atypical NMS. Electroconvulsive therapy (ECT) treatment was initiated, affording remission of psychotic symptoms and nonrecurrence of NMS and rhabdomyolysis. Our experience confirmed the efficacy of ECT treatment in providing symptom relief of psychosis complicated by recurrent episodes of NMS and atypical NMS. Likewise, it illustrated the efficacy of ECT treatment for rhabdomyolysis.

  6. Comparison of eye-movement patterns in schizophrenic and normal adults during examination of facial affect displays.

    Science.gov (United States)

    Shimizu, T; Shimizu, A; Yamashita, K; Iwase, M; Kajimoto, O; Kawasaki, T

    2000-12-01

    Patients with schizophrenia are known to have deficits in facial affect recognition. Subjects were 25 schizophrenic patients and 25 normal subjects who were shown pairs of slides of laughing faces and asked to compare the intensity of laughter in the two slides. Eye movements were recorded using an infrared scleral reflection technique. Normal subjects efficiently compared the same facial features in the two slides, examining the eyes and mouth, important areas for recognizing laughter, for a longer time than other regions of the face. Schizophrenic patients spent less time ex amining the eyes and mouth and often examined other regions of the face or areas other than the face. Similar results were obtained for the number of fixation points. That schizophrenic patients may have employed an inefficient strategy with few effective eye movements in facial comparison and recognition may help to explain the deficits in facial recognition observed in schizophrenic patients.

  7. An open prospective study evaluating efficacy and safety of a new medical device for rectal application of activated carbon in the treatment of chronic, uncomplicated perianal fistulas

    DEFF Research Database (Denmark)

    Zawadzki, Antoni; Johnson, Louis Banka; Bohe, Måns;

    2017-01-01

    PURPOSE: It has been proposed that biological/chemical substances in the intestine might play a role in the occurrence and deterioration of perianal fistulas. Elimination of such unidentified factors from the lower gastrointestinal tract might offer a new strategy for the management of anal...... fistulas. The aim of this study was to evaluate the clinical effects on non-Crohn's disease perianal fistula healing, and the safety and tolerability of a new medical device that applies high-purity, high-activity granular activated carbon locally into the rectum twice daily of patients with perianal...... fistulas without any concomitant medication. METHODS: An open, single-arm, prospective study with active treatment for 8 weeks and an optional follow-up until week 24 ( ClinicalTrial.gov identifier NCT01462747) among patients with chronic, uncomplicated perianal fistulas scheduled for surgery was conducted...

  8. An open prospective study evaluating efficacy and safety of a new medical device for rectal application of activated carbon in the treatment of chronic, uncomplicated perianal fistulas

    DEFF Research Database (Denmark)

    Zawadzki, Antoni; Johnson, Louis Banka; Bohe, Måns

    2017-01-01

    PURPOSE: It has been proposed that biological/chemical substances in the intestine might play a role in the occurrence and deterioration of perianal fistulas. Elimination of such unidentified factors from the lower gastrointestinal tract might offer a new strategy for the management of anal...... fistulas. The aim of this study was to evaluate the clinical effects on non-Crohn's disease perianal fistula healing, and the safety and tolerability of a new medical device that applies high-purity, high-activity granular activated carbon locally into the rectum twice daily of patients with perianal...... fistulas without any concomitant medication. METHODS: An open, single-arm, prospective study with active treatment for 8 weeks and an optional follow-up until week 24 ( ClinicalTrial.gov identifier NCT01462747) among patients with chronic, uncomplicated perianal fistulas scheduled for surgery was conducted...

  9. Quality of primary care for resettled refugees in the Netherlands with chronic mental and physical health problems: a cross-sectional analysis of medical records and interview data.

    Science.gov (United States)

    van Melle, Marije A; Lamkaddem, Majda; Stuiver, Martijn M; Gerritsen, Annette A M; Devillé, Walter L J M; Essink-Bot, Marie-Louise

    2014-09-23

    A high prevalence of mental and physical ill health among refugees resettled in the Netherlands has been reported. With this study we aim to assess the quality of primary healthcare for resettled refugees in the Netherlands with chronic mental and non-communicable health problems, we examined: a) general practitioners' (GP) recognition of common mental disorders (CMD) (depression and anxiety, and post-traumatic stress disorder (PTSD) symptoms); b) patients' awareness of diabetes type II (DMII) and hypertension (HT); and c) GPs' adherence to guidelines for CMD, DMII and HT. From 172 refugees resettled in the Netherlands, interview data (2010-2011) and medical records (n = 106), were examined. Inclusion was based on medical record diagnoses for DMII and HT, and on questionnaire-based CMD measures (Hopkins Symptom Checklist for depression and anxiety; Harvard Trauma Questionnaire for PTSD). GP recognition of CMD was calculated as the number of CMD cases registered in the medical record compared with those found in interviews. Patient awareness of HT and DMII was scored as the percentage of subjects diagnosed by the GP who reported their condition during the interview. GPs' adherence to guidelines for CMD, DMII and HT was measured using established indicators. We identified 37 resettled refugees with CMD of which 18 (49%) had been recognised by the GP. We identified 16 refugees with DMII and 14 with HT from the medical record; 24 (80%) were aware of their condition. Thirty-five out of these 53 (66%) resettled refugees with chronic mental and non-communicable disorders received guideline-adherent treatment. This study shows that awareness in resettled refugees of GP diagnosed DMII and HT is high, whereas GP recognition of CMD and overall guideline adherence are moderate.

  10. [Efficacy of motivational interviewing for reducing medication errors in chronic patients over 65 years with polypharmacy: Results of a cluster randomized trial].

    Science.gov (United States)

    Pérula de Torres, Luis Angel; Pulido Ortega, Laura; Pérula de Torres, Carlos; González Lama, Jesús; Olaya Caro, Inmaculada; Ruiz Moral, Roger

    2014-10-21

    To evaluate the effectiveness of an intervention based on motivational interviewing to reduce medication errors in chronic patients over 65 with polypharmacy. Cluster randomized trial that included doctors and nurses of 16 Primary Care centers and chronic patients with polypharmacy over 65 years. The professionals were assigned to the experimental or the control group using stratified randomization. Interventions consisted of training of professionals and revision of patient treatments, application of motivational interviewing in the experimental group and also the usual approach in the control group. The primary endpoint (medication error) was analyzed at individual level, and was estimated with the absolute risk reduction (ARR), relative risk reduction (RRR), number of subjects to treat (NNT) and by multiple logistic regression analysis. Thirty-two professionals were randomized (19 doctors and 13 nurses), 27 of them recruited 154 patients consecutively (13 professionals in the experimental group recruited 70 patients and 14 professionals recruited 84 patients in the control group) and completed 6 months of follow-up. The mean age of patients was 76 years (68.8% women). A decrease in the average of medication errors was observed along the period. The reduction was greater in the experimental than in the control group (F=5.109, P=.035). RRA 29% (95% confidence interval [95% CI] 15.0-43.0%), RRR 0.59 (95% CI:0.31-0.76), and NNT 3.5 (95% CI 2.3-6.8). Motivational interviewing is more efficient than the usual approach to reduce medication errors in patients over 65 with polypharmacy. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  11. A comparison between effectiveness of three types of music on memory activity and sustained attention in schizophrenic patients

    OpenAIRE

    Narges bahmany; Karamatollah Zandi ghashghaee; Sadrollah Khosravi

    2014-01-01

    Background: schizophrenia is a psychiatric disorder in which a lot of cognitive functions including memory, attention, motor skills, executive functions and intelligence are compromised. Numerous empirical studies showed that schizophrenic patients have problem in sustain retention and memory activity. The objective of this study was a comparison between effectiveness of three types of music on memory activity and sustain retention in schizophrenic patients. Material and Methods: A total of 6...

