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Symptom Severity (symptom + severity)
Kinds of Symptom Severity Terms modified by Symptom Severity Selected AbstractsPathways to help-seeking in bulimia nervosa and binge eating problems: A concept mapping approachINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 6 2007Natasha Hepworth PhD Abstract Objective: To conduct an in-depth study, using concept mapping, of three factors related to help-seeking for bulimia nervosa and binge eating: problem recognition, barriers to help-seeking, and prompts to help-seeking. Method: Semistructured interviews were conducted to elicit information about help-seeking with 63 women (18,62 years) with past or present bulimic behaviors. Results: Using Leximancer software, factors identified as associated with problem recognition were Changes in Behavior, Interference with Life Roles, Comments about Changes and Psychological Problems. Salient barriers to help-seeking were Fear of Stigma, Low Mental Health Literacy/Perception of Need, Shame, Fear of Change and Cost. Prompts to help-seeking were increased Symptom Severity, Psychological Distress, Interference with Life Roles, Health Problems, and Desire to Get Better. Conclusion: Results highlighted the need for awareness campaigns to reduce both self and perceived stigma by others towards bulimic behaviors, and the need to enhance awareness of available interventions for people ready to engage in treatment, to increase help-seeking. © 2007 by Wiley Periodicals, Inc. [source] The development and validation of a Nocturnal Gastro-oesophageal Reflux Disease Symptom Severity and Impact Questionnaire for adultsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2010B. M. Spiegel Aliment Pharmacol Ther 2010; 32: 591,602 Summary Background, Current questionnaires for assessing gastro-oesophageal reflux disease (GERD) symptoms are limited in their ability to capture nocturnal symptoms. Aim, To develop and validate an instrument, the Nocturnal Gastro-oesophageal Reflux Disease Symptom Severity and Impact Questionnaire (N-GSSIQ), to assess severity and impact of nocturnal GERD symptoms. Methods, Two focus groups and 16 cognitive debriefing interviews were conducted among GERD patients to identify key issues about nocturnal symptoms. A draft instrument was tested in 196 patients at 11 clinics in the US to evaluate psychometric properties. Exploratory factor and item response theory analyses were conducted to finalize items and subscales. Internal consistency reliability, reproducibility and construct validity were examined. Results, Mean age was 45 (s.d. = 13.8) years; 76% were female and 68% were Caucasian. Patient-rated severity was mild,moderate for 69% of participants; 48% reported symptoms on two to three nights the past week. The final questionnaire includes 20 items and three subscales: Nocturnal GERD Symptoms, Morning Impact of Nocturnal GERD and Concern about Nocturnal GERD. The subscales demonstrated internal consistency reliability (Cronbach's alpha 0.84,0.94) and were significantly correlated with similar measures and disease severity (0.41,0.81; P < 0.0001). Conclusion, The results support the reliability and validity of the N-GSSIQ as a measure of severity, morning impact and concern about nocturnal GERD. [source] Pharmacokinetic profile of immediate-release omeprazole in patients with gastro-oesophageal reflux associated with gastroparesisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2010J. M. WO Aliment Pharmacol Ther,31, 516,522 Summary Background, Immediate-release omeprazole has a more rapid absorption compared with delayed-release omeprazole in asymptomatic volunteers. However, effects of delayed gastric emptying on omeprazole absorption remain unknown. Aim, To compare pharmacokinetics between immediate and delayed-release omeprazole in patients with GERD associated with gastroparesis. Methods, Open-label, randomized, cross-over study was performed. Antireflux and prokinetic medications were discontinued. Subjects were randomized into: (i) Immediate-release omeprazole 40 mg suspension o.m. for 7 days, wash-out for 10,14 days, followed by delayed-release omeprazole 40 mg capsule o.m. for 7 days, or (ii) the same schedule in reverse order. On day 7, omeprazole concentrations were obtained before and up to 5 h after taking the study drug. Patient Assessment of GI Disorders,Symptom Severity Index was obtained. Results, A total of 12 women (mean age 51 years) completed the protocol. Time to maximal omeprazole concentration was significantly shorter for omeprazole. Maximal concentration was significantly greater for omeprazole, but total area under concentration,time curves was similar. Pharmacokinetic profile was less variable for immediate compared with delayed-release omeprazole. Conclusions, Immediate-release omeprazole was associated with a more rapid absorption and less variable pharmacokinetic profile compared with delayed-release omeprazole in reflux patients associated with gastroparesis. [source] Clinical trial: the treatment of gastro-oesophageal reflux disease in primary care , prospective randomized comparison of rabeprazole 20 mg with esomeprazole 20 and 40 mgALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2009A. EGGLESTON Summary Background, A trial of empirical PPI therapy is usual practice for most patients with symptoms of gastro-oesophageal reflux disease (GERD) in primary care. Aim, To determine if the 4-week efficacy of rabeprazole 20 mg for resolving heartburn and regurgitation symptoms is non-inferior to esomeprazole 40 mg or 20 mg. Methods, In all, 1392 patients were randomized to rabeprazole 20 mg, esomeprazole 20 mg or 40 mg once daily. Patients, doctors and assessors were blinded. Symptom resolution data were collected on days 0,7 and day-28 using the Patient Assessment of Upper Gastrointestinal Disorders Symptom Severity Index with a shortened version used on days 8,27. Results, Rabeprazole 20 mg was non-inferior to esomeprazole 40 mg for complete resolution of regurgitation and satisfactory resolution of heartburn and regurgitation. For complete heartburn resolution, the efficacy of rabeprazole 20 mg and esomeprazole 40 mg was statistically indistinguishable, although the non-inferiority test was inconclusive. Rabeprazole 20 mg was non-inferior to esomeprazole 20 mg for all outcomes. Conclusions, In uninvestigated GERD