Pub Date : 2002-03-01DOI: 10.2190/7QNE-ENF5-2KEL-723X
J. Gallo, L. Meredith, J. Gonzales, L. Cooper, P. Nutting, D. Ford, L. Rubenstein, K. Rost, K. Wells
Objectives: The purpose of this investigation was to assess the relationship of primary care specialty training with self-assessed skill, knowledge, attitudes, and behavior toward depression recognition and management. Method: A baseline self-report questionnaire was administered to 184 internists and 138 family physicians participating in a multisite depression intervention study. Results: There were no marked differences in knowledge of internists and family physicians regarding depression, in attitudes about the effectiveness of specific therapies, or in barriers to providing optimum treatment for depression. However, compared to internists, family physicians rated themselves as more skilled in the management of depression. When considering management of patients with moderate to severe depression, family physicians were more likely to report that they prescribed a selective serotonin-reuptake inhibitor (relative odds (RO) = 3.51, 95 percent Confidence interval (CI) [2.19, 5.60] and to personally counsel patients (RO = 1.97, 95 percent CI [1.16, 3.38]) more than half the patients, but were less likely to refer to a specialist in mental health (RO = 0.52, 95 percent CI [0.33, 0.82]) than were internists. Additional potentially influential characteristics did not wholly account for the reported differences in practice according to specialty. Physicians of both specialties expressed considerable uncertainty in their knowledge of psychotherapy and in their evaluation of the effectiveness of other strategies for the prevention of recurrence of depression. Conclusion: Strategies to improve mental health care should account for the orientation of primary care physicians to mental health issues.
{"title":"Do Family Physicians and Internists Differ in Knowledge, Attitudes, and Self-Reported Approaches for Depression?","authors":"J. Gallo, L. Meredith, J. Gonzales, L. Cooper, P. Nutting, D. Ford, L. Rubenstein, K. Rost, K. Wells","doi":"10.2190/7QNE-ENF5-2KEL-723X","DOIUrl":"https://doi.org/10.2190/7QNE-ENF5-2KEL-723X","url":null,"abstract":"Objectives: The purpose of this investigation was to assess the relationship of primary care specialty training with self-assessed skill, knowledge, attitudes, and behavior toward depression recognition and management. Method: A baseline self-report questionnaire was administered to 184 internists and 138 family physicians participating in a multisite depression intervention study. Results: There were no marked differences in knowledge of internists and family physicians regarding depression, in attitudes about the effectiveness of specific therapies, or in barriers to providing optimum treatment for depression. However, compared to internists, family physicians rated themselves as more skilled in the management of depression. When considering management of patients with moderate to severe depression, family physicians were more likely to report that they prescribed a selective serotonin-reuptake inhibitor (relative odds (RO) = 3.51, 95 percent Confidence interval (CI) [2.19, 5.60] and to personally counsel patients (RO = 1.97, 95 percent CI [1.16, 3.38]) more than half the patients, but were less likely to refer to a specialist in mental health (RO = 0.52, 95 percent CI [0.33, 0.82]) than were internists. Additional potentially influential characteristics did not wholly account for the reported differences in practice according to specialty. Physicians of both specialties expressed considerable uncertainty in their knowledge of psychotherapy and in their evaluation of the effectiveness of other strategies for the prevention of recurrence of depression. Conclusion: Strategies to improve mental health care should account for the orientation of primary care physicians to mental health issues.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"8 1","pages":"1 - 20"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90714106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-12-01DOI: 10.2190/JDGG-GHA8-QQ60-UBRJ
R. Sansone, Theresa Sparkman
Psychiatric research is continuing to expand in the primary care setting. Because of this, we wish to describe our difficulties in completing a Time-1/Time-2 study among patients in an internal medicine, resident-based outpatient clinic. At Time-1, subjects (N= 120) were 34 males and 86 females. Age ranged between 19 and 54 years (M = 36.03, SD = 8.92). Most were Caucasian (91 percent) and had obtained a high school diploma (85 percent), with 18 percent reporting a bachelor’s degree or higher. Each participant was recruited through the clinic receptionist to participate in a study “examining stress and physical symptoms.” Exclusion criteria were cognitive impairment or illness severity that would preclude participation. Participation entailed the onsite completion of a research booklet (about 20 minutes) that contained a demographic inquiry, childhood