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Psychological Dysfunction (psychological + dysfunction)
Selected AbstractsNeuropathic pain and diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2003Dilip Kapur Abstract Neuropathic pain is a common phenomenon resulting from injury to the central or peripheral nervous system. The means by which diabetes results in nerve injury is unclear but the effect is to cause injury at all levels of the nervous system from the level of the peripheral nerves to the brain. Nerve injury causes pain through a cascade of mechanisms resulting in altered processing of sensory input into the nervous system. This alteration occurs through chemical and anatomical changes in the nervous system that are similar to some of the processes seen in central sensitisation following acute pain. Following nerve injury, neuropathic pain occurs not only when these mechanisms are activated but also when sensitisation is maintained. Other processes occurring in neuropathic pain appear to be a loss of normal inhibitory controls as seen by a reduction in local GABA-ergic and descending monoaminergic influences. There are also important changes mediated via glial cells that can maintain neuropathic pain. Diabetes affects all areas of the nervous system and the contribution of higher levels of the nervous system is often overlooked. Neurophysiological and MRI evidence strongly suggest that these may contribute to the pain of diabetic neuropathy. Psychological dysfunction in diabetic patients is an important factor in increasing the suffering associated with all aspects of the disease, but treatment and control of pain can greatly improve the quality of life. Copyright © 2003 John Wiley & Sons, Ltd. [source] Policy related to abdominoplasty in publicly funded elective surgery programs: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2009Alan Pearson RN, DipNEd Abstract Objectives, This systematic review set out to establish best practice in relation to policy for the inclusion/exclusion of abdominoplasty procedures within public health systems. Inclusion criteria, The review considered any studies relating to abdominoplasty that addressed issues of inclusion/exclusion from public funded health systems including criteria for clinical need, contraindications, fit/ready for surgery, policy compliance and issues in relation to surgical training. Search strategy, The search strategy sought to find published and unpublished studies and papers limited to English. An initial search of Medline and CINAHL was undertaken, followed by an analysis of keywords contained in the title, abstract and index terms. A second comprehensive search was then undertaken using Medline, CINAHL, EMBASE, AUSTROM, Health Business, and FullTEXT Elite and PsycINFO. The search was restricted to the period 1995,2005. Methodological quality, Each paper identified was assessed by two independent reviewers for methodological quality before inclusion in the review using an appropriate critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management and Assessment Review Instrument package. Results, A total of 19 papers were included in the review. Owing to the diverse nature of the papers no meta-analysis or meta-synthesis was able to be used to pool studies. The results are therefore presented in a narrative form. The papers identified were mainly retrospective audits and discussion/opinion papers. The main issues addressed were criteria to establish clinical need, contraindications and policy compliance. Conclusion, There are clinical indicators, mainly in relation to physical symptoms/dysfunction, to support exemption of some cases of abdominoplasty. For abdominoplasty to be conducted clinical need must be assessed and formally documented. Where clinical need is primarily based on psychological distress/dysfunction a formal psychiatric assessment should be used to justify surgery. [source] The development of a specialist hostel for the community management of personality disordered offendersCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2009Stephen Blumenthal Background,Since the late 1990s, in England and in Wales, there has been increasing interest in the particular challenges of managing offenders with personality disorder (PD). In 1999, a specialist hostel, managed by the probation service but with a high level of forensic mental health service input, was opened to high-risk PD offenders. Aims,To describe the first 93 high-risk residents with PD who were completing sentences under life licence, parole or probation, and their outcome. Methods,We investigated the nature of the offences residents had previously committed, their psychological profile in terms of personality patterns on the Millon Clinical Multiaxial Inventory (MCMI-III) and the Psychopathy Checklist-Revised (PCL-R), as well as staff commentary on their progress, to establish whether these factors related to outcome in terms of completion of stay in the hostel or premature discharge. Curfew failures and rearrest rates were also measured. Results,Of the 80 men who completed their residency within the two years of the study, the majority (50) left the hostel for positive reasons under mutual agreement. One-fifth were rearrested while resident, which is a lower rate than would be expected for such a group of offenders. PCL-R scores were predictive of outcome, but so was previous offending history. Self-defeating traits on the MCMI-III and negative comments written by hostel staff were also associated with failure. Conclusions,The hostel development demonstrated that probation and health services can work together to manage violent offenders with high levels of psychological dysfunction, and the evaluation provided some indications of how such arrangements might be enhanced. Copyright © 2009 John Wiley & Sons, Ltd. [source] Clinical and psychological characteristics of TMD patients with trauma historyORAL DISEASES, Issue 2 2010H-II Kim Oral Diseases (2010) 16, 188,192 Objective:, The purpose of this study was to investigate clinical and psychological characteristics of temporomandibular