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PubMed1981

Psychopathology induced by "speed drugs".

The CNS stimulants produce profound psychopathological conditions in animals and man. The mental and motoric changes in humans make it relevant to retain the amphetamine and cocaine psychoses as possible models for endogenous psychoses, such as certain forms of the schizophrenias and manic-depressive disorders. The following behavioral aberrations in humans were found: (1) motor stereotypies with bizarre movements; repetitive, aimless activities; ("pottering"= "knick-knacking"= "punding") with various objects, including own body; repetition of single words, phrases or musical expressions; stereotyped drawing and writing (phenomena which are examples of mental stereotypy); (2) social stereotypies: prolonged sexual intercourse without ejaculation; collective monologues; (3) social withdrawal: "autism", social isolation with no or inappropriate responses to social stimuli; (4) paranoia; (5) hallucinations and illusions: auditory, visual, tactile (microhallucinations). Parallels to the overt behaviors have consistently been found in lower and higher animal species. Comparative data from experiments with rats and monkeys are presented. The findings have some important implications: drug addiction, basic understanding of social behavior and mental functions, screening and use of neuroleptic drugs, and side effects on social contact and behavior by the therapeutic use of CNS stimulants.

Animals↗

PubMed2002

Lamotrigine monotherapy improves health-related quality of life in epilepsy: a double-blind comparison with valproate.

The effects of monotherapy with lamotrigine on health-related quality of life were compared with those of valproate monotherapy in a randomized, double-blind trial designed to evaluate treatment-emergent weight changes in patients with epilepsy. At the end of 8 months of treatment, significantly more patients using lamotrigine compared with valproate experienced quality-of-life improvements on the Health Perceptions (42% vs 15%), Energy/Fatigue (47% vs 28%), and Social Isolation (35% vs 16%) subscales of the Quality of Life in Epilepsy-89 (QOLIE-89) questionnaire (P<0.05). Compared with valproate-treated patients, lamotrigine-treated patients were four times more likely to experience improvement in Health Perceptions, 2.3 times more likely to experience improvement in Energy/Fatigue, and 2.8 times more likely to experience improvement in Social Isolation (P<0.05). These quality-of-life improvements are consistent with the improvements in mood measured with the Beck Depression Inventory, the Cornell Dysthymia Rating Scale, and the Profile of Mood States among patients receiving lamotrigine. These data show that lamotrigine monotherapy provides benefits over valproate monotherapy in improving several aspects of health-related quality of life in patients with epilepsy. The observation that quality-of-life improvements during lamotrigine monotherapy occurred concurrently with improvements in mood suggests that the quality-of-life and mood changes may be causally related.

Journal Article↗

PubMed2003

Cognitive and somatic symptoms of depression are associated with medical comorbidity in patients after acute myocardial infarction.

BACKGROUND: Depression is common in patients with acute myocardial infarction (AMI) and is associated with adverse health outcomes. However, the extent to which clinical depression is related to comorbid medical conditions is unknown. This study examined the degree of association between clinical depression and medical comorbidity in patients hospitalized with AMI. METHODS: Two thousand four hundred and eighty-one depressed or socially isolated patients with AMI were enrolled, as part of the National Heart, Lung, and Blood Institute-sponsored Enhancing Recovery in Coronary Heart Disease clinical trial. A structured interview was used to diagnose major and minor depression and dysthymia; severity of depression was measured by the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Level of social support was measured by the ENRICHD Social Support Instrument. A modified version of the Charlson Comorbidity Index was used to measure the cumulative burden of medical comorbidity. RESULTS: The adjusted odds ratios (ORs) for having major depression increased linearly with medical comorbidity (ORs 1.6, 2.2, 2.7 for each increasing medical comorbidity category). This relationship remained after adjusting for coronary heart disease severity (ORs 1.4, 1.7, 1.9, P <.001). The relationship between severity of depression and medical comorbidity was also maintained after excluding somatic symptoms of depression (F = 21.5, P <.0001). CONCLUSIONS: Patients with AMI and clinical depression have significantly greater levels of medical comorbidity than nondepressed, socially isolated patients. Further research is needed to determine whether comorbid medical illness contributes to the more frequent rehospitalizations and increased risk of mortality associated with depression.