patients, rabeprazole 20 mg was non-inferior to esomeprazole 40 mg for complete and satisfactory relief of regurgitation and satisfactory relief of heartburn, and not different for complete resolution of heartburn. [source] Clinical trial: a multistrain probiotic preparation significantly reduces symptoms of irritable bowel syndrome in a double-blind placebo-controlled studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2009E. A. WILLIAMS Summary Background, The efficacy of probiotics in alleviating the symptoms of irritable bowel syndrome (IBS) appears to be both strain- and dose-related. Aim, To investigate the effect of LAB4, a multistrain probiotic preparation on symptoms of IBS. This probiotic preparation has not previously been assessed in IBS. Methods, Fifty-two participants with IBS, as defined by the Rome II criteria, participated in this double blind, randomized, placebo-controlled study. Participants were randomized to receive either a probiotic preparation comprising two strains of Lactobacillus acidophilus CUL60 (NCIMB 30157) and CUL21 (NCIMB 30156), Bifidobacterium lactis CUL34 (NCIMB 30172) and Bifidobacterium bifidum CUL20 (NCIMB 30153) at a total of 2.5 × 1010 cfu/capsule or a placebo for 8 weeks. Participants reported their IBS symptoms using a questionnaire fortnightly during the intervention and at 2 weeks post-intervention. Results, A significantly greater improvement in the Symptom Severity Score of IBS and in scores for quality of life, days with pain and satisfaction with bowel habit was observed over the 8-week intervention period in the volunteers receiving the probiotic preparation than in the placebo group. Conclusion, LAB4 multistrain probiotic supplement may benefit subjects with IBS. [source] Symptom Severity, Alcohol Craving, and Age of Trauma Onset in Childhood and Adolescent Trauma Survivors with Comorbid Alcohol Dependence and Posttraumatic Stress DisorderTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 6 2006Julie A. Schumacher PhD Posttraumatic stress disorder (PTSD) and alcohol dependence (AD) are frequently comorbid disorders. Given evidence that childhood traumas may be associated with broader, more severe psychological sequelae than later traumas, the present study examined whether the association between alcohol and trauma symptomatology is more pronounced among individuals with earlier trauma onsets in a sample of 42 childhood and adolescent trauma survivors diagnosed with comorbid AD-PTSD. As predicted, individuals reporting childhood traumas reported greater severity of trauma and alcohol symptoms and greater alcohol craving. These results suggest that individuals with childhood trauma histories may be particularly vulnerable to relapse following AD treatment. [source] Abnormalities of the Repolarization Characteristics of Patients with Heart Failure Progress with Symptom SeverityANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2004Ch.B., Christopher C. E. Lang B.Sc. (Hons) Background:,Congestive heart failure is a common condition with high mortality. Many of these deaths are sudden and unexpected. Ventricular action potential, surface repolarization (QT interval), and dispersion of repolarization are prolonged in the failing heart, contributing to arrhythmogenesis and sudden death. We studied the relationship between QT and heart rate (RR interval) from ambulatory recordings using a novel method in patients with ischemic heart disease and varying degrees of left-ventricular impairment (IHD) and compared them to healthy subjects (HS). We compare the degree of abnormality with the functional impairment and ejection fraction. Methods:,Using a previously described automated method for continuous estimation of the QT/RR characteristic that incorporates a correction formula for compensation of QT adaptation lag (VERDA, Del Mar Reynolds Medical Ltd., Hertford, UK), we compared recordings from 41 IHD patients with age-matched HS. Results:,IHD Patients have prolonged 24-hour mean QTo (461 ms vs 426 ms, P < 0.01), and abnormal rate dependence relative to controls (24-hour mean slope: 0.20 vs 0.14, P < 0.001; J: 0.38 vs 0.28, P < 0.001). There is increased temporal variation in J with respect to HS. These abnormalities of repolarization increase with worsening NYHA class, but do not correlate with ejection fraction. Conclusions:,The use of a universal correction formula to compare dynamic QT data in IHD patients is inappropriate. The observed progressive abnormalities may be responsible for the high incidence of sudden death through promotion of arrhythmias. [source] Randomized, placebo-controlled trial of flax oil in pediatric bipolar disorderBIPOLAR DISORDERS, Issue 2 2010Barbara L Gracious Gracious BL, Chirieac MC, Costescu S, Finucane TL, Youngstrom EA, Hibbeln JR. Randomized, placebo-controlled trial of flax oil in pediatric bipolar disorder. Bipolar Disord 2010: 12: 142,154. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objectives:, This clinical trial evaluated whether supplementation with flax oil, containing the omega-3 fatty acid ,-linolenic acid (,-LNA), safely reduced symptom severity in youth with bipolar disorder. Methods:, Children and adolescents aged 6,17 years with symptomatic bipolar I or bipolar II disorder (n = 51), manic, hypomanic, mixed, or depressed, were randomized to either flax oil capsules containing 550 mg ,-LNA per 1 gram or an olive oil placebo adjunctively or as monotherapy. Doses were titrated to 12 capsules per day as tolerated over 16 weeks. Primary outcomes included changes in the Young Mania Rating Scale, Child Depression Rating Scale-Revised, and Clinical Global Impressions-Bipolar ratings using Kaplan-Meier survival analyses. Results:, There were no significant differences in primary outcome measures when compared by treatment assignment. However, clinician-rated Global Symptom Severity was negatively correlated with final serum omega-3 fatty acid compositions: %,-LNA (r = ,0.45, p < 0.007), % eicosapentaenoic acid (EPA) (r = ,0.47, p < 0.005); and positively correlated with final arachidonic acid (AA) (r = 0.36, p < 0.05) and docosapentaenoic acid (DPA) n-6 (r = 0.48, p < 0.004). The mean duration of treatment for ,-LNA was 11.8 weeks versus 8 weeks for placebo; however, the longer treatment duration for ,-LNA was not significant after controlling for baseline variables. Subjects discontinued the study for continued