disorders (TMD) patients with trauma history. Materials and methods:, The clinical and psychological characteristics of 34 TMD patients with trauma history were compared with those of 340 TMD patients without trauma history. Craniomandibular index (CMI) was used for clinical characteristics of TMD patients. Symptom severity index (SSI) was used to assess the multiple dimensions of pain. Symptom checklist-90-revision (SCL-90-R) was used for psychological evaluation. Results:, Temporomandibular disorders patients with trauma history displayed significantly higher CMI and palpation index. TMD patients with trauma history also exhibited higher values in duration, sensory intensity, affective intensity, tolerability, scope of symptom, and total SSI score. In addition, these patients showed significantly higher values in symptom dimensions of somatization, depression, anxiety, phobic anxiety, and paranoid ideation. Among the symptom dimensions of SCL-90-R, somatization showed the most significant correlations with CMI and SSI. Conclusions:, Temporomandibular disorders patients with trauma history displayed more severe subjective, objective, and psychological dysfunction than those without trauma history. Pain of myogenous origin, history of physical trauma, and psychosocial dysfunction were all closely related. [source] Measuring psychological morbidity for diabetes commissioningPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 1 2010A cross-sectional survey of patients attending a secondary care diabetes clinic Abstract The aim of this study was to investigate the prevalence of psychological morbidity in the local secondary care population of people with type 1 diabetes or type 2 diabetes (T1DM or T2DM) in order to determine appropriate treatment provision. Four hundred patients seen in diabetes outpatient clinics were sent a number of standardised and validated questionnaires designed to measure: diabetes related distress; anxiety and depression; disordered eating behaviours; and borderline personality disorder. A response rate of 52.7% was achieved, providing a total of 211 completed questionnaires (111 T1DM, 100 T2DM) for analysis. This study has demonstrated a high prevalence of psychological morbidity in the local secondary care population of people with diabetes, with as many as half of those surveyed (52%) reporting some level of psychological disturbance. After controlling for age, gender and diabetes type, few differences in levels of psychological dysfunction were identified between the T1DM and T2DM cohorts. The exception to this was disinhibited eating behaviours: 22% of people with T2DM had severe levels of disinhibited eating, twice that recorded in the T1DM population. Overall, 36% (n=76) of study participants had moderate,severe levels of depression, anxiety or both, and 9.5% (16 of 168) had scores suggestive of borderline personality disorder. Copyright © 2010 John Wiley & Sons. [source] Emotional issues after kidney transplantation: a prospective psychotherapeutic studyCLINICAL TRANSPLANTATION, Issue 6 2002Lyndsay S Baines Abstract:,Background:, Negative emotional states are the single most influential factor in determining quality of life after a successful kidney transplant. We designed a prospective study using psychotherapeutic principles to understand and intervene in emotional issues in adult recipients of first cadaver kidney transplants. Methods:, Forty-nine recipients of first cadaver kidney transplants were subjected to 12 sessions (at weekly intervals) of psychotherapy within 3 months of receiving their transplant. The Beck Depression Inventory (BDI) was utilized as a measure of change in emotional state, pretherapy, at 3, 6, 9 and 12 months. A higher score on BDI was suggestive of psychological dysfunction. In the first instance, data was analysed within a quantitative framework, by virtue of the BDI. In the second instance, data was considered in terms of recurring themes described by patients during psychotherapy and was analysed qualitatively. In the third instance, both qualitative and quantitative data was considered in terms of individual patient's ability to achieve some feeling of having implemented some social, relational and vocational equilibrium into their everyday life. Recipients of live kidneys, paediatric transplants and patients who received more than one transplant were excluded, as emotional issues are different in this cohort of patients. All patients have completed 1 yr of follow up. None of the patients were on antidepressant medication before or after therapy. Results:, This is an ongoing study in which we are comparing individual vs. group therapy vs. controls (who receive no therapy). The total number of patients recruited will be 120 and the final report will be available in 2003,04. The results reported in this paper form the 49 patients in the individual arm of the study. All the patients in our study happened to be white people. There was significant improvement in the BDI scores following therapy. The mean score was 26.3 ± 7.9 before and 20.5 ± 8.8 after therapy (p = 0.001); the lowering of the scores remained sustained at 12 months. Multivariate analysis of age, gender, employment status, duration of dialysis (if in dialysis for more than 3 yrs) and psychotherapy given before transplantation did not affect the results of our study. For the qualitative aspect of the study, we grouped the emotional problems as expressed by the patients into three recurring themes (i) fear of rejection, (ii) feelings of paradoxical loss post-transplant despite having received a successful transplant and (iii) the psychological integration of the newly acquired kidney. Conclusions:, Psychotherapeutic intervention was an effective means of addressing emotional problems in recipients of kidney transplants. The recurring themes as identified above provided a baseline for psychotherapeutic exploration and resolution of these issues. Successful resolution of these issues was associated with lower BDI scores and the redefinition of normality in daily living post-transplant. [source] | ||||||||||