abuse questionnaire, somatization inventory, depression scale, worry scale, and two self-report measures of borderline personality disorder. Subjects were also asked, “Would you be willing to be contacted for future research?” with response options of “yes” or “no.” At Time-2 (10 months later), we attempted to contact all subjects (N = 98) who acknowledged their willingness to participate in future research for enrollment in a second related project (completion of a research booklet and a 60-minute interview). We initially attempted contact by telephone (28 percent contact with answering machine, only; 10 percent contact with a family member, only; 16 percent telephone repeatedly busy or no answer; 11 percent contacted but declined participation; 8 percent contacted and participated; 25 percent no contact due to death, no telephone, telephone disconnected, or incorrect number). Two months
{"title":"The Perils of Time-1/Time-2 Psychiatric Research in an Internal Medicine Clinic","authors":"R. Sansone, Theresa Sparkman","doi":"10.2190/JDGG-GHA8-QQ60-UBRJ","DOIUrl":"https://doi.org/10.2190/JDGG-GHA8-QQ60-UBRJ","url":null,"abstract":"Psychiatric research is continuing to expand in the primary care setting. Because of this, we wish to describe our difficulties in completing a Time-1/Time-2 study among patients in an internal medicine, resident-based outpatient clinic. At Time-1, subjects (N= 120) were 34 males and 86 females. Age ranged between 19 and 54 years (M = 36.03, SD = 8.92). Most were Caucasian (91 percent) and had obtained a high school diploma (85 percent), with 18 percent reporting a bachelor’s degree or higher. Each participant was recruited through the clinic receptionist to participate in a study “examining stress and physical symptoms.” Exclusion criteria were cognitive impairment or illness severity that would preclude participation. Participation entailed the onsite completion of a research booklet (about 20 minutes) that contained a demographic inquiry, childhood abuse questionnaire, somatization inventory, depression scale, worry scale, and two self-report measures of borderline personality disorder. Subjects were also asked, “Would you be willing to be contacted for future research?” with response options of “yes” or “no.” At Time-2 (10 months later), we attempted to contact all subjects (N = 98) who acknowledged their willingness to participate in future research for enrollment in a second related project (completion of a research booklet and a 60-minute interview). We initially attempted contact by telephone (28 percent contact with answering machine, only; 10 percent contact with a family member, only; 16 percent telephone repeatedly busy or no answer; 11 percent contacted but declined participation; 8 percent contacted and participated; 25 percent no contact due to death, no telephone, telephone disconnected, or incorrect number). Two months","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"138 1","pages":"451 - 453"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82830863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-12-01DOI: 10.2190/A2E4-976Y-BW2Q-D9XX
A. Leon, L. Portera, J. Walkup
Objective: There is literature demonstrating elevated prevalence of depression in primary care. Yet there remains a need for a brief depression screen designed and evaluated specifically for use among medically ill patients. Our objective was to develop and validate a brief, unobtrusive screen for depression among severely medically ill long-term disability claimants. Methods: The study sample consisted of 480 long-term disability claimants, less than 55 years of age, with one of the following illnesses: cancer, diabetes, myocardial infarction, rheumatoid arthritis, stroke, or multiple sclerosis. Each subject completed a questionnaire that included 26 potential screening items. A subset of subjects was administered the SCID, which served as the gold standard for the DSM-IV depression and dysthymia diagnoses. Results: The Brief Depression Screen, a three-item screen for major depressive disorder and dysthymia, was developed. About 34 percent of the sample met criteria for major depressive disorder or dysthymia. The Brief Depression Screen detected 75 percent of those subjects in this sample. Furthermore, nearly half of the subjects with positive screen results met criteria for depression or dysthymia. These results are comparable to those of the eight-item Burnam screen, but not as sensitive as the more widely used, twenty item CES-D. Conclusion: The Brief Depression Screen was developed and evaluated for use with severely ill long-term disability claimants. In practice, a positive screen for depression is to be followed with a comprehensive diagnostic assessment that could be conducted by a trained clinician. Further research is warranted to determine whether the identification and treatment of depression in disability claimants with non-psychiatric medical illnesses will facilitate return to work, even in the presence of comorbid medical illnesses.