depressive symptoms. Conclusions:, Studies of essential fatty acid supplementation are feasible and well tolerated in the pediatric population. Although flax oil may decrease severity of illness in children and adolescents with bipolar disorder who have meaningful increases in serum EPA percent levels and/or decreased AA and DPA n-6 levels, individual variations in conversion of ,-LNA to EPA and docosahexaenoic acid as well as dosing burden favor the use of fish oil both for clinical trials and clinical practice. Additionally, future research should focus on adherence and analysis of outcome based on changes in essential fatty acid tissue compositions, as opposed to group randomization alone. [source] Impact of fesoterodine on quality of life: pooled data from two randomized trialsBJU INTERNATIONAL, Issue 1 2008Con J. Kelleher OBJECTIVE To evaluate the effect of fesoterodine on health-related quality of life (HRQoL) in patients with overactive bladder (OAB) syndrome. PATIENTS AND METHODS Pooled data from two randomized placebo-controlled phase III studies were analysed. Eligible patients with frequency and urgency or urgency urinary incontinence were randomized to placebo or fesoterodine 4 or 8 mg for 12 weeks; one trial also included tolterodine extended release (tolterodine-ER) 4 mg. HRQoL was assessed using the King's Health Questionnaire (KHQ), International Consultation on Incontinence Questionnaire,Short Form (ICIQ-SF), a six-point Likert scale measuring the severity of bladder-related problems, and treatment response. RESULTS By the end of treatment, all active-treatment groups had significantly improved HRQoL compared with those on placebo, as shown by an improvement in the KHQ and ICIQ-SF scores, treatment response rate, and a major improvement in self-reported bladder-related problems. The fesoterodine 8-mg group had statistically significant improvements over placebo in eight of nine KHQ domains. Fesoterodine 4 mg and tolterodine-ER produced statistically significant improvements in seven of nine KHQ domains. Fesoterodine 8 mg gave better results than 4 mg in two domains; Emotions and Symptom Severity (P < 0.05). A major improvement (,2 points) in bladder-related problems was reported by 33% of patients on fesoterodine 4 mg, 38% on fesoterodine 8 mg, and 34% on tolterodine-ER, vs 21% on placebo (P < 0.001). CONCLUSIONS Fesoterodine significantly improved HRQoL in patients with OAB. Both fesoterodine 4 and 8 mg produced significant improvements on most KHQ domains, the ICIQ-SF, treatment response rate, and a Likert scale measuring bladder-related problems. [source] Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant useACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010A. K. B. Van Reedt Dortland van Reedt Dortland AKB, Giltay EJ, van Veen T, Zitman FG, Penninx BWJH. Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use. Objective:, The metabolic syndrome (MetSyn) predisposes to cardiovascular disease and diabetes mellitus. There might also be an association between the MetSyn and anxiety and depression, but its nature is unclear. We aimed to investigate whether diagnosis, symptom severity and antidepressant use are associated with the MetSyn. Method:, We addressed the odds for the MetSyn and its components among 1217 depressed and/or anxious subjects and 629 controls, and their associations with symptom severity and antidepressant use. Results:, Symptom severity was positively associated with prevalence of the MetSyn, [adjusted odds ratio (OR) 2.21 for very severe depression: 95% confidence interval (CI): 1.06,4.64, P = 0.04], which could be attributed to abdominal obesity and dyslipidemia. Tricyclic antidepressant (TCA) use also increased odds for the MetSyn (OR 2.30, 95% CI: 1.21,4.36, P = 0.01), independent of depression severity. Conclusion:, The most severely depressed people and TCA users more often have the MetSyn, which is driven by abdominal adiposity and dyslipidemia. [source] Lactose intolerance in patients with chronic functional diarrhoea: the role of small intestinal bacterial overgrowthALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2010J. ZHAO Aliment Pharmacol Ther,31, 892,900 Summary Background, Many studies report a high prevalence of lactose intolerance in patients with functional, gastrointestinal disease. Aim, To evaluate the role of small intestinal bacterial overgrowth (SIBO) in condition of lactose intolerance and the mechanism by which SIBO may impact lactose tolerance in affected patients. Methods, Consecutive out-patients with chronic functional diarrhoea (CFD) and healthy controls underwent a validated 20 g lactose hydrogen breath test (HBT). Patients completed also a 10 g lactulose HBT with concurrent assessment of small bowel transit by scintigraphy. Results, Lactose malabsorption was present in 27/31 (87%) patients with CFD and 29/32 (91%) healthy controls (P = 0.708). From the patient group 14/27 (52%) had lactose intolerance and 13/27 (48%) experienced no symptoms (lactose malabsorption controls). Only 5 (17%) healthy controls reported symptoms (P < 0.01). The oro-caecal transit time was similar between patient groups with or without symptoms (P = 0.969). SIBO was present in 11 (41%) subjects and was more prevalent in lactose intolerance than in lactose malabsorption [9/14 (64%) vs. 2/13 (15%), P = 0.018]. Symptom severity was similar in lactose intolerance patients with and without SIBO (P = 0.344). Conclusions, Small intestinal bacterial overgrowth increases the likelihood of lactose intolerance in patients with CFD as a direct result of lactose fermentation in the small intestine, independent of oro-caecal transit time and visceral sensitivity. [source] Posttraumatic stress, anxiety, and depression in survivors of severe acute respiratory syndrome (SARS)JOURNAL OF TRAUMATIC STRESS, Issue 1 2005Kitty K. Wu This study examines the psychological impact of severe acute respiratory syndrome (SARS) in 195 adult patients in Hong Kong. The Impact of Event Scale,Revised and Hospital Anxiety and Depression Scale were administered to patients 1 month after their discharge. Of the participants 10% to 18% reported symptoms related to posttraumatic stress disorder, anxiety, and depression. Symptom severity was associated with high perceived life threat and low emotional support. Women and participants who had low education level were more likely to have symptoms