HSV-1 and risk of Alzheimer's disease.
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Aged↗
Biomedical subjects
B Faragher
Publications and source records attributed to B Faragher.
Does post-traumatic stress disorder occur after stroke: a preliminary study.
BACKGROUND AND PURPOSE: Psychological reactions after stroke have been recognized for some time. The present study examined whether psychological symptoms consistent with post-traumatic stress disorder (PTSD) could occur after stroke as a consequence of the sudden and unpredictable occurrence of a life-threatening internal stressor. METHODS: Sixty-one patients who had experienced a first-ever stroke or transient ischaemic attack were assessed using standard self-report clinical measures for anxiety, depression and PTSD. Those patients who fulfilled criteria on at least one PTSD self-report measure were subsequently assessed using a structured clinical interview for PTSD. RESULTS: Six (9.8%) patients fulfilled criteria for PTSD. No significant differences were found between the post-stroke PTSD group and the non-PTSD group in terms of premorbid health and lifestyle, or experiences of adverse life events. Significant differences were noted with respect to self-reported post-stroke mental health and premorbid neuroticism. The post-stroke PTSD group also scored consistently higher on measures of anxiety, depression and psychiatric caseness. CONCLUSIONS: The results of this study demonstrate a number of close similarities between post-stroke PTSD and classical PTSD. We therefore conclude that PTSD or a PTSD-like syndrome can occur after stroke.
Adult↗
Clinical factors associated with short-term changes in outcome of patients with somatized mental disorder in primary care.
BACKGROUND: There is little research that examines demographic, clinical and treatment factors associated with changes in physical symptoms, psychiatric symptoms and functional outcome in patients with somatized depression or anxiety in primary care. METHOD: Factors associated with the outcome of psychologized or somatized depression or anxiety were derived from the literature. These factors were tested individually for their effects on changes in physical symptoms, psychiatric symptoms and functional outcome between baseline consultation with the general practitioner and 1 or 3 months later in 215 patients with somatized depression or anxiety. Individual factors associated with a particular outcome, demographic, DSM-IV diagnosis and treatment variables were entered into a multiple regression analysis. RESULTS: Factors associated with a better outcome on all three types of outcome measure were the absence of generalized anxiety disorder and/or simple or social phobias, absence of physical pathology, and the prescription of fewer drugs, especially hypnotics or benzodiazepines. In addition, a better psychiatric symptom outcome was associated with the patients' perceived satisfaction with the general practitioner's understanding or explanation of the patient's problems. A better functional outcome was associated with having a job, less distress over physical symptoms, not receiving invalidity benefit and no referral to hospital. CONCLUSION: There are clinical and demographic factors associated with all types of short-term outcome in patients with somatized depression or anxiety but there are additional factors that are associated only with either psychiatric or functional outcome.
Adaptation, Psychological↗
A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression.
OBJECTIVE: To study the effectiveness of fluoxetine and cognitive-behavioural counselling in depressive illness in postnatal women: to compare fluoxetine and placebo, six sessions and one session of counselling, and combinations of drugs and counselling. DESIGN: Randomised, controlled treatment trial, double blind in relation to drug treatment, with four treatment cells: fluoxetine or placebo plus one or six sessions of counselling. SUBJECTS: 87 women satisfying criteria for depressive illness 6-8 weeks after childbirth, 61 (70%) of whom completed 12 weeks of treatment. SETTING: Community based study in south Manchester. MAIN OUTCOME MEASURES: Psychiatric morbidity after 1, 4, and 12 weeks, measured as mean scores and 95% confidence limits on the revised clinical interview schedule, the Edinburgh postnatal depression scale and the Hamilton depression scale. RESULTS: Highly significant improvement was seen in all four treatment groups. The improvement in subjects receiving fluoxetine was significantly greater than in those receiving placebo. The improvement after six sessions of counselling was significantly greater than after a single session. Interaction between counselling and fluoxetine was not statistically significant. These differences were evident after one week, and improvement in all groups was complete after four weeks. CONCLUSIONS: Both fluoxetine and cognitive-behavioural counselling given as a course of therapy are effective treatments for non-psychotic depression in postnatal women. After an initial session of counselling, additional benefit results from either fluoxetine or further counselling but there seems to be no advantage in receiving both. The choice of treatment may therefore be made by the women themselves.
