Psychiatric screening for patients with faecal incontinence or chronic constipation referred for surgical treatment

Fifty patients attending for surgical treatment of chronic constipation (n = 21) or faecal incontinence (n = 29) were studied using two psychiatric screening tests: the Hospital Anxiety and Depression (HAD) scale and the General Health Questionnaire (GHQ). Each patient was assessed preoperatively and 6-12 months postoperatively. Results were compared with age and sex-matched controls (n = 50). Constipated patients had significantly higher HAD depression scores compared with controls (median and range): 6 (2-12) versus 4 (0-8), P less than 0.05. Constipated patients who were improved by operation (n = 13) had significantly lower preoperative HAD anxiety scores compared with those who were not improved (n = 8): 8 (3-14) versus 15 (10-19), P less than 0.01; they also had significantly lower HAD depression scores: 4 (2-12) versus 7 (5-11), P less than 0.05. Using these parameters incontinent patients did not differ from controls, but patients who had a bad result after operation (n = 15) had significantly higher HAD anxiety scores than those who obtained clinical benefit (n = 14): 10 (2-15) versus 6 (2-12), P less than 0.05; HAD depression scores were also greater: 5 (2-15) versus 3 (0-9), P less than 0.05; and GHQ scores were greater: 12 (0-47) versus 4 (0-41), P less than 0.05.     

Anxiety and depression in patients with an intracranial neoplasm before and after tumour surgery.

The aims of this prospective study were to investigate levels of anxiety and depression in patients with a solitary intracranial neoplasm before and after surgery, and to determine if relationships exist between high levels of anxiety or depression and the hemispheric location of the tumour, the tumour type or patient gender. Patients aged between 17 and 79 years with a solitary intracranial neoplasm completed the Hospital Anxiety and Depression Scale (HAD) before and after biopsy or resective tumour surgery. A control group of non-brain-damaged subjects also completed the HAD before and after lumbar spinal surgery. Of the 109 patients with a brain tumour 30 and 16% demonstrated the likely presence of anxiety and depression, respectively, according to HAD scoring criteria. A greater proportion of females with a left hemisphere tumour reported higher levels of emotional disturbance than any other group of patients; relationships between dysphasia and levels of anxiety or depression were not significant. Patients with a meningioma had higher levels of anxiety and depression as measured by the HAD than those with any other tumour types. Levels of both anxiety and depression were significantly lower after tumour surgery according to the HAD. There were no significant differences in HAD scores between (a) left and right hemispheric tumour groups, and (b) the tumour and control (n = 20) groups. This study has found that anxiety and depression as measured by the HAD are relatively uncommon in patients with an intracranial neoplasm, and that levels of mood disturbance do not differ significantly from those in patients undergoing lumbar spinal surgery. Levels of anxiety and depression become lower after surgery in patients with a brain tumour. Patterns of anxiety and depression in patients with a brain tumour appear to differ from those reported in stroke.     

Patient perceived barriers to treatment of depression and anxiety in hemodialysis patients

Untreated psychiatric illness correlates with increased mortality, reduced quality of life and increased risk of suicide in renal failure patients, but little is known about why these patients fail to seek mental health care. The purpose of this study was to identify the perceived barriers to mental health services in the hemodialysis patient population. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to identify the prevalence and severity of depression and anxiety in a group of 179 hemodialysis patients. Of the 103 patients who completed the surveys, 73.8% were African-American and 62.1% were male. Of the 54.4% of patients identified with depression by scoring 10 or greater on the BDI, 34.0% had mild-to-moderate, 12.6% had moderate-to-severe, and 7.8% had severe depression. Only 13.6% of respondents met criteria for anxiety. Each patient was asked to choose from a list of possible barriers, and 71.4% of patients meeting criteria for depression or anxiety identified a barrier to mental health treatment. Of these, over 70% of patients were unaware of symptoms of depression/ anxiety or did not perceive the need for help. Our results indicate a high prevalence of untreated depression in hemodialysis patients. Patient perceptions of the need for therapy present the most significant barriers to identification and treatment.     