{"title":"The Development and Evaluation of the Brief Depression Screen in Medically Ill Disability Claimants","authors":"A. Leon, L. Portera, J. Walkup","doi":"10.2190/A2E4-976Y-BW2Q-D9XX","DOIUrl":"https://doi.org/10.2190/A2E4-976Y-BW2Q-D9XX","url":null,"abstract":"Objective: There is literature demonstrating elevated prevalence of depression in primary care. Yet there remains a need for a brief depression screen designed and evaluated specifically for use among medically ill patients. Our objective was to develop and validate a brief, unobtrusive screen for depression among severely medically ill long-term disability claimants. Methods: The study sample consisted of 480 long-term disability claimants, less than 55 years of age, with one of the following illnesses: cancer, diabetes, myocardial infarction, rheumatoid arthritis, stroke, or multiple sclerosis. Each subject completed a questionnaire that included 26 potential screening items. A subset of subjects was administered the SCID, which served as the gold standard for the DSM-IV depression and dysthymia diagnoses. Results: The Brief Depression Screen, a three-item screen for major depressive disorder and dysthymia, was developed. About 34 percent of the sample met criteria for major depressive disorder or dysthymia. The Brief Depression Screen detected 75 percent of those subjects in this sample. Furthermore, nearly half of the subjects with positive screen results met criteria for depression or dysthymia. These results are comparable to those of the eight-item Burnam screen, but not as sensitive as the more widely used, twenty item CES-D. Conclusion: The Brief Depression Screen was developed and evaluated for use with severely ill long-term disability claimants. In practice, a positive screen for depression is to be followed with a comprehensive diagnostic assessment that could be conducted by a trained clinician. Further research is warranted to determine whether the identification and treatment of depression in disability claimants with non-psychiatric medical illnesses will facilitate return to work, even in the presence of comorbid medical illnesses.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"121 1","pages":"389 - 400"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82439770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-12-01DOI: 10.2190/F4MP-KLYE-VED4-3LDD
D. King, A. Mainous, T. Steyer, W. Pearson
Objective: Previous studies have shown an association between attendance at religious services and health, particularly cardiovascular morbidity and mortality. Little research has focused on religious attendance and physiological markers of cardiovascular risk. The purpose of this study was to explore the relationship between religious attendance and inflammatory markers of cardiovascular risk. Method: Nationally representative sample of non-institutionalized United States adults aged 40 and over derived from the National Health and Nutrition Examination Survey III 1988–1994 (n = 10,059). The main outcome measures were the inflammatory system markers C-reactive protein, fibrinogen, and white blood cell count. Results: 40.8 percent of the population attended religious services 40 or more times in the previous year while 22.4 percent attended services less than 40 times and 36.8 percent attended no religious services at all. Non-attenders of religious services were more likely than attenders to have elevated white blood cell counts (p = .001), highly elevated C-reactive protein (p = .02), and elevated fibronogen (p = .05). After adjusting for demographic variables, health status, and BMI, the association between religious attendance and cardiovascular markers remained. Once current smoking was added to the model the independent effect of religious attendance dropped below conventional confidence limits. Conclusions: These findings suggest that people who have attended religious services in the previous year are less likely to have elevated levels of certain inflammatory markers, however, current smoking has significant shared variance with religious attendance.
