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Biomedical subjects

F H Creed

Publications and source records attributed to F H Creed.

At least 19 recordsLinked to original sources
PubMed2006

Contribution of depression and anxiety to impaired health-related quality of life following first myocardial infarction.

BACKGROUND: The extent to which depression impairs health-related quality of life (HRQoL) in the physically ill has not been clearly established. AIMS: To quantify the adverse influence of depression and anxiety, assessed at the time of first myocardial infarction and 6 months later, on the physical aspect of HRQoL 12 months after the infarction. METHOD: In all, 260 in-patients, admitted following first myocardial infarction, completed the Hospital Anxiety and Depression Scale and the Medical Outcomes Study SF-36 assessment before discharge and at 6- and 12-month follow-up. RESULTS: Depression and anxiety 6 months after myocardial infarction predicted subsequent impairment in the physical aspects of HRQoL (attributable adjusted R(2)=9%, P<0.0005). These negative effects of depression and anxiety on outcome were mediated by feelings of fatigue. Depression and anxiety present before myocardial infarction did not predict HRQoL 12 months after myocardial infarction. CONCLUSIONS: Detection and treatment of depression and anxiety following myocardial infarction improve the patient's health-related quality of life.

Age Factors↗
PubMed2004

The risk factors for depression in first myocardial infarction patients.

BACKGROUND: Depression affects outcome following myocardial infarction but the risk factors for such depression have been little studied. This study considered whether the causes of depression occurring before and after myocardial infarction were similar to those of depression in the general population. METHOD: Consecutive patients admitted to hospital following their first myocardial infarction were interviewed with the Schedule for Clinical Assessment in Neuropsychiatry to detect psychiatric disorders and the Life Events and Difficulties Schedule to assess recent stress. Participants completed the Hospital Anxiety and Depression Scale (HADS) at entry to the study and 1 year later and the risk factors associated with a high score at both times were assessed. RESULTS: Of 314 (88% of eligible) patients who were recruited, 199 (63%) were male and 63 (20%) had depressive disorders. Logistic regression identified the following as independently associated with depressive disorder that had been present for at least I month before the myocardial infarction: younger age, female sex, past psychiatric history, social isolation, having marked non-health difficulties and lack of a close confidant. At follow-up 269/298 (90%) responded; of 189 participants not depressed at first assessment, 39 (21%) became depressed by the 1 year follow-up. Logistic regression identified frequent angina as the only significant predictor of raised HADS scores at 12 months. CONCLUSIONS: Depression developing during the year following myocardial infarction does not have the same risk factors as that which precedes myocardial infarction. Further clarification of the mechanisms linking depression to poor outcome may require separation consideration of pre- and post-myocardial infarction depression, and its risk factors.

Age Factors↗
PubMed2004

Lack of a close confidant, but not depression, predicts further cardiac events after myocardial infarction.

OBJECTIVE: To assess the role of depression and lack of social support before myocardial infarction (MI) in determining outcome in a large representative sample of patients admitted after MI in the UK. DESIGN: Prospective cohort design. PATIENTS: 1034 consecutive patients were screened 3-4 days after MI. MAIN OUTCOME MEASURES: Mortality and further cardiac events over one year after an MI. RESULTS: At 12 months' follow up mortality and further cardiac events were assessed in 583 of 654 eligible patients (90% response); 140 of 589 for whom baseline data were collected (23.8%) were depressed before their MI. Patients who were depressed before their MI were not more likely to die (mortality 5.2% v 5.0% of non-depressed patients) or suffer further cardiac events (cardiac events rate 20.7% v 20.3% of non-depressed patients). After controlling for demographic factors and severity of MI, the absence of a close confidant predicted further cardiac events (hazard ratio 0.57, p = 0.022). CONCLUSION: Lack of a close confidant but not depression before MI was associated with adverse outcome after MI in this sample. This association may be mediated by unhealthy behaviours and lack of compliance with medical recommendations, but it is also compatible with difficulties in early life leading to heart disease.