Adult↗

PubMed2001

Health profiles for patients with Ménière's disease.

The Nottingham Health Profile (NHP) has been used to investigate the health profiles for many medical conditions, such as herpes zoster infection, migraine, cancer and epilepsy. However, so far, it has not been used to investigate the health profile for patients suffering from Ménière's disease, but only for patients with dizziness, severe hearing loss and tinnitus. Each of these three symptoms have shown to have a significant impact on the quality of life. In the present study, 116 consecutive patients with Ménière's disease, diagnosed according to the AAO-HNS guidelines, visiting at the department of Audiology were included in the study. The NHP was used to measure the health related quality of life and includes the following subscales: "Sleep", "Energy", "Emotional reaction", "Pain", "Physical mobility", "Social isolation" and items concerning daily activity. The Tinnitus Severity Questionnaire (TSQ) was used to measure symptoms specific to tinnitus. The results showed that the perceived severity of tinnitus in patients with Ménière's disease had a significant negative influence on their health related quality of life. The patients with Ménière's disease suffered from more sleep disturbances and social isolation than patients referred to our clinic due to tinnitus. The quality of life was, on the whole, worse for patients of working age compared to retired pensioners. Emotional disturbances could explain 40.3 % of the variance of the tinnitus severity in patients with Ménière's disease. This can be compared with 20.6% in patients with tinnitus. This underscores the importance of providing psychological and psychiatric interventions and support to patients with Ménière's disease.

Journal Article↗

PubMed1999

[A survey of the psychosocial situation of homeless men in Frankfurt am Main].

In a current field-study a sample of 71 homeless men (mean age 35.4 years) was investigated with a semi-standardized interview. Sociodemographically, a low education level, a high unemployment rate and low income were noted. The income was gained mainly through regular social welfare support. Mostly unmarried and without children, the participants seldom lived in a stable partnership during their life. Psychosocial conflicts (59.2%) were one of the most important causes for homelessness at an average age of 28.1 years. Interpersonal conflicts, release from jail and loss of job were the most frequently reported causes of current homelessness. 42.3% had been treated in psychiatric hospitals in the past, the majority because of alcoholism. In summary the current findings indicate that homeless men experience social isolation early during their maturation and that the frequency of psychiatric disorders is high.

Adult↗

PubMed1987

Social network ties and mortality among the elderly in the Alameda County Study.

Seventeen-year mortality data from the Alameda County Study are used to examine the relative importance of social ties as predictors of survival at different ages, ranging from 38-94 years at baseline. Previous analyses of Alameda County data by Berkman and Syme (Am J Epidemiol 1979;109:186-204) have shown that such ties are significant predictors of lower nine-year mortality risk for persons aged less than 70 years at baseline. Proportional hazard analyses indicate that social ties are also significant predictors of lower 17-year mortality risks for those aged 70 and older after adjusting for age, sex, race, baseline health status, perceived health, depression, and health practices (relative hazard = 1.49 for Berkman-Syme Social Network Index; 95% confidence interval (CI) = 1.09-2.05). Comparisons of the relative importance of four types of social ties reveal an interesting shift across the age groups. Marital status assumes primary importance for those aged less than 60 years at baseline (relative hazard = 1.6 and 1.4 for those aged 38-49 and 50-59, respectively; 95% CI = 1.12-2.29 and 1.02-1.91, respectively). However, ties with close friends and/or relatives assume greater importance for those aged 60 and older (relative hazard = 1.17 comparing those reporting five or more contacts per month to the more socially isolated who report less than five such contacts per month; 95% CI = 0.98-1.89).

Adult↗

PubMed2004

The interaction of housing condition and acute immobilization stress on the elevated plus-maze behaviors of protein-malnourished rats.

