Psychological distress among patients with musculoskeletal illness in general practice

The authors investigated the importance of psychological distress and somatization among patients with musculoskeletal illness in general practice. The authors used the Hopkins Symptom Check List (SCL-8) and the Whiteley Index to rate 1,720 patients with musculoskeletal illness referred to physiotherapy from general practice. General practitioners (GPs), patients, and physiotherapists often noted stress or psychological distress to be a possible cause of the patient's musculoskeletal illness, but agreement between them was low. If the GP included the patient's own view on psychological distress, the result of the SCL-8 did not add much to the detection of distress. The results emphasize the importance of discussing psychological distress when dealing with patients with musculoskeletal illness.     

Psychological distress: outcome and consultation rates in one general practice

This paper reports a one-year follow-up of random samples of 90 male and 96 female patients attending one general practitioner. There was no statistically significant difference between men and women in the total score on the 28-item general health questionnaire or any of the subscores. However, the diagnostic labels applied to the two sexes were strikingly different as was the prescribing of psychotropic drugs. Outcome of psychological distress was assessed in terms of change in total general health questionnaire score. Two thirds of the patients (65%) showed normal scores at the beginning and end of the follow-up period, 19% changed from abnormal to normal and 8% changed from normal to abnormal. The remaining 9% had persistently high scores though less than half had been given a psychiatric diagnosis. They had very high consultation rates persisting over several years and three-quarters were known to have chronic physical illness. It seems possible that some patients with persistently high consultation rates who present with chronic, mainly somatic, symptoms may be or may become psychologically distressed to a significant degree and that this psychological distress goes unrecognized in the presence of physical disease.     

Fatal illness in general practice

In an investigation of fatal illness during a 12-month period in a practice of 5,897 patients in Glasgow, 58 deaths (42 male, 16 female) were recorded. Malignant neoplasms and myocardial infarction in male patients of 50 years and over accounted for 27 (46·6 per per cent) of the deaths. Thirty (51·7 per cent) of the deaths took place in hospital. Fifteen (25·9 per cent) of the deaths were sudden. In patients dying in hospital of malignant, cardiac, and respiratory disease the duration of the terminal stay in hospital represented a small proportion of the total duration of the illness, the principal burden of their care falling upon their families and community resources.

In an integrated health service much yet remains to be accomplished in co-ordinating the efforts of hospital and community teams in caring for the fatally ill patient.

     

中青年淋巴瘤患者的心理痛苦及相关因素

目的:了解中青年淋巴瘤患者的心理痛苦现状及其相关因素。方法:选取住院中青年淋巴瘤患者145例,采用心理痛苦温度计(DT)、疾病认知问卷简版(BIPQ)和恐惧疾病进展简化量表(FoP-Q-SF)评估患者的心理痛苦程度、负性疾病认知程度和恐惧疾病进展水平。DT≥4分为显著心理痛苦(4~6分为中度心理痛苦、7~10分为重度心理痛苦)。结果:中青年淋巴瘤患者的显著心理痛苦检出率为81.4%,中度检出率为42.8%,重度检出率为38.6%。多重线性回归分析结果显示,BIPQ和FoP-Q-SF得分与心理痛苦得分正向关联(β=0.27、0.28,均P<0.05),已婚、家庭月收入较高的患者其心理痛苦程度较低(β=0.25、-0.16,均P<0.05)。结论:中青年淋巴瘤患者的显著心理痛苦检出率高,婚姻状况、家庭月收入、疾病认知和恐惧疾病进展是心理痛苦的重要相关因素。     

Disease versus illness in general practice

Two different, though interrelated, conceptions of ill-health — disease and illness — are described. Recent literature on this disease/illness model is reviewed, and the value of this approach to general practice is shown.     

Psychological distress and associated risk factors in bronchial asthma patients in Kuwait

Context: Recent literature shows a high prevalence of psychological distress in bronchial asthma. Aim: To find the extent of psychological distress and associated risk factors in bronchial asthma patients in Kuwait. Design: Case-control study. Materials and Methods: In a study at Kuwait's allergy center, 102 patients aged 20-60 years with asthma (67%), asthma with allergic rhinitis (33%) completed a self-administered questionnaire (WHO-Five Well-being Index). A score below 13 was considered as psychological distress; and 13 and above, as normal. An equal number of controls, matched for age, gender, nationality, were also enrolled. Statistical Analysis: The data were analyzed using SPSS software, and proportions were tested with Chi-square or Fisher's test. Odds ratio (OR) with 95% confidence interval (CI) was calculated to quantify the risk factors. Results: A significantly large proportion (69%) of patients were found to be psychologically distressed, compared to 24% among controls (P Conclusions: We found a high rate of poor well-being and psychological distress in patients suffering from asthma. Young patients and those with relatively short duration of illness, as well as asthmatic females, are more vulnerable to distress and need further psychological evaluation.     

Problem patients in general practice: identifying young women with recurrent abnormal illness behaviour

The concept of recurrent illness behaviour and the importance of problem patients in general practice are discussed. The need for further research and the early identification of these patients is emphasized. The medical records of 1134 women between the ages of 16 and 25 years were analysed. The annual rate of potentially functional complaints was determined for each woman. The 51 women with the highest annual rates were selected as cases for interview, along with 51 randomly selected controls.

Analysis showed there were significant differences between the cases and controls. The cases reported more health and emotional problems and had a higher dependence on alcohol and cigarettes than the controls. They had more social disadvantages, such as a history of parental death and unemployment; they were more likely to be housewives with children; they had fewer qualifications, held jobs for shorter periods of time and had a history of truancy from school. They were heavy users of primary care facilities and also hospital services but, despite this, were dissatisfied with the service provided and were less compliant with treatment. Finally, despite a need to discuss health problems, they experienced less family support in this area. Significant variables were entered into a step-wise multiple regression analysis to predict rates of potentially functional complaints and a logistic discriminant analysis was also carried out. The results of these analyses were used in a further discriminant function to form an index for the identification of recurrