Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Symptomatology

  • clinical symptomatology
  • depressive symptomatology
  • disorder symptomatology
  • eating disorder symptomatology
  • externalizing symptomatology
  • internalizing symptomatology
  • psychiatric symptomatology
  • psychotic symptomatology
  • ptsd symptomatology
  • stress symptomatology

  • Selected Abstracts

    Diagnostic utility of the Quick Inventory of Depressive Symptomatology (QIDS-C16 and QIDS-SR16) in the elderly

    P. M. Doraiswamy
    Doraiswamy PM, Bernstein IH, Rush AJ, Kyutoku Y, Carmody TJ, Macleod L, Venkatraman S, Burks M, Stegman D, Witte B, Trivedi MH. Diagnostic utility of the Quick Inventory of Depressive Symptomatology (QIDS-C16 and QIDS-SR16) in the elderly. Objective:, To evaluate psychometric properties and comparability ability of the Montgomery-Åsberg Depression Rating Scale (MADRS) vs. the Quick Inventory of Depressive Symptomatology,Clinician-rated (QIDS-C16) and Self-report (QIDS-SR16) scales to detect a current major depressive episode in the elderly. Method:, Community and clinic subjects (age ,60 years) were administered the Mini-International Neuropsychiatric Interview (MINI) for DSM-IV and three depression scales randomly. Statistics included classical test and Samejima item response theories, factor analyzes, and receiver operating characteristic methods. Results:, In 229 elderly patients (mean age = 73 years, 39% male, 54% current depression), all three scales were unidimensional and with nearly equal Cronbach , reliability (0.85,0.89). Each scale discriminated persons with major depression from the non-depressed, but the QIDS-C16 was slightly more accurate. Conclusion:, All three tests are valid for detecting geriatric major depression with the QIDS-C16 being slightly better. Self-rated QIDS-SR16 is recommended as a screening tool as it is least expensive and least time consuming. [source]

    Irritability is associated with anxiety and greater severity, but not bipolar spectrum features, in major depressive disorder

    R. H. Perlis
    Objective:, Irritability is common during major depressive episodes, but its clinical significance and overlap with symptoms of anxiety or bipolar disorder remains unclear. We examined clinical correlates of irritability in a confirmatory cohort of Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study participants with major depressive disorder (MDD). Method:, Logistic regression was used to identify features associated with presence of irritability on the clinician-rated Inventory of Depressive Symptomatology. Results:, Of 2307 study participants, 1067(46%) reported irritability at least half the time during the preceding week; they were more likely to be female, to be younger, to experience greater depression severity and anxiety, and to report poorer quality of life, prior suicide attempts and suicidal ideation. Bipolar spectrum features were not more common among those with irritability. Conclusion:, Irritable depression is not a distinct subtype of MDD, but irritability is associated with greater overall severity, anxiety comorbidity and suicidality. [source]

    Day clinic or inpatient care for severe bulimia nervosa?

    Almut Zeeck
    Abstract Objective: Treating severe eating disorders in a day treatment programme has advantages, but also limitations compared with inpatient settings. A day clinic can provide intense, specialized psychotherapy while patients stay in their social context. Method: The integrated treatment programme of the day clinic in Freiburg, which has a psychodynamic background, will be presented. In an exploratory study a group of consecutively treated bulimic patients (N,=,18) was matched with an inpatient sample (N,=,18) and examined concerning short-term course. Symptomatology was evaluated again in a 1.5-year follow-up. Results: At discharge, 27.8 per cent of the day clinic patients and 33.3 per cent of the inpatients showed complete remission and 22.2 vs. 38.9 per cent partial remission,50 vs. 27.8 per cent still fulfilled DSM-IV criteria for the last 4 weeks of treatment. At follow-up, 50 per cent of the day clinic patients showed complete remission, 28.6 per cent partial remission and 21.4 per cent were still fully symptomatic. Copyright © 2003 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

    No Influence of 5-HTTLPR Gene Polymorphism on Migraine Symptomatology, Comorbid Depression, and Chronification

    HEADACHE, Issue 3 2010
    Thomas Wieser MD
    (Headache 2010;50:420-430) Background., The serotonergic system is thought to play an important role for mediating susceptibility to migraine and depression, which is frequently found comorbid in migraine. The functional polymorphism in the serotonin transporter gene linked polymorphic region (5-HTTLPR/SLC6A4) was previously associated with attack frequency and, thus, possibly with chronification. Objective., We hypothesized that patients with the "s" allele have higher attack frequency and, paralleling results in depression research, higher scores of depression. Methods., Genetic analysis of the SLC6A4 44 bp insertion/deletion polymorphism (5-HTTLPR) was performed in 293 patients with migraine with and without aura. Self-rating questionnaires were used for assessment of depression. Results., Multinomial logistic regression analysis found no evidence for association of the 5-HTTLPR polymorphism with either depression or migraine attack frequency. Conclusion., We were not able to demonstrate any influence of the serotonin transporter 5-HTTLPR polymorphism on migraine phenomenology (attack frequency or comorbid depression), thereby excluding this variant to be a common genetic denominator for chronic migraine and depression. [source]