{"title":"The Relationship between Attendance at Religious Services and Cardiovascular Inflammatory Markers","authors":"D. King, A. Mainous, T. Steyer, W. Pearson","doi":"10.2190/F4MP-KLYE-VED4-3LDD","DOIUrl":"https://doi.org/10.2190/F4MP-KLYE-VED4-3LDD","url":null,"abstract":"Objective: Previous studies have shown an association between attendance at religious services and health, particularly cardiovascular morbidity and mortality. Little research has focused on religious attendance and physiological markers of cardiovascular risk. The purpose of this study was to explore the relationship between religious attendance and inflammatory markers of cardiovascular risk. Method: Nationally representative sample of non-institutionalized United States adults aged 40 and over derived from the National Health and Nutrition Examination Survey III 1988–1994 (n = 10,059). The main outcome measures were the inflammatory system markers C-reactive protein, fibrinogen, and white blood cell count. Results: 40.8 percent of the population attended religious services 40 or more times in the previous year while 22.4 percent attended services less than 40 times and 36.8 percent attended no religious services at all. Non-attenders of religious services were more likely than attenders to have elevated white blood cell counts (p = .001), highly elevated C-reactive protein (p = .02), and elevated fibronogen (p = .05). After adjusting for demographic variables, health status, and BMI, the association between religious attendance and cardiovascular markers remained. Once current smoking was added to the model the independent effect of religious attendance dropped below conventional confidence limits. Conclusions: These findings suggest that people who have attended religious services in the previous year are less likely to have elevated levels of certain inflammatory markers, however, current smoking has significant shared variance with religious attendance.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"28 1","pages":"415 - 425"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88023596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: We report a case of severe depression in an elderly and critically ill patient with multiple medical complications who was treated with a combination of methylphenidate and sertraline. The objective of this report is to outline the usefulness of methylphenidate as an antidepressant in a patient with respiratory insufficiency. Method: Case description. Results: The patient had a positive clinical response with initial mental confusion due to methylphenidate. An initial dose of 2.5 mg/day allowed antidepressant response and improvement of respiratory function permitting the removal of mechanical ventilation. Conclusion: Methylphenidate may be useful for patients with severe medical conditions including ventilatory insufficiency.
{"title":"Methylphenidate in a Patient with Depression and Respiratory Insufficiency","authors":"Danusa Céspedes Guizzo Ayache, Renério Fráguas Júnior","doi":"10.2190/CXNE-0UFR-7Q04-CQ3M","DOIUrl":"https://doi.org/10.2190/CXNE-0UFR-7Q04-CQ3M","url":null,"abstract":"Objective: We report a case of severe depression in an elderly and critically ill patient with multiple medical complications who was treated with a combination of methylphenidate and sertraline. The objective of this report is to outline the usefulness of methylphenidate as an antidepressant in a patient with respiratory insufficiency. Method: Case description. Results: The patient had a positive clinical response with initial mental confusion due to methylphenidate. An initial dose of 2.5 mg/day allowed antidepressant response and improvement of respiratory function permitting the removal of mechanical ventilation. Conclusion: Methylphenidate may be useful for patients with severe medical conditions including ventilatory insufficiency.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"18 1","pages":"443 - 449"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89083418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-12-01DOI: 10.2190/61ME-F2M0-3PH5-G59E
J. Cook, P. Areán, P. Schnurr, J. Sheikh
Objective: The current study explored the relationship between past traumatic experiences and current depression in a sample of depressed older adult primary care patients. Method: Sixty-six patients were referred from primary care to a psychogeriatric clinic that specialized in the treatment of unipolar depressive disorders. All patients received an extensive psychological assessment. Results: Twenty-one percent had a history of trauma reported in their medical charts. Despite no differences found on a clinician-rated measure of depression, those with a trauma history had more depressive symptoms on a self-report measure. Conclusions: Although older patients with a history of trauma may not appear more depressed than a non-trauma comparison group, they may be in more psychological distress. The clinical implications of these findings and recommendations for mental health professionals are discussed.