of avoidance. Participants who personally knew someone who had SARS were more likely to be affected by depressive symptoms. [source] Costs of health care for irritable bowel syndrome, chronic constipation, functional diarrhoea and functional abdominal painALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2007K. A. NYROP Summary Aim To provide estimates of actual costs to deliver health care to patients with functional bowel disorders, and to assess the cost impact of symptom severity, recency of onset, and satisfaction with treatment. Methods We enrolled 558 irritable bowel (IBS), 203 constipation, 243 diarrhoea and 348 abdominal pain patients from primary care and gastroenterology clinics at a health maintenance organization within weeks of a visit. Costs were extracted from administrative claims. Symptom severity, satisfaction with treatment and out-of-pocket expenses were assessed by questionnaires. Results Average age was 52 years, 27% were males, and 59% participated. Eighty percent were seen in primary care clinics. Mean annual direct health care costs were $5049 for IBS, $6140 for diarrhoea, $7522 for constipation and $7646 for abdominal pain. Annual out-of-pocket expenses averaged $406 for treatment of IBS symptoms, $294 for diarrhoea, $390 for constipation and $304 for abdominal pain. Lower gastrointestinal costs comprised 9% of total costs for IBS, 9% for diarrhoea, 6.5% for constipation and 9% for abdominal pain. In-patient care accounted for 17.5% of total costs (15.2% IBS). Conclusion Costs were affected by disease severity (increased), recent exacerbation of bowel symptoms (increased), and whether the patient was consulting for the first time (decreased). [source] Symptom severity of cassava mosaic disease in relation to concentration of African cassava mosaic virus in different cassava genotypesPLANT PATHOLOGY, Issue 1 2003F. O. Ogbe The concentration of African cassava mosaic virus (ACMV) was assessed by enzyme-linked immunosorbent assay in relation to symptom severity among resistant, moderately resistant and susceptible cassava genotypes. Resistant genotype NR 8083 had significantly lower symptom severity scores (P < 0·05) than the susceptible genotype TMS 91934, but the two genotypes contained similar levels of virus concentration. The moderately resistant genotypes TMS 30572 and NR 8082 expressed significantly lower symptom severities (P < 0·05) than the susceptible genotypes TMS 91934 and TME 117, but they contained significantly higher virus concentrations (P < 0·05) than TMS 91934 and similar virus concentration as in TME 117. However, two other resistant genotypes, TME 1 and TME 8, had low symptom severity scores and virus concentrations. There was significant interaction (P , 0·05) between cropping season and virus concentration in all the genotypes except TMS 30572. The resistant and moderately resistant genotypes that had high virus concentrations sustained storage root yield losses. The severity of symptoms expressed was not necessarily a reflection of the virus concentration in some of the genotypes. In addition to the use of symptom severity scores to group genotypes into resistant classes, it is recommended that virus concentration should also be considered. Genotypes displaying mild symptoms, but with high levels of virus accumulation, could be an important source of inoculum in the spread of ACMV by the whitefly vectors. This suggests that each genotype should be tested for virus accumulation prior to its release to the farmers. [source] Vibration exposure and disease in a shipyard: A 13-year revisitAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 6 2004Martin Cherniack MD Abstract Background In a 1988 study of shipyard workers, a progressive association was observed between cumulative exposure to vibration and the vascular and neurological symptoms of the hand-arm vibration syndrome (HAVS). In 2001, after a decade of exposure reduction and ageing of the workforce, a second study at the same site was initiated. Methods In 2001, 214 subjects were selected; they represented four current weekly vibration exposure time intervals,0 hr, >0,<,5 hr, ,5,<,20 hr, ,20 hr. The 1988 and 2000 cross-sectional populations were compared on the basis of exposure duration and current symptoms. Results In 2001, the study population was 9.6 years older than the 1988 group. Current weekly exposure hours were similar in the low and medium exposure groups 2001 and 1988, but exposure was reduced by an average of 9.7 hr per week in the highest exposure group (,20 hr) in 2001. Symptom severity was regressed polychotomously on estimated exposure (log cumulative hours); the OR was weaker in 2001 than in 1988 for sensorineural symptoms,1.44 [CI 1.04,1.98] versus 2.35 [CI 1.48,3.73]. This was also true for vascular symptoms,1.70 [CI 1.06,2.71] versus 3.99 [CI 2.27,7.01]. Vascular symptoms were more prevalent in the highest lifetime vibration exposure group in 1988 (68.7 vs. 43.2% in 2001); sensorineural symptoms were more prevalent in the least vibration exposed group in 2001 (52.6 vs. 20.7% in 1988). Conclusions The prevalence of vascular symptoms associated with cumulative vibratory exposure was significantly greater in 1988, but neurological symptoms were more common at lower exposure levels in 2001. The presumption that reducing exposure duration alone is sufficient, in the absence of change in vibration magnitude, is not supported by the results of this study. Am. J. Ind. Med. 45:500,512, 2004. © 2004 Wiley-Liss, Inc. [source] Age of Onset as a Discriminator Between Alcoholic Subtypes in a Treatment-Seeking Outpatient PopulationTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 1 2000Bankole A. Johnson M.D., Ph.D. Subtyping alcoholics may provide a more accurate guide as to the course and character of the disease. Classifications of different ages of onset of problem drinking have so far resulted in categorical inconsistencies. In the past, hospital-based alcoholics have over-represented those most severely ill, and comprehensive evaluations of psychopathology for discriminating between alcoholic subtypes have been infrequent. In a heterogeneous treatment-seeking, outpatient, alcoholic population, we tested the hypothesis that age of onset represents a continuum of disease, and that greater severity of psychopathology is associated with lower ages of onset. Using a standard questionnaire, 253 male and female treatment-seeking alcoholics were stratified according to specific ages of onset: a) <20 years; b) 20,25 years, and c) >25 years. These age of onset groups were compared on alcohol severity and craving, family history, childhood behavior, personality, hostility, overt aggression, mood, and social functioning. Symptom severity and age of onset were negatively correlated, and the 20,25-year onset group usually had intermediate scores. The <20 year onset group was characterized by greater severity of alcohol-related problems, family history, childhood behavioral problems, craving, hostility, antisocial traits, mood disturbance, and poor social functioning. Alcoholics with an earlier age of onset have relatively greater psychopathology than those of later onset. While the preponderance of psychopathology among those in the <20-year onset group could be conceptualized as a clinical "subtype," such a characterization would not define an entirely homogenous category. Yet, this clinical characterization would be clinically important if specific age of onset levels were found to be differentially sensitive to pharmacological and/or psychological treatments. [source] Chronic Recurrent Rhinosinusitis: Disease Severity and Clinical CharacterizationTHE LARYNGOSCOPE, Issue 2 2005Neil Bhattacharyya MD Objectives/Hypothesis: The objective was to clinically characterize and determine disease severity parameters for chronic recurrent rhinosinusitis (CRRS). Study Design: Prospective. Methods: A consecutive series of adult patients undergoing evaluation for CRRS was prospectively evaluated. Patients with four or more acute rhinosinusitis episodes in the previous calendar year with an absence of symptoms between episodes were considered as manifesting CRRS. Symptom severity and disease data from the Rhinosinusitis Symptom Inventory was obtained, as well as Lund staging information from the paranasal sinus CT scan. The Lund staging scores for patients with CRRS were compared with a control group of patients without CRRS. Symptom domain scores and disease severity parameters were compared between the CRRS group and a third group of patients with chronic persistent rhinosinusitis. Results: In all, 30 patients met inclusion criteria for the diagnosis of CRRS. Mean age was 40.9 years with a 3:1 female preponderance. The mean Lund score for patients with CRRS was 3.79. Patients with CRRS failed to demonstrate a statistically different Lund score from control patients (mean Lund score, 4.26 [P = .538]). Symptom severity scores according to Rhinosinusitis Symptom Inventory domains were largely similar for the nasal, facial, and total symptom domains between patients with CRRS versus chronic persistent rhinosinusitis. However, patients with CRRS demonstrated statistically significant increases in oropharyngeal and systemic symptom domain scores. Patients with CRRS also had significant increases in number of antibiotic courses (4.8 vs. 2.9 [P < .001]) and number of missed workdays (8.8 vs. 4.6 d [P = .046]) attributable to rhinosinusitis. Conclusion: Chronic recurrent rhinosinusitis is a distinct form of chronic rhinosinusitis differing somewhat from chronic persistent rhinosinusitis. However, patients with CRRS still experience significant symptoms associated with this diagnosis, which results in significant medication usage and workplace impact. [source] Plasma free polyunsaturated fatty acid levels are associated with symptom severity in acute maniaBIPOLAR DISORDERS, Issue 7 2007M Elizabeth Sublette Objectives:, Nutritionally essential polyunsaturated fatty acids (PUFAs) have been implicated as potentially important factors in mood disorders. For instance, n-3 PUFA supplementation is reported to improve outcomes in major depressive disorder and bipolar disorder. However, the role of PUFAs in acute mania has been minimally investigated. We performed a pilot study to compare plasma levels of free (non-esterified) and esterified PUFAs between patients in an acute manic episode and healthy volunteers, and to explore associations between symptom severity and levels of fatty acids and of the arachidonic acid metabolite, prostaglandin E2 (PGE2). Methods:, Patients (n = 10) who were medication-free for at least two weeks and seeking inpatient admission for an acute manic episode were compared with healthy volunteers (n = 10). Symptom severity was assessed at admission and after six weeks of naturalistic treatment. Fasting baseline free and esterified plasma levels of docosahexaneoic acid (DHA, 22:6n-3), eicosapentaenoic acid (EPA, 20:5n-3), arachidonic acid (AA,20:4n-6) and the AA metabolite PGE2 were determined, and PGE2 levels were tested again at six weeks. Results:, No between-group differences were found in levels of individual or total fatty acids, or of PGE2. Among subjects, manic symptom severity correlated negatively with levels of free AA and free EPA, and positively with the free AA:EPA ratio. PGE2 levels did not differ between groups or in subjects pre- and post-treatment. Conclusions:, Our preliminary results suggest that, in susceptible persons, low plasma levels of free EPA compared with AA are related to the severity of mania. [source] Symptom severity of cassava mosaic disease in relation to concentration of African cassava mosaic virus in different cassava genotypesPLANT PATHOLOGY, Issue 1 2003F. O. Ogbe The concentration of African cassava mosaic virus (ACMV) was assessed by enzyme-linked immunosorbent assay in relation to symptom severity among resistant, moderately resistant and susceptible cassava genotypes. Resistant genotype NR 8083 had significantly lower symptom severity scores (P < 0·05) than the susceptible genotype TMS 91934, but the two genotypes contained similar levels of virus concentration. The moderately resistant genotypes TMS 30572 and NR 8082 expressed significantly lower symptom severities (P < 0·05) than the susceptible genotypes TMS 91934 and TME 117, but they contained significantly higher virus concentrations (P < 0·05) than TMS 91934 and similar virus concentration as in TME 117. However, two other resistant genotypes, TME 1 and TME 8, had low symptom severity scores and virus concentrations. There was significant interaction (P , 0·05) between cropping season and virus concentration in all the genotypes except TMS 30572. The resistant and moderately resistant genotypes that had high