Sleep disturbances associated with minor psychiatric disorders in medical students

We performed a cross-sectional study with 342 medical students (age range, 18–35 years) to identify, among a group of sleep disturbances, those which are related to minor psychiatric disorders in this population. The instruments employed for data collection were the self-reporting questionnaire (SRQ-20), the morningness/eveningness questionnaire, the Epworth sleepiness scale, and a general questionnaire regarding demographic characteristics, use of drugs, history of psychopathology, usual fall-asleep time, usual wake-up time, amount of sleep, arousal during the night, and insomnia. We used a logistic regression model to determine independent factors associated with minor psychiatry disorders. Daytime sleepiness [odds ratio (OR), 2.12; 95% CI, 1.21–3.71], arousal [OR, 4.54; 95% CI, 1.97–10.47], insomnia [OR 2.45; 95% CI, 1.32–4.56], and sleeping less than 7 hours per night [OR, 2.02; 95% CI, 1.11–3.67] were associated with minor psychiatric disorders. This group of variables determined a cumulative risk ratio of 5.47 [95% CI, 2.87–10.41] for the main outcome. Received: 11 September 2001 / Accepted in revised form: 26 February 2002     

某医科大学医学生爱情态度差异研究

目的了解医科大学学生恋爱的现状和特点,以帮助其树立正确的恋爱观,为高校加强医学生心理健康教育提供依据和指导。方法采用分层随机抽样方法,应用Hendricks编制的爱情态度量表(LAS)(中文版)调查296名在校医学生对激情之爱、游戏之爱、友谊之爱、现实之爱、依附之爱和奉献之爱六个维度的爱情态度。结果男生的激情之爱、友谊之爱、依附之爱和奉献之爱维度评分均高于女生(P均0.01),女生的现实之爱维度评分高于男生(P0.05);大一和大四、大二和大四年级男生的依附之爱维度评分差异有统计学意义(P0.05),大一和大三、大一和大四、大二和大四年级男生的奉献之爱维度评分差异有统计学意义(P0.05)。结论该地区医学生的爱情观存在差异,女生倾向于现实之爱,男生倾向于激情之爱、友谊之爱、依附之爱和奉献之爱,低年级男生较高年级学生倾向于依附之爱和奉献之爱。     

Depressions secondary to other psychiatric disorders and medical illnesses

The authors studied 401 patients with depressions secondary to psychiatric illnesses (substance abuse disorders or somatoform, anxiety, or personality disorders) or depressions secondary to medical illnesses. They found that the patients with depressions secondary to psychiatric illnesses had an earlier age at onset, were more likely to have suicidal thoughts or to have made suicide attempts, were less likely to have memory problems, were less improved with treatment and more likely to relapse on follow-up, and had more alcoholism in their families than patients with depressions secondary to medical illnesses. Depressions secondary to medical illnesses seem to fit the category of reactive depression, and depressions secondary to psychiatric illnesses fit the definition of neurotic depression.     

Significance of psychiatric symptoms in general medical patients with mood disorders

Little difference was found between the psychiatric symptoms of medical patients and general-population subjects with affective disorder, both groups having been assessed with the same procedure (Present State Examination). Discrimination between medical patients with and without affective disorder was best achieved when patients with depressive and anxiety disorders were considered separately. Depressed mood, morning depression, and hopelessness were the key symptoms in the depressives, and nervous tension, free-floating anxiety, panic attacks, and specific phobias in the patients with anxiety disorders. Symptom profile did not distinguish patients with persistent affective disorders from those whose disorders had resolved at a 4-month follow-up.     

Knowledge and attitude towards suicide among medical students in Japan: preliminary study

Japan has one of the highest suicide rates in the world. Suicides numbered 32,863 in 1998 and have exceeded 30,000 in every subsequent year. Education of those involved in general and psychosocial patient care can contribute greatly to suicide prevention. The authors administered a brief knowledge and attitude assessment questionnaire concerning suicide to students in their first, third, and fifth years at a Japanese medical school. Participants numbered 160 (94 men with a mean age of 21.8 years, SD = 3.01, and 66 women with a mean age of 21.2 years, SD = 2.64); 59 first year, 52 third year, and 49 in their fifth year. The questionnaire consists of eight multiple-choice questions asking knowledge of suicide and one open-ended question asking attitude. In the knowledge part, only about half of the items were answered correctly (mean score was 4.21, SD = 1.28). A significant difference was observed in prevalence of attitudes as categorical variables between student years (P = 0.001). Sympathetic comments increased along with student years, while critical comments decreased. Given the frequent and interventional opportunities of primary-care medical contacts, poor understanding of suicide from the medical viewpoint was of concern. Moreover, judgmental attitudes were common, especially in earlier school years. Better informed, more understanding physicians and other health professionals could contribute greatly to prevention.     