  12. Effects of meta-chlorophenylpiperazine on neuroendocrine and behavioral responses in male schizophrenic patients and normal volunteers.

    Science.gov (United States)

    Maes, M; Meltzer, H Y

    1996-10-16

    Functional alterations in the central serotonergic system, including presynaptic and postsynaptic function, have been reported in schizophrenia. Recently, there have been conflicting reports that the increase in plasma cortisol or prolactin concentrations induced by meta-chlorophenylpiperazine (mCPP) was significantly blunted in schizophrenic patients compared with normal volunteers. Studies of the behavioral effects of mCPP, a serotonin (5-HT) receptor partial agonist with high affinity for 5-HT1C binding sites, have also yielded conflicting results in schizophrenic patients. The purpose of this study was to examine plasma levels of prolactin and cortisol, body temperature, and behavioral responses to mCPP and placebo in a single-blind study in 25 schizophrenic and 15 normal men. No differences either between schizophrenic patients and normal volunteers or between paranoid and undifferentiated/residual subtypes of schizophrenia were found in mCPP-induced prolactin, cortisol, or temperature responses. Schizophrenic patients and normal volunteers reported significant increases in feeling calm and feeling strange of comparable magnitude following mCPP. No significant differences between normal volunteers and schizophrenic patients were found in post-mCPP behavioral ratings, such as anxiety, irritability, depression, restlessness, or arousal.

  13. Long-term pain relief with optimized medical treatment including antioxidants and step-up interventional therapy in patients with chronic pancreatitis.

    Science.gov (United States)

    Shalimar; Midha, Shallu; Hasan, Ajmal; Dhingra, Rajan; Garg, Pramod Kumar

    2017-01-01

    Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach. All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 µg organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure. A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (P < 0.001). Of the 288 patients, 261, 218, 112, and 51 patients were followed up for 3, 5, 10, and 15 years, respectively; 54.0%, 57.3%, 60.7%, and 68.8% of them became pain free at those follow-up periods. Significant pain relief is achieved in the majority of patients with optimized medical and interventional treatment. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  14. Negative association between a history of obstetric complications and the number of neurological soft signs in first-episode schizophrenic disorder.

    Science.gov (United States)

    Boks, Marco P M; Selten, Jean-Paul; Leask, Stuart; Castelein, Stynke; van den Bosch, Robert J

    2007-01-15

    We examined the relationship between a history of obstetric complications (OCs) and the number of neurological soft signs (NSS) in a group of 132 patients experiencing their first episode of psychosis. We measured NSS by means of a comprehensive standardized assessment and gained information on a selection of nine OCs from the patient's mother. Contrary to our expectations we found significantly more NSS in the group of patients without a history of OCs. This effect was independent of medication in the group of patients with a schizophrenic disorder, but not in the entire group. It is possible that the patients with a history of OCs carry fewer genes for schizophrenia (and NSS) and 'needed' the OCs to develop schizophrenia.

  15. [Clinical-chemical studies in schizophrenic out-patients under neuroleptic long-term treatment with particular consideration of the hepatic metabolism (author's transl)].

    Science.gov (United States)

    Gonçalves, N; Grüneberg, F

    1977-01-01

    A series of clinical-chemical tests was conducted in 68 schizophrenic out-patients under long-term neuroleptic medication, with particular consideration of the hepatic metabolism, i.e.: Erythrocyte sedimentation rate, alpha 1-glycoprotein, ceruloplasmin, fibrinogen, GPT, GOT, gamma-GT, total protein and serum-protein-electrophoresis. Furthermore, the glucose tolerance tests was carried out. In 44% of the patients an increased erythrocyte sedimentation rate and positive correlations with increased fibrinogen values were found. Increased gamma-GT-values were proven in 33% of the patients; they correlated positively with the increased GPT-and/or GOT-values as well as with pathological glucose tolerance values. Overweight of more than 10 kilos was found in 46% of the patients. A significant correlation between overweight and pathological glucose tolerance values existed. The results were interpreted as consequence of a light fatty liver.

  16. Pharmacist Web-Based Training Program on Medication Use in Chronic Kidney Disease Patients: Impact on Knowledge, Skills, and Satisfaction

    Science.gov (United States)

    Legris, Marie-eve; Seguin, Noemie Charbonneau; Desforges, Katherine; Sauve, Patricia; Lord, Anne; Bell, Robert; Berbiche, Djamal; Desrochers, Jean-Francois; Lemieux, Jean-Philippe; Morin-Belanger, Claudia; Paradis, Francois Ste-Marie; Lalonde, Lyne

    2011-01-01

    Introduction: Chronic kidney disease (CKD) patients are multimorbid elderly at high risk of drug-related problems. A Web-based training program was developed based on a list of significant drug-related problems in CKD patients requiring a pharmaceutical intervention. The objectives were to evaluate the impact of the program on community…

  17. Prevalence and risk factors of chronic post-thoracotomy pain in Chinese patients from Peking Union Medical College Hospital

    Institute of Scientific and Technical Information of China (English)

    WANG Hai-tang; LIU Wei; LUO Ai-lun; MA Chao; HUANG Yu-guang

    2012-01-01

    Background In clinical practice,the mechanisms underlying chronic post-surgical pain (CPSP) remain insufficientlyunderstood.The primary goals of this study were to determine the incidence of chronic pain after thoracic surgery and to identify possible risk factors associated with the development of chronic post-thoracotomy pain in Chinese patients.The secondary goal was to determine whether the difference between pre-and post-operative white blood cell (WBC) counts could predict the prevalence of CPSP after thoracotomy.The impact of chronic pain on daily life was also investigated.Methods We contacted by phone 607 patients who had undergone thoracotomy at our hospital during the period February 2009 to May 2010.Statistical comparisons were made between patients with or without CPSP.Results Results were ultimately analyzed from 466 qualified patients.The overall incidence of CPSP was 64.5%.Difference between pre-and post-operative WBC counts differed significantly between patients with or without CPSP (P<0.001) and was considered as an independent risk factor for the development of CPSP following thoracotomy (P<0.001).Other predictive factors for chronic pain included younger age (<60 years,P <0.001),diabetes mellitus (P=0.023),acute post-operative pain (P=0.005) and the duration of chest tube drainage (P <0.001).At the time of interviews,the pain resulted in at least moderate restriction of daily activities in 15% of the patients,of which only 16 patients had paid a visit to the doctor and only three of them were satisfied with the therapeutic effects.Conclusions Chronic pain is common after thoracotomy.WBC count may be a new independent risk factoring surgical patients during peri-operative period.Besides,age,diabetes mellitus,acute post-operative pain,and duration of chest tube drainage may also play a role in chronic post-surgical pain occurrence.