    Epidemiology and Symptomatology of Migraine Among School Children: Denizli Urban Area in Turkey

    HEADACHE, Issue 8 2004
    Mehmet Zencir MD
    Objective.,This study was aimed at finding the prevalence, associated factors, and symptomatology of migraine among 5 to 8 grades of secondary and 9 to 11 grades of high school children (age range between 11 and 18 years old) in the Denizli urban area in the western part of Turkey. Background.,Data from the developed countries indicate that migraine is the most common cause of recurrent headaches in children. Also, childhood migraine is sufficiently severe to prevent the half of the suffering children from carrying on their usual daily activities. Methods.,A cross-sectional school-based study was conducted between May 2000 and June 2000. There were 2,490 participants selected by a multistage stratified clustered sampling procedure. A validated self-administered questionnaire designed according to the International Headache Society criteria was given to the school children of age between 11 and 18 years. Results.,Overall migraine prevalence was 8.8%; it was 6.7% in boys and 11.0% in girls (OR: 1.7; 95% CI: 1.3 to 2.3). Among girls, the highest prevalence (17.7%) occurred at 15 years of age, but among boys, the highest prevalence (11.9%) occurred at 16 years of age. Of children with migraine, 56.5% had a positive family history, and only 29.1% visited a doctor for headache. Conclusion.,Migraine is a common health problem among school children in Denizli urban area and it often goes underdiagnosed. [source]

    Olanzapine monotherapy for acute depression in patients with bipolar I or II disorder: results of an 8-week open label trial

    William V. Bobo
    Abstract We evaluated the efficacy, tolerability, and safety of olanzapine monotherapy in 20 adult patients with bipolar I or II disorder, depressed phase. Patients received open-label olanzapine monotherapy (mean modal dose, 15,mg/day) for 8 weeks. Assessments of psychopathology (Montgomery,Asberg Depression Rating Scale [MADRS], Quick Inventory of Depressive Symptomatology [QIDS-SR-16], Young Mania Rating Scale [YMRS]), clinical global state (Clinical Global Impressions [CGI] scale), and safety/tolerability were performed at baseline, and at 1, 2, 4, 6, and 8 weeks. Seventeen patients (85.0%) completed the study. Improvement in MADRS total scores was observed after the first week of treatment, and at all remaining follow-up time points (p,,,0.005). Parallel improvement in QIDS-SR-16 (p,<,0.001) and CGI-Severity (p,<,0.001) was observed between baseline and study endpoint. Nine (45%) subjects achieved positive treatment response, eight of whom (40%) also achieved symptom remission. There were significant increases in weight (+3.2,kg, p,=,0.001) and body mass index (+1.1,kg/m2, p,=,0.001), but not fasting glucose or lipids, with the exception of reduced triglyceride levels in the overall sample, and reduced HDL cholesterol in females. Olanzapine may be an effective, well-tolerated option for treating acute non-psychotic depression across a variety of bipolar disorder subtypes. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    The Associations Between Basal Salivary Cortisol and Illness Symptomatology in Chronic Fatigue Syndrome

    Susan Torres-Harding
    Hypocortisolism has been reported in chronic fatigue syndrome (CFS), with the significance of this finding to disease etiology unclear. This study examined cortisol levels and their relationships with symptoms in a group of 108 individuals with CFS. CFS symptoms examined included fatigue, pain, sleep difficulties, neurocognitive functioning, and psychiatric status. Alterations in cortisol levels were examined by calculation of mean daily cortisol, and temporal variation in cortisol function was examined by means of a regression slope. Additionally, deviation from expected cortisol diurnal pattern was determined via clinical judgment. Results indicated that fatigue and pain were associated with salivary cortisol levels. In particular, variance from the expected pattern of cortisol was associated with increased levels of fatigue. The implications of these findings are discussed. [source]

    The clinical and cultural factors in classifying low back pain patients within Greece: a qualitative exploration of Greek health professionals

    Evdokia V. Billis MSc
    Abstract Rationale, aims and objectives, Identifying homogenous subgroups of low back pain (LBP) patients is considered a priority in musculoskeletal rehabilitation and is believed to enhance clinical outcomes. In order to achieve this, the specific features of each subgroup need to be identified. The aim of this study was to develop a list of clinical and cultural features that are included in the assessment of LBP patients in Greece, among health professionals. This ,list' will be, utilized in a clinical study for developing LBP subgroups. Methods, Three focus groups were conducted, each one comprising health professionals with homogenous characteristics and all coordinated by a single moderator. There were: 11 physiotherapists (PTs) with clinical experience in LBP patients, seven PTs specialized in LBP management, and five doctors with a particular spinal interest. The focus of discussions was to develop a list of clinical and cultural features that were important in the examination of LBP. Content analysis was performed by two researchers. Results, Clinicians and postgraduates developed five categories within the History (Present Symptoms, History of Symptoms, Function, Psychosocial, Medical History) and six categories within the Physical Examination (Observation, Neurological Examination, Active and Passive Movements, Muscle Features and Palpation). The doctors identified four categories in History (Symptomatology, Function, Psychosocial, Medical History) and an additional in Physical Examination (Special Tests). All groups identified three cultural categories; Attitudes of Health Professionals, Patients' Attitudes and Health System influences. Conclusion, An extensive Greek ,list' of clinical and cultural features was developed from the groups' analysis. Although similarities existed in most categories, there were several differences across the three focus groups which will be discussed. [source]