{"title":"Symptom Differences between Older Depressed Primary Care Patients with and without History of Trauma","authors":"J. Cook, P. Areán, P. Schnurr, J. Sheikh","doi":"10.2190/61ME-F2M0-3PH5-G59E","DOIUrl":"https://doi.org/10.2190/61ME-F2M0-3PH5-G59E","url":null,"abstract":"Objective: The current study explored the relationship between past traumatic experiences and current depression in a sample of depressed older adult primary care patients. Method: Sixty-six patients were referred from primary care to a psychogeriatric clinic that specialized in the treatment of unipolar depressive disorders. All patients received an extensive psychological assessment. Results: Twenty-one percent had a history of trauma reported in their medical charts. Despite no differences found on a clinician-rated measure of depression, those with a trauma history had more depressive symptoms on a self-report measure. Conclusions: Although older patients with a history of trauma may not appear more depressed than a non-trauma comparison group, they may be in more psychological distress. The clinical implications of these findings and recommendations for mental health professionals are discussed.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"79 1","pages":"401 - 414"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86272432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-12-01DOI: 10.2190/5VPD-WGL1-MTWN-6JA6
Catherine A. Birndorf, Alison Madden, L. Portera, A. Leon
Objective: To examine psychiatric symptomatology and associated functional impairment among pregnant women; and to examine the obstetrical patient's receptivity to discussion of and intervention regarding emotional distress. Methods: Fifty-seven patients 16 weeks or less pregnant presenting for routine obstetrical appointments at a faculty practice at a major medical center participated in this study. Each completed a self-administered assessment packet regarding psychopathology, functional impairment and service utilization attitudes. Statistical analyses were performed using chi-square and Mann-Whitney tests. Results: Seventeen subjects (29.8 percent) screened positive for at least one anxiety disorder. Fourteen of those subjects also screened positive for depression. Those with positive screens for either anxiety and/or depression had significantly higher levels of functional impairment. Only five (29.4 percent) of the 17 subjects with positive screens reported having discussed an emotional issue with their Ob/Gyn, although 14 (82.4 percent) said that they would be willing to do so. All subjects (100 percent) reported that they would see a mental health professional if their Ob/Gyn referred them. Conclusion: Routine screens for mental disorders in early pregnancy appear to be a useful adjunct in an obstetrical setting. Although most had never discussed their emotional concerns with their Ob/Gyn, a substantial proportion of our study sample reported psychiatric symptomatology and significant levels of functional impairment that had not been recognized by their Ob/Gyn. All of the patients in our study sample reported a willingness to see a mental health professional if their Ob/Gyn referred them. Further studies investigating the benefits of antenatal diagnosis and treatment of psychiatric disorders are warranted.
{"title":"Psychiatric Symptomsc, Functional Impairment, and Receptivity toward Mental Health Treatment among Obstetrical Patients","authors":"Catherine A. Birndorf, Alison Madden, L. Portera, A. Leon","doi":"10.2190/5VPD-WGL1-MTWN-6JA6","DOIUrl":"https://doi.org/10.2190/5VPD-WGL1-MTWN-6JA6","url":null,"abstract":"Objective: To examine psychiatric symptomatology and associated functional impairment among pregnant women; and to examine the obstetrical patient's receptivity to discussion of and intervention regarding emotional distress. Methods: Fifty-seven patients 16 weeks or less pregnant presenting for routine obstetrical appointments at a faculty practice at a major medical center participated in this study. Each completed a self-administered assessment packet regarding psychopathology, functional impairment and service utilization attitudes. Statistical analyses were performed using chi-square and Mann-Whitney tests. Results: Seventeen subjects (29.8 percent) screened positive for at least one anxiety disorder. Fourteen of those subjects also screened positive for depression. Those with positive screens for either anxiety and/or depression had significantly higher levels of functional impairment. Only five (29.4 percent) of the 17 subjects with positive screens reported having discussed an emotional issue with their Ob/Gyn, although 14 (82.4 percent) said that they would be willing to do so. All subjects (100 percent) reported that they would see a mental health professional if their Ob/Gyn referred them. Conclusion: Routine screens for mental disorders in early pregnancy appear to be a useful adjunct in an obstetrical setting. Although most had never discussed their emotional concerns with their Ob/Gyn, a substantial proportion of our study sample reported psychiatric symptomatology and significant levels of functional impairment that had not been recognized by their Ob/Gyn. All of the patients in our study sample reported a willingness to see a mental health professional if their Ob/Gyn referred them. Further studies investigating the benefits of antenatal diagnosis and treatment of psychiatric disorders are warranted.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"171 1","pages":"355 - 365"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91047999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-12-01DOI: 10.2190/TUJB-B2M7-6UPV-XPLV