  18. Chronic medical conditions and mental health in older people : disability and psychosocial resources mediate specific mental health effects

    NARCIS (Netherlands)

    Ormel, J; Kempen, GIJM; Penninx, BWJH; Brilman, EI; Beekman, ATF; VanSonderen, E

    1997-01-01

    Background. This study describes the differences in psychological distress, disability and psychosocial resources between types of major medical conditions and sensory impairments (collectively denoted as CMCs); and tests whether disability and psychosocial resources mediate CMC-specific mental heal

  19. Chronic medical conditions and mental health in older people : disability and psychosocial resources mediate specific mental health effects

    NARCIS (Netherlands)

    Ormel, J; Kempen, GIJM; Penninx, BWJH; Brilman, EI; Beekman, ATF; VanSonderen, E

    Background. This study describes the differences in psychological distress, disability and psychosocial resources between types of major medical conditions and sensory impairments (collectively denoted as CMCs); and tests whether disability and psychosocial resources mediate CMC-specific mental

  20. Medication monitoring and optimization : a targeted pharmacist program for effective and cost-effective improvement of chronic therapy adherence

    NARCIS (Netherlands)

    van Boven, Job F.M.; Stuurman-Bieze, Ada G.G.; Hiddink, Eric G.; Postma, Maarten J.; Vegter, Stefan

    2014-01-01

    BACKGROUND: Community pharmacies provide a promising platform for monitoring and improving therapy adherence and providing pharmaceutical care. Structured methods and appropriate software are important tools to increase pharmacist effectiveness and improve health outcomes. In 2006, the Medication Mo

  1. Comparison of the efficacy of electromyographic biofeedback, cognitive-behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain.

    Science.gov (United States)

    Flor, H; Birbaumer, N

    1993-08-01

    In this study, three types of treatments for chronic musculoskeletal pain were compared. Fifty-seven patients who suffered from chronic back pain and 21 patients who suffered from temporomandibular pain and dysfunction were randomly assigned to either electromyographic (EMG) biofeedback, cognitive-behavioral therapy, or conservative medical treatment. At posttreatment, improvements were noted in all three treatment groups, with the biofeedback group displaying the most substantial change. At the 6- and 24-month follow-up, only the biofeedback group maintained significant reductions in pain severity, interference, affective distress, pain-related use of the health care system, stress-related reactivity of the affected muscles, and an increase in active coping self-statements. Treatment outcome was predicted by chronicity and treatment-specific variables. Analysis of attrition showed a significant effect for therapist and extent of somatic pathology. Results suggest that pain patients who suffer from musculoskeletal pain problems and display few physical disabilities may profit the most from short-term EMG biofeedback treatment.

  2. A cross-sectional study on occurrence of type 2 diabetes among patients admitted with chronic liver diseases in a medical college in Kolkata

    Directory of Open Access Journals (Sweden)

    Shuvankar Mukherjee

    2013-01-01

    Full Text Available Objectives: To study the magnitude of the problem of type 2 diabetes mellitus and impaired glucose intolerance among the patients with various types of chronic liver diseases and to find out the association of diabetes mellitus and impaired glucose tolerance with the demographic and clinical characteristics of the patients. Materials and Methods: This observational study, which was cross-sectional in design, was undertaken in the Department of General Medicine at a medical College in Kolkata during October 2010 to July 2011. Altogether 161 patients diagnosed with chronic liver disease (CLD were admitted in the General Medicine ward during the study period, out of which 9 patients got themselves discharged against medical advice. From the remaining 152 patients, a total of 136 patients aged 20 years and above were selected for the study according to the inclusion criteria. A detailed history was taken, and a thorough clinical examination was done followed by further investigations, all of which were recorded in a pre-designed, structured proforma. Results : Among the study subjects, 58.1% had impaired glucose tolerance (IGT, while 14.0% had overt diabetes mellitus. IGT and diabetes were significantly higher among the CLD patients aged 45 years or more (P < 0.05. However, similar association was not observed with regard to sex of the patients. No association was found between the occurrence of IGT and/or overt diabetes with either severity (as per Child-Pugh score or with the duration of CLD. More than half of the study subjects having alcoholic liver disease or chronic hepatitis B or C or autoimmune hepatitis and one third of those having Wilson's disease had IGT, while one third of those with either chronic hepatitis C or Wilson's disease and one fourth of those having autoimmune hepatitis had overt diabetes. Twenty-one percent of those with chronic hepatitis B also found to have overt diabetes, which was least in those with alcoholic liver

  3. [Intercorrelation of psychopathological, morphologic, neurophysiologic an psychometric parameters in schizophrenic patients].

    Science.gov (United States)

    Pester, U; Schwarz, A; Lerche, J; Brosz, M; Kropf, S; Ulrich, S; Bogerts, B; Wurthmann, C

    1997-07-01

    The present study was designed to determine the intercorrelation between schizophrenic symptoms, brain morphology, electrophysiological and neuropsychological variables. 44 patients, who met ICD-10 criteria for schizophrenic disorder, were included. At baseline, after 3 and 6 weeks BPRS, CGI, psychometric measurements and QEEG/ERP were performed. A CT scan was performed only at the beginning of the study. Data were evaluated by a multivariate test for data with an inherent structure. One of the most interesting findings is a correlation between BPRS total score and theta EEG power at baseline as well as under treatment. In conclusion, the study suggests the usefulness of multimethodological approaches in order to optimise diagnostic procedures in schizophrenia.

  4. [Coping and psychological compensation in patients with endogenous psychoses of schizophrenic origin].

    Science.gov (United States)

    Dittmann, J; Schüttler, R

    1989-07-01

    For a long period of time, the coping and compensatory mechanisms that arise from the patients with schizophrenic psychoses themselves have been considered only to a small extent by the psychiatric research. On the basis of Huber's concept of basic symptoms, we extended the six categories of coping mechanisms which are described in the Bonn Scale for the Assessment of Basic Symptoms (BSABS) by three further categories. With ten schizophrenic patients - mostly in-patients - semistructured interviews concerning these categories were done. All patients were found to have coping and compensatory mechanisms, and as a contribution to recognize and describe these mechanisms, parts of the patients' remarks are quoted. This is a prerequisite for an operationalized recording on larger patient populations that will possibly also allow correlation-statistical conclusions.

  5. Perinatal complications in births to low socioeconomic status schizophrenic and depressed women.

    Science.gov (United States)

    Goodman, S H; Emory, E K

    1992-05-01

    Pregnancy and birth complications in births to 57 schizophrenic, 28 depressed, and 31 well women were studied. The sample was of low socioeconomic status and predominantly African-American. The study extended earlier work on the perinatal status of infants born to schizophrenic women by including measures of severity of maternal disturbance, mother's age, IQ, and premorbid social competence, and family composition. The results show that maternal competence and the mother's diagnosis of schizophrenia were significant variables in determining the likelihood of less adequate prenatal care and more complicated births. The results indicate the importance of an assessment not only of a disturbed woman's diagnosis but also of her personal background and social competence in determining the likelihood of obstetrical complications.

  6. Neurological soft signs, cognitive dysfunction and ventricular brain ration in schizophrenics.

    Science.gov (United States)

    Lal, N; Tiwari, S C; Srivastava, S; Khalid, A; Siddhartha; Kohli, N

    1998-04-01

    An association between cognitive dysfunction, neurological soft signs, enlarged brain ventricles and widened cortical sulci has been reported in schizophrenia. The present work aimed to study the relevance of positive and negative dichotomy with relation to neuropsychological performance of the schizophrenic patients, and the presence of neurological soft signs. In 23 schizophrenics patients diagnosed according to DSM-III-R of which 14 were of positive subtype and 9 were of negative subtype. At least one neurological soft sign was present in all the patients. The positive group had higher WMS and IQ scores and lower BGT scores than the negative group. Negative, correlation was seen for WMS and BGT scores with Ventricular Brain Ratio (VBR), and the soft signs showed positive correlation in the positive subtype only.

