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F Creed

Publications and source records attributed to F Creed.

117 records · Page 7Linked to original sources
PubMedDate not supplied

Consultation-Liaison psychiatric service delivery: results from a European study.

The reported findings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation-liaison service delivery by 56 services from 11 European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reliability tested method of patient data collection, and data were collected describing pertinent characteristics of the hospital, the C-L service, and the participating consultants. The consultation rate of 1% (median; 1.4% mean) underscores the discrepancy between epidemiology and the services delivered. The core function of C-L services in general hospitals is a quick, comprehensive emergency psychiatric function. Reasons to see patients were the following. deliberate self-harm (17%), substance abuse (7.2%), current psychiatric symptoms (38.6%), and unexplained physical complaints (18.6%) (all means). A significant number of patients are old and seriously ill. Mood disorders and organic mental disorders are most predominant (17.7%). Somatoform and dissociative disorders together constitute 7.5%. C-L services in European countries are mainly emergency psychiatric services and perform an important bridge function between primary, general health, and mental health care.

Adult↗
PubMedDate not supplied

European consultation-liaison services and their user populations: the European Consultation-Liaison Workgroup Collaborative Study.

The authors identified variations in the characteristics of patients referred to 56 consultation-liaison (C-L) services in 11 European countries. The authors found differences in the types of patients referred to the services, and there were significant differences between countries. The first difference lays in whether services saw patients for deliberate self-harm and for substance abuse. German psychosomatic C-L services saw virtually no such patients, although in other C-L services these patients constituted one-quarter to one-third of the patients referred. The second difference lays in the remaining group of referred patients. This group is best characterized by two dimensions. One describes the severity of psychopathology -- ranging from organic mental conditions to somatization. The other describes the clarity of the physical diagnosis -- ranging from patients referred by surgical wards to those referred by general medicine and neurology wards.

Adult↗
PubMedDate not supplied

The relationship between pain and depression in a trial using paroxetine in sufferers of chronic low back pain.

Previous studies have shown a positive association between pain and depression, though evidence supporting a direct link between these two variables is less robust. Using a placebo-controlled trial, the authors examined the analgesic and antidepressant efficacy of paroxetine (20 mg) in chronic low back pain sufferers. The authors examined the associations among pain, depression, disability, and illness attitudes. Paroxetine showed no effects on pain or depression compared with placebo; however, subjects randomized to paroxetine were more likely to reduce concomitant analgesic medication. The cross-sectional association of depression and pain at baseline (r = 0.2, P = 0.02) was weaker than the association between depression and disability (r = 0.3, P = 0.004). Similarly, the association of change in depression scores with change in pain (r = 0.25, P = 0.016) was weaker than change between depression and disability (r = 0.49, P<0.0005). Whereas the relationship between pain and depression became nonsignificant when disability and illness attitudes were controlled, the relationship between depression and disability remained highly significant when pain and illness attitudes were controlled. These data are consistent with the association between pain and depression being wholly modulated by disability and illness attitudes, with no direct relationship between pain and depression.

Adolescent↗
PubMedDate not supplied

Emotional, cognitive, and behavioral characteristics of medical outpatients: a preliminary analysis.

The authors examined the relationship among emotional, cognitive, and behavioral factors in 65 new outpatients attending neurology and cardiology clinics. The patients completed the Hospital Anxiety and Depression Scale, the Illness Perception Questionnaire, the Somatosensory Amplification Scale, the Private Body Consciousness Scale, and the Health Anxiety Questionnaire. A principal component factor analysis revealed two factors, somatosensory amplification/anxiety and depression/pessimism, that together accounted for 44% of the variance. The factors the authors identified may be useful as a basis for understanding different patterns of illness behavior. The use of these factors may help to rationalize and refine the large number of existing measures and simplify the assessment process, as well as contributing to the development of treatment interventions.

Adolescent↗
PubMedDate not supplied

Anxiety, depression and management of medically unexplained symptoms in medical clinics.

This study assessed the prevalence of medically unexplained symptoms in cardiology, gastroenterology and neurology outpatient clinics at a large teaching hospital and investigated the current clinical management of these patients. Data were collected retrospectively from the casenotes of all new referrals to these clinics over a two month period. The total number of new patients seen was 343, of whom 120 (35%) had a final diagnosis of 'functional' disorder, 204 (59.5%) a final diagnosis of organic disorder and 19 (5.5%) remained undiagnosed. The number of investigations was similar in patients whether the eventual diagnosis was 'functional' or organic (median 2, range 0-9 in each case). However, the cost of investigation was significantly higher for the organic group (median 89 pounds compared with 41 pounds, p > or = 0.01). Anxiety and depression were documented in 33% of patients with unexplained symptoms. In 73 (61%) of patients with an eventual 'functional' diagnosis, the information that organic disease had been excluded was communicated to the GP, but there was no advice about further management. Four percent were referred to psychiatrists and 2% started on antidepressants. The paucity of recommended management strategies for patients with a 'functional' diagnosis suggests that physicians see their role with this group of patients as primarily one of exclusion of organic disease. It is suggested that more positive management strategies, including treatment of anxiety and depression, might lead to greater patient satisfaction and play a role in reducing the development of chronic somatisation.

Antidepressive Agents↗
PubMedDate not supplied

Predictors of mortality and morbidity following admission with chest pain.

This study aimed to identify the predictors of outcome in 102 patients following their first admission with acute chest pain. Outcome was measured at three months by interview and at five years by questionnaire. Chest pain, change in physical activity, return to work, smoking, psychiatric disorder, and mortality were assessed. The principal predictors of chest pain and smoking were previous psychiatric disorder and a diagnosis of non-specific chest pain; a previous history of psychiatric disorder was associated with a five-fold increase in the risk of continued chest pain at five-year follow-up (95% CI = 1.1-25.0). Psychiatric disorder at five years was predicted by psychiatric disorder at admission (adjusted odds ratio (adj OR) = 3.2; 95% CI 1.0-11.0) and non-specific chest pain (adj OR = 7.5; 95% CI = 1.7-32.1). Mortality at five-year follow-up was independently associated with older age (adj OR = 1.1; 95% CI = 1.01-1.2), an elevated Norris score (adj OR = 1.41; 95% CI = 1.01-1.96) and a previous history of psychiatric disorder (adj OR = 5.06; 95% CI = 1.13-22.0). These findings suggest that prediction of outcome, irrespective of underlying diagnosis, requires careful assessment of previous or current psychiatric symptoms in patients admitted with chest pain. Early intervention with psychological treatment for patients with non-specific chest pain should be considered; this may also involve help to reduce smoking. The study provides further evidence that mortality following myocardial infarction is closely linked to psychiatric disorder, but suggests that prior psychiatric disorder may be more important than 'post-infarction' depression. A larger study is needed to confirm these results.

Adult↗