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Biomedical subjects

F Creed

Publications and source records attributed to F Creed.

At least 109 records · Page 6Linked to original sources
PubMed1988

Psychiatric disorder and illness behaviour in rheumatoid arthritis.

A detailed physical and psychiatric assessment of 80 patients with definite or classical rheumatoid arthritis was performed using diagnostic criteria for psychiatric disorder appropriate for those with physical illness. Seventeen (21%) patients had depression or anxiety severe enough to warrant treatment. The presence of pychiatric disorders was not related to the duration of the arthritis nor to 11 other indicators of its severity with the exception of grip strength (p less than 0.002) and Fries Functional grade (p less than 0.005). It was significantly related to the presence of social stress (p less than 0.05) and lack of social support (p less than 0.005). Those with psychiatric symptoms scored higher on an illness behaviour scale, indicating that they perceived their illness as very severe. These also worried excessively about it and failed to be reassured by the doctor. Such illness behaviour was displayed by some patients who had severe arthritis but lacked social support. In others the complaints were unfounded because their arthritis was mild. They also experienced much social stress and lacked social support. We conclude that psychiatric illness occurs in rheumatoid arthritis with similar frequency to that of other general medical patients. It is principally related to social stress and lack of support rather than severity of arthritis, and may lead to abnormal illness behaviour. Since lack of social support appears of prime importance in determining disability, its assessment is essential for the rehabilitation of the disabled patient with RA.

Adolescent↗
PubMed1988

Functional abdominal pain, psychiatric illness, and life events.

Patients undergoing appendicectomy, attending a gastroenterology clinic or admitted to hospital after self-poisoning have been examined using the same reliable measures to establish whether life events and psychiatric illness preceded abdominal pain. Life events involving threat were experienced more commonly by those with organic and functional abdominal illness, compared with community comparison subjects. The greatest difference was with severe events, especially those involving the break-up of close relationships, which preceded the development of functional abdominal pain as often as they occurred before self-poisoning, and significantly more frequently than before the onset of organic gastrointestinal illness. Abdominal pain of recent onset, for which no organic cause is found, is often preceded by environmental stress, whether it presents to the surgeon or the physician. Those presenting in the clinic were older than those undergoing appendicectomy and had experienced more long lasting interpersonal difficulties. Many had psychiatric illness, but for the remainder the stress might either have caused colonic pain directly or led to consultation for abdominal pains that had not previously presented to a gastroenterologist.

Abdomen↗
PubMed1988

Psychiatric morbidity and illness behaviour in female neurological in-patients.

Ninety three female neurological in-patients were assessed in a collaborative neurological and psychiatric study. An overall prevalence of definite psychiatric disorder of 34% was found, depression being the most common diagnosis. Psychiatric morbidity was most common when the neurologist felt that the presentation could not be explained by a neurological disorder. The majority of such patients had symptoms which could be explained by the psychiatric disorder but a substantial number could not be given a definite diagnosis. The General Health Questionnaire was not found to be a useful screening instrument in this setting.

Cerebrovascular Disorders↗
PubMed1988

Assessment of self-poisoning patients by psychiatrists and junior medical staff.

Case notes of patients admitted to hospital or seen in the casualty department following an overdose were assessed in a standardized way. The medical records were deficient in several important areas, especially for those patients seen in casualty and not referred to a psychiatrist. If only selected patients were to be assessed by psychiatrists, closer monitoring of the psychiatric assessments and management initiated by junior medical staff would be required. Although the poor records may reflect lack of motivation as much as lack of education, there was no significant relationship between the doctors' attitudes towards self-poisoning patients in general and the standard of their assessments.

Attitude of Health Personnel↗
PubMed1987

Students' attitudes towards psychiatry.