Psychological difficulties amongst plastic surgery ex-patients following surgery to the face: a survey.

Qualitative accounts suggest that social difficulties are a major source of psychological disturbance to disfigured people. However, there have been few systematic investigations of their psychological and social difficulties, and those which do exist are usually small studies with methodological difficulties. Social skills training and cognitive-behavioural therapy are promising interventions, particularly if it can be demonstrated that anxiety is a major element of the psychological difficulties experienced by disfigured people.A postal survey was sent to all ex-patients at a plastic surgery clinic who received plastic surgery to the face between 6 months and 5 years 6 months prior to the date of the survey. Of these, 105 ex-patients returned questionnaires, representing a 41.8% response rate. Respondents did not differ from non-respondents according to age, sex or diagnosis. The majority of respondents were not experiencing psychological difficulty, but GHQ caseness, HAD anxiety and HAD depression scores were generally higher than in general population samples. Their levels of social phobia appeared higher than prevalence in the general population, although direct comparison is hampered by the different instruments used. Women showed greater disturbance than men on many of the scales used, and patients who had undergone surgery for revision of scars showed greater disturbance than those who had undergone surgery for cancer.The current study may be considered more representative of disfigured people than previous surveys, since its subjects were neither awaiting nor receiving treatment, although the response rate was still low. Contrary to assertions in previous studies, standardised measures detected dysphoria in this sample. Anxiety, particularly in social situations, with associated phobic avoidance, was the most frequently reported difficulty, with depression considerably less common. Given the success of cognitive-behaviour therapy in addressing such difficulties, both via formal therapy and self-help methods, there are clear implications for treatment from this finding.     

Evaluation of depression and anxiety in patients with systemic sclerosis

OBJECTIVE: To determine the prevalence of depression and anxiety in patients receiving follow-up in France for systemic sclerosis. PATIENTS: We prospectively evaluated 42 patients admitted for a follow-up evaluation of systemic sclerosis, including 18 with diffuse cutaneous scleroderma and 24 with limited cutaneous scleroderma. Patients admitted for recent organ involvement were excluded. Mean age was 57 +/- 13 years, mean disease duration was 10.2 +/- 8 years, and the mean functional Health Assessment Questionnaire score was 0.682 +/- 0.649. Only four patients had a history of antidepressive drug therapy. We used the Montgomery-Asberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating Scale to evaluate depression and anxiety, respectively. RESULTS: Eighteen (43%) patients met criteria for depression and 11 (26%) had scores above the cutoff usually taken to define moderate-to-severe depression. Twenty-seven (64%) patients met criteria for minor anxiety and eight (19%) for major anxiety. Depression and anxiety were strongly correlated with each other (r = 0.89; P < 0.0001). The MADRS score was significantly higher in the patients with pulmonary restrictive disease (P = 0.009) but was not associated with the extent of skin involvement, organ involvement, or disability. CONCLUSION: Systemic scleroderma is associated with a high prevalence of depression and anxiety. These disorders should be looked for routinely and the need for specific treatment evaluated.     

Psychiatric risk factors for traumatic brain injury

Objective: To examine the risk of sustaining a traumatic brain injury (TBI) associated with prior psychiatric conditions beyond that of fixed demographic variables.

Design: Retrospective cohort study of non-referred community-dwelling male US veterans.

Methods: Two-hundred and seventy-one individuals who sustained a TBI with altered consciousness were compared with 630 controls without a history of head injury, selected from a larger sample of 3766.

Results: Hierarchical logistic regression analyses were used to model odds ratios and 95% confidence intervals for the unique association between pre-existing psychiatric disorders and the likelihood of incurring a TBI while adjusting for demographic characteristics and other known predictor variables. Mood (odds ratio 2.48, 95% confidence interval 1.23-5.01), anxiety (OR 1.64, 95% CI 1.01-2.68) and conduct disorders (OR 1.66, 95% CI 1.16-2.38) increased the risk of head injury.