Age Factors↗
PubMed2001

Negative symptoms of schizophrenia and compliance with medication.

Poor compliance with medication has been reported in up to 40 percent of outpatients with schizophrenia. This study examines the relationship between compliance with depot neuroleptic medication and severity of negative symptoms of schizophrenia. Compliance with depot neuroleptic medication during the preceding year was calculated for 64 patients with a DSM-III-R diagnosis of schizophrenia. The severity of negative symptoms was assessed using the Scale for the Assessment of Negative Symptoms (SANS). Patients who complied poorly with medication had significantly greater severity of negative symptoms of schizophrenia, especially avolition, apathy, and alogia. Duration of illness and duration of prescribed medication were independently associated with compliance, but no other features were associated in the multiple regression model. These findings suggest that negative symptoms are one of the factors of importance in determining whether a patient will attend for depot neuroleptic medication.

Adult↗
PubMed1999

The effects of dothiepin on subjects with rheumatoid arthritis and depression.

BACKGROUND: The relative importance of direct analgesic and antidepressant effects of antidepressant drugs in rheumatoid arthritis (RA) is not clear. METHOD: Forty-eight female out-patients with RA, with depression and/or anxiety, were entered into a double-blind, placebo-controlled study of dothiepin in doses up to 150 mg daily to assess the effects on mood [Hospital Anxiety and Depression (HAD) scale and Hamilton Rating Scale (HRS) for Depression], pain [visual analogue scale (VAS)] and disability [Health Assessment Questionnaire (HAQ)]. RESULTS: Repeated measures multivariate analysis of variance revealed that treatment had a significant effect on pain (F(d.f. 1,39) =5.7, P=0.02). There were further interaction effects between treatment and time on pain (F(d. f. 3,117) =3.3, P=0.03), disability (F(d.f. 3,117)=4.2, P=0.008) and duration of early morning stiffness (F(d.f. 3,117) =3.3, P=0.03). Depression (HRS) was considerably reduced in both the dothiepin and placebo groups, and there was no significant difference between groups. Post hoc analyses using analysis of covariance revealed that, in the dothiepin group, pain was significantly reduced by week 4 and remained so at week 12. Disability scores and duration of early morning stiffness were consistently lower in the dothiepin group, although differences failed to reach statistical significance at any follow-up assessment. In the group as a whole, reductions in pain were highly significantly correlated with reductions in HAD depression (r =0.63, P<0.0005), HAD anxiety (r=0.46, P=0.001) and HRS depression (r=0.37, P=0.01). CONCLUSION: Dothiepin is effective in relieving pain, disability and reducing the duration of early morning stiffness in out-patients with RA. Although there is a general association between pain reduction and improved anxiety and depression, the analgesic effect of dothiepin is independent of its antidepressant effect. Individual variation is considerable and further research should try to identify mechanisms of interaction between the antidepressant and analgesic effects of treatment in different patient groups.

Affect↗
PubMed1999

Psychosocial aspects of the functional gastrointestinal disorders.

The functional gastrointestinal disorders (FGID) are the most frequent conditions seen in gastroenterology practice and comprise a major portion of primary care. Psychosocial factors are important in these disorders with regard to: (1) their effects on gut physiology; (2) their modulation of the symptom experience; (3) their influence on illness behavior; (4) their impact on outcome; and (5) the choice of the therapeutic approach. This paper provides a review and consensus of the existing literature by gastroenterologists, psychiatrists, psychologists, physiologists, and health services investigators. Evidence is provided to support the biopsychosocial model as a basis for understanding and treating these disorders, and epidemiological and clinical information on the relations of psychosocial factors to gut physiology, symptom presentation, health behavior, and outcome is offered. Features of motility, personality, abuse history, health concerns, and treatment-seeking differ between patients with FGID and healthy controls, but they are not specific to FGID. They occur in other patients with chronic medical conditions and/or psychiatric disorders. Review of treatment trials indicates clear support for psychotherapeutic treatments, especially in the long term, as well as some evidence for the benefit of antidepressants in FGID, even in the absence of improvements in mood.