The nurturing of medical students: a psychotherapeutic approach to psychiatric education

Students' resistances to learning psychiatry and their difficulties in relating to disturbed patients are both due largely to their own anxieties. Therefore it is both necessary and possible for the teacher to give them effective psychotherapeutic help as and when required as an integral part of the educational process.     

The attitude of 200 hospitalized psychiatric patients and their doctors toward treatment (author's transl)]

1 week after their admission to a psychiatric clinic, a representative sample of 200 patients were interviewed as to their attitude toward hospitalization and their opinion of the doctors, nursing personnel, psychopharmaca, as well as the industrial- and creative occupational therapy they underwent. They were also questioned as to the general physical environment. At the same time, the 15 assistants treating these patients were asked their opinion of the attitudes of their patients toward some of the above points. The patients answered less favorably with regard to their wards (particularly if these were closed) and with regard to the hospitalization in general, but they answered more favorably reacted more positively to their doctors and nurses than to the various methods of treatment (counseling, psychopharmaca, occupational therapy). Information on the patients from their doctors concerning noticeable side effects of psychopharmaca proved insufficient. There was no difference in the patients attitude toward occupational therapy that consisted of unpaid industrial work and the creative occupational therapy. Women were more critical than men. The opinions of the patients were in good agreement with those of the doctors.     

The relationship between social support and psychiatric symptomatology in medical students

This study investigated the relationship between social support and psychiatric symptom-atology among 82 first-year medical students at the University of Texas Medical School at Houston. A questionnaire was administered at several points during the medical school year. This questionnaire included the Hopkins Symptom Checklist and a measure of social support adapted for this study. It was hypothesized that social support and psychiatric symptomatology would be negatively correlated, i.e., that students who described themselves as experiencing more social support would be less symptomatic. The data supported this hypothesis at the beginning of the school year. However, by midyear, social support and symptomatology were positively correlated with each other. These findings, in conjunction with a few isolated studies in the social support literature, led the authors to conclude that in certain settings such as medical school, social ties may present competing demands on an individual's time and energy which have potentially detrimental as well as beneficial effects on mental health. In addition, the findings suggested that the relationship of social support to psychiatric symptomatology may change over time, that there are gender differences in the relationship, and that there may be an interaction between demographic factors, such as gender and marital status, and social support.     

Socialization scores in psychiatric patients and their implications for the diagnosis of personality disorders

The distribution scores on the Socialization (So) scale of the California Psychological Inventory was examined in a series of 83 admissions to a general hospital psychiatric service. The series was divided into groups of low and high scorers (Low So and High So). Low So scorers were younger than high scorers and had a raised mean Neuroticism score. A strong association was found between So scores and the quality of parental care which patients reported receiving from their fathers. Other parental attributes are reported. Patients with a clinical diagnosis of personality disorder were found in the Low So, but not the High So group.     

Use of general medical services by VA patients with psychiatric disorders

OBJECTIVE: Patients with psychiatric disorders, particularly those with severe mental illnesses, have high rates of undetected and untreated medical problems and substantially elevated mortality rates due to medical illness. The authors sought to develop a better understanding of the demographic, medical, and psychiatric characteristics of this population to inform efforts to improve the medical care of these persons. METHODS: Using Department of Veterans Affairs (VA) databases, the authors examined use of medical services by 175,653 patients who were treated in Southern California and Nevada during fiscal year 2000. Multivariate regression models were used to examine factors affecting receipt of any medical care and the number of medical visits. RESULTS: Patients with psychiatric diagnoses had fewer medical visits than other VA patients; the largest differences were seen for patients with severe mental illnesses. Patients who were younger and male had few visits. Patients with diabetes or hypertension who had been diagnosed as having schizophrenia, bipolar disorder, or an anxiety disorder had substantially fewer visits than those who did not have these psychiatric diagnoses. Patients older than 50 years were less likely to have any medical care if they had a diagnosis of a substance use, depressive, bipolar, or anxiety disorder or posttraumatic stress disorder. CONCLUSIONS: Use of medical care varies by psychiatric diagnosis. Young adults with schizophrenia and posttraumatic stress disorder and adults of all ages with bipolar disorder have an especially high risk of not receiving general medical services. Interventions to improve medical care may need to be tailored to the population being targeted.     