Adult↗
Herpes simplex virus type 1 in brain and risk of Alzheimer's disease.
BACKGROUND: The apolipoprotein E epsilon 4 (APOE-epsilon 4) allele is a risk factor for Alzheimer's disease (AD), but it is neither essential nor sufficient for development of the disease. Other factors-genetic or environmental-must therefore have a role. By means of a PCR we have detected herpes simplex virus type 1 (HSV1) in latent form in brains of elderly people with and without AD. We have postulated that limited reactivation of the virus causes more damage in AD patients than in elderly people without AD because of a difference in the hosts. We now report the APOE genotypes of AD patients and non-AD sufferers with and without HSV1 in brain. METHODS: DNA was extracted from 84 samples of brain from 46 AD patients (39 temporal lobe, 39 frontal lobe, three hippocampus) and from 75 samples of brain from 44 non-AD elderly people (33 temporal lobe, 36 frontal lobe, six hippocampus). PCR amplification was used to detect HSV1 thymidine kinase gene and the host APOE gene. FINDINGS: By multiple logistic regression, the APOE-epsilon 4 allele frequency was significantly higher in the patients positive for HSV1 in brain than in the HSV1-negative AD group, the HSV1-positive non-AD group, or the HSV1-negative non-AD group (52.8% vs 10.0%, 3.6%, and 6.3%, respectively). The odds ratio for APOE-epsilon 4 in the HSV1-positive AD group compared with HSV1-negative non-AD group was 16.8 (95% CI 3.61-77.8) and in the HSV1-negative AD group, 1.67 (0.21-13.4). We also compared APOE genotypes of 40 people who had recurrent cold sores and 33 non-sufferers; the APOE-epsilon 4 allele frequencies were 36% and 9%, respectively (p < 0.0001). INTERPRETATION: These findings suggest that the combination of HSV1 in brain and carriage of an APOE-epsilon 4 allele is a strong risk factor for AD, whereas either of these features alone does not increase the risk of AD. The findings in people with cold sores support our hypothesis that APOE-epsilon 4 and HSV1 together are damaging in the nervous system.
Aged↗
Attitudes toward motherhood in postnatal depression: development of the Maternal Attitudes Questionnaire.
This article describes the development of the Maternal Attitudes Questionnaire (MAQ), a 14-item self-report instrument measuring cognitions relating to role change, expectations of motherhood, and expectations of the self as a mother in postnatal women. This questionnaire was found to have good test-retest and internal reliability. In a large sample of women (n = 483) at 6-8 weeks postpartum, scores on the questionnaire were highly correlated with scores on the Edinburgh Postnatal Depression Scale (EPDS) and the Revised Clinical Interview Schedule (CIS-R). Cluster analysis demonstrated that, among depressed women with similar symptom scores on the CIS-R, the MAQ discriminated a group with low MAQ scores and a group with high MAQ scores. This finding supports the hypothesis that women who are depressed postnatally are cognitively heterogeneous; such differences may be important in understanding the etiology and determining the treatment of postnatal depression.
Adult↗
The influence of small solute clearance on dietary protein intake in continuous ambulatory peritoneal dialysis patients: a methodologic analysis based on cross-sectional and prospective studies.