Colonic Diseases, Functional↗
PubMed1997

Psychological distress in patients with hyperprolactinaemia.

OBJECTIVE: In addition to the physical symptoms of galactorrhoea and amenorrhoea, hyperprolactinaemia in women is also reported to be associated with psychological symptoms. Previous studies have found an increased incidence of depression, anxiety and hostility in female patients with hyperprolactinaemia. In this study, psychological symptoms were assessed in a large population of patients and symptom scores were compared between patients with definite evidence of pituitary adenoma on high-resolution CT scanning and those without, who were presumed to have idiopathic or 'functional' hyperprolactinaemia. DESIGN: Postal survey: population-control study of female patients with hyperprolactinaemia. PATIENTS: Sixty-five women with hyperprolactinaemia were compared with a control group of 26 women with normoprolactinaemic pituitary disease (acromegaly or nonfunctioning pituitary adenoma). The hyperprolactinaemic patients were subdivided according to whether a pituitary adenoma was visible on high-resolution CT scanning (39 patients) or whether they had normal CT scans, in which case they were categorized as having idiopathic or 'functional' hyperprolactinaemia (26 patients). MEASUREMENTS: Patients were sent 2 questionnaires, the Hospital Anxiety and Depression (HAD) Scale and the 90-item Symptom Checklist (SCL-90), to assess psychological wellbeing. RESULTS: Overall, 54% of hyperprolactinaemic patients were found to have definite or borderline anxiety as judged by HAD scores, compared with 27% of normoprolactinaemic control patients. Those with normal CT scans were significantly more likely to have definite or borderline anxiety (73% of patients) than those with CT evidence of a pituitary tumour causing their hyperprolactinaemia (41%, P < 0.003), despite similar levels of serum prolactin. A similar increased proportion of hyperprolactinaemic patients scored highly on the anxiety component of the SCL-90, although mean scores were not different from controls. No differences were seen in scores for depression, but both subgroups of hyperprolactinaemic patients scored more highly than controls for hostility on the SCL-90 questionnaire. CONCLUSION: These findings confirm the presence of significant anxiety in a proportion of women with hyperprolactinaemia. Hyperprolactinaemic women with no abnormality on CT scans displayed more psychological distress than those with definite pituitary microadenomas. These results may provide insight into the pathogenesis of 'functional' hyperprolactinaemia.

Adenoma↗
PubMed1997

Access to psychiatric care; the results of the Pathways to Care study in Preston.

BACKGROUND: The aim of the present research was to study factors that might determine speed of access to psychiatric care, including the effect of the introduction of a community psychiatric service. METHODS: A Pathways to Care analysis was used to detail new referrals to mental health professionals (MHPs) during two one-month intervals one year apart, before and after the introduction of a community service (n = 279). Univariate analysis of possible factors that might affect access was undertaken, including socio-demographic factors, clinical factors and style of service. Significant associations were then investigated using stepwise logistic regression. RESULTS: The inception rate for treatment was similar to that reported for other services (0.10 per cent). After the establishment of community teams, there was an overall 22 per cent increase in the number of patients seen, with the greatest increase being for neurotic disorders and patients seen by non-medical staff. Of patient-based factors, younger age and suicidal ideation were associated with shorter pathways. Older age, married status, somatic symptoms, anxiety and depression were associated with slower pathways. Patients with suicidal ideation were seen within three days. The introduction of a community pathways team was associated with a lengthening of time to specialist care. CONCLUSIONS: Following a non-experimental change in service delivery, an increase in referrals for less severe mental illness was demonstrated. Continued comprehensive data collection of this type can be used by purchasers to monitor referral patterns and can provide a basis for determining priorities in service delivery.

Adolescent↗
PubMed1995

Functional bowel disorders. A multicenter comparison of health status and development of illness severity index.

