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Biomedical subjects

G Rodin

Publications and source records attributed to G Rodin.

34 records · Page 2Linked to original sources
PubMed1991

The Endstage Renal Disease Severity Index (ESRD-SI).

Measures of disease severity are required as experimental, control and outcome variables in studies of the psychosocial aspects of physical illness. The Endstage Renal Disease Severity Index (ESRD-SI) was developed for these purposes during a prospective study of patient adjustment to dialysis and endstage renal disease (ESRD). It was found to have adequate inter-rater reliability, test-retest reliability, and construct and predictive validity in two subsamples (total N = 233) of dialysis patients. The ESRD-SI is suitable as a sensitive indicator of disease severity in these patients.

Adaptation, Psychological↗
PubMed1990

Quality of life in adults with insulin-dependent diabetes mellitus.

Conventional measures of psychiatric or medical morbidity do not adequately reflect the consequences of chronic illness. Quality of life refers to a more comprehensive assessment of the impact of illness. Uncomplicated insulin-dependent diabetes is usually associated with mild reported reduction in quality of life. Increased depressive and anxiety disorders have been reported in individuals with insulin-dependent diabetes mellitus, particularly in association with more severe medical complications and low social support. The potential benefits of intensive treatment approaches must be weighed against adverse effects on the quality of life.

Activities of Daily Living↗
PubMed1988

Suicide attempts and resuscitation dilemmas.

The conventional psychiatric opinion that suicide is a manifestation of psychiatric illness may not apply to circumstances in which suicide or the refusal of life-sustaining medical treatment results from the rational decisions of autonomous individuals. As medical technology advances, questions about the prolongation of life and the discontinuation of medical treatment have become commonplace in the medical setting. In this context, contradictions may exist between the principle of patient autonomy and that of physician responsibility. Dilemmas about treatment decisions that emerge from these conflicting perspectives are highlighted in this article. We report two cases of attempted suicide in the context, respectively, of (1) terminal illness and (2) advanced age. Some of the complex psychiatric, ethical, and legal issues related to the case reports are addressed.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Research in consultation-liaison psychiatry: the Toronto General Hospital experience.

Research that has developed in association with the consultation-liaison service at the Toronto General Hospital is reviewed in this paper. The value of systematic investigation in the consultation-liaison setting is addressed. Such approaches may be necessary to establish consultation-liaison psychiatry as a theoretical discipline which can advance knowledge in addition to enhancing patient care.

Humans↗
PubMed1987

Depressive symptoms and functional impairment in the medically ill.

Depressive symptoms of at least moderate severity were reported by more than 25% of a consecutive sample of end-stage renal disease (ESRD) patients awaiting cadaveric transplantation. Subjects with depressive symptoms in the clinically significant range were more often unemployed and were more functionally disabled than subjects with depressive symptoms of lesser severity. Depressive symptoms and functional disability were significantly correlated at lower but not higher levels of depression. Although depressed medical patients tend to be more impaired than those who are not depressed, the occurrence of depressive symptoms of clinical severity may depend upon the interaction among multiple additional factors. Clinically significant depression is not inevitable with severe medical disabilities and its occurrence should draw attention to specific individual vulnerabilities.

Adolescent↗
PubMed1987

Geriatric referrals to a psychiatric consultation-liaison service.

Geriatric patients constitute a significant proportion of referrals to a psychiatric consultation-liaison service, accounting for 29% of referrals in the present study. Organic mental disorders, the most common psychiatric diagnosis, were identified in 51% of geriatric referrals. The next most common psychiatric conditions were affective disorders and adjustment disorders, each of which were diagnosed in 17% of geriatric referrals. Transfers to in-patient psychiatry were unusual and the most common recommendations were for psychotropic medications, further medical investigations, and for psychosocial and behavioural interventions to be carried out by the ward staff. Although more specialized psychogeriatric units and community treatment resources are necessary, it is likely that the general hospital setting will continue to be important in the diagnostic assessment and short-term management of medical-psychiatric problems in the elderly.

Age Factors↗
PubMed1986

Depression in the medically ill: an overview.

Depressive symptoms and syndromes are common in the medically ill, although they are frequently unrecognized and untreated. The authors review the epidemiology, differential diagnosis, clinical presentations, and response to treatment of this clinical problem. They address such methodological issues in the current literature in this area as the advantages and limitations of standardized assessment measures and discuss treatment modalities for depression in the medically ill, including antidepressant medication and ECT. This clinical problem warrants attention for a variety of reasons: its prevalence, associated morbidity, and treatability. Elucidation of the mechanisms of depression in the medically ill may also contribute to a broader understanding of depression in other populations.

Adjustment Disorders↗
PubMed1984

Somatization and the self: psychotherapeutic issues.

Somatization has often been regarded as a defense against underlying unconscious conflict. However, it may also represent an internal experience which arises in response to psychological stress. During psychotherapy with patients with an unstable self-representation, a perceived disruption in the transference relationship may produce distress that is experienced in terms of physical discomfort and heightened bodily awareness.

Adult↗
PubMed1984

Long term open loop intravenous insulin infusion in type I diabetes: feasibility, problems and promise.