  7. [Common categories in the speech of Bert Brechts and the speech of a schizophrenic].

    Science.gov (United States)

    Adler, M

    1975-01-01

    The author demonstrates structural similarities and phenomenal resemblances between the language of Bertolt Brecht and the idiosyncrasies of expression of schizophrenic subjects. He compares some typical modes of expression on the basis of which he draws some general conclusions. What they have in common appears to be a 'disorganization' of the world as we know it which consists of 'things' and 'symbols'. It is only the notion of the more or less conscious use of these means of expression which allows one to distinguish between the 'linguistic world' of Brecht and that of schizophrenic subjects. These findings agree with those of other studies which have revealed affinities between the artistic expression of the mentally deranged and certain trends in art. The author has elaborated a number of heuristic categories which may be employed to understand the various modes of expression and has presented them in table form.

  8. The effects of reflexology on chronic low back pain intensity in nurses employed in hospitals affiliated with Isfahan University of Medical Sciences.

    Science.gov (United States)

    Eghbali, Maryam; Safari, Reza; Nazari, Fatemeh; Abdoli, Samereh

    2012-03-01

    Humans have been involved with the phenomena of pain and pain relief from the ancient times. Back pain is the most common pain. In fact, eight out of ten people experience it in their lifetime. However, individuals with specific jobs, including nurses, are faced with this problem more. Nursing is in the top ten careers suffering from the most severe musculoskeletal injuries. There are non-pharmacologic and pharmacologic treatments to relieve back pain. One of the non-medical treatments of pain is called reflexology which is a branch of complementary and alternative therapies. This research has been conducted to investigate the effect of reflexology on chronic low back pain intensity. This study was a double-blind clinical trial. The study population consisted of 50 female and male nurses suffering from chronic low back pain working in hospitals affiliated with Isfahan University of Medical Sciences. The participants were divided into two groups of reflexology and non-specific massage. A questionnaire was completed through interviews and a 40 minute sessions of interventions were performed three times a week for two weeks. Pain intensity was measured by Numerical Analogue Scale for pain before and after the intervention. Descriptive and inferential statistics, including independent t-test and chi-square test, were used to analyze the data. The results showed a significantly higher reduction in pain intensity scores in the reflexology group after the intervention as compared with the non-specific massage group. However, the non-specific massage was also significantly effective in reducing pain. Reflexology can be effective in reducing the severity of chronic back pain, i.e. it is able to reduce pain from moderate to mild. Thus, this technique is recommended to be performed by nurses as a complementary therapy in patient care.

  9. PET findings in patients with chronic paranoid schizophrenia

    Energy Technology Data Exchange (ETDEWEB)

    Uesugi, Hideji [National Center of Neurology and Psychiatry, Kodaira, Tokyo (Japan). National Center Hospital for Mental, Nervous and Muscular Disorders; Toyoda, Junzo; Iio, Masaaki

    1995-07-01

    The regional cerebral blood flow (rCBF) of chronic schizophrenic patients with auditory hallucinations and paranoid delusions and normal controls was compared. The subjects were 5 male chronic inpatients (average age of 41.4 yrs, BPRS 29.3{+-}15.0). Normal controls (6 males) were matched for age and sex. rCBF was determined by PET, based on the consecutive inhalation of {sup 15}O-CO{sub 2}. rCBF in the paranoid schizophrenics was significantly higher than that in normal controls in the temporal lobe and cerebellum (p<0.05). rCBF in paranoid schizophrenia showed a tendency to be higher in the frontal lobe, parietal lobe, caudate nucleus, parahippocampus and putamen, but not in the thalamus. (author).

  10. The genetic basis of the beta power in the resting electroencephalogram of schizophrenic patients

    OpenAIRE

    Opitz, Damaris

    2011-01-01

    This association study builds on research demonstrating that schizophrenic patients have increased beta activity compared to healthy subjects. Moreover, huge collaborative studies investigating alcoholic patients showed that the increased beta power of these patients in resting electroencephalogram (EEG) is linked to GABA-A receptor genes. More specifically research in this field identified an association of increased beta power with a single nucleotide polymorphism (SNP) rs279...

  11. Development of the caregivers attitude scale on home care of schizophrenics (CASHS)

    OpenAIRE

    Balasubramanian, N.; Sathyanarayana Rao, T. S.; D’Sa, Juliana Linnette

    2014-01-01

    Background: Schizophrenia is a severe mental disorder that elicits feelings of strangeness and discomfort, which may create stigma and lead to the social exclusion of the mentally ill and of the people relating with them. In the past decade, there has been an increase in the number of research studies on attitudes toward mental disorders. Materials and Methods: An instrument was developed to assess the attitude of primary caregivers on home care of schizophrenics. This article describes the d...

  12. Detecting Potential Adverse Reactions of Sulpiride in Schizophrenic Patients by Prescription Sequence Symmetry Analysis

    OpenAIRE

    2014-01-01

    PURPOSE: Previous studies have demonstrated sulpiride to be significantly more effective than haloperidol, risperidone and olanzapine in schizophrenic treatment; however, only limited information is available on the potential risks associated with sulpiride treatment. This study attempts to provide information on the potential risks of sulpiride treatment of schizophrenia, especially with regard to unexpected adverse effects. MATERIALS AND METHODS: Patients with schizophrenia aged 18 and olde...

  13. Schizophrenic thought disorders: comparison between units of symptoms and axial syndrome.

    Science.gov (United States)

    Arnold, O H

    1985-01-01

    The schizophrenic axial syndrome postulates the presence of thought disorder and/or cryptic neologisms. The theory of symptom units postulates three groups of symptoms within the schizophrenic pattern. Each group arises through a special basic disturbance within the performance of experience close to the biological substrate. 465 schizophrenics have been examined personally at least twice within 8 years. We investigated signs (A) of subjectively perturbed experience of thoughts, such as transitoriness, disconnection, pressing, movielike thinking, double-sense thinking: withdrawal, broadcasting, telepathy, insertion, audible thinking, postresonance, echo; lack of impressivenes, veiled thinking, hazy thinking, thoughts getting stuck; thoughts getting muddled and crossed, condensation, contamination; (B) of perturbed performance of thinking, such as loosening of association, thought gaps, derailment, substitution, blocking, desultory thinking, tangentiality, performed word contaminations, word approximation, dissolution of terms, private use of words, disturbed formulation of the meaning of facts, vague thinking, paraphrasia, neologism, driveling. The series of general frequency shows: driveling 67.9%, desultory thinking 57.3%, withdrawal, broadcasting, insertion 32.7%, loosening of association, gaps, derailment 28.9%, blocking 16.5%, transitoriness, movielike thinking, double-sense thinking 12.0%. From the practical point of view, the time of the first manifestation of the symptoms is important. This will de demonstrated. The study confirms the presence of thought disorders in each case but at different times within the course depending on the type of course (phases, attacks, attack processes, process). With regard to these results the theory of symptom units can assist the practicability of the schizophrenic axis syndrome.

  14. Memory tests in first-degree adult relatives of schizophrenic patients: a meta-analysis.

    OpenAIRE

    Trandafir, Anca; Méary, Alexandre; Schürhoff, Franck; Leboyer, Marion; Szöke, Andrei

    2006-01-01

    BACKGROUND: Memory deficits have been clearly demonstrated in schizophrenic patients. However, studies of memory performances in their relatives compared to normal controls provide conflicting results. A meta-analysis was carried out to synthesize all the published data. Unlike previous meta-analyses, which were based on composite scores, we analyzed each memory test separately. This prevents theoretically questionable choices in grouping variables, leads to results with clearer implications ...