Protein malnutrition induces structural, neurochemical and functional alterations in the central nervous system, leading to behavioral alterations. In the present study, we used the elevated plus-maze (EPM) as a measure of anxiety to evaluate the interaction between acute immobilization and housing conditions on the behavior of malnourished rats. Pups (6 males and 2 females) were fed by Wistar lactating dams receiving a 6% (undernourished) or 16% (well-nourished) protein diet. After weaning, the animals continued to receive the same diets ad libitum until 49 days of age when they started to receive a regular lab chow diet. From weaning to the end of the tests on day 70, the animals were housed under two different conditions, i.e., individual or in groups of three. On the 69th day, half of the animals were submitted to immobilization for 2 h, while the other half were undisturbed, and both groups were tested 24 h later for 5 min in the EPM. Independent of other factors, protein malnutrition increased, while immobilization and social isolation per se decreased, EPM exploration. Analysis of the interaction of diet vs immobilization vs housing conditions showed that the increased EPM exploration presented by the malnourished group was reversed by acute immobilization in animals reared in groups but not in animals reared individually. The interaction between immobilization and housing conditions suggests that living for a long time in social isolation is sufficiently stressful to reduce the responses to another anxiogenic procedure (immobilization), while living in groups prompts the animals to react to acute stress. Thus, it is suggested that housing condition can modulate the effects of an anxiogenic procedure on behavioral responses of malnourished rats in the EPM.

Animals↗

PubMed1980

Social stress influences tumor growth.

Growth of syngeneic P815 mastocytoma in DBA/2J male mice was evaluated following social and physical stress exposure. Although social isolation following tumor cell transplantation enhanced tumor growth, it appeared that it was the abrupt change in social conditions, rather than the isolation per se which was responsible for the exacerbation of tumorigenicity. Moreover, it was found that the animals' behavior after social change could modify this effect. If mice engaged in persistent fighting, the tumorigenic consequences of social change were not apparent. In addition, it was observed that social conditions interacted with physical stress. Footshock enhanced tumor growth among group housed mice, but retarded tumor development among socially isolated mice.

Adaptation, Psychological↗

PubMed2000

Postpartum depression: identification of women at risk.

OBJECTIVE: To identify and test the predictive power of demographic, obstetric, and psychosocial risk factors of postpartum depression. DESIGN: Community-based, prospective follow up study based on questionnaires on past history of psychiatric disease, psychological distress and social support during pregnancy and depression at four months after delivery. Obstetric files were collected at time of birth. SETTING: Antenatal care clinic and delivery ward, Aarhus University Hospital, Denmark. POPULATION: 6,790 women giving birth between 1 January 1994 and 31 December 1995, who attended the antenatal clinic during pregnancy; 5,252 (78%) completed all questionnaires. The validation population comprised 528 women enrolled immediately prior to and after the study period. MAIN OUTCOME MEASURE: Postpartum depression four months after giving birth assessed by the Edinburgh Postnatal Depression Scale. RESULTS: 5.5% of the women suffered from postpartum depression, corresponding to a score of 13 or higher on the Edinburgh Postnatal Depression Scale. Risk factors identified by multivariate logistic regression analysis included psychological distress in late pregnancy (OR 6.3 [95% CI 4.4-9.1]), perceived social isolation during pregnancy (OR 3.6 [95% CI 1.9-7.0]); high parity (OR 3.8 [95% CI 1.8-8.0]); and a positive history of prepregnant psychiatric disease (OR 2.1 [95% CI 1.4-3.2]). No association was found between pregnancy or delivery complications, and postpartum depression. The maximum predictive power of the identified risk factors was 0.3. According to these results, one out of three women who suffers from psychological distress in late pregnancy with perceived social isolation will develop postpartum depression. CONCLUSION: Antenatal focus on psychosocial wellbeing may help to identify women at risk of postpartum depression.

Adolescent↗

PubMed1996

Life after cardiac arrest; a retrospective study.

AIM: We decided to evaluate the life situation of the survivors after out-of-hospital cardiopulmonary resuscitation (CPR). METHOD: CPR survivors who were 75 years or younger at the time and who were discharged alive from the hospital were identified consecutively. Average follow-up time was 25.5 months, and at follow-up 24% were deceased and 9% were lost. A questionnaire was completed by 93% and 71% were positive to an interview. RESULTS: Cognitive functions were reduced as well as capacity to perform activities in daily living. This resulted in dependence on other persons for living (nursing homes) and a low return to work. Social isolation was a common complaint. The survivors also reported lower pain awareness than the reference population. As far as other aspects of health-related quality of life, this small group show many similarities with previously evaluated post-infarction patients. CONCLUSION: Lower pain awareness should be taken into consideration when the CPR patients have ischemic heart disease. If possible, try to prevent social isolation.