The statistical relationship between solute clearance (expressed as Kt/V) and dietary protein intake (DPI; estimated from the normalized protein catabolic rate [NPCR]) has led to the assumption that dialysis dose is one of the most important determinants of DPI in continuous ambulatory peritoneal dialysis patients. However, there is increasing concern about the clinical value of such a correlation between variables that contain common components. We have investigated the statistical nature of the cross-sectional correlation between Kt/V and NPCR using mathematical modelling. In addition, in a prospective study, the impact of increasing Kt/V on protein intake estimated from the NPCR and from 3-day food diaries (DPI) was evaluated in 59 patients over a 1-year period. Two thousand sets of random numbers were generated for the components, from which Kt/V and NPCR were calculated. The subsequent cross-sectional correlation between the randomly generated Kt/V and NPCR was highly significant (r = 0.64 to 0.74). In contrast, there was a much weaker cross-sectional correlation between relatively independent measures of dialysis dose (urea clearance) and protein intake measured from food diaries (r = 0.36). Analysis of the prospective relationship revealed a significant correlation with a decrease in urea clearance (due to loss of renal function) accompanied by a decrease in both PCR (r = -0.80) and DPI (r = -0.51). In contrast, when Kt/V was increased (by larger volume exchanges) there was no significant increase in protein intake. This study has demonstrated that the strength of the cross-sectional relationship between Kt/V and NPCR is due to mathematical coupling of "like with like," and this correlation cannot be used to substantiate a link between dialysis dose and nutrition. Prospective analysis does show a dependence of protein intake on urea clearance. However, this dependence is only seen in those patients undergoing a reduction in clearance due to loss of renal function. Increasing exchange volume to offset such losses was not accompanied by improvements in protein intake.
Adult↗
A prospective study of psychiatric and psychological aspects of Cushing's syndrome.
OBJECTIVE: Cushing's syndrome is associated with psychiatric and psychological disturbances. The aim of this study was to ascertain the extent of mental illness in patients before and after treatment for Cushing's syndrome. DESIGN AND PATIENTS: Patients with Cushing's syndrome were identified for a prospective study. Control patients were selected with pituitary adenomas secreting GH or PRL. The aim was to reassess patients after Cushing's syndrome had been treated. MEASUREMENTS: Psychiatric symptoms were measured and classified using the Present State Examination (PSE), and analysed on the Catego Programme. The Hamilton Rating Scale (HRS) was used to measure depression. The Crown-Crisp Experiential Index was used to measure common psychoneurotic symptoms (anxiety, phobia, obsession, somatic, depression and hysteria scales). The Eysenck Personality Inventory was used to assess extroversion and neuroticism. Cortisol, ACTH, and other hormones were measured by conventional methods. Parametric and non-parametric tests were used where appropriate. RESULTS: Catego analysis of psychiatric ratings showed only 8 patients of 43 with active Cushing's syndrome (19%) were normal. Psychiatric diagnoses were obtained as follows: neurotic depression in 20 (46%), possible neurotic depression in 1 (2%), reactive depression in 6 (14%), and non-specific neurotic symptoms in 8 (19%). Additional Catego ratings of suspected other psychoses were made for 3 patients who were also depressed. None of these 43 patients with active Cushing's syndrome had ratings of schizophrenia or mania, obsessional neurosis or pathological anxiety. In the control group 13 (87%) were normal, 1 patient with acromegaly had an anxiety state and one patient with a prolactinoma had neurotic depression. It was possible to reassess the Present State Examination after treatment in 25 patients, when cortisol levels had been substantially reduced (to normal in 88%), the percentage rated as psychiatrically normal increased from 19 to 68 (chi 2 = 11.7, 1 d.f., P < 0.01). Hamilton Rating Scale scores for depression showed significant improvements after treatment for Cushing's syndrome (mean decrease from 9.2 to 2.4, n = 36, P < 0.001). Crown-Crisp experiential index data showed significant improvements in anxiety, somatic symptoms, and depression (n = 25, P < 0.05). Eysenck Personality Inventory assessments showed a significant improvement in neuroticism score (n = 26 P = 0.016), but no significant change in extroversion (P = 0.5) or lie score (P = 0.6). CONCLUSIONS: Most patients with Cushing's syndrome had significant psychiatric pathology, usually depressive illness. As cortisol levels were returned to normal there were significant improvements in scores for depression and anxiety. Management of patients with Cushing's syndrome should include careful assessment of psychological and psychiatric illness.