  15. Influencing and moderating factors analyzed in the group art therapy of two schizophrenic inpatients.

    Science.gov (United States)

    Hung, Chung-Chieh; Ku, Yung-Wen

    2015-12-01

    Art therapy has been considered a guideline treatment for schizophrenia. Due to difficulty in the outcome measurement, the research is difficult and controversial. Here, we presented two schizophrenic patients receiving the regular art group therapy. We compared their characteristics and different outcome. Art therapy is difficult to quantify. However, we could qualify the improvement from the individual case. Further study might be focus on how to make appropriate qualification of art therapy and individualized difference instead of enrollment of huge data bank.

  16. Development and validation of a skin fibroblast biomarker profile for schizophrenic patients

    Directory of Open Access Journals (Sweden)

    Marianthi Logotheti

    2016-12-01

    Full Text Available Gene expression profiles of non-neural tissues through microarray technology could be used in schizophrenia studies, adding more information to the results from similar studies on postmortem brain tissue. The ultimate goal of such studies is to develop accessible biomarkers. Supervised machine learning methodologies were used, in order to examine if the gene expression from skin fibroblast cells could be exploited for the classification of schizophrenic subjects. A dataset of skin fibroblasts gene expression of schizophrenia patients was obtained from Gene Expression Omnibus database. After applying statistical criteria, we concluded to genes that present a differential expression between the schizophrenic patients and the healthy controls. Based on those genes, functional profiling was performed with the BioInfoMiner web tool. After the statistical analysis, 63 genes were identified as differentially expressed. The functional profiling revealed interesting terms and pathways, such as mitogen activated protein kinase and cyclic adenosine monophosphate signaling pathways, as well as immune-related mechanisms. A subset of 16 differentially expressed genes from fibroblast gene expression profiling that occurred after Support Vector Machines Recursive Feature Elimination could efficiently separate schizophrenic from healthy controls subjects. These findings suggest that through the analysis of fibroblast based gene expression signature and with the application of machine learning methodologies we might conclude to a diagnostic classification model in schizophrenia.

  17. Association study of MAO-A and DRD4 genes in schizophrenic patients with aggressive behavior.

    Science.gov (United States)

    Fresan, Ana; Camarena, Beatriz; Apiquian, Rogelio; Aguilar, Alejandro; Urraca, Nora; Nicolini, Humberto

    2007-01-01

    Genes involved in dopamine neurotransmission are interesting candidates to be analyzed in schizophrenia and aggressive behavior. Therefore, we analyzed the functional polymorphisms of the dopamine receptor D4 (DRD4) and monoamine oxidase A (MAO-A) genes in a sample of 71 schizophrenic patients assessed with the Overt Aggression Scale to measure aggressive behavior. CLUMP analysis of the DRD4 48-bp repeat-exon III polymorphism in schizophrenic patients showed significant differences between the aggressive behavior and the nonaggressive groups (T1 = 18.77, d.f. = 6, p = 0.0046; T3 = 6.54, p = 0.0195). However, analysis of the promoter polymorphism of the MAO-A gene revealed no significant association between aggressive and nonaggressive patients. Finally, analysis of Overt Aggression Scale dimensions exhibited significant differences for the DRD4 and MAO-A genes. Our preliminary findings suggest that the DRD4 and MAO-A genes may be involved in aggressive schizophrenic patients.

  18. Self-concept in adult children of schizophrenic parents: an exploratory study.

    Science.gov (United States)

    Manjula, M; Raguram, A

    2009-09-01

    Much of the work on children of schizophrenic parents has primarily focused on the risk of developing various kinds of psychiatric disorders, behavioural problems and cognitive vulnerability factors. There has been inadequate attention given to children without a clinical diagnosis and particularly the adult offspring of schizophrenic parents. It would be worthwhile to study the wellness or otherwise of these children, especially in terms of the self-concept of these individuals. To study the impact of parental mental illness on the self-concept of adult children. Thirty subjects who had one parent diagnosed as suffering from schizophrenia formed the study group, and 30 subjects, matched on age and gender with the study group, formed the control group. Subjects were assessed using a socio-demographic and clinical data sheet and a self-concept scale. The results showed that the study group had significantly poorer self-concept compared to the control group. The current clinical status of the parents had an impact on the family self-esteem of the children. Subjects who were above 10 years of age at the onset of the parental mental illness had a poorer self-concept, as compared to those who were below 10 years at the onset of illness in their parents. The results provide evidence for poor self-concept in adult children of schizophrenic parents compared to children of normal parents.

  19. The Self Representation in Schizophrenic patients: Considerations on the Draw a Tree Test

    Directory of Open Access Journals (Sweden)

    Salvatore Settineri

    2015-09-01

    Full Text Available Abstract   Objective: The tree is the archetypal symbol of the identification in the growing life. The objective of this study is to evaluate the representation of the self in schizophrenic patients through the tree drawing. Methods: Were identified 36 patients, 22 women and 14 (M-age=53, suffering from schizophrenic disorder. Through the Scale for the Assessment of Negative Symptoms (SANS and the Scale for the Assessment of Positive Symptoms (SAPS positive and negative symptoms, and the reactive tree representation of the self were assessed.   Results: In the group with negative symptoms archetypal figures are more frequent, such as images that are part of the collective unconscious, or thought more archaic. In patients in which emerges the delirium, that is part of the most evolved thinking, near to the secondary process, the reality testing is better preserved. In cases where there are symptoms mixed the tree structure leads to an archetypal image. Conclusions: This study shows that in the draw of the tree trunk-to-crown ratio in schizophrenic patients was significantly higher than that of healthy individuals. The usefulness of the study insert itself in the Jungian analytic thought, for which psychotic thought corresponds to an abbaissement of the self activity.   Keyword: Representation of Self; Schizophrenia; Draw a Tree Test.

  20. Neuropsychology, Social Cognition and Global Functioning Among Bipolar, Schizophrenic Patients and Healthy Controls: Preliminary Data

    Directory of Open Access Journals (Sweden)

    Elisabetta eCaletti

    2013-10-01

    Full Text Available This study aimed to determine the extent of impairment in social and non-social cognitive domains in an ecological context comparing bipolar (BD, schizophrenic patients (SKZ and healthy controls (HC. The sample was enrolled at the Department of Psychiatry of Policlinico Hospital, University of Milan, it includes stabilized schizophrenic patients (n = 30, euthymic bipolar patients (n = 18 and healthy controls (n = 18. Patients and controls completed psychiatric assessment rating scales, the Brief Assessment of Cognition in Schizophrenia (BACS and the Executive and Social Cognition Battery (ESCB that contains both ecological tests of executive function and social cognition, in order to better detect cognitive deficits in patients with normal results in standard executive batteries. The three groups differed significantly for gender and substance abuse, however the differences did not influence the results. Bipolar patients showed less impairment on cognitive performance compared to schizophrenic patients, even in ecological tests that mimic real life scenarios. In particular, BD performed better than SKZ in verbal memory (p

  1. PSYCHIATRIC MORBIDITY PATTERN OF THE FIRST-DEGREE RELATIVES OF SCHIZOPHRENICS: CROSS-SECTIONAL STUDY

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    Alexander Gnana Durai

    2015-11-01

    Full Text Available : CONTEXT: Family, Twin and Adoption studies show the inheritance patterns of schizophrenia. The findings from these studies provide support to the claim that familial clustering of schizophrenia is a combined expression of genetic and environmental factors. AIMS: Following the line of previous research, this study attempts to find out any difference in the psychiatric morbidity pattern among the first-degree relatives of familial and sporadic schizophrenics. SETTINGS AND DESIGN: We conducted a cross-sectional survey among a convenience sample of 100 first-degree relatives (age between 18 to 55 years of familial (n=22 and sporadic (n=29 schizophrenics from psychiatric outpatient clinic, of a Government Hospital, India. The schizophrenics satisfied the DSM-IV criteria and all the first degree relatives interviewed never had any psychiatric consultation before or were abusing alcohol or other substances or having any organic pathology. METHODS AND MATERIAL: Informed consent from the patients and relatives was obtained. Survey questionnaires were administered and no personal identifying information was collected. Middle Sex Hospital Questionnaire (MHQ, Eysenck's Personality Questionnaire (EPQ, Multi-Phasic Personality Questionnaire (MPQ and Screening Test for Co-Morbid Personality Disorders (STCPD were administered to the participants.