In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings. To develop the FBDSI, multiple regression analysis used the demographic and clinical variables to predict the physician's rating of severity. We found that most health status measures of patients with FBD across study sites are comparable and the derived and validated FBDSI scoring system uses three easy to obtain variables: FBDSI = [current pain by visual analog scale (0-100)] + [diagnosis of chronic functional abdominal pain (0 if absent and 106 if present)] + [number of physicians visits over previous six months x 11]. The FBDSI can be used to select patients for research protocols and/or follow their clinical outcome or response to treatments over time.

Abdominal Pain↗
PubMed1995

A long-term follow-up study of patients with ischaemic heart disease versus patients with nonspecific chest pain.

Ninety consecutive patients who were admitted to hospital with acute chest pain were followed-up five years later. At the time of the original admission, all of the patients received a detailed physical and psychiatric evaluation. Seventy-one patients were diagnosed as having ischaemic heart disease, and 19 were diagnosed as having nonspecific chest pain. Patients with nonspecific pain were younger, consumed greater amounts of alcohol, smoked more than their organic counterparts, and were more likely to suffer from psychiatric disorder. The five-year assessment was carried out using a self-report questionnaire. Of the original 71 patients with ischaemic heart disease, 14 had died; 43 questionnaires were returned, 80.2% of the original sample. Sixteen (84.9%) of the patients with nonspecific pain were followed up; none had died. Both groups were predominantly male. The patients with nonspecific pain still smoked more than the patients with ischaemic heart disease, and they had significantly more symptoms of anxiety. The overall prevalence of psychiatric morbidity remained high, however, in both groups. Patients who had psychiatric illness at the time of the original assessment were more anxious at follow-up and more likely to complain of chest pain than those who had been well. Patients with nonspecific chest pain continued to seek treatment on a regular basis from their general practitioners either for chest pain or for other symptoms, but few were in frequent contact with hospital services. The possible preventive effects of psychiatric intervention at an earlier stage in both groups of patients needs to be investigated.

Anxiety↗
PubMed1995

Embarking upon a medical career: psychological morbidity in first year medical students.

This study was undertaken to measure the prevalence of psychological morbidity, and the nature and source of stress, in first year medical students. Two hundred and four first year medical students at a university in the north of England were sent a postal, self-report questionnaire. They were asked to complete the General Health Questionnaire (GHQ), the Stress Incident Record and to give details of their alcohol consumption. A total of 172 students (84.3%) replied. Thirty-six per cent of the students scored above the threshold of the GHQ, indicating probable psychological disturbance. There was no difference between men and women. Approximately half of the students described a stressful incident, the majority of which were related to medical training rather than to personal problems. Male students reported drinking significantly more alcohol than female students, but there was no relationship between levels of alcohol consumption and either psychological disturbance or reporting of stress. The findings suggest that even at the preliminary stages of medical training, many students find aspects of the medical course very stressful. The psychological well-being of medical students needs to be more carefully addressed, and closer attention paid to the styles of medical teaching that may provoke avoidable distress.

Alcohol Drinking↗
PubMed1994

Life events and the onset of rheumatoid arthritis.

This study used the Life Events and Difficulties Schedule to assess whether an excess of life events occurred prior to onset of rheumatoid arthritis (RA) in 60 consecutive out-patients. There was no evidence of an excess of events of any kind during the 12 months before onset of RA. There was no difference between seropositive and seronegative RA or between those with and without a family history. There was a non-significant trend for an excess of events before onset compared with after; this may be explained by the reduction of events after onset as a consequence of disabling disease. The prevalence of psychiatric disorder measured using the Psychiatric Assessment Schedule was 13.3% at the time of interview.

Adult↗
PubMed1994

Depression, cognitive impairment and social stress in multiple sclerosis.

Twenty-four out-patients with established multiple sclerosis (MS) who had been neurologically assessed underwent detailed psychiatric, cognitive and social assessments. Depression was associated with significant cognitive impairment and with social stress but not with degree of neurological impairment, specific neurological symptoms, disability or handicap. It is suggested that depression in relapsing-remitting MS may arise when cognitive deficits cause problems in occupational performance and impinge on close personal relationships.