    Plasma and gastric mucosal 5-hydroxytryptamine concentrations following cold water intake in patients with diarrhea-predominant irritable bowel syndrome

    Xiu Li Zuo
    Abstract Background and Aim:, The purpose of the present paper was to investigate the effects of cold water intake on 5-hydroxytryptamine (5-HT) and its metabolite 5-hydroxyindole acetic acid (5-HIAA) in diarrhea-predominant irritable bowel syndrome (d-IBS) patients, and to observe the relationship between 5-HT and symptomatology. Methods:, The plasma 5-HT/5-HIAA concentrations at 0, 30 min, 60 min, 90 min, 120 min, 150 min and 180 min following cold or warm water intake were investigated in 32 female subjects with d-IBS and 21 healthy female subjects. Gastric mucosal 5-HT under fasting conditions and following water intake were further investigated in 15 d-IBS patients and nine healthy subjects. Symptomatology was assessed throughout the study. Results:, The plasma 5-HT concentrations in IBS patients were significantly higher than those of controls at 30 min (P = 0.022), 60 min (P < 0.001), 90 min (P < 0.001), 120 min (P < 0.001) and 150 min (P = 0.001) after cold water intake. The peak plasma 5-HT/5-HIAA and area under the curve for 5-HT/5-HIAA were also higher in d-IBS patients (P < 0.001). Gastric mucosal 5-HT in d-IBS patients and controls did not show any significant differences both under fasting condition (P = 0.596) and after cold water intake (P = 0.426). Last, the d-IBS patients with symptoms had higher 5-HT concentration (P < 0.001) and there was a positive correlation (r = 0.714, P = 0.001)between the symptomatology and plasma 5-HT level. Conclusions:, These data suggest that symptomatology following cold water intake may be associated with increased plasma 5-HT concentrations in female subjects with d-IBS. [source]

    Pathways Among Marital Distress, Parental Symptomatology, and Child Adjustment

    Lauren M. Papp
    A community sample of 295 mothers, fathers, and children (M age = 11.14 years, SD = 2.32 years) rated marital distress, maternal and paternal psychological symptoms, and child adjustment. The predicted direct relations between these family and child variables were demonstrated for both fathers and mothers. Tests of pathways among these variables were conducted for separate but complementary mediation models. Maternal and paternal symptoms mediated the association between marital distress and child adjustment. Marital distress mediated the link between fathers' symptoms and child adjustment, but the direct pathway between mothers' symptoms and child adjustment remained. Pubertal status was modestly related to higher levels of family stressors. Joint implications of marital distress and parental symptoms for child adjustment are discussed. [source]

    Common Genetic Contributions to Alcohol and Cannabis Use and Dependence Symptomatology

    ALCOHOLISM, Issue 3 2010
    Carolyn E. Sartor
    Background:, Despite mounting evidence that use of and dependence on alcohol and cannabis are influenced by heritable factors, the extent to which heritable influences on these phenotypes overlap across the 2 substances has only rarely been explored. In the current study, we quantified cross-substance overlap in sources of variance and estimated the degree to which within-substance associations between use and dependence measures are attributable to common genetic and environmental factors for alcohol and cannabis. Methods:, The sample was comprised of 6,257 individuals (2,761 complete twin pairs and 735 singletons) from the Australian Twin Registry, aged 24 to 36 years. Alcohol and cannabis use histories were collected via telephone diagnostic interviews and used to derive an alcohol consumption factor, a frequency measure for cannabis use, and DSM-IV alcohol and cannabis dependence symptom counts. Standard genetic analyses were conducted to produce a quadrivariate model that provided estimates of overlap in genetic and environmental influences across the 4 phenotypes. Results:, Over 60% of variance in alcohol consumption, cannabis use, and cannabis dependence symptoms, and just under 50% of variance in alcohol dependence (AD) symptoms were attributable to genetic sources. Shared environmental factors did not contribute significantly to the 4 phenotypes. Nearly complete overlap in heritable influences was observed for within-substance measures of use and dependence symptoms. Genetic correlations across substances were 0.68 and 0.62 for use and dependence symptoms, respectively. Conclusions:, Common heritable influences were evident for alcohol and cannabis use and for AD and cannabis dependence symptomatology, but findings indicate that substance-specific influences account for the majority of the genetic variance in the cannabis use and dependence phenotypes. By contrast, the substantial correlations between alcohol use and AD symptoms and between cannabis use and cannabis dependence symptoms suggest that measures of heaviness of use capture much of the same genetic liability to alcohol- and cannabis-related problems as dependence symptomatology. [source]

    Is Depressive Symptomatology Associated with Worse Oral Functioning and Well-being Among Older Adults?