Activities of Daily Living↗

PubMed1986

Use of the Nottingham Health Profile with patients after a stroke.

The Nottingham Health Profile (NHP) is easy to use with stroke patients and may be used with those who cannot manage more complicated mood questionnaires, such as the General Health Questionnaire (GHQ). Stroke patients rate their health, and especially emotions and feelings of social isolation, as much worse than that of people of similar age. NHP emotion scores correlate with objective measures of disability, length of hospital stay, and GHQ scores. The NHP is a valid indicator of depressed mood, and combining its components into a total score gives the greatest accuracy in detecting depression. Patients with high scores at one month continued to report large numbers of problems at six months after their stroke. Many patients experienced pain, disturbed sleep, and social isolation, which are important, potentially treatable problems not usually considered in the management of stroke patients. Many patients with problems did not see their general practitioner or any other source of help, and additional follow up was needed.

Cerebrovascular Disorders↗

PubMedDate not supplied

'Breathtaking': the consequences of chronic respiratory disorder.

Chronic obstructive airways disease (COAD) is a major, though neglected, medical and social problem in the United Kingdom today. Dyspnoea is one of the most distressing and disabling symptoms of COAD, which is itself the largest single cause of absence from work in the United Kingdom. This paper reports on 92 patients suffering from COAD, who were interviewed in order to assess impairment, disability and handicap, and a smaller subsample of 24 of these patients who were followed-up using open-ended, semi-structured, tape-recorded interviews in order to cover in more detail some of the issues raised in the first quantitative stage of the study. Low correlations were found between lung function and disability (-0.38 p less than 0.001), accounting for only 14% of the variance, and high correlations between measures of dyspnoea and disability (-0.90 p less than 0.001). Major areas of disability and handicap included: household management, ambulation, sleep and rest, recreation and pastimes, and work. Financial problems and difficulties, housing problems and problems of social isolation were also frequently reported. The paper then attempts to explore the relationship between impairment, disability and handicap, drawing on both the quantitative and qualitative data collected in order to illustrate the variable nature of this relationship. The paper concludes by suggesting both the need for a more integrated approach to the care and rehabilitation of COAD patients and their families, and for a complementary social perspective and approach to COAD and its treatment.

Activities of Daily Living↗

PubMed1986

[Medical and social aspects of the psychological health of the elderly].

As a consequence of falling birth-rates and increasing life expectancy, the absolute and relative number of the elderly has been considerably growing in all industrial countries during the last hundred years. According to the findings of a field study carried out among inhabitants of the City of Mannheim, well in concordance with the results of comparable investigations undertaken in rural and urban areas of other countries, about a quarter of the individuals aged over 65 are mentally ill. Under the assumption of unchanged age-related morbidity rates, the absolute number of elderly persons suffering from mental illness more than doubled in the Federal Republic of Germany between 1950 and 1980, due to demographical changes only. The quantitatively most important risk factor for psychiatric morbidity in old age, especially for psycho-organic syndromes, seem to be physical illness and handicaps. Environmental factors determining the microsocial milieu of the elderly seem to influence the frequency of depressive syndromes, as was shown by a study carried out in homes for the elderly in New York, Mannheim and London. Also in old age, belonging to the lower socioeconomic stratum - as a macrosocial factor - correlates with increased rates for psychiatric morbidity as a whole, as it does with poor physical health and increased mortality. However, this correlation is significant only for the group of psycho-organic syndromes. In functional syndromes it is hardly marked. It can be assumed that to a large part, unfavourable socioeconomic conditions mainly have an indirect impact on psychiatric morbidity by way of higher rates of those somatic diseases leading to psychiatric sequelae, e.g. cardiovascular diseases. Events of losses and social isolation in a sense of experienced loneliness accompanied by a lack of contact enlarge the risk of developing psychiatric disturbances, in particular depressive syndromes, and also the risk of somatic diseases and suicides. Since coping resources of the individual also often decrease in old age, this phase of life shows specific mental health risks which should be counteracted as long as possible by medical and social care on the levels discussed before.