R. Bright, S. Eisendrath, L. Damon
Objective: We report the case of factitiously induced aplastic anemia by the ingestion of busulfan, a bifunctional alkylating chemotherapeutic agent used in the treatment of chronic myelogenous leukemia. The medical consequences and financial costs of this illness are reported. The reader will gain an understanding of the relevant clues to the diagnosis of a factitious hematologic illness, the psychodynamic issues present in this case and the legal, ethical and countertransferential issues raised by the case. Method: A single case review including medical and billing records, patient and staff interviews and literature review. Results: The covert ingestion of busulfan by this patient resulted in life-threatening bone marrow suppression, bilateral aseptic hip necrosis, transfusion-dependent thrombocytopenia and a chronic pain syndrome. Her treatment was complicated by noncompliance with prescribed treatments and polymicrobial sepsis possibly secondary to the self-injection of feces into her central line. To date, the total cost of care for the treatment of this patient's medical complications secondary to her ingestion of busulfan exceeds $1,100,000.00. Conclusions: This case underscores the importance of the early recognition by the primary care physician of the possibility of a factitious etiology of hematologic abnormalities such as aplastic anemia due to the ingestion of bone marrow ablative medications. The index of suspicion is increased when the patient is a young health care provider, usually female, with atypical pancytopenia and an unusual disease course and response to treatment.
{"title":"A Case of Factitious Aplastic Anemia","authors":"R. Bright, S. Eisendrath, L. Damon","doi":"10.2190/TUJB-B2M7-6UPV-XPLV","DOIUrl":"https://doi.org/10.2190/TUJB-B2M7-6UPV-XPLV","url":null,"abstract":"Objective: We report the case of factitiously induced aplastic anemia by the ingestion of busulfan, a bifunctional alkylating chemotherapeutic agent used in the treatment of chronic myelogenous leukemia. The medical consequences and financial costs of this illness are reported. The reader will gain an understanding of the relevant clues to the diagnosis of a factitious hematologic illness, the psychodynamic issues present in this case and the legal, ethical and countertransferential issues raised by the case. Method: A single case review including medical and billing records, patient and staff interviews and literature review. Results: The covert ingestion of busulfan by this patient resulted in life-threatening bone marrow suppression, bilateral aseptic hip necrosis, transfusion-dependent thrombocytopenia and a chronic pain syndrome. Her treatment was complicated by noncompliance with prescribed treatments and polymicrobial sepsis possibly secondary to the self-injection of feces into her central line. To date, the total cost of care for the treatment of this patient's medical complications secondary to her ingestion of busulfan exceeds $1,100,000.00. Conclusions: This case underscores the importance of the early recognition by the primary care physician of the possibility of a factitious etiology of hematologic abnormalities such as aplastic anemia due to the ingestion of bone marrow ablative medications. The index of suspicion is increased when the patient is a young health care provider, usually female, with atypical pancytopenia and an unusual disease course and response to treatment.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"5 1","pages":"433 - 441"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91353994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-12-01DOI: 10.2190/6FK8-DBGL-MWR1-MV58
D. Iosifescu, Shauna Howarth, J. Alpert, A. Nierenberg, J. Worthington, M. Fava
Objective: We examined the correlation between the basal triiodothyronine resin uptake (T3-RU) levels in depressed subjects and the response to antidepressant treatment. Method: We treated with fluoxetine 235 outpatients meeting DSM-IV criteria for major depression. We measured T3 resin uptake (T3-RU) levels before the onset of treatment. The 17-item Hamilton Rating Scale for Depression (Ham-D-17) was administered before, during and after the eight weeks of treatment to assess changes in depressive symptoms. Results: 16 patients (6.8 percent) had low T3-RU levels (range 16.5–21), and 7 patients (3.0 percent) had high T3-RU levels (range 36–38). No relationship was found between T3-RU levels and clinical improvement, defined as either total Ham-D-17 score change or Ham-D-17 score ≤ 7 in the last 3 weeks of treatment, even after adjusting for baseline severity of depression. Conclusion: Abnormal T3-RU levels are rather uncommon in outpatient depression and do not correlate with the response to antidepressant treatment or lack thereof.