    Nancy R. Kressin PhD;
    Abstract Objectives: Although depression negatively affects individuals' physical functioning and well-being, its association with oral functioning and well-being has not been examined previously. The objective of this study was to examine the association between depressive symptomatology and oral quality of life. Methods: We utilized data from two samples of older adults: community-dwelling participants who used community primary care physicians in Los Angeles (n=7,653) and individuals who sought ambulatory care through four Department of Veterans Affairs facilities in the Boston metropolitan area (n=212). Depressive symptomatology was measured with the CES-D scale; Oral Quality of Life was measured with the Geriatric Oral Health Assessment Instrument and the Oral Health-related Quality of Life measure. We conducted hierarchical regression analyses to examine the effects of depression on oral quality of life, controlling for self-reported oral health, age, education, income, and marital status. Results: Individuals with more depressive symptoms reported worse oral quality of life, controlling for socio demographic factors and self-reported oral health. This finding persisted across multiple samples and both sexes, and using two measures of oral quality of life. Conclusion: These findings further emphasize the importance of treating depression among older adults, and suggest that both dentists and physicians have a role in recognizing and referring patients for such treatment. [source]

    5-hydroxytryptamine signalling in irritable bowel syndrome with diarrhoea: effects of gender and menstrual status

    Summary Background, Symptomatology and physiology differ between men and women and across the menstrual cycle in irritable bowel syndrome (IBS). Ovarian hormones influence 5-hydroxytryptamine (5-HT), an amine known to play a role in gut motor-sensory function. Aim, To assess the effects of gender and menstrual status on platelet-depleted plasma (PDP) 5-HT concentration in IBS patients with diarrhoea (IBS-D) patients compared with healthy volunteers (HV). Methods, Platelet-depleted plasma 5-HT concentrations were assessed under fasting and fed conditions in 73 IBS-D patients (aged 18,58 years; 18 men) and 64 HV (aged 18,50 years; 24 men). Women were divided into those with low or high progesterone/oestrogen (P/O) levels. Results, Irritable bowel syndrome patients with diarrhoea had higher PDP 5-HT concentrations than HV under fasting (P = 0.002) and fed (P = 0.049) conditions. This was particularly related to IBS-D men having higher PDP 5-HT concentrations than healthy controls (P = 0.002). Moreover, PDP 5-HT concentrations in IBS-D women with low P/O levels were similar to healthy controls. Conclusions, Similar to IBS-D women with high P/O levels, IBS-D men also have raised PDP 5-HT concentrations. 5-HT concentration normalizes at menses in IBS-D women, suggesting a shift in the mechanisms responsible for abnormal 5-HT signalling in these patients. [source]

    Pepino mosaic virus: a successful pathogen that rapidly evolved from emerging to endemic in tomato crops

    SUMMARY Taxonomy:Pepino mosaic virus (PepMV) belongs to the Potexvirus genus of the Flexiviridae family. Physical properties: PepMV virions are nonenveloped flexuous rods that contain a monopartite, positive-sense, single-stranded RNA genome of 6.4 kb with a 3, poly-A tail. The genome contains five major open reading frames (ORFs) encoding a 164-kDa RNA-dependent RNA polymerase (RdRp), three triple gene block proteins of 26, 14 and 9 kDa, and a 25-kDa coat protein. Genome diversity: Four PepMV genotypes, with an intergenotype RNA sequence identity ranging from 78% to 95%, can be distinguished: the original Peruvian genotype (LP); the European (tomato) genotype (EU); the American genotype US1; and the Chilean genotype CH2. Transmission: PepMV is very efficiently transmitted mechanically, and a low seed transmission rate has been demonstrated. In addition, bumblebees have been associated with viral transmission. Host range: Similar to other Potexviruses, PepMV has a rather narrow host range that is thought to be largely restricted to species of the Solanaceae family. After originally being isolated from pepino (Solanum muricatum), PepMV has been identified in natural infections of the wild tomato species S. chilense, S. chmielewskii, S. parviflorum and S. peruvianum. PepMV is causing significant problems in the cultivation of the glasshouse tomato Solanum lycopersicum, and has been identified in weeds belonging to various plant families in the vicinity of tomato glasshouses. Symptomatology: PepMV symptoms can be very diverse. Fruit marbling is the most typical and economically devastating symptom. In addition, fruit discoloration, open fruit, nettle-heads, leaf blistering or bubbling, leaf chlorosis and yellow angular leaf spots, leaf mosaic and leaf or stem necrosis have been associated with PepMV. The severity of PepMV symptoms is thought to be dependent on environmental conditions, as well as on the properties of the viral isolate. Minor nucleotide sequence differences between isolates from the same genotype have been shown to lead to enhanced aggressiveness and symptomatology. Control: Prevention of infection through strict hygiene measures is currently the major strategy for the control of PepMV in tomato production. Cross-protection can be effective, but only under well-defined and well-controlled conditions, and the effectiveness depends strongly on the PepMV genotype. [source]