Conclusions: The pre-existence of psychiatric illness, particularly depression, anxiety and conduct disorder, increased the future risk of incurring a TBI. The implementation of early identification and treatment of psychiatric conditions may potentially lower risk and reduce yearly incidence rates of TBI.     

Anxiety, depressive, and posttraumatic stress symptoms in mothers of children with type 1 diabetes

This study investigated the prevalence of mothers' anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms triggered by their child's type 1 diabetes and identified individual diabetes-related traumatic stressors. Sixty mothers of children who had been diagnosed with diabetes within the past 5 years were interviewed using the Structured Clinical Interview (SCID) DSM-IV-PTSD module, and completed the Posttraumatic Stress Diagnostic Scale (PDS) and the Hospital Anxiety and Depression Scale (HADS). Fifteen percent of participants met criteria for partial and 10% for full PTSD. Fifty-five percent of participants identified hearing about their child's diagnosis as the traumatic stressor. Forty percent of participants reported moderate to severe symptoms of state-anxiety and 17% moderate to severe symptoms of depression. This study highlights the significant emotional impact this diagnosis in children can have on mothers, and identifies a population with clinical needs.     

Do men and women differ in their course following traumatic brain injury? A preliminary prospective investigation of early outcome

Primary objective: To examine the effect of a patient's sex on measures of outcome in a matched sample of patients admitted for acute traumatic brain injury (TBI).

Research design: A prospective multi-centred group comparison study based in metropolitan Sydney, Australia.

Methods and procedures: Data was collected on 25 women admitted for treatment following non-penetrating TBI. Forty-five men were then matched with regards to age and injury severity. All subjects met the study criteria of having a moderate-to-severe TBI and aged 50 years old or younger. Exclusion criteria included history of previous head injury, psychiatric disturbance and significant alcohol and/or substance abuse. Data included injury details and physiological and psychometric measures of outcome.

Main outcomes and results: Women demonstrated better outcomes as indicated by their Glasgow Outcome Scale scores (adjusted for initial injury severity and age at injury odds ratio [OR] 4.2, 95% CI 1.4-12.7) and having shorter Length of Stay (adjusted OR 9.03, 95% CI 3.13-26.08).

Conclusions: Understanding the presence of sex differences in outcome following TBI is an emerging area of research. This study indicated that, after matching for initial injury severity and age at injury, women with severe TBI demonstrate a better early outcome than men.     

Associations between erectile dysfunction and psychological disorders (depression and anxiety): A cross‐sectional study in a Chinese population

The present cross‐sectional survey was performed to evaluate the prevalences and correlations of depression and anxiety among Chinese erectile dysfunction (ED) men. Between February 2017 and January 2019, male patients with or without ED treated in andrology clinic and urology clinic were enrolled in the investigation. All enrolled patients were required to fill in the International Index of Erectile Function Questionnaire (IIEF‐5), Patient Health Questionnaire (PHQ‐9) and Generalized Anxiety Disorder 7‐item scale (GAD‐7) which intended to evaluate the diagnosis and severity of ED, depression and anxiety respectively. Of the 958 included participants, 79.82% (613/768) and 79.56% (611/768) ED patients appeared to have anxiety and depression; 13.68% (26/190) of men without ED had anxiety and depression. In addition, young ED patients (age ≤35 years) and long ED duration patients (duration >12 months) had higher incidences and severities of anxiety and depression (p < .05). After adjusting the age, IIEF‐5 was negatively correlated with PHQ‐9 (adjusted r = ?.653, p < .001) and GAD‐7 scores (adjusted r = ?.607, p < .001). The prevalences of anxiety and depression were 79.82% and 79.56% in Chinese ED patients. The prevalences and severities of anxiety and depression increased as the ED severity increased. Based on the high incidences of anxiety and depression among Chinese ED patients, clinicians are supposed to pay more attention to early diagnosis and therapy of psychiatric symptoms for ED patients, especially among young patients and patients with long ED duration.     