The course of postpartum psychiatric disorders in women and their partners

This study examined the course of postpartum psychiatric disorders in a community sample of mothers and their partners to determine whether sociodemographic variables, life stress, and psychiatric history were related to persistence of mental health problems. At 6 months postpartum, 48 index couples where the wife had a psychiatric disorder at 2 months postpartum and 50 control couples with no such diagnosis underwent diagnostic interviews and completed questionnaires on psychological symptoms, life stress, and treatment history. The results indicate that at follow-up, 54% of the index mothers still had a psychiatric diagnosis, as did 60% of their partners who had had a psychiatric diagnosis at 2 months postpartum. Socioeconomic status, country of origin, and life stress were related to persistence, as were diagnosis and timing of onset of the disorder. About a third of the parents were referred for treatment. It is concluded that for many families, postpartum psychiatric disorders are not a transient phenomenon.     

Heart and brain -- the influence of psychiatric disorders and their therapy on the heart rate variability

Psychiatric disorders are associated with autonomic dys-regulations. There is evidence that these dys-regulations are partly responsible for the increased mortality in patients with psychiatric disorders. The determination of the heart rate variability (HRV) is a method easily applicable and allows the assessment of the autonomic control of the heart rate regulation. A multitude of HRV parameters with different physiological meanings have been introduced, the most widely used parameters are presented and characterized in this paper. Many studies have shown a reduced HRV in patients with major depression. Most studies found a reduced parasympathetic activity. However some authors discuss an elevated sympathetic activity. The magnitude of HRV reduction correlates to the severity of the depression. In patients with coronary diseases, major depression is an independent risk factor of mortality. Antidepressive therapy with serotonin reuptake inhibitors has failed to improve the prognosis of this patients. Patients with panic disorders also have a reduced HRV due to an elevated sympathetic control and reduced vagal control. In schizophrenic patients a reduced HRV was found in long term electrocardiogram recordings, whereas short term recordings did not show a reduced HRV. Patients with Alzheimer's disease also have a reduced HRV, which is limited to the low frequency component. Therapy with cholinesterase inhibitors further influences HRV by reducing the high frequency component and might increase the risk for arrhythmias. HRV analysis and integration in the assessment and monitoring of psychiatric patients before and during therapy elucidate the role of autonomic disturbances in such diseases and may help to optimize treatment.     

The exclusion of people with psychiatric disorders from medical research

People with psychiatric disorders are excluded from medical research to an unknown degree with unknown effects. We examined the prevalence of reported psychiatric exclusion criteria using a sample of 400 highly-cited randomized trials (2002–2010) across 20 common chronic disorders (6 psychiatric and 14 other medical disorders). Two coders rated the presence of psychiatric exclusion criteria for each trial. Half of all trials (and 84% of psychiatric disorder treatment trials) reported possible or definite psychiatric exclusion criteria, with significant variation across disorders (p < .001). Non-psychiatric conditions with high rates of reported psychiatric exclusion criteria included low back pain (75%), osteoarthritis (57%), COPD (55%), and diabetes (55%). The most commonly reported type of psychiatric exclusion criteria were those related to substance use disorders (reported in 48% of trials reporting at least one psychiatric exclusion criteria). General psychiatric exclusions (e.g., “any serious psychiatric disorder”) were also prevalent (38% of trials). Psychiatric disorder trials were more likely than other medical disorder trials to report each specific type of psychiatric exclusion (p's < .001). Because published clinical trial reports do not always fully describe exclusion criteria, this study's estimates of the prevalence of psychiatric exclusion criteria are conservative. Clinical trials greatly influence state-of-the-art medical care, yet individuals with psychiatric disorders are often actively excluded from these trials. This pattern of exclusion represents an under-recognized and worrisome cause of health inequity. Further attention should be paid to how individuals with psychiatric disorders can be safely included in medical research to address this important clinical and social justice issue.