    Symptomatology of Late-onset Schizophrenia and Paranoid Disorders

    PSYCHOGERIATRICS, Issue 1 2002
    Hidemichi Hamada
    Abstract: There is controversy concerning the classification of late-onset paranoid disorders, but many interpret it as schizophrenia that is first manifested in old age. As a result of the revival of the concept of late-onset catatonia in recent years, the classification of late schizophrenia has been reorganized. Late-onset paranoid disorders have two characteristics in terms of their symptomatology: a transition from the boundaries of the self to material boundaries, and delusions of injury. In late-onset paranoid disorders there is adherence of the boundaries of the self to physical boundaries in an external form that can be seen with the eyes. Delusions of injury, in which living space within physical boundaries is infringed, become manifestations, such as delusions of robbery, jealousy, and delusions of infestation. [source]

    Stress-Induced Drinking in Parents of Adolescents with Externalizing Symptomatology: The Moderating Role of Parent Social Support

    Elizabeth D. Handley MA
    Parenting adolescents with externalizing symptomatology has been repeatedly shown to be stress-inducing for parents. One possible coping strategy for parents dealing with this chronic stress may be drinking. The current study extended previous research by examining the prospective relations between adolescents' externalizing behaviors and parents' negative affect and alcohol consumption. Additionally, the present study tested whether this mediated effect is a function of parental social support. Adolescents' externalizing symptoms prospectively predicted mothers' negative affect. Interestingly, however, mothers' negative affect prospectively predicted mothers' drinking only for those mothers with low social support. Furthermore, the mediated effect (Wave 1 adolescent externalizing symptoms , Wave 2 mother negative affect , Wave 3 mother drinking) was significant only for mothers with low social support. There were no effects of adolescents' externalizing symptoms on fathers. [source]

    Clinical Symptomatology and Paranasal Sinus Involvement With Nasal Septal Perforation

    THE LARYNGOSCOPE, Issue 4 2007
    FACS, Neil Bhattacharyya MD
    Abstract Objective: Determine the symptom manifestations, clinical impact, and incidence of chronic rhinosinusitis (CRS) in patients with newly diagnosed nasal septal perforation. Methods: A consecutive series of adult patients with nasal septal perforation were prospectively studied at the time of endoscopic diagnosis with the rhinosinusitis symptom inventory (RSI) and sinus computed tomography (CT). Patients' symptoms in the RSI symptom domains were computed. From the CT scan, septal perforation size and Lund scores were obtained. A separate (control) cohort of patients with CRS without septal perforation was matched to these patients for age, sex, and Lund score. RSI symptom domain comparisons were conducted between groups to determine the additional symptom burden conferred by septal perforation. Results: Thirty-three patients with septal perforation were enrolled (mean age, 48.2 yr; 69.7% female). Mean perforation size was 1.9 (SD, 2.1) cm2. The mean Lund score was 5.8 (SD, 5.3); 16 (57.1%) patients met radiographic criteria for a concurrent diagnoses of CRS. Patients with septal perforation reported significant nasal and facial symptom domain scores (56.8 and 47.0, respectively [range, 0,100]). Oropharyngeal and systemic symptoms were less severe (29.7 and 34.7, respectively). However, after comparison with the matched control patients, no statistically significant differences were identified in sinonasal symptoms between patients with and without septal perforation (all P > .131). Conclusions: Concurrent CRS may frequently accompany nasal septal perforation and may require appropriate treatment along with the perforation itself. The presence of septal perforation does not appear to significantly augment symptom severity in CRS. [source]

    Maternal Socialization of Positive Affect: The Impact of Invalidation on Adolescent Emotion Regulation and Depressive Symptomatology

    CHILD DEVELOPMENT, Issue 5 2008
    Marie B. H. Yap
    This study examined the relations among maternal socialization of positive affect (PA), adolescent emotion regulation (ER), and adolescent depressive symptoms. Two hundred early adolescents, 11,13 years old, provided self-reports of ER strategies and depressive symptomatology; their mothers provided self-reports of socialization responses to adolescent PA. One hundred and sixty-three mother,adolescent dyads participated in 2 interaction tasks. Adolescents whose mothers responded in an invalidating or "dampening" manner toward their PA displayed more emotionally dysregulated behaviors and reported using maladaptive ER strategies more frequently. Adolescents whose mothers dampened their PA more frequently during mother,adolescent interactions, and girls whose mothers reported invalidating their PA, reported more depressive symptoms. Adolescent use of maladaptive ER strategies mediated the association between maternal invalidation of PA and early adolescents' concurrent depressive symptoms. [source]