virus concentrations sustained storage root yield losses. The severity of symptoms expressed was not necessarily a reflection of the virus concentration in some of the genotypes. In addition to the use of symptom severity scores to group genotypes into resistant classes, it is recommended that virus concentration should also be considered. Genotypes displaying mild symptoms, but with high levels of virus accumulation, could be an important source of inoculum in the spread of ACMV by the whitefly vectors. This suggests that each genotype should be tested for virus accumulation prior to its release to the farmers. [source] Early adversity in chronic depression: clinical correlates and response to pharmacotherapy,,DEPRESSION AND ANXIETY, Issue 8 2009Daniel N. Klein Ph.D. Abstract Background: There is growing evidence suggesting that early adversity may be a marker for a distinct pathway to major depressive disorder (MDD). We examined associations between childhood adversity and a broad variety of clinical characteristics and response to pharmacotherapy in a large sample of patients with chronic forms of MDD. Methods: Subjects included 808 patients with chronic forms of MDD (chronic MDD, double depression, or recurrent MDD with incomplete recovery between episodes and a total continuous duration of >2 years) who were enrolled in a 12-week open-label trial of algorithm-guided pharmacotherapy. Baseline assessments included a semi-structured diagnostic interview, and clinician- and self-rated measures of depressive symptoms, social functioning, depressotypic cognitions, and personality traits, and childhood adversity. Patients were re-evaluated every 2 weeks. Results: A longer duration of illness; earlier onset; greater number of episodes, symptom severity, self-rated functional impairment, suicidality, and comorbid anxiety disorder; and higher levels of dysfunctional attitudes and self-criticism were each associated with multiple forms of childhood adversity. A history of maternal overcontrol, paternal abuse, paternal indifference, sexual abuse, and an index of clinically significant abuse each predicted a lower probability of remission. Among patients completing the 12-week trial, 32% with a history of clinically significant abuse, compared to 44% without such a history, achieved remission. Conclusions: These findings indicate that a history of childhood adversity is associated with an especially chronic form of MDD that is less responsive to antidepressant pharmacotherapy. Depression and Anxiety, 2009. Published 2009 Wiley-Liss, Inc. [source] Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory UniversityDEPRESSION AND ANXIETY, Issue 6 2008Ph.D., Steven J. Garlow M.D. Abstract The objective of this investigation was to examine suicidal ideation and depression in undergraduate college students who participated in the American Foundation for Suicide Prevention-sponsored College Screening Project at Emory University. The principal measure of depressive symptoms was the nine-item depression module from the Patient Health Questionnaire (PHQ-9). Additional questions were focused on current suicidal ideation, past suicide attempts, and episodes of deliberate self-harm and on symptoms of anxiety and distress. Seven hundred and twenty-nine students participated over a 3-school-year interval (2002,2005). Most notably, 11.1% of the students endorsed current (past 4 weeks) suicidal ideation and 16.5% had a lifetime suicide attempt or self-injurious episode. Students with current suicidal ideation had significantly higher depression symptom severity than those without suicidal ideation (t = ,9.34, df = 706, P<.0001, d = 1.9), and 28.5% of the students with PHQ-9 scores of 15 or higher reported suicidal ideation compared to 5.7% of those with lower scores (,2 = 56.29, df = 1, P<.0001, two-tailed). Suicidal ideation was prominently associated with symptoms of desperation (odds ratio 2.6, 95% CI 1.5,4.6, P<.001). The vast majority of students with moderately severe to severe depression (85%) or current suicidal ideation (84%) were not receiving any psychiatric treatment at the time of assessment. These results suggest that there is a strong relationship between severity of depressive symptoms and suicidal ideation in college students, and that suicidal feelings and actions are relatively common in this group. This underscores the need to provide effective mental health outreach and treatment services to this vulnerable population. As this analysis was based on data collected at a single institution, the results may not be representative of all college students or young adults. Depression and Anxiety 0:1,7, 2007. © 2007 Wiley-Liss, Inc. [source] Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible-dose, progressive-titration, placebo-controlled trialDEPRESSION AND ANXIETY, Issue 3 2008Moira Rynn M.D. Abstract Generalized anxiety disorder (GAD), a prevalent and chronic illness, is associated with dysregulation in both serotonergic and noradrenergic neurotransmission. Our study examined the efficacy, safety, and tolerability of duloxetine hydrochloride, a dual reuptake inhibitor of serotonin and norepinephrine, for short-term treatment of adults with GAD. In a 10-week, double-blind, progressive-titration, flexible-dose trial, 327 adult outpatients with a DSM-IV,defined GAD diagnosis were randomized to duloxetine 60,120,mg (DLX, N=168) or placebo (PLA, N=159) treatment. The primary efficacy measure was mean change from baseline to endpoint in Hamilton Anxiety Scale (HAMA) total score. Secondary outcome measures included response rate (HAMA total score reduction ,50% from baseline), Clinician Global Impression,Improvement (CGI-I) scores, and Sheehan Disability Scale (SDS) scores. Patients who received duloxetine treatment demonstrated significantly greater improvement in HAMA total scores (P=.02); a higher response rate (P=.03), and greater improvement (P=.04) than patients who received placebo. Duloxetine-treated patients were also significantly more improved than placebo-treated patients on SDS global functional (P<.01) and work, social, and family/home impairment scores (P<.05). The rate of discontinuation due to adverse events (AEs) was higher for the duloxetine group compared with the placebo group (P=.002). The AEs most frequently associated with duloxetine were nausea, dizziness, and somnolence. Duloxetine was an