  2. Excessive weight gain after remission of depression in a schizophrenic patient treated with risperidone: case report

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    Psarros Constantin

    2006-09-01

    Full Text Available Abstract Background The use of atypical antipsychotics in schizophrenic patients has been associated with a risk of weight gain. Similarly, recovery from depression is often followed by improved appetite, greater food intake and potential increase in weight. Case presentation A Caucasian 33-year-old schizophrenic female patient was being treated with 6 mg/day of risperidone and 15 mg/day of clorazepate. She developed depressive symptomatology and 40 mg/day of fluoxetine was gradually added to her treatment regimen for about 9 months. After the remission of depression, and the discontinuation of fluoxetine, she experienced an increase in appetite and subsequently excessive weight gain of 52 kg. Re-administration of fluoxetine did not reverse the situation. The patient developed diabetes mellitus, which was successfully controlled with metformin 1700 mg/day. The addition at first of orlistat 360 mg/day and later of topiramate 200 mg/day has helped her to lose a significant part of the weight gained (30 kg. Conclusion The case suggests a probable association between the remission of depressive symptomatology and weight gain in a schizophrenic patient.

  3. A comparative study of attentional strategies of schizophrenic and highly creative normal subjects.

    Science.gov (United States)

    Dykes, M; McGhie, A

    1976-01-01

    Frequent references have been made to the similarities between highly creative and psychotic thinking. This study attempts to test the hypothesis that one explanation for such a correspondence lies in the fact that individuals in both these populations habitually employ common attentional strategies which cause them to sample an unusually wide range of available environmental stimuli. A group of highly creative adults and a group of equally intelligent but low creative adults were compared with a group of acute non-paranoid schizophrenic adults on three tests designed to assess attentional and other cognitive styles. The results offer support to the view that both highly creative and schizophrenic individuals habitually sample a wider range of available environmental input than do less creative individuals. In the case of the schizophrenic this involuntary widening of attention tends to have a deleterious effect on performance, while, in contrast, the highly creative individual is more able to successfully process the greater input without this incurring a performance deficit.

  4. Entropy and complexity measures for EEG signal classification of schizophrenic and control participants.

    Science.gov (United States)

    Sabeti, Malihe; Katebi, Serajeddin; Boostani, Reza

    2009-11-01

    In this paper, electroencephalogram (EEG) signals of 20 schizophrenic patients and 20 age-matched control participants are analyzed with the objective of classifying the two groups. For each case, 20 channels of EEG are recorded. Several features including Shannon entropy, spectral entropy, approximate entropy, Lempel-Ziv complexity and Higuchi fractal dimension are extracted from EEG signals. Leave-one (participant)-out cross-validation is used for reliable estimate of the separability of the two groups. The training set is used for training the two classifiers, namely, linear discriminant analysis (LDA) and adaptive boosting (Adaboost). Each classifier is assessed using the test dataset. A classification accuracy of 86% and 90% is obtained by LDA and Adaboost respectively. For further improvement, genetic programming is employed to select the best features and remove the redundant ones. Applying the two classifiers to the reduced feature set, a classification accuracy of 89% and 91% is obtained by LDA and Adaboost respectively. The proposed technique is compared and contrasted with a recently reported method and it is demonstrated that a considerably enhanced performance is achieved. This study shows that EEG signals can be a useful tool for discrimination of the schizophrenic and control participants. It is suggested that this analysis can be a complementary tool to help psychiatrists diagnosing schizophrenic patients.

  5. Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM, using a national panel study of chronic disease

    Directory of Open Access Journals (Sweden)

    Colman Shoshana S

    2004-02-01

    Full Text Available Abstract Background The objective of this study was to develop and psychometrically evaluate a general measure of patients' satisfaction with medication, the Treatment Satisfaction Questionnaire for Medication (TSQM. Methods The content and format of 55 initial questions were based on a formal conceptual framework, an extensive literature review, and the input from three patient focus groups. Patient interviews were used to select the most relevant questions for further evaluation (n = 31. The psychometric performance of items and resulting TSQM scales were examined using eight diverse patient groups (arthritis, asthma, major depression, type I diabetes, high cholesterol, hypertension, migraine, and psoriasis recruited from a national longitudinal panel study of chronic illness (n = 567. Participants were then randomized to complete the test items using one of two alternate scaling methods (Visual Analogue vs. Likert-type. Results A factor analysis (principal component extraction with varimax rotation of specific items revealed three factors (Eigenvalues > 1.7 explaining 75.6% of the total variance; namely Side effects (4 items, 28.4%, Cronbach's Alpha = .87, Effectiveness (3 items, 24.1%, Cronbach's Alpha = .85, and Convenience (3 items, 23.1%, Cronbach's Alpha = .87. A second factor analysis of more generally worded items yielded a Global Satisfaction scale (3 items, Eigenvalue = 2.3, 79.1%, Cronbach's Alpha = .85. The final four scales possessed good psychometric properties, with the Likert-type scaling method performing better than the VAS approach. Significant differences were found on the TSQM by the route of medication administration (oral, injectable, topical, inhalable, level of illness severity, and length of time on medication. Regression analyses using the TSQM scales accounted for 40–60% of variation in patients' ratings of their likelihood to persist with their current medication. Conclusion The TSQM is a psychometrically sound

  6. Medication-related issues associated with adherence to long-term tyrosine kinase inhibitors for controlling chronic myeloid leukemia: a qualitative study.