脊髓损伤伴神经源性肠功能障碍患者肠道管理最佳证据总结

目的 总结脊髓损伤伴神经源性肠功能障碍患者肠道管理的最佳证据,为改善患者肠道功能提供依据。方法 检索国内外相关循证资源网站及数据库中关于脊髓损伤肠道功能障碍患者肠道管理证据。对纳入文献进行方法学质量评价和证据提取。结果 共纳入17篇文献,其中指南7篇、专家共识5篇、系统评价3篇、随机对照试验2篇。总结了关于肠道功能评估方法、评估量表、健康教育、饮食干预、药物干预、行为干预及手术干预7个方面的26条证据。结论 脊髓损伤伴神经源性肠功能障碍患者最佳证据可为临床医护人员评估患者肠道功能及采取干预措施提供依据,实际应用中应结合临床实际情况和患者需求选择证据。     

Posttraumatic stress disorder after implantation of a mechanical assist device followed by heart transplantation: evaluation of patients and partners

AIM: We sought to investigate the prevalence of posttraumatic stress disorder, anxiety, and depression in patients and their partners after implantation of a mechanical assist device as a bridge to heart transplantation. METHODS: This was a retrospective assessment of 41 patients (age 46.3 +/- 12.0 years; male-female ratio, 38:3; time since transplantation, 55.3 +/- 34.2 months [range, 7-122 months) and 27 partners (male-female ratio 2:25) by standardized instruments (Impact of Event Scale, Hospital Anxiety and Depression Scale), in 2 University Heart Transplant Centers (Vienna, Austria, Munster, Germany). The duration of the support systems (MicroMed DeBakey-VAD in 17 patients, Novacor in 10, Thoratec in 8, TCI HeartMate in 5, and Berlin Heart Incor in 1 patient) ranged from 28 to 711 (176 +/- 146) days. RESULTS: None of the patients, but 23% of the partners (n = 6), met the criteria for posttraumatic stress disorder (Maercker cutoff >0). The Impact of Event Scale (IES) sum scales differed significantly between the 2 groups (21.2 +/- 15.1, mean +/- SD) for the patients versus 38.1 +/- 27.8 for the partners, respectively; P = .001). Two percent of the patients, but 19% of the partners, showed mild to moderate depression; 4% of patients, but 23% of their partners, reported mild to moderate anxiety. None of the results were significantly influenced by the time since transplantation, patient age, diagnoses, type of assist device, or indication for heart transplantation. CONCLUSIONS: Despite patients being much closer to a life threat, their partners experience significantly more psychologic distress even in the long run. Our findings highlight the need for attention to the supporting persons.     

Pre-injury depression and anxiety in patients with orthopedic trauma and their treatment

PurposeDepressive symptoms have a known negative impact on outcomes following musculoskeletal injury. This study determined the pre-injury prevalence of psychiatric diagnoses of depression and anxiety, medication lapses and psychiatric consult services among patients admitted for orthopaedic trauma.MethodsThis is a retrospective study of data from our Level-1 trauma center. Patients admitted to the orthopaedic trauma service during 2010–2015 were included (N = 4053). Demographics, Injury Severity Scores (ISS), mental health diagnoses, psychotropic medications, medication type and delay, psychiatric consultation use, intensive care unit (ICU) stay and total hospital length of stay (LOS) were abstracted from medical records and the institutional trauma registry.ResultsThe 12-month prevalence of a major depressive episode is 6.6%–8.6% in adults in the United States. In our database, only 152/4053 (3.8%) of the patients had documented medical history of depression (80%) or anxiety (30%), and these patients had a 32% longer LOS (p < 0.016). Nearly two-thirds of patients who used psychotropic medications prior to injury experienced a delay in receiving these medications in the hospital (median = 1.0 day, range 0–14 days). Sixteen percent of patients also received a new psychotropic medication while hospitalized: an antipsychotic (8/16 patients, to treat delirium), an anxiolytic (3/16 patients for acute anxiety), or an antidepressant (1/16). Among patients with depression or anxiety, 16.7% received a psychiatric consult. Patients with psychiatric consults had higher ISS, were more likely to have longer ICU LOS and had longer hospital LOS than those without consults (all p < 0.05).ConclusionThe prevalence of depression and anxiety is grossly under-reported in our registry compared to national prevalence data. Patients with pre-existing disease had longer LOS and a higher rate of extended ICU care. Further studies are needed to characterize the true prevalence of disease in this patient population and its effect on patient outcomes after traumatic orthopaedic injury.     