    Memory, Maternal Representations, and Internalizing Symptomatology Among Abused, Neglected, and Nonmaltreated Children

    CHILD DEVELOPMENT, Issue 3 2008
    Kristin Valentino
    A depth-of-processing incidental recall task for maternal-referent stimuli was utilized to assess basic memory processes and the affective valence of maternal representations among abused (N = 63), neglected (N = 33), and nonmaltreated (N = 128) school-aged children (ages 8,13.5 years old). Self-reported and observer-rated indices of internalizing symptoms were also assessed. Abused children demonstrated impairments in recall compared to neglected and nonmaltreated children. Although abused, neglected, and nonmaltreated children did not differ in valence of maternal representations, positive and negative maternal schemas related to internalizing symptoms differently among subgroups of maltreated children. Valence of maternal schema was critical in differentiating those with high and low internalizing symptomatology among the neglected children only. Implications for clinical intervention and prevention efforts are underscored. [source]

    Diagnostik von Mykosen des Auges und seiner Adnexe

    MYCOSES, Issue 2006
    W. Behrens-Baumann
    Zusammenfassung Das Spektrum der Mykosen des Auges und seiner Adnexe wird im klinischen Bild und im labordiagnostischen Vorgehen abgehandelt. Die einzelnen Lokalisationsformen unterscheiden sich in ihrer Symptomatik, in ihren Risikofaktoren und im Erregerspektrum. Summary The spectrum of fungal infections of the eye and of its adnexa is presented with respect to their clinical pictures as well as to their laboratory diagnostic monitoring. The various types of localisation are different in their symptomatologies, in their risk factors and in their aetiology. [source]

    Outcome of Pulmonary Valve Replacements in Adults after Tetralogy Repair: A Multi-institutional Study

    Thomas P. Graham Jr. MD
    ABSTRACT Objective., The purpose of this study was to assess the outcome of pulmonary valve replacement (PVR) in adults with moderate/severe pulmonary regurgitation after tetralogy repair, with particular emphasis on patient outcome, durability of valve repair, and improvement in symptomatology. Design/Setting/Patients., The project committee of the International Society of Congenital Heart Disease undertook a retrospective multi-institutional analysis of PVR. Seven centers participated in submitting data on 93 patients >18 years of age who had the operation performed and follow-up obtained. The average age of PVR was 26± years (median 27 years). Time of follow-up after replacement was 3 years (range 4 days,28 years). Outcomes/Measures/Results., Kaplan,Meier estimates of durability of PVR showed approximately 50% replacement at 11 years. There were two deaths at 6 and 12 months after valve replacement. Right ventricular (RV) size estimated by echocardiography from pre- to postoperative studies decreased in 81% (P < 0.001 testing for equal proportions), but RV systolic function increased in only 36% (P = 0.09). Ability index improved in 59% (P < 0.001) and clinical heart failure status improved in 57% with this problem before PVR. PVR did not improve arrhythmia status in a small group of patients. Conclusions., PVR is associated with low mortality, decrease in RV size and improvement in ability index, and uncertain effects on RV systolic function. Average valve durability was approximately 11 years. Criteria for PVR that will preserve RV function are not clearly identified, and management of these patients remains a difficult enterprise. [source]

    Is Functional Capacity Related to Left Atrial Contractile Function in Nonobstructive Hypertrophic Cardiomyopathy?

    Yukitaka Shizukuda MD
    The mechanisms underlying reduced exercise capacity in patients with nonobstructive hypertrophic cardiomyopathy (NHCM) could include perturbations of ventricular relaxation, diastolic compliance, or compensatory atrial systolic function. We hypothesized that a loss of atrial contractility in NHCM patients leads to reduced functional capacity. To test this hypothesis, we compared resting noninvasive left atrial ejection phase indices in 49 consecutive patients with NHCM (ages 36±10 years; 41% female) and normal left ventricular ejection fraction (mean, 68%±8%) with objective metabolic exercise parameters. Left atrial active emptying fraction, ejection force, and kinetic energy failed to predict exercise capacity. Only left atrial total and active emptying volumes correlated weakly with minute volume/CO2 production slope (r=0.31 and r=0.33; p<0.05 for both). Furthermore, when subjects were stratified by New York Heart Association symptomatology, exercise parameters,but not atrial contractility,differed between groups. These data, obtained at rest, fail to suggest that NHCM-related heart failure symptoms are due to an atrial myopathy. [source]

    Excessive violence and psychotic symptomatology among homicide offenders with schizophrenia

