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Biomedical subjects

A House

Publications and source records attributed to A House.

At least 19 recordsLinked to original sources
PubMed1991

Mood disorders in the year after first stroke.

An unselected community sample of 128 patients were studied over the 12 months after their first stroke, and compared with a control sample of subjects from the general population. Psychiatric status was assessed using the PSE and BDI. Symptoms of mood disorder were commoner in the stroke patients than the controls, but the differences were not substantial and had largely disappeared by 12 months. Psychiatric problems encountered included agoraphobia, social withdrawal, apathy and self-neglect, irritability and pathological emotionalism. While there was a high cumulative incidence of psychiatric disorder, little of it persisted: only two cases of major depression were present for the whole 12 months. We believe undue emphasis has been placed in the recent literature on major depression as a specific syndrome following stroke.

Adolescent↗
PubMed1990

The relationship between intellectual impairment and mood disorder in the first year after stroke.

In a community-based study of patients with a first-ever stroke, intellectual impairment (as defined by scores on a common screening test for dementia, the Mini-Mental State Examination) was found in 26% at 1 month post-stroke, and in 21% at 6 and 12 month follow-up. Low scores on the screening test were associated with greater age, physical disability before the stroke, larger stroke lesion volumes as measured on CT scan, and non-stroke changes such as atrophy and white matter low attenuation on the CT scan. There was a negative correlation between scores on the Mini-Mental State Examination and symptom levels on two measures of mood disorder. However, there was no evidence of a specific relationship between major depression and low scores on the Mini-Mental State. We examined various aspects of the relationship between mood symptoms and low scores on the Mini-Mental State, but found no evidence to support the suggestion that this relationship represented an example of depressive pseudodementia. We discuss the significance of our findings for clinical psychiatry and neuropsychology.

Adolescent↗
PubMed1990

Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume.

Sixty surviving patients from a community-based stroke register who had CT scan evidence of a single brain lesion and neurological signs appropriate to it were interviewed three to five years following their first-ever stroke. Mood disorder (anxiety and depression), physical disability, and intellectual impairment were assessed using standardized measures. The position and volume of the brain lesion was determined from CT scans performed soon after the stroke. The prevalence of depressive disorder was lower in this sample than that reported in previous studies (DSM-IIIR major depression 8.3%; all DSM-IIIR depressive disorders 18.3%). Reports by other workers for an association of depressive disorder either with left-sided brain lesions, or with anteriorly placed lesions in the left cerebral hemisphere, were not supported. Neither was there evidence of a correlation between symptom score and proximity of the lesion to the anterior pole of the left cerebral hemisphere. Psychiatric symptom scores were however greater with larger volume brain lesions. Anxiety disorders, especially agoraphobia, were relatively common (20% if diagnosed in the presence of depressive disorder), but were not related to lesion location or volume.

Activities of Daily Living↗
PubMed1990

Mood disorders after stroke and their relation to lesion location. A CT scan study.

In a community-based study of stroke survivors, we identified 73 consecutive patients with a stroke, the first ever in a lifetime, who had a CT scan which showed a neurologically appropriate single stroke lesion, and who did not have a psychiatric disorder in the year preceding the stroke. A detailed follow-up study of these patients using standardized psychiatric assessments failed to confirm a number of recent claims about poststroke depressive disorders. We found no evidence that left-sided lesions were associated with more severe or persistent depressive symptoms, or that right-sided lesions were associated with hypomania. The DSM III syndrome of major depression was much less common than has previously been reported, and was not specifically associated with lesions placed anteriorly in the left hemisphere. There was a weak correlation between mood symptom scores and the proximity of the stroke lesion to the frontal pole of the hemisphere, but no evidence of a difference between right and left hemisphere strokes in the nature of the relationship between lesion distribution and mood symptoms. We suggest that previous studies have different findings because of differences in the conventions applied to the definition and measurement of psychiatric disorders after stroke, and because other studies have concentrated on selected inpatient populations.

Adolescent↗
PubMed1990

Life events and difficulties preceding stroke.

Life events and difficulties were recorded for the year before stroke, using a standardised semi-structured interview, in 113 surviving patients seen after their first ever in a lifetime stroke. An age and sex-matched control group (n = 109) was also interviewed about the preceding year. The stroke patients reported fewer non-threatening events and events with only a short-term threat, while difficulties were reported with equal frequency by the two groups. However, events which were severely threatening in the long-term were significantly more common in the stroke patients (in the 52 weeks before stroke 26% versus 13%, odds ratio 2.3, 95% confidence interval 1.1-4.9). The increased rate was apparent throughout the year and not just in the weeks immediately before stroke onset. The number of stroke patients experiencing severe events in the follow up year fell to the level found in the control group. Recognised risk factors for stroke were found equally in those patients with and without severe events before onset, except that hypertension was rather less common in the patients who had experienced a severe event. It therefore appears that severe life events may be one of the determinants of stroke onset.