Alcoholism, depression, and abnormal cognition in head and neck cancer: a pilot study.

OBJECTIVE: To determine prevalence of alcohol abuse and dependency, depression, and cognitive impairment in presurgical head and neck cancer patients. STUDY DESIGN: Standardized testing by diagnostic interview was used to determine major depression and alcoholism. Mattis Dementia Rating Scale examined cognitive ability preoperatively. Twenty-four patients with advanced head and neck cancer participated. SETTING: University hospital. RESULTS: A total of 63.6% met criteria for alcohol abuse and 62 percent for alcohol dependence; 26.1 % of patients met criteria for major depression. Testing in multiple subsets of cognitive function demonstrated measurable deficits in both alcohol dependents and abusers. All deficits were significant when compared with population norms. CONCLUSIONS: Findings suggest that prevalence of alcohol abuse, major depression, and cognitive impairment is common in head and neck cancer patients preoperatively. Early diagnosis and management of these disorders should be considered in care of the head and neck cancer patient.     

Factors affecting health-related quality of life among patients with lower urinary tract symptoms

BACKGROUND: This study aimed to evaluate the association of factors such as pain, lower urinary tract symptoms (LUTS), anxiety, depression and psychiatric morbidity on health-related quality of life (HRQoL) of patients with LUTS. METHODS: A total of 227 patients with LUTS were recruited into the study. The patients were assessed on pain, LUTS, anxiety, depression, psychiatric morbidity and health-related quality of life (HRQoL) using standardized questionnaires. RESULTS: The study showed that after adjustment, age, pain, anxiety, depression, psychiatric morbidity and LUTS contributed 31%, 13%, 45%, 16% and 48% respectively to the variability of the physical, mental, social, global and overall HRQoL. CONCLUSION: Age, pain, psychiatric morbidity, anxiety and depression are associated with HRQoL among patients with LUTS.     

Normal computed tomograms in acute head injury: correlation of intracranial pressure, ventricular size, and outcome

To assess the predictive value of a normal computed tomographic (CT) scan obtained shortly after head injury, we reviewed all cases of patients with acute closed injury seen at the North Carolina Baptist Hospital over a 42-month period for whom initial CT scanning and continuous intracranial pressure (ICP) monitoring had been done. Of 160 patients meeting those criteria, the initial CT scan was interpreted as normal in 17 patients, all of whom had a Glasgow coma scale score of 9 or less. Of those 17 patients, 7 had elevated ICP (higher than 25 mm Hg) and required mannitol. Six of the 7 had a major pulmonary injury. From the 27 CT scans of the 17 patients, we calculated an inverse cella media index and compared it to previously published standards in an attempt to delineate more quantitatively the "slit ventricles" often seen in cases of head injury. Two patients died of extracranial injuries; I had severe disability and 2 had moderate disability - all related to extracranial factors. The remaining 12 made good recoveries. From these findings, we conclude that a normal initial CT scan in patients with closed head injury and pulmonary injury does not preclude increased ICP (and thus should not preclude ICP monitoring) and that patients with closed head injury and a normal initial CT scan in the absence of associated extracranial injuries should make a good recovery.     

Head Injury as a Predictor of Psychological Outcome in Combat Veterans

Although it is recognized that psychosocial variables influence the expression of psychopathology following trauma exposure, physiological variables have received less attention as potential mediators of psychological outcome in trauma victims. The purpose of this study was to examine the relationship of head injury to psychological outcome in 171 combat veterans seeking compensation for service-connected disabilities for mental disorders attributed to etiologies other than head injury. Veterans underwent structured psychiatric diagnostic interview and completed self-report measures of combat exposure, posttraumatic stress disorder (PTSD), depression, and occurrence of head injury. Comparisons between veterans with and without history of head injury indicated that head injury was associated with more severe depression. Regression analysis suggested that head injury predicted depression, but not PTSD, severity.     