    Taina Laajasalo
    Background,It is not currently known how psychotic symptoms are associated with the nature of violence among homicide offenders with schizophrenia, or, more specifically, whether different psychotic symptoms are differentially linked with excessive violence. Aim,To identify factors associated with the use of excessive violence among homicide offenders with schizophrenia. Methods,Forensic psychiatric examination statements and Criminal Index File data of 125 consecutive Finnish homicide offenders with a diagnosis of schizophrenia were analysed. Results,Nearly one-third of the cases in this sample involved extreme violence, including features such as sadism, mutilation, sexual components or multiple stabbings. Excessive violence was a feature of acts when the offender was not the sole perpetrator or when there was a previous homicidal history. Positive psychotic symptoms, including delusions, were not associated with the use of excessive violence. Conclusions,These results highlight the importance of variables other than clinical state when examining qualitative aspects of homicidal acts, such as the degree and nature of violence, by offenders with schizophrenia. Further study is needed with a more specific focus on the qualities of the violence among different subgroups of offenders, but inclusive of those with psychosis. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    Understanding sexual offending in schizophrenia

    Christopher R. Drake M Clin Psych MAPS
    Background Studies have found an elevated incidence of violent sexual offences in males with schizophrenia. The relationship between sexual offending and psychiatric illness is, however, complex and poorly defined. Aims The aim of the present article is to delineate possible mechanisms that underlie offensive sexual behaviour in schizophrenia that can be used as a framework for assessing and treating these behaviours. A review of research pertaining to the aetiology of sexual deviance in schizophrenia was conducted, focusing in particular on the role of early childhood experiences, deviant sexual preferences, antisocial personality traits, psychiatric symptomatology and associated treatment effects, the impact of mental illness on sexual and social functioning, and other potential contributory factors. Towards a typology It is proposed that schizophrenic patients who engage in sexually offensive activities fall into four broad groups: (1) those with a pre-existing paraphilia; (2) those whose deviant sexuality arises in the context of illness and/or its treatment; (3) those whose deviant sexuality is one manifestation of more generalized antisocial behaviour, and (4) factors other than the above. This classification provides a useful framework for evaluating and treating sexually offensive behaviours in schizophrenic patients. Copyright © 2004 Whurr Publishers Ltd. [source]

    Demographic and clinical characteristics of motor vehicle accident victims in the community general health outpatient clinic: a comparison of PTSD and non-PTSD subjects

    Marina Kupchik M.D.
    Abstract Motor vehicle accidents (MVAs) are the leading cause of posttraumatic stress disorder (PTSD) in the general population, often with enduring symptomatology. This study details epidemiological and clinical features that characterize PTSD among MVA victims living in a nonhospitalized community setting long after the MVA event, and includes exploration of premorbid and peritraumatic factors. MVA victims (n=60; 23 males, 37 females) identified from the registry of a community general health outpatient clinic during a 7-year period were administered an extensive structured battery of epidemiological, diagnostic and clinical ratings. Results indicated that 30 subjects (50%; 12 males, 18 females) had MVA-related PTSD (MVAR-PTSD). Among those with PTSD, 16 individuals exhibited PTSD in partial remission, and six, in full remission. There were no significant demographic or occupational function differences between PTSD and non-PTSD groups. The most common comorbid conditions with MVAR-PTSD were social phobia (20%), generalized anxiety disorder (7.8%) and obsessive,compulsive disorder (0.5%). Previous MVA's were not predictive of PTSD. Subjects with MVAR-PTSD scored worse on the Clinician-Administered Posttraumatic Stress Disorder Scale, Part 2 (CAPS-2), Impact of Event Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Impulsivity Scale, and Toronto Alexithymia Rating Scale. Study observations indicate a relatively high rate of PTSD following an MVA in a community-based sample. The relatively high rate of partially remitted MVAR-PTSD (N=16) underscores the importance of subsyndromal forms of illness. Alexithymia may be an adaptive method of coping with event stress. The development of PTSD appears not to be associated with the severity of MVA-related physical injury. Depression and Anxiety 24:244,250, 2007. © 2006 Wiley,Liss, Inc. [source]

    High-end specificity of the children's depression inventory in a sample of anxiety-disordered youth

    Jonathan S. Comer M.A.
    Abstract Using a receiver operating characteristic (ROC) analysis, the present study investigated the ability of the Children's Depression Inventory (CDI) to correctly detect depression in a sample of treatment-seeking anxious youth (N=44). The ADIS-C/P was used to determine diagnostic status of participants. Anxious children who met diagnostic criteria for a depressive disorder scored higher on the CDI than anxious children who did not meet criteria for a depressive disorder, supporting the CDI as a continuous measure of depressive symptomatology. In contrast, with regard to detecting a depressive disorder, CDI cut scores did not achieve favorable values across diagnostic utility indices (including the cut score of 13 that has been recommended). These findings support the CDI as a continuous measure of depressive symptoms, but do not support the CDI as a sole assessment for a diagnosis of depression within a sample of anxiety-disordered youth. Depression and Anxiety 22:11,19, 2005. © 2005 Wiley-Liss, Inc. [source]