Adolescent↗
PubMed1990

Prison suicides.

Explore the source record for details and available documents.

Humans↗
PubMed1989

Emotionalism after stroke.

OBJECTIVE: To estimate the prevalence of emotionalism after stroke, to assess its relation with other mood disorders, and to identify clinical variables with which it is associated. DESIGN: Descriptive study of a cohort of patients consecutively entered on a community stroke register. SETTING: Community based research project. PATIENTS: A total of 128 patients who had suffered first ever stroke. INTERVENTIONS AND END POINTS: Patients were interviewed by a psychiatrist at 1, 6, and 12 months after stroke. Mood state was assessed by standardised semistructured interview (present state examination) and self report (Beck depression inventory). Intellectual impairment was assessed by mini mental state examination and Frenchay aphasia screening test. In addition, stroke lesions were localised by computed tomography. MAIN RESULTS: Emotionalism was reported by 13 of 89 patients (15%) at one month, 25 of 119 (21%) at six months, and 12 of 112 (11%) at 12 months after stroke. Patients with emotionalism had higher scores on both measures of mood disorder (at 6 months: mean Beck score 10.5 v 6.4; present state examination score 7.2 v 5.1) and more diagnosable psychiatric disorder (at 6 months: 40% v 14%; odds ratio 4.2, 95% confidence interval 1.5 to 11.9). Almost all episodes were provoked by clearly identified and appropriate emotional experiences. Patients with emotionalism also had more intellectual impairment and larger lesions on computed tomography. Lesions in the left frontal and temporal regions were particularly associated with emotionalism: at 6 months 8 of 14 patients (57%) with such lesions had emotionalism compared with 10 of 52 (19%) of those with lesions elsewhere (odds ratio 5.6, 95% confidence interval 1.4 to 22). CONCLUSIONS: Emotionalism is common after stroke. It is neither emotionally meaningless and inappropriate, nor is it found mostly in patients with bilateral brain damage. Emotionalism is associated with symptoms of a more general mood disturbance and is found especially in patients with left frontal and temporal lesions.

Affective Symptoms↗
PubMed1989

Psychiatric referrals from a renal unit: a study of clinical practice in a British hospital.

Renal patients referred for a psychiatric opinion were compared with patients from the same unit who had never seen a psychiatrist. Overall the referrals had more psychiatric symptoms, but syndrome profiles of the two groups were very similar. In diagnostic terms, the referrals differed in having a range of adjustment disorders characterised by changes other than simple mood disturbance. There were relatively few major mental illnesses. Three other factors were associated with referral: youth, absence of a confiding relationship; and currently receiving haemodialysis. Most referrals were managed with short term non-intensive therapies, and there was little need for psychiatric in patient care. Psychiatric disorder did not influence survival. The significance of these findings for renal unit psychiatry is discussed.

Adult↗
PubMed1989

Hypochondriasis and related disorders. Assessment and management of patients referred for a psychiatric opinion.

This article outlines the main components of a comprehensive plan for the assessment and management of patients referred for a psychiatric opinion with hypochondriasis and related disorders. Particular emphasis is placed on the discussion of attitudes to previous medical contact, to the value of physical investigations, and to the psychiatric referral itself; these attitudes are often neglected and yet are of clinical importance because they are usually associated with resistance to psychiatric treatment. A short-term flexible therapeutic approach to the presenting syndrome itself is outlined, which is based on cognitive-behavioral strategies used in other emotional disorders and on the literature on hypochondriasis. Clinical experience with this approach suggests that nonattendance may be high even in those who present for initial assessment, but that for attenders the prognosis may be good, with 80% showing a marked or moderate improvement on discharge. Younger patients, those with a past psychiatric history, and those receiving state benefits did worse, and those with major depression had the best prognosis. Social function, personal distress, and preoccupation with symptoms all tend to improve more than the underlying physical symptoms themselves.

Adult↗
PubMed1989

Methods of identifying mood disorders in stroke patients: experience in the Oxfordshire Community Stroke Project.

Four simple methods for assessing mood disorders were examined in a cohort of stroke patients: the Beck Depression Inventory; a visual analogue mood scale; a nurses' depression rating; and a carers' depression rating. None of the measures was entirely satisfactory, either because of inaccuracy when compared to a standardized psychiatric interview, or because of low response rates. A review of their case records showed that the patients' general practitioners were aware of nearly all those with severe persistent mood disorders. The implications of these findings for clinical practice are discussed.

Cerebrovascular Disorders↗