efficacious, safe, and well-tolerated treatment that resulted in clinically significant improvements in symptom severity and functioning for patients with GAD. Depression and Anxiety 0:1,8, 2007. © 2007 Wiley-Liss, Inc. [source] Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant useACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010A. K. B. Van Reedt Dortland van Reedt Dortland AKB, Giltay EJ, van Veen T, Zitman FG, Penninx BWJH. Metabolic syndrome abnormalities are associated with severity of anxiety and depression and with tricyclic antidepressant use. Objective:, The metabolic syndrome (MetSyn) predisposes to cardiovascular disease and diabetes mellitus. There might also be an association between the MetSyn and anxiety and depression, but its nature is unclear. We aimed to investigate whether diagnosis, symptom severity and antidepressant use are associated with the MetSyn. Method:, We addressed the odds for the MetSyn and its components among 1217 depressed and/or anxious subjects and 629 controls, and their associations with symptom severity and antidepressant use. Results:, Symptom severity was positively associated with prevalence of the MetSyn, [adjusted odds ratio (OR) 2.21 for very severe depression: 95% confidence interval (CI): 1.06,4.64, P = 0.04], which could be attributed to abdominal obesity and dyslipidemia. Tricyclic antidepressant (TCA) use also increased odds for the MetSyn (OR 2.30, 95% CI: 1.21,4.36, P = 0.01), independent of depression severity. Conclusion:, The most severely depressed people and TCA users more often have the MetSyn, which is driven by abdominal adiposity and dyslipidemia. [source] Default mode network connectivity as a predictor of post-traumatic stress disorder symptom severity in acutely traumatized subjectsACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010R. A. Lanius Objective:, The goal of this study was to investigate the relationship between default mode network connectivity and the severity of post-traumatic stress disorder (PTSD) symptoms in a sample of eleven acutely traumatized subjects. Method:, Participants underwent a 5.5 min resting functional magnetic resonance imaging scan. Brain areas whose activity positively correlated with that of the posterior cingulate/precuneus (PCC) were assessed. To assess the relationship between severity of PTSD symptoms and PCC connectivity, the contrast image representing areas positively correlated with the PCC was correlated with the subjects' Clinician Administered PTSD Scale scores. Results:, Results suggest that resting state connectivity of the PCC with the perigenual anterior cingulate and the right amygdala is associated with current PTSD symptoms and that correlation with the right amygdala predicts future PTSD symptoms. Conclusion:, These results may contribute to the development of prognostic tools to distinguish between those who will and those who will not develop PTSD. [source] Ten-year follow-up study of PTSD diagnosis, symptom severity and psychosocial indices in aging holocaust survivorsACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2009R. Yehuda Objective:, We performed a longitudinal study of holocaust survivors with and without post-traumatic stress disorder (PTSD) by assessing symptoms and other measures at two intervals, approximately 10 years apart. Method:, The original cohort consisted of 63 community-dwelling subjects, of whom 40 were available for follow-up. Results:, There was a general diminution in PTSD symptom severity over time. However, in 10% of the subjects (n = 4), new instances of delayed onset PTSD developed between time 1 and time 2. Self-report ratings at both assessments revealed a worsening of trauma-related symptoms over time in persons without PTSD at time 1, but an improvement in those with PTSD at time 1. Conclusion:, The findings suggest that a nuanced characterization of PTSD trajectory over time is more reflective of PTSD symptomatology than simple diagnostic status at one time. The possibility of delayed onset trajectory complicates any simplistic overall trajectory summarizing the longitudinal course of PTSD. [source] Dichotic listening and school performance in dyslexiaDYSLEXIA, Issue 1 2008Turid Helland Abstract This study focused on the relationship between school performance and performance on a dichotic listening (DL) task in dyslexic children. Dyslexia is associated with impaired phonological processing, related to functions in the left temporal lobe. DL is a frequently used task to assess functions of the left temporal lobe. Due to the predominance of the contralateral neuronal pathways, a right ear advantage in the DL task reflects the superior processing capacity for the right ear stimulus in the left hemisphere (Kimura, 1963). Previous studies using DL in dyslexia are, however, inconclusive, and may reflect degree of severity of dyslexia. The aim of the present study was therefore to investigate lateralized processing in two sub-groups of dyslexia, differing in symptom severity. Two groups of dyslexic 12-year-old children and an age-matched control group were tested with a consonant,vowel DL task. The two dyslexia groups differed in severity through how they responded to training efforts being made in their schools, while otherwise being matched for age, IQ and diagnosis. The D1 (respondent group) group showed a DL performance pattern similar to the control group, i.e. a right ear advantage, while the D2 (non-respondent) group failed to show a right ear advantage on the DL task. The performance on the DL task by the two dyslexia groups may provide better insight as to the degree of reading and writing impairment in dyslexia. ,Cracking the code' and acquiring automatized literacy skills may seem harder for the D2 group children compared to the D1 children. Also, the present study points to the use of DL as a valid assessment tool in clinical work to improve differential diagnoses, particularly in relation to measures of school performance. Copyright © 2007 John Wiley & Sons, Ltd. [source] Staging anorexia nervosa: conceptualizing illness severityEARLY INTERVENTION IN PSYCHIATRY, Issue 1 2008Sarah Maguire Abstract In recent years, there has been increasing attention to the conceptualization of anorexia nervosa (AN) and its diagnostic criteria. While varying levels of severity within the illness category of AN have long been appreciated, neither a