Using a reliable measure, a self-administered questionnaire (ATP), and adequate numbers of students, this study demonstrates the negative effects of general medical/surgical training and the positive effect of the psychiatry clerkship on students' reported attitudes towards psychiatry. A negative view of psychiatry at the beginning of the clerkship may make students reluctant to improve their interview skills but is otherwise unimportant in determining their reactions and performance in the clerkship. Medical students' interest in psychiatry as a career increases during the psychiatry clerkship but this merely offsets the decline in interest that occurs at other stages during the clinical training. Much of the attitudinal change that occurs during the psychiatry clerkship is maintained into the pre-registration year but the housemen recorded a significant negative change on the items concerning efficacy of psychiatric treatment and attitudes towards psychiatric patients. Additional training by psychiatrists during the pre-registration year might increase the motivation of young doctors to detect and treat psychiatric illness which they will encounter in all branches of medicine.

Attitude of Health Personnel↗
PubMed1987

Doctors' interest in psychiatry as a career.

Fifty pre-registration housemen were interviewed to elicit their attitudes towards a career in psychiatry. The doctors were all those in one academic year who were recommended for honours on the basis of their performance during the psychiatry clerkship. Those who gained honours in other subjects as well as psychiatry were unlikely to choose a career in psychiatry. The study indicates that further improvements in the psychiatry clerkship will not improve recruitment. Factors outside psychiatry--the pull to general practice and other specialties and the negative attitudes towards psychiatry expressed by other doctors--are among the major deterrents for young doctors considering a career in psychiatry. Collaborative teaching between psychiatrist, physicians and surgeons during the pre-registration year should encourage recruitment and gradually improve the widely held negative attitudes towards psychiatry.

Attitude of Health Personnel↗
PubMed1987

Psychological factors in the irritable bowel syndrome.

This paper reviews recent psychological studies of patients with the irritable bowel syndrome (IBS) or 'functional abdominal pain'. Many studies have used unreliable or invalid methods of assessment and some have confused personality with treatable psychiatric illness. Reliable and valid measures have indicated that 40-50% of patients with recently diagnosed functional abdominal pain have demonstrable psychiatric illness; these patients have a worse prognosis than those who are psychologically normal. When psychiatric disorder is diagnosed in a patient with IBS there are three possibilities: (1) The patient may have developed abdominal and psychiatric symptoms simultaneously in which case treatment of the latter may relieve the bowel symptoms. (2) Psychiatric disorder may precipitate increased concern about bowel symptoms, and consequent attendance at the gastroenterology clinic, of those with chronic mild symptoms. In this case it is illness behaviour, rather than abdominal symptoms, that is caused by the anxiety/depression. (3) Those with chronic neurotic symptoms as part of their personality must be screened for organic disease if they have a fresh onset of bowel symptoms; but they are at high risk of becoming persistent clinic attenders. Further research is needed to clarify when psychological abnormalities play a role in the aetiology of IBS and when they are coincidental, but lead to illness behaviour. The role of psychological factors in the aetiology of the irritable bowel syndrome (IBS) is far from clear, but a review of the literature suggests that some consistent patterns are emerging in spite of methodological problems. There have been three major defects with studies that have linked IBS with neurotic symptomatology. First, the measurement of psychological factors has generally been imprecise. Second, most studies have considered IBS patients as a single group, without making allowance for differing symptom patterns. Third, conclusions have been drawn about hospital samples and extrapolated to all IBS subjects, without taking account of factors which affect consulting behaviour. Most studies have been concerned with psychological factors so these will be considered in most detail.

Colonic Diseases, Functional↗
PubMed1986

Hostility and deliberate self-poisoning.

Patients admitted to hospital following deliberate self-poisoning have been shown to have high levels of hostility, but the exact role of hostility in self-poisoning is not clear. It was hypothesized that those subjects with marked depression would have high intro-punitive scores whereas those deliberately poisoning themselves who did not have marked depression would have high extra-punitive scores. Seventy young adults admitted to hospital following deliberate self-poisoning completed the Hostility and Direction of Hostility Questionnaire and half of these subjects had an identifiable depressive syndrome. Very high intro-punitive scores were found in the depressed subjects but high extra-punitive scores were found in all deliberate self-poisoning subjects irrespective of depression. This suggests that extra-punitiveness might distinguish self-poisoners from other psychiatric patients. Within the self-poisoning group, high intro-punitive scores were associated with greatest suicidal intent but further studies are needed to see if these are an aspect of the depression or part of the personality.