Aged↗

PubMedDate not supplied

[A study of the effectiveness of the bereavement program of Severance Hospice].

Grief that is not acknowledged and worked through may manifest itself in some emotional, mental or physical problem. In recent years much as been learned about coping with grief which the hospice program can utilize to help family members cope with their grief. This study was carried out to determine the helpfulness of the bereavement care of Severance Hospice and to learn more about the grief response of the bereaved. The tools used to collect data were an assessment form used in the bereavement program and the Grief Experience Inventory developed by Sanders and revised and translated by the researcher. Data was obtained from bereaved family members (54 for the final grief assessment and 39 for the grief response assessment) receiving bereavement follow-up, from July 1989 to March 1991. Results of the study were as follows: 1. Final Grief Assessment Regarding the resolution of their grief the majority of the bereaved accepted the reality of the death of their family member, while slightly more than three-quarters were able to express their feelings toward their loss. A large majority had returned to activities of daily living well or fairly well and had reinvested their energy in a person other than the deceased. In addition, the physical condition of the majority was good or fairly good. A majority of the bereaved considered the bereavement care to be helpful and almost three-quarters were not considered to be in need of more follow-up. 2. Grief Response Assessment Age was found to have a moderately positive correlation to appetite disturbance (r = .41, P less than .01) and loss of vigor (r = .37, P less than .01) A moderately positive correlation was found between the number of contacts and sleep disturbance (r = 2.38, P less than .01) Significant differences were found between men and women in regard to guilt (t = 2.38, P less than .05), social isolation (t = 2.44, P less than .05) and depersonalization (t = 2.07, P less than .05) with men having the more intense grief. Significant differences were found in the grief responses of somatization (F = 5.82, P less than .001), physical symptoms (F = 5.87, P less than .001), appetite disturbance (F = 4.40, P less than .01), despair (3.79, P less than .01), anger (Fp2.83, P less than .05), social isolation (F = 3.61, P less than .05), guilt (F = 3.62, P less than .05) and depersonalization (F = 2.58, P less than .05).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed2000

Perceived health status in patients over 70 before and after open-heart operations.

AIM: to evaluate improvement and predictors of improvement in patients' perceived health status after cardiac surgery in older patients. METHODS: three hundred and seventy-seven patients from three different departments of cardiac surgery completed the Nottingham Health Profile questionnaire before and 1 and 2 years after open-heart surgery. We analysed pre- and postoperative data and pre- and postoperative Nottingham Health Profile scores. RESULTS: the mean age was 74+/-3 years. The comparison between pre- and postoperative scores showed an improvement in all but the social isolation section. Logistic regression showed that the predictors of patients who became worse after surgery were (i) in the energy section: age over 75 [odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.02-3.2], coronary artery disease (OR = 2.4, 95% CI = 1.04-3.6) and postoperative events (OR = 1.9, 95% CI = 1.01-3.7); (ii) in the physical mobility section: diabetes mellitus (OR = 2.4, 95% CI = 1.2-4.7); and (iii) in the social isolation section: physical mobility impairment (OR = 3.4, 95% CI = 1.3-8.7). CONCLUSIONS: cardiac surgery improves perceived health status in patients over 70. This improvement is better for those undergoing aortic valve replacement than for those undergoing coronary artery bypass surgery. Comparison with reference scores for a standard population shows that, even when successful, cardiac surgery results in fatigue and persistent sleep disturbance in older patients.

Aged↗

PubMed1995

Psychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations.