    Science.gov (United States)

    Tan, Bee Kim; Tan, Seng Beng; Chen, Li-Chia; Chang, Kian Meng; Chua, Siew Siang; Balashanker, Sharmini; Kamarul Jaman, Habiba Nazeera Begum; Edmund, Syed Carlo; Bee, Ping Chong

    2017-01-01

    Poor adherence to tyrosine kinase inhibitors (TKIs) could compromise the control of chronic myeloid leukemia (CML) and contributes to poorer survival. Little is known about how medication-related issues affect CML patients' adherence to TKI therapy in Malaysia. This qualitative study aimed to explore these issues. Individual face-to-face, semistructured interviews were conducted at the hematology outpatient clinics of two medical centers in Malaysia from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed a TKI were invited to participate in the study. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Four themes were identified from 18 interviews: 1) concerns about adverse reactions to TKIs, 2) personal beliefs regarding the use of TKIs, 3) mismanagement of TKIs in daily lives, and 4) financial burden in accessing treatment. Participants skipped their TKIs due to ineffective emesis control measures and perceived wastage of medication from vomiting. Participants also modified their TKI therapy due to fear of potential harm from long-term use, and stopped taking their TKIs based on belief in curative claims of traditional medicines and misconception about therapeutic effects of TKIs. Difficulty in integrating the dosing requirements of TKIs into daily lives led to unintentional skipping of doses, as well as the risk of toxicities from inappropriate dosing intervals or food interactions. Furthermore, financial constraints also resulted in delayed initiation of TKIs, missed clinic appointments, and treatment interruptions. Malaysian CML patients encountered a range of medication-related issues leading to a complex pattern of nonadherence to TKI therapy. Further studies should investigate whether regular contact with patients to improve understanding of treatment rationale, to elicit and address patients' concerns about adverse reactions, and to empower patients with skills to self-manage their medications might

  7. Interferon-free therapy, oral medication, and global cure: a new era for treatment of chronic hepatitis C

    Directory of Open Access Journals (Sweden)

    HU Keqin

    2015-11-01

    Full Text Available Hepatitis C Virus (HCV Infection affects approximately 170 million people globally, that causes chronic hepatitis C and has been associated with cirrhosis and hepatocellular carcinoma. In the past few years, significant advances have been made in development and clinical application of direct anti-viral agents (DAA that have been demonstrated highly safe and effective with very high sustained virological response (SVR rates. This article provides systemic review in this field, especially USA FDA approved DAA regimens for HCV treatment.

  8. Factor Analysis of Responsibility in Schizophrenic Patients%精神分裂症患者责任能力相关因素分析

    Institute of Scientific and Technical Information of China (English)

    王小平; 蔡伟雄; 蒋少艾

    2003-01-01

    Objective: To explore and assess the relative factors of responsibility in schizophrenic patients. Method:A self-developed responsibility rating scale for mental illness was used to assess 286 schizophrenic offenders who were divided into three groups according to the different responsibility level. Results: No realistic motivation, impairment of life ability and impairment of reality testing are main relative factors of responsibility assessment for schizophrenic offenders. Conclusion: It is concluded that responsibility rating scale is more effective than experimental evaluation in the assessment of responsibility for schizophrenic offenders.

  9. Comparison by objective parameters in patients with chronic rhinosinusitis managed medically and surgically (with and without powered instruments)

    Science.gov (United States)

    Behera, Samarendra; Patro, Sourabha K.; Gupta, Ashok K.

    2016-01-01

    Objective: To compare mucociliary clearance time and quality of life in patients who underwent sinus surgery using conventional and powered instruments, and in patients who were treated nonsurgically. Methods: A total of 151 patients with chronic rhinosinusitis were included. Fifty-four patients were treated conservatively, 48 patients were managed surgically by using conventional instruments and 49 patients were managed by using a microdebrider. Kupferberg nasal endoscopy grades, 20-item Sino-Nasal Outcome Test scores, Lund-Mackay scores, and mucociliary clearance time were analyzed. Results: On comparison among the groups, it was found that there was a significant difference between group A (nonsurgically treated) compared with group B (surgery by conventional means) or group C (surgery with microdebrider) in nasal endoscopic grades, Lund-Mackay scores, 20-item Sino-Nasal Outcome Test scores, and mucociliary clearance time. However, in comparison between groups B and C, there was no statistically significant difference. Conclusion: Mucociliary clearance time tended to recover after starting treatment for chronic rhinosinusitis both after conservative treatment and after surgical treatment. Surgery provided better improvement in different objective scores in chronic rhinosinusitis. There exists no statistical difference in parameters independent of the instrument used for surgery. PMID:28107141

  10. Chronic somatic comorbidity and excess mortality due to natural causes in persons with schizophrenia or bipolar affective disorder.

    Directory of Open Access Journals (Sweden)

    Thomas Munk Laursen

    Full Text Available BACKGROUND: Suicide and death by accidents in persons with schizophrenia and bipolar disorder are common, but excess mortality from natural death accounts for even more years of life lost. The impact of somatic comorbidity, however, often is not duly considered in analyses and explanations of excess mortality in patients with psychotic disorders. OBJECTIVE/METHODS: This study investigates and evaluates the impact of 19 severe chronic diseases on excess mortality due to diseases and medical conditions (natural death in individuals with psychotic disorders compared with the general population using a population-based cohort study in Denmark. Incidence/mortality rate ratios of admission/mortality were calculated using survival analysis. RESULTS: Cohort members with psychotic disorders had higher incidence rates of hospital contacts for almost all of the 19 disorders than the general population. The mortality rate ratio (MRR of natural death was 7.10 (95% CI 6.45, 7.81 for schizophrenic men, decreasing to 4.64 (95% CI 4.21, 5.10 after adjustment for the somatic disorders. The same pattern existed in women and in both genders with bipolar disorder. Highest MRRs were observed for psychotic patients without hospital admissions with the investigated somatic disorders. CONCLUSION: Chronic somatic diseases accounted for half of the excess mortality in patients with schizophrenia or bipolar disorder. Chronic disorders investigated in this paper seem to be under-treated or under-detected among such patients.

  11. Hypermethylation of the reelin (RELN) promoter in the brain of schizophrenic patients: a preliminary report.

    Science.gov (United States)

    Abdolmaleky, Hamid Mostafavi; Cheng, Kuang-hung; Russo, Andrea; Smith, Cassandra L; Faraone, Stephen V; Wilcox, Marsha; Shafa, Rahim; Glatt, Stephen J; Nguyen, Giang; Ponte, Joe F; Thiagalingam, Sam; Tsuang, Ming T

    2005-04-05

    DNA methylation changes could provide a mechanism for DNA plasticity and dynamism for short-term adaptation, enabling a type of cell memory to register cellular history under different environmental conditions. Some environmental insults may also result in pathological methylation with corresponding alteration of gene expression patterns. Evidence from several studies has suggested that in schizophrenia and bipolar disorder, mRNA of the reelin gene (RELN), which encodes a protein necessary for neuronal migration, axonal branching, synaptogenesis, and cell signaling, is severely reduced in post-mortem brains. Therefore, we investigated the methylation status of the RELN promoter region in schizophrenic patients and normal controls as a potential mechanism for down regulation of its expression. Ten post-mortem frontal lobe brain samples from male schizophrenic patients and normal controls were obtained from the Harvard Brain Tissue Resources Center. DNA was extracted using a standard phenol-chloroform DNA extraction protocol. To evaluate differences between patients and controls, we applied methylation specific PCR (MSP) using primers localized to CpG islands flanking a potential cyclic AMP response element (CRE) and a stimulating protein-1 (SP1) binding site located in the promoter region. For each sample, DNA extraction, bisulfite treatment, and MSP were independently repeated at least four times to accurately determine the methylation status of the target region. Forty-three PCR trials were performed on the test and control samples. MSP analysis of the RELN promoter revealed an unmethylated signal in all reactions (43 of 43) using DNA from the frontal brain tissue, derived from either the schizophrenic patients or normal controls indicating that this region of the RELN promoter is predominantly unmethylated. However, we observed a distinct methylated signal in 73% of the trials (16 of 22) in schizophrenic patients compared with 24% (5 of 21) of controls. Thus, the

  12. P50 auditory sensory gating in first onset schizophrenics and normal healthy adults

    Institute of Scientific and Technical Information of China (English)

    WANG Hongxing; ZHANG Mingdao; CHEN Xingshi; LOU Feiying; LIANG Jianhua; CHEN Chong; SHI Tiantao; LU Qiulin