Adolescent↗
PubMed1985

Life events and physical illness.

This paper reviews research on the role of stressful life events in the aetiology of physical illness. Particular attention is given to the methodological problems involved in the identification and measurement of life events. There has been insufficient sound research for firm conclusions to be drawn but prospective studies make it clear that assessment of life events will lead to a more complete understanding of how psychosocial factors interact with bodily functioning. Future research studies will need to be based on an interactional model.

Adaptation, Psychological↗
PubMed1981

Life events and appendicectomy.

Life events were recorded for the year preceding appendicectomy in 119 patients aged 17-30. In 63 appendicitis was confirmed histologically and in 56 the appendix was not acutely inflamed. Both groups had experienced significantly more events than a community comparison group when those events which carry some degree of threat to the individual are considered. In the case of severe events, however, the patients whose appendix was normal or only mildly inflamed demonstrated a pattern similar to that found in depression, whereas those with acute appendicitis were similar to the community comparison group. A follow-up study demonstrated that the number of people experiencing threatening events fell to the expected level postoperatively and that depression was associated with continued abdominal pain. These findings may be relevant to the understanding of the irritable-bowel syndrome.

Abdomen↗
PubMed1981

The teaching of clinical skills at a postgraduate hospital.

The teaching of 'clinical skills' is generally held to be central to postgraduate training in psychiatry, but the term itself has so far escaped exact definition. In an effort to study some of the component clinical abilities, their inter-relationships, and the factors promoting their transmission, all junior psychiatrists at the Maudsley Hospital were surveyed for their views on the clinical training they had received. Three hundred and seventy three assessement on 43 units were made. Trainees perceived the academic instruction and advice on formulating cases which they had received as being quite unrelated to the quality of help with interview skills and instruction in practical management, but feedback from the consultant to the trainee on the latter's performance was necessary for a high standard of both academic and practical instruction. Encouragement to do research was transmitted independently of other clinical teaching. Over a 3-year period the standard of multi-disciplinary teamwork appeared to improve, but there was a decline in the standard of academic instruction and in encouragement to do research. These overall differences were due to changes in the teaching staff, rather than alterations in teaching methods. Surveys such as this may help to define the goals of postgraduate clinical training, and also monitor the extent to which an institution is achieving these goals.

Attitude of Health Personnel↗
PubMed1979

Psychiatrists' models of mental illness and their personal backgrounds.

Seventy-nine junior psychiatrists at the Maudsley Hospital answered 16 biographical questions and a 68-item questionnaire measuring attitudes to the psychoanalytical, biological, social, behavioural, and anti-medical models of mental illness. The psychoanalytical model was the most clearly defined and its adherents the most dogmatic, while those supporting the social model were the most eclectic. Sex, social class, education and political sympathy proved a poor guide to the orientation of the respondent. Individuals who had decided on a career in psychiatry before entering medical school were the most critical of the biological model. Biologically minded psychiatrists were older and, in contrast to Kreitman's findings, there was a shift from a psychoanalytical to a biological preference with increasing psychiatric experience. The importance of scientific attitudes in psychiatry was endorsed by biologically and behaviourally inclined psychiatrists but denigrated by supporters of the analytical approach. Adherents of the psychoanalytical model had as many academic qualifications as the biologically inclined, but had fewer publications and were less active in research. It appears that interest in psychoanalysis is antipathetic to the development of scientific attitudes conducive to research.

Age Factors↗
PubMed1978

Vascular anatomy of the human uterus and pregnancy wastage.

In uteri removed at hysterectomy the uterine arteries were injected with radioopaque media and the vascular configuration was correlated with reproductive histories. Patients whose uteri had two ascending uterine arteries on each side had significantly more abortions and smaller newborn infants than patients with a single ascending branch of the uterine artery.

Abortion, Spontaneous↗