Anxiety↗
The incidence of minor sequelae following anaesthesia in children.
A survey was performed to estimate the incidence of the minor sequelae of anaesthesia in children. During an eight-month period 266 children, aged five years and over, were personally interviewed by an anaesthetist following recovery from anaesthesia. At interview the child was questioned to ascertain any morbidity suffered and record was made of the operation performed and the anaesthetic administered. Data were then evaluated, using multivariate analysis, to identify risk factors for the more common sequelae. This study revealed a higher incidence of the minor sequelae of anaesthesia in children than had previously been reported. The three most common sequelae recorded were nausea (48.1%), vomiting (35.0%), and sore throat (31.4%).
Anesthesia↗
Physical symptoms and illness attitudes in adolescents: an epidemiological study.
A secondary school population of 805 11-16-year-olds reported lifetime prevalence of 31 physical symptoms and illness attitudes. Girls had a median of six symptoms (range 0-22) and boys five (range 0-22); 67 (8.3%) had 13 or more. Older girls reported more symptoms than younger ones. The excess of symptoms in older girls was related to reporting painful periods rather than simply to age or the menarche. High symptom scorers of both sexes had significantly higher scores on seven Illness Attitude Sub-Scales (Kellner, 1987), with more distress about illness and more treatment experience. The implications of these findings are discussed.
Adolescent↗
Demographic and obstetric risk factors for postnatal psychiatric morbidity.
BACKGROUND: Postnatal depression follows 10% of live births but there is little consensus on the risk factors associated with its development. Previous smaller studies have been unable to quantify the impact of independent risk factors as relative and attributable risks. METHOD: The Edinburgh Postnatal Depression Scale (EPDS) was used to screen a systematic sample of 2375 women, six to eight weeks after delivery. Information on socio-demographic and obstetric variables was collected at the screening interview. The risk factors associated with high EPDS scores (> 12) were determined and entered stepwise into a regression model. RESULTS: Four independent variables were found to be associated with an EPDS score above this threshold. These were an unplanned pregnancy (OR 1.44); not breast-feeding (OR 1.52), and unemployment in either the mother, i.e. no job to return to following maternity leave (OR 1.56), or the head of household (OR 1.50). These four variables appeared to explain the risk associated with other risk factors. CONCLUSIONS: Although a direct aetiological role for these risk factors is not certain, they may indicate strategies for the prevention of affective morbidity in postnatal women. These may include reducing unwanted pregnancy and employment for women after childbirth.
Adolescent↗
Muscle thickness, measured with ultrasound, may be an indicator of lean tissue wasting in multiple organ failure in the presence of edema.
Multiple organ failure (MOF) is accompanied by muscle wasting, but changes in body composition are frequently obscured by fluid retention (edema), mainly in superficial and visceral tissue. There is a need to assess body composition and changes in body composition in these circumstances independently of edema. A relation was sought between fat-free (lean tissue) mass [calculated from body weight and skinfold thicknesses and measured by using dual-energy X-ray absorptiometry (DXA)] and muscle thickness (measured using ultrasound at a variety of sites accessible in an unconscious supine subject) to determine which sites correlated best with lean body mass. The three best sites were midbiceps, midforearm anteriorly, and midthigh anteriorly: R2 for the simple sum of the three sites correlated with fat-free mass from skinfold thicknesses was 71.1%, and with lean tissue mass from DXA was 76.1%. Serial measurements of both muscle thickness and midupper-arm circumference in nine patients with MOF showed a complete dissociation; in all nine there was a significant negative correlation of muscle thickness with time (P < 0.05) but changes in arm circumference were random. Only one patient showed a significant negative correlation with time, seven showed no change, and one other showed a significant increase. The muscle thicknesses that correlate best with lean body mass are measured over the biceps, anterior forearm, and anterior thigh. Monitoring muscle thicknesses at these three sites identifies wasting in edematous patients as it is happening.