precise definition of severity nor an empirical examination of severity in AN has been undertaken. The aim of this article is to review the current state of knowledge on illness severity and to propose a theoretical model for the definition and conceptualization of severity in AN. AN is associated with significant medical morbidity which is related to the ,severity' of presentation on such markers as body mass index, eating and purging behaviours. The development of a functional staging system, based on symptom severity, is indicated for reasons similar to those cited by the cancer lobby. Improving case management and making appropriate treatment recommendations have been the primary purpose of staging in other fields, and might also apply to AN. Such a standardized staging system could potentially ease communication between treatment settings, and increase the specificity and comparability of research findings in the field of AN. [source] Randomized controlled trial of dexamphetamine maintenance for the treatment of methamphetamine dependenceADDICTION, Issue 1 2010Marie Longo ABSTRACT Aim To investigate the safety and efficacy of once-daily supervised oral administration of sustained-release dexamphetamine in people dependent on methamphetamine. Design Randomized, double-blind, placebo-controlled trial. Participants Forty-nine methamphetamine-dependent drug users from Drug and Alcohol Services South Australia (DASSA) clinics. Intervention Participants were assigned randomly to receive up to 110 mg/day sustained-release dexamphetamine (n = 23) or placebo (n = 26) for a maximum of 12 weeks, with gradual reduction of the study medication over an additional 4 weeks. Medication was taken daily under pharmacist supervision. Measurements Primary outcome measures included treatment retention, measures of methamphetamine consumption (self-report and hair analysis), degree of methamphetamine dependence and severity of methamphetamine withdrawal. Hair samples were analysed for methamphetamine using liquid chromatography-mass spectrometry. Findings Treatment retention was significantly different between groups, with those who received dexamphetamine remaining in treatment for an average of 86.3 days compared with 48.6 days for those receiving placebo (P = 0.014). There were significant reductions in self-reported methamphetamine use between baseline and follow-up within each group (P < 0.0001), with a trend to a greater reduction among the dexamphetamine group (P = 0.086). Based on hair analysis, there was a significant decrease in methamphetamine concentration for both groups (P < 0.0001). At follow-up, degree of methamphetamine dependence was significantly lower in the dexamphetamine group (P = 0.042). Dexamphetamine maintenance was not associated with serious adverse events. Conclusions The results of this preliminary study have demonstrated that a maintenance pharmacotherapy programme of daily sustained-release amphetamine dispensing under pharmacist supervision is both feasible and safe. The increased retention in the dexamphetamine group, together with the general decreases in methamphetamine use, degree of dependence and withdrawal symptom severity, provide preliminary evidence that this may be an efficacious treatment option for methamphetamine dependence. [source] Predictors of 4-year outcome of community residential treatment for patients with substance use disordersADDICTION, Issue 4 2008Charlene Laffaye ABSTRACT Aims This study examined systematically how predictors of substance use disorder (SUD) treatment outcome worked together over time and identified mediators and moderators of outcome. Design The MacArthur model was applied in this naturalistic study to identify how baseline, discharge and 1-year follow-up factors worked together to predict 4-year improvement in substance-related problems. Setting Eighty-eight community residential facilities were selected based on geographic representativeness, number of patient referrals and type of treatment orientation. Participants Of 2796 male patients who completed intake assessments, 2324 were assessed at the 1-year follow-up and 2023 at the 4-year follow-up. Measurements Self-report measures of symptom severity, functioning, social resources and coping, treatment and involvement in Alcoholics Anonymous (AA) were collected at baseline and at 1- and 4-year follow-ups. Provider-rated treatment participation measures were obtained at discharge. Findings Greater substance use severity, more psychiatric symptoms, more prior arrests and stronger belief in AA-related philosophy at treatment entry predicted improvement significantly in substance-related problems 4 years later. At the 1-year follow-up, being employed and greater use of AA-related coping predicted outcome significantly. AA-related coping at 1 year mediated the relationship partially between belief in AA philosophy at treatment entry and 4-year outcome. Conclusions The findings highlight the unique and positive impact of AA involvement on long-term SUD treatment outcome and extend understanding of why AA is beneficial for patients. [source] Major depression, chronic minor depression, and the five-factor model of personalityEUROPEAN JOURNAL OF PERSONALITY, Issue 4 2002Kate L. Harkness Fifty-eight outpatients with major depression completed the NEO Personality Inventory at intake (time 1) and after up to three months of anti-depressant treatment (time 2). Within this group, 26 patients met additional Research Diagnostic Criteria for chronic minor depression. Repeated-measures analyses revealed significant decreases in Neuroticism scores, and significant increases in Extraversion and Conscientiousness scores, from time 1 to time 2 for both patient groups. In addition, despite similar symptom severity at time 2, the patients with major depression+chronic minor depression scored significantly higher on the Angry Hostility facet of Neuroticism and significantly lower on Agreeableness than those with major depression alone. We suggest from these findings that Angry Hostility and low Agreeableness may represent a trait vulnerability in individuals with chronic minor depression that persists even following remission of the major depressive state, and that this may help to explain their high rates of relapse and recurrence. Copyright © 2002 John Wiley & Sons, Ltd. [source] | |||||||||||||||||||||||||||||||||||||||||||