The psychosocial problems of decreased social contact, depression, and loneliness that occur for many with traumatic brain injury (TBI) create a major challenge for enhancing efforts at community re-entry. Despite dramatic physical progress within the first six months after injury, these psychosocial problems remain a persistent long-term problem for the majority of individuals with severe TBI. Researchers have consistently suggested that the psychosocial problems associated with TBI may actually be the major challenge facing rehabilitation. The majority of individuals who sustain TBI are young males between the ages of 19 and 25, who are in the early stages of establishing their independence in areas including friendships, leisure activities, intimate relationships, residence, and employment. The problem of social isolation and decreased leisure activities create a renewed dependence of the survivor on his/her family to meet these needs. In this article we review a large number of papers which examine the psychosocial and emotional sequelae for TBI patients. The results of those studies demonstrate four primary themes. The first theme depicts that individuals who experience severe TBI are at high risk for a significant decrease in their friendships and social support. The second theme relates to the lack of opportunity for establishing new social contacts and friends. The third theme relates to the decrease in leisure activities for individuals with severe TBI. Finally, anxiety and depression are found at high levels for prolonged periods of time following severe TBI. Several clinical recommendations are drawn from this literature review. They are: (1) Clinicians such as psychiatric social workers, psychologists, or psychiatrists may need to be called upon more quickly for intervention. The treating physiatrist cannot be expected to provide the insight and frequency of psychological services that may be necessary for many of these patients. (2) Since the literature seems to suggest that the presence of one psychosocial deficit, e.g., anxiety, will often be followed by other similar types of problems, e.g. depression, the treatment team needs to be sensitive to how rapidly these problems can cascade into a very dangerous situation. (3) Perhaps the most compelling recommendation we can make is for community rehabilitation specialists to focus significantly more energies and resources upon the psychological health of clients with TBI. Staff need to be trained to detect these signals that clients with TBI are often sending. It is apparent that psychosocial factors contribute to a rising obstacle level to community adjustment.

Activities of Daily Living↗

PubMedDate not supplied

Psychosocial, hemostatic, and inflammatory correlates of delayed poststress blood pressure recovery.

OBJECTIVE: Delayed poststress cardiovascular recovery has been associated with cardiovascular disease risk. This study assessed relationships between systolic blood pressure (BP) recovery, psychosocial risk factors, and delayed recovery of inflammatory and hemostatic variables. METHOD: Data were analyzed from 228 middle-aged men and women from the Whitehall Psychobiology study who performed color/word and mirror-tracing tasks. Systolic BP recovery was assessed as the difference between baseline and levels recorded 40 to 45 minutes poststress. Associations were analyzed with socioeconomic markers (grade of employment, education, income), psychosocial factors (social isolation, hostility, mental health, financial strain), and recovery of heart rate, heart rate variability, von Willebrand factor, factor VIII clotting activity, plasma fibrinogen, and plasma viscosity. RESULTS: Systolic BP was on average 6.19 +/- 9.6 mm Hg higher on recovery than baseline. Delayed BP recovery was associated with lower grade of employment, lower education and lower income independently of age, gender, and systolic BP stress reactivity. Delayed BP recovery was related to social isolation and poor mental health independently of age, gender, socioeconomic position, and task reactivity. Delayed systolic BP recovery was also associated with delayed recovery in diastolic BP, heart rate, factor VIII, and plasma viscosity but not delayed heart rate variability recovery, independently of age, gender, body mass, and task reactivity. CONCLUSION: Socioeconomic and psychosocial risk factors for cardiovascular disease are related to delays in poststress recovery. Delayed systolic BP recovery may be a marker for prolonged responses in hemostatic variables that have a direct influence on cardiovascular disease pathogenesis.

Biomarkers↗

PubMed2005

Social networks among users of mental health day care--predictors of social contacts and confiding relationships.

BACKGROUND: The social networks of people with mental illness have received much attention, but users of day care services have rarely been considered. METHODS: Users of day hospitals and day centres were surveyed cross-sectionally. Demographic and illness factors were tested for associations with network size, while intrinsic relationship factors were tested for association with confiding in a network member. RESULTS: There was some evidence that a longer duration of contact with services, more unmet needs, working, living in supported accommodation and needing help with psychotic symptoms were associated with having a larger network, while a longer duration of contact was associated with having more confidantes. Day centre users confided in people who were more likely to be friends or neighbours than professionals, and who were more likely to be the same sex. CONCLUSION: For people in day care, the stereotype that people with longer-term mental health problems are socially isolated is contradicted by this study. The limited role of professionals in providing confiding relationships is striking.

Adult↗