The response of four Type I diabetic patients to long term (1,4,4, and 8 months) intravenous insulin infusion is reported. As compared to their usual subcutaneous depot insulin treatment, glycosylated hemoglobin (HbAl) decreased from 12.2 +/- 0.7 to 8.8 +/- 0.9 (p less than 0.05). However, only 49 to 76.5% of self blood glucose monitoring results were between 60-179 mg/dl range. Although 6.3 to 15.2% of capillary blood glucose levels were less than 60 mg/dl, severe hypoglycemia occurred only on one occasion. Plasma cholesterol, triglyceride and high density lipoprotein all decreased significantly (p less than 0.005). The major motivating factors for participation in this study were: (1) the hope of preventing diabetic complications; (2) the wish for more knowledge about diabetes; (3) a sense of special purpose and (4) a general interest in science and research. Catheter obstruction as a result of insulin aggregation terminated the study in two subjects. A third subject requested the study be stopped primarily because of imposed travel restrictions. In one subject, the study was stopped because of a disrupted personal life and developing depression. Diabetic ketoacidosis or sepsis from the centrally placed intravenous catheter did not occur. Although long term intravenous insulin infusion is feasible in a clinical research setting, insulin aggregation continues to be a major limiting factor. The widespread clinical use of implantable pumps will have to await the development of a suitable insulin formulation.

Adult↗
PubMed1983

Differential diagnosis of emotional disorders that cause weight loss.

Recently, anorexia nervosa has received much attention in the scientific and lay press. As a result there is a danger that the other emotional disorders that can present with weight loss and vomiting will be overlooked. Case examples are presented for anorexia nervosa, conversion disorder, schizophrenia and depression. The presentation and treatment of these four disorders are compared.

Adolescent↗
PubMedDate not supplied

Physical sequelae and self-perceived attachment in adult survivors of childhood cancer.

The association between the physical sequelae of childhood cancer and self-reported attachment behavior was investigated in 97 adult survivors. Attachment was assessed using standardized self-report questionnaires. Functional disability and cosmetic sequelae of the cancer and its treatment were evaluated by the attending oncologist using a standardized rating scale. Results suggest that attachment is not significantly associated with physician-rated physical sequelae, but may be related to the time of onset of the functional deficits, independent of the current age or age at diagnosis. Further, survivors with functional sequelae in adulthood describe themselves as more insecure in their relationships in general and more ambivalent in their relationship with their parents. These findings, if replicated, suggest that the duration of the functional deficits as well as the developmental stage of the individual when they began may be important variables which affect the survivor's capacity to develop and maintain intimate relationships that are secure and satisfying.

Activities of Daily Living↗
PubMedDate not supplied

Alexithymia, depression, and treatment outcome in bulimia nervosa.

Disturbances in emotional awareness, sometimes referred to as alexithymia, have been hypothesized to contribute to the development of binge/purge symptoms among women with bulimia nervosa (BN) and/or are considered secondary to the state of depression and/or disordered eating. The present study was designed to assess alexithymia among women with BN, to evaluate the interrelationship between alexithymia, depression, and somatic symptoms, and to determine whether an intensive group psychotherapy program contributes to a reduction in the degree of alexithymia. Thirty-one of 50 BN women (62%) who completed The Toronto Hospital Day Hospital Program for Eating Disorders (DHP) were administered pretreatment and posttreatment questionnaires. Findings from this clinical sample were compared with those from 20 non-eating-disordered women who completed the same battery. Using the Toronto Alexithymia Scale (TAS), significantly more BN women were alexithymic at pretreatment (61.3%) and post-treatment (32.3%) than in the comparison group (5.0%), even when depression was controlled for. At discharge, abstinence from binge/purge episodes was associated with a significant reduction in alexithymia, although there was a significant correlation between TAS scores, depression, and vomit frequency. Alexithymia among BN women is not simply a concomitant of disordered eating. Its partial reversibility following an intensive psychotherapy program may be a direct effect of the treatment and/or may be secondary to a reduction in depressive and/or binge/purge symptoms.

Adolescent↗
PubMedDate not supplied

The psychology of factitious disorders. A reconsideration.

Factitious disorder (FD) is a form of somatization that involves apparent deception, simulation of illness, and imposture. This deception may be distinguished from other forms of lying in that patients with FD may suffer from underlying disturbances in the sense of reality and in reality testing. These features may be associated with a poorly consolidated sense of self and with difficulty regarding emotional experience as real. Factitious behavior may serve to stabilize the sense of self by concretizing and legitimizing the subjective experience of distress and by evoking responsiveness of a care-giver in a relatively safe, structured context. A psychotherapeutic stance focused on identifying and validating the patient's subjective experience may lead to a reduction in factitious behavior and to a more authentic and stable sense of self, in which emotional as well as physical experience is regarded as real. However, most patients with FD refuse treatment. Further, psychosis and suicidality are complications that may occur during the course of psychotherapy.

Adult↗
PubMedDate not supplied

Cadaveric renal transplant failure: the short-term sequelae.

Quality of life was evaluated in 103 patients initially when each was placed on the waiting list for a cadaveric transplant. Patients who were not transplanted were reassessed six months after being placed on the waiting list. Patients who received a transplant were reassessed six months after the surgery. Cadaveric transplantation was performed in sixty-three patients by the time of follow-up. The mortality rate of 12.7 percent in transplanted patients after six months was more than twice that in patients who remained on the waiting list without a transplant, but this difference was not statistically significant. There was a graft failure rate of 23.6 percent among transplanted patients who survived six months. Graft failures were associated with some deterioration in subsequent physical activity (F = 5.4, p less than 0.03) but not in psychosocial functioning. Successful cadaveric transplants were associated with a marked and significant improvement in psychosocial well-being (F = 10.5, p less than 0.002) after six months even though physical activity did not increase. These findings suggest that 1) a successful cadaveric transplant is associated with an improved quality of life, 2) the graft failure rate of 23 percent with cadaveric transplantation is still appreciable but 3) graft failure is not necessarily associated in the short term with deterioration in psychosocial well-being.

Adolescent↗