Absorptiometry, Photon↗
Urea kinetic modeling exaggerates the relationship between nutrition and dialysis in CAPD patients. (The hazards of cross-sectional analysis)
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Computer Simulation↗
Multivariate analysis: should the numbers speak for themselves?
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Attitude to Computers↗
In-patient treatment of 165 adolescents with emotional and conduct disorders. A study of outcome.
A two-year follow-up study of 165 teenagers with conduct and emotional disorders treated as in-patients on a regional adolescent unit (YPU) is described. The target types of behaviour for each subject were scored independently by the teenager, the parent or guardian, and the professional referrer before admission and at one month, one year and two years after discharge. The significant overall improvement in behaviour observed at one month after discharge was sustained at one and two years. Thirty-three subjects who abandoned treatment within six weeks of admission had made significantly less progress than the fully treated group at one month after discharge, but there were no significant differences at the one- and two-year evaluations. Two years after treatment, between 69% and 79% of the 132 subjects who completed treatment were regarded as improved, depending on which respondent made the assessment. Adolescents who completed treatment had different characteristics from those who terminated treatment prematurely and were more likely to be girls in care referred by social services.
Adolescent↗
Measuring psychiatric disorder in the recent past: the use of the Psychiatric Assessment Schedule retrospectively.
Ninety-four patients were asked about the presence of psychiatric symptoms on admission to hospital using the revised Psychiatric Assessment Schedule. Three months later they were asked to recall their symptoms at admission using the same instrument retrospectively. The results of the initial and retrospective interviews showed good rates of agreement in terms of PAS score, ID level, psychiatric 'caseness' and both CATEGO and DSM-III-R diagnoses. The study demonstrates that it is possible to make reliable measurements of the mental status of three months previously, simultaneously with assessments of current mental status. The uses of such a measuring instrument are discussed.
Follow-Up Studies↗
Referral rates to a regional adolescent psychiatric service: a comparison of visited and unvisited general practitioners.
A survey was undertaken through personal visits to general practitioners to determine the effectiveness of distributing information about a Regional Adolescent Psychiatric Service for emotionally and conduct disordered adolescents. The referral rates to the Unit over the four years before, and over the four years after the period of the visits were recorded both for those GPs who were visited and those who were not. The findings show an immediate significant increase in referral rates among the visited general practitioners, which was still evident after four years. This finding supports the hypothesis that a personal approach is more likely to be an effective means of disseminating information than posted printed materials. This paper also contains a description of other valuable, but unquantifiable results.
Adolescent↗
Mental health, job satisfaction, and job stress among general practitioners.
OBJECTIVE: To identify sources of job stress associated with high levels of job dissatisfaction and negative mental wellbeing among general practitioners in England. DESIGN: Multivariate analysis of large database of general practitioners compiled from results of confidential questionnaire survey. Data obtained on independent variables of job stress, demographic factors, and personality. Dependent variables were mental health, job satisfaction, alcohol consumption, and smoking. SETTING: National sample of general practitioners studied by university department of organisational psychology. SUBJECTS: One thousand eight hundred seventeen general practitioners selected at random by 20 family practitioner committees in England. INTERVENTIONS: None. END POINT: Determination of the combination of independent variables that were predictive of mental health and job satisfaction. MEASUREMENTS AND MAIN RESULTS: Women general practitioners both had job satisfaction and showed positive signs of mental wellbeing in contrast with other normative groups. Conversely, male doctors showed significantly higher anxiety scores than the norms, had less job satisfaction, and drank more alcohol than their women counterparts. Multivariate analysis disclosed four job stressors that were predictive of high levels of job dissatisfaction and lack of mental wellbeing; these were demands of the job and patients' expectations, interference with family life, constant interruptions at work and home, and practice administration. CONCLUSIONS: There may be substantial benefit in providing a counselling service for general practitioners and other health care workers who suffer psychological pressure from their work.
Adult↗