    2007-01-01

    The aim of this research was to investigate the variations of P50 auditory sensory gating(P50)in normal healthy adults and the first onset schizophrenics.By using the American Nicolet Bravo electromyography/evoked potential (EMG/EP)system,P50 was measured with conditioningtesting paradigm(paired-click stimuli S1 and S2 were used)in 58 first onset schizophrenics and 108 healthy adults,and the Positive and Negative Syndrome Scale(PANSS)was applied.The following three conclusions have been reached.(1)In normal control(NC)group,measured from central,anterior and posterior zone(Cz,Fz and Pz respectively),there were no statistical differences(P>0.05)between S1 and S2 evoked P50 peak latencies(S1-P50 and S2-P50);the amplitudes of S2-P50 [(2.2±1.4),(2.3±1.5)and(2.1±1.4)μV respectively] reduced significantly as compared with S1-P50 [(5.6±3.3),(5.6±3.9)and(4.9±2.8)μV respectively](P<0.01);the S2/S1 ration,S1-S2 difference,and 100(1-S2/S1)had no statistical differences(P>0.05).(2)Compared with NC,the schizophrenic group significantly showed lower S1-P50 amplitudes(P<0.01,except at Pz in which Z=2.030,P=0.042),higher S2-P50 amplitudes,higher S2/S1 ratio,lower S1-S2 difference,and more decreased 100(1-S2/S1)(P<0.01)at Cz,Fz and Pz.(3)No significant correlations were found among S2/S1 ratio,S1-S2,100(1-S2/S1)of sensory gating and PANSS(P>0.05)in schizophrenic group.The first onset schizophrenics had sensory gating deficits,which could be quantified by P50.

  13. An Overview of Multiple Sclerosis: Medical, Psychosocial, and Vocational Aspects of a Chronic and Unpredictable Neurological Disorder

    Science.gov (United States)

    Rumrill, Phillip D., Jr.; Roessler, Richard T.

    2015-01-01

    This article presents an overview of multiple sclerosis (MS), one of the most common neurological disorders in the western hemisphere. Medical and psychosocial aspects of the disease such as causes and risk factors, diagnosis, incidence and prevalence, symptoms, courses, and treatment are described. Existing research regarding the employment…

  14. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature

    NARCIS (Netherlands)

    Vervloet, M.; Linn, A.J.; van Weert, J.C.M.; de Bakker, D.H.; Bouvy, M.L.; van Dijk, L.

    2012-01-01

    Background: Many patients experience difficulties in adhering to long-term treatment. Although patients' reasons for not being adherent are diverse, one of the most commonly reported barriers is forgetfulness. Reminding patients to take their medication may provide a solution. Electronic reminders (

  15. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature.

    NARCIS (Netherlands)

    Vervloet, M.; Linn, A.J.; Weert, J.C.M. van; Bakker, D.H. de; Bouvy, M.L.; Dijk, L. van

    2012-01-01

    Background: Many patients experience difficulties in adhering to long-term treatment. Although patients’ reasons for not being adherent are diverse, one of the most commonly reported barriers is forgetfulness. Reminding patients to take their medication may provide a solution. Electronic reminders (

  16. Medical Expenditure for Chronic Diseases in Mexico: The Case of Selected Diagnoses Treated by the Largest Care Providers.

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    Alejandro Figueroa-Lara

    Full Text Available Chronic diseases (CD are a public health emergency in Mexico. Despite concern regarding the financial burden of CDs in the country, economic studies have focused only on diabetes, hypertension, and cancer. Furthermore, these estimated financial burdens were based on hypothetical epidemiology models or ideal healthcare scenarios. The present study estimates the annual expenditure per patient and the financial burden for the nine most prevalent CDs, excluding cancer, for each of the two largest public health providers in the country: the Ministry of Health (MoH and the Mexican Institute of Social Security (IMSS.Using the Mexican National Health and Nutrition Survey 2012 (ENSANUT as the main source of data, health services consumption related to CDs was obtained from patient reports. Unit costs for each provided health service (e.g. consultation, drugs, hospitalization were obtained from official reports. Prevalence data was obtained from the published literature. Annual expenditure due to health services consumption was calculated by multiplying the quantity of services consumed by the unit cost of each health service.The most expensive CD in both health institutions was chronic kidney disease (CKD, with an annual unit cost for MoH per patient of US$ 8,966 while for IMSS the expenditure was US$ 9,091. Four CDs (CKD, arterial hypertension, type 2 diabetes, and chronic ischemic heart disease accounted for 88% of the total CDs financial burden (US$ 1.42 billion in MoH and 85% (US$ 3.96 billion in IMSS. The financial burden of the nine CDs analyzed represents 8% and 25% of the total annual MoH and IMSS health expenditure, respectively.The financial burden from the nine most prevalent CDs, excluding cancer, is already high in Mexico. This finding by itself argues for the need to improve health promotion and disease detection, diagnosis, and treatment to ensure CD primary and secondary prevention. If the status quo remains, the financial burden could be

  17. Medical Expenditure for Chronic Diseases in Mexico: The Case of Selected Diagnoses Treated by the Largest Care Providers.

    Science.gov (United States)

    Figueroa-Lara, Alejandro; Gonzalez-Block, Miguel Angel; Alarcon-Irigoyen, Jose

    2016-01-01

    Chronic diseases (CD) are a public health emergency in Mexico. Despite concern regarding the financial burden of CDs in the country, economic studies have focused only on diabetes, hypertension, and cancer. Furthermore, these estimated financial burdens were based on hypothetical epidemiology models or ideal healthcare scenarios. The present study estimates the annual expenditure per patient and the financial burden for the nine most prevalent CDs, excluding cancer, for each of the two largest public health providers in the country: the Ministry of Health (MoH) and the Mexican Institute of Social Security (IMSS). Using the Mexican National Health and Nutrition Survey 2012 (ENSANUT) as the main source of data, health services consumption related to CDs was obtained from patient reports. Unit costs for each provided health service (e.g. consultation, drugs, hospitalization) were obtained from official reports. Prevalence data was obtained from the published literature. Annual expenditure due to health services consumption was calculated by multiplying the quantity of services consumed by the unit cost of each health service. The most expensive CD in both health institutions was chronic kidney disease (CKD), with an annual unit cost for MoH per patient of US$ 8,966 while for IMSS the expenditure was US$ 9,091. Four CDs (CKD, arterial hypertension, type 2 diabetes, and chronic ischemic heart disease) accounted for 88% of the total CDs financial burden (US$ 1.42 billion) in MoH and 85% (US$ 3.96 billion) in IMSS. The financial burden of the nine CDs analyzed represents 8% and 25% of the total annual MoH and IMSS health expenditure, respectively. The financial burden from the nine most prevalent CDs, excluding cancer, is already high in Mexico. This finding by itself argues for the need to improve health promotion and disease detection, diagnosis, and treatment to ensure CD primary and secondary prevention. If the status quo remains, the financial burden could be higher.

  18. Acute and chronic stress increase salivary cortisol: a study in the real-life setting of a national examination undertaken by medical graduates.

    Science.gov (United States)

    González-Cabrera, J; Fernández-Prada, M; Iribar-Ibabe, C; Peinado, J M

    2014-03-01

    Spanish medical graduates who apply for a medical specialty training position (MIR) must take an examination that will shape their future personal and professional lives. Preparation for the test represents an important stressor that persists for several months. The aim of this study was to elucidate t