    Cross-cultural evaluation of the Panic Disorder Severity Scale in Japan

    Ikuyo Yamamoto M.D.
    Abstract The Panic Disorder Severity Scale (PDSS) [Shear et al., 1997] is rapidly gaining world-wide acceptance as a standard global severity measure of panic disorder, however, its cross-cultural validity and reliability have not been reported yet. We developed the Japanese version of the PDSS and examined its factor structure, internal consistency and inter-rater reliability and concurrent validity among Japanese patients with panic disorder with or without agoraphobia. We also established rules of thumb for interpreting PDSS total scores, taking the Clinical Global Impression severity scale as the anchoring criterion. The identical one-factor structure of the PDSS was confirmed among the Japanese patients as among the United States patients. Both internal and inter-rater reliability was excellent (Cronbach's alpha was 0.86, and ANOVA ICCs were all above 0.90). Concurrent validity of the PDSS items with self-report questionnaires tapping similar or overlapping domains was satisfactory (Pearson correlation coefficients were mostly above 0.5). Using the anchor-based approach, the following interpretative guides are suggested: among those with established panic disorder diagnosis, PDSS total scores up to 10 correspond with "mild," those between 11 and 15 with "moderate," and those at or above 16 correspond with "severe" panic disorder. The present findings support the cross-cultural generalizability of panic disorder symptomatology and of the PDSS, in particular. Depression and Anxiety 20:17,22, 2004. © 2004 Wiley-Liss, Inc. [source]

    Cognitive,behavioral therapy with childhood anxiety disorders: Functioning in adolescence

    Katharina Manassis M.D.
    Abstract We examined anxiety symptoms, anxiety-related impairment, and further treatment in adolescents who received cognitive behavioral therapy (CBT) for childhood anxiety disorders 6,7 years previously. Forty-three adolescents and their parents (14 boys, 29 girls; mean age 16.7 years) participated in structured telephone interviews. Participants (68% of initial sample of 63) did not differ in age, diagnostic profile, socioeconomic status, or initial severity from nonparticipants but more girls than boys participated. Indices based on child- and parent-reported symptoms and impairment were calculated, and within-sample comparisons by age, gender, diagnosis, and initial severity were done using t tests. Predictors of symptoms and impairment were also examined. On average, adolescents reported modest levels of anxiety-related impairment. Further treatment for anxiety had occurred in 30% (13 of 43) of patients. Stepwise regressions found female gender and diagnosis other than generalized anxiety disorder predictive of increased symptoms by parent report, and initial severity predicted adolescent-reported impairment. Adolescents showed limited internalizing symptomatology and impairment but almost one third had required further treatment. Studies comparing treated and untreated samples are needed to clarify whether CBT alters the natural history of childhood anxiety disorders and to replicate our findings regarding predictors of symptomatology and impairment. Depression and Anxiety 00:000,000, 2004. © 2004 Wiley-Liss, Inc. [source]

    Cognitive mediation of panic reduction during an early intervention for panic

    P. Meulenbeek
    Meulenbeek P, Spinhoven P, Smit F, van Balkom A, Cuijpers P. Cognitive mediation of panic reduction during an early intervention for panic. Objective:, This study investigated cognitive mediation of improvement in panic disorder (PD) symptomatology during and after an early intervention for panic symptoms in subthreshold and mild PD. Method:, We executed a pragmatic, pre-post, two-group, multi-site, randomized trial of an early intervention for panic symptoms, based on cognitive-behavioural therapy, vs. a wait-list control group in a sample of 217 participants with subthreshold PD or mild PD. Results:, First, two of the three subscales of the mediator variable Panic Appraisal Inventory (PAI-anticipation and PAI-coping) significantly mediated residual change in PD symptomatology on the PD Severity Scale-Self Report. Second, preintervention to postintervention PAI-anticipation and PAI-coping change scores significantly predicted postintervention to follow-up change in PD symptomatology after controlling for other change scores. However, the converse association was also significant. Conclusion:, The results suggest that changes in cognitions may mediate changes in PD symptomatology and that the process of change is circular. [source]

    No evidence for switching the antidepressant: systematic review and meta-analysis of RCTs of a common therapeutic strategy

    T. Bschor
    Bschor T, Baethge C. No evidence for switching the antidepressant: systematic review and meta-analysis of RCTs of a common therapeutic strategy. Objective:, Switching antidepressants is a common strategy for managing treatment-resistant depressed patients. However, no systematic reviews have been conducted to date. Method:, We systematically searched MEDLINE/EMBASE/Cochrane Central Register of Controlled Trials and additional sources. We included double-blind studies of patients with depressive symptomatology who were not responding to initial antidepressant monotherapy and were subsequently randomized to another antidepressant or to continue the same antidepressant. Results were pooled for meta-analysis of response + remission rates using a fixed-effects model. Results:, A total of three studies were included. Switching to another antidepressant was not superior to continuing the initial antidepressant in any of these studies. Our meta-analysis showed no significant advantages to either strategy and no significant heterogeneity of results [OR for response rates: 0.85 (95% CI: 0.55,1.30) favoring continuing]. Conclusion:, There is a discrepancy between the published evidence and the frequent decision to switch antidepressants, indicating an urgent need for more controlled studies. Pending such studies we recommend that physicians rely on more thoroughly evaluated strategies. [source]