Pre-existing psychiatric disorder is related to lower mortality from road traffic accident: A Japanese nationwide retrospective cohort study

BackgroundPrevious studies have reported inconsistent results on the mortality from trauma among psychiatric patients comparing to non-psychiatric population, which may be partly explained by the inclusion of both suicidal and accidental trauma. This study aimed to investigate the association of psychiatric diagnoses on admission with the outcomes of hospitalized patients for accidental trauma, namely road traffic injury.MethodsDetailed information of patients aged 15 years or older who were hospitalized for road traffic injury between 2004 and 2017 was extracted from the Japan Trauma Data Bank. The primary outcome was to compare in-hospital mortality between patients with and without a psychiatric disorder. We also conducted a subgroup analysis among patients with and without a serious head injury.ResultsAltogether, 85,069 patients were included. Of these, 3,895 patients (4.6%) had a psychiatric diagnosis. The in-hospital mortality rate was significantly lower among patients with a psychiatric diagnosis than those without (5.4% vs. 8.3%; adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.47-0.70, p<0.001). In a subgroup analysis of patients with a serious head injury, in-hospital mortality was significantly lower in patients with a psychiatric diagnosis than in those without (10.5% vs. 17.3%; adjusted OR 0.48, 95% CI 0.37-0.62, p<0.001); in-hospital mortality of patients without a serious head injury showed no differences between patients with or without a psychiatric diagnosis (2.8% vs. 3.5%; adjusted OR 0.84, 95% CI 0.61-1.16, p=0.295).ConclusionsIn-hospital mortality from road traffic injury was significantly lower among patients with a psychiatric diagnosis than those without, which was primarily evident in a subgroup of patients with a serious head injury. While further replication is necessary, results might be indicative of the neuroprotective effect of psychotropic medications.     

头面部和双手电弧烧伤患者不同治疗阶段心理反应差异的研究

目的:对头面部及双手电弧烧伤住院患者在伤后不同治疗阶段进行心理问卷调查,了解患者焦虑和抑郁的发生状况.方法:对20例成人头面部及双手电弧烧伤住院患者于入院初(伤后24 h内),扩创术前(伤后第5天)、恢复期(伤后2周～1个月)3个不同治疗阶段,采用Zung氏焦虑和抑郁评定量表进行心理问卷调查,统计分析存在焦虑、抑郁状态的存在情况.结果:20例患者在入院初(伤后24 h内)、扩创术前(伤后第5天)及恢复期(伤后2周～1个月)3个治疗阶段均存在焦虑或(和)抑郁倾向;患者在入院初(伤后24 h内)的焦虑和抑郁状况最明显,焦虑和抑郁评分(37.60±7.06和36.90±8.48)均明显高于扩创术前(33.45±6.15±和34.70±8.24)和恢复期(28.75±5.63和29.30±5.69),差异均有显著性(P均＜0.05).结论:头面部及双手电弧烧伤住院患者伤后24 h内焦虑抑郁状态相对于其他诊疗阶段重,建议采取相应的心理护理干预措施.     

Effect of small burn injury on physical, social and psychological health at 3–4 months after discharge

Comparatively little attention has been given to the impact of smaller burns (less than 20% body surface area) on patients' health status after their return to normal life. The objective of this study was to investigate patients' own assessment of their physical and psychological health 3–4 months after discharge from in-patient treatment. A postal survey was employed which utilised: (a) personal and employment status questions; (b) a short health status questionnaire which was developed for use with this group of patients; (c) the hospital anxiety and depression scale (HAD); (d) the impact of event scale (IES). The response rate to the survey was 71%. Physical and social function were reported to be affected at the follow-up point in a minority of patients. The greatest impact of the injury was on levels of anxiety and response to trauma-related stress, as measured by the HAD and IES instruments — almost one third of the responders (15 patients) had clinically significant scores on either or both dimensions of the IES. Factors which may be associated with the response to trauma-related stress are discussed.