Adolescent↗
PubMed1993

Lymphocyte response in depressed patients and subjects anticipating bereavement.

Lymphocyte response to stimulation with phytohaemagglutinin (PHA) was assessed in 11 patients with major depression and 8 subjects anticipating bereavement, in order to examine whether altered immune response (PHA stimulation index) was more closely related to depressed mood than to sleep and weight changes. No significant relationship was found between sleep or weight changes and immune response. Depression, measured using the HRSD (with and without sleep scores) and the BDI, was related differently in the two groups. For the depressed patients, increasing depression was associated with reduction in immune response; among those anticipating bereavement (with low depression scores), increasing depression was associated with enhanced immune response. A regression curve using data from both samples demonstrated an inverted 'U'-shaped curve relating immune response to mild and severe depressed states. The results of this study suggest a hypothesis that may explain previous discrepant results and which requires testing on more subjects.

Adult↗
PubMed1993

Psychological aspects of recurrent chest pain.

Of 113 consecutive patients admitted recurrently with chest pain 28% exhibited psychiatric morbidity using the GHQ-28 (General Health Questionnaire). Eighty patients had ischaemic heart disease, 17 had non-specific pain and 13 were excluded because of other organic causes for their pain. Of the non-specific group, seven had been admitted previously with chest pain. In common with previous studies of first admissions with non-specific chest pain, recurrent admissions were younger and predominantly male. They also had a history of greater alcohol and cigarette use than patients with ischaemic heart disease. Greater psychiatric morbidity was not demonstrated in this small group of patients. In spite of the absence of an organic aetiology, patients with non-specific pain showed similar rates of re-admission to those with ischaemic heart disease before and after the study. Further research is indicated to identify aetiological and maintaining factors for continued non-specific pain.

Alcohol Drinking↗
PubMed1992

The course of psychiatric disorder associated with non-specific chest pain.

One hundred and eight consecutive patients admitted urgently for the first time with chest pain were interviewed to assess psychiatric symptoms prior to admission, at admission and three months later. Seventy-one patients had ischaemic heart disease, 19 had non-specific chest pain and 18 patients were excluded because of other organic causes for the pain. Compared to the ischaemic heart disease subjects, the non-specific chest pain patients tended to have more psychiatric disorder which increased over the three assessments; at follow up 33% of ischaemic heart disease patients and 59% of non-specific chest pain patients had psychiatric disorder. Chest pain was reported by 71% of the non-specific group at three months but this was not related to presence of psychiatric disorder. Unlike previous studies which 'have assessed out-patients with normal coronary angiograms', this study has shown that males predominate among patients admitted urgently with non-specific chest pain. In addition, these subjects use greater amounts of cigarettes and alcohol, and experience significantly more psychiatric disorder compared to patients admitted with ischaemic heart disease. The factors which lead to some of these patients developing chronic non-specific chest pain need to be investigated in further studies.

Adult↗
PubMed1992

Outpatients with irritable bowel syndrome: a comparison of first time and chronic attenders.

Fifty two chronic clinic attenders with irritable bowel syndrome were compared with 97 newly referred patients in respect of physical symptoms and psychiatric status. Profound differences between the two groups emerged. Many abdominal and non-colonic symptoms were perceived as much more severe in chronic attenders compared with first time attenders (p less than 0.0001 for abdominal pain and abdominal distension). Chronic attenders were much more likely to complain of constant symptoms (p less than 0.05), and the social consequences of their illness were much more striking (p less than 0.0001). There was, however, no difference in the prevalence of psychiatric morbidity in the two groups. Clinical trials and other investigations of the irritable bowel syndrome are usually conducted on hospital outpatient populations. The results of this study indicate that the patient populations used for these purposes need to be carefully defined.

Abdominal Pain↗