{"title":"T3 Blood Levels and Treatment Outcome in Depression","authors":"D. Iosifescu, Shauna Howarth, J. Alpert, A. Nierenberg, J. Worthington, M. Fava","doi":"10.2190/6FK8-DBGL-MWR1-MV58","DOIUrl":"https://doi.org/10.2190/6FK8-DBGL-MWR1-MV58","url":null,"abstract":"Objective: We examined the correlation between the basal triiodothyronine resin uptake (T3-RU) levels in depressed subjects and the response to antidepressant treatment. Method: We treated with fluoxetine 235 outpatients meeting DSM-IV criteria for major depression. We measured T3 resin uptake (T3-RU) levels before the onset of treatment. The 17-item Hamilton Rating Scale for Depression (Ham-D-17) was administered before, during and after the eight weeks of treatment to assess changes in depressive symptoms. Results: 16 patients (6.8 percent) had low T3-RU levels (range 16.5–21), and 7 patients (3.0 percent) had high T3-RU levels (range 36–38). No relationship was found between T3-RU levels and clinical improvement, defined as either total Ham-D-17 score change or Ham-D-17 score ≤ 7 in the last 3 weeks of treatment, even after adjusting for baseline severity of depression. Conclusion: Abnormal T3-RU levels are rather uncommon in outpatient depression and do not correlate with the response to antidepressant treatment or lack thereof.","PeriodicalId":22510,"journal":{"name":"The International Journal of Psychiatry in Medicine","volume":"27 1","pages":"367 - 373"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84356551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-12-01DOI: 10.2190/5RFM-C4UG-VVBL-3KV6
A. Marx, A. Bollmann, S. Dunbar, L. Jenkins, M. Hawthorne
Objective: To describe psychological reactions among family members of patients receiving an implantable cardioverter/defibrillator (ICD) during the first 9 months after implantation. Methods: Eighty-two family members (age 56 ± 12 years, 74 percent female, 79 percent married, 88 percent Caucasian) of ICD patients completed questionnaires regarding their mood (Profile of Mood State), cognitive illness appraisals (Meaning of Illness Questionnaire) and coping strategies (Jalowiec Coping Scale) prior to ICD implantation, and as well as 1 and 9 months postoperatively. Results: Total mood disturbance score (TMD), threat appraisal, and emotion- and problem-focused coping were highest prior to ICD implantation, and decreased during the first postoperative month showing stable values thereafter. There was no change in challenge appraisal. Multiple regression analysis found that the use of psychotropic drugs (anxiolytics, sedatives; Beta = .25), emotion-focused coping (Beta = .37), and challenge appraisal (Beta = .21) at 1 month accounted for 26 percent of variance in TMD at 9 months. Conclusion: A spouse's ICD implantation is a major stressful event for family members leading to a diminished mood state prior ICD implantation. Reduction in emotion-focused coping and the use of challenge appraisal may improve mood state in family members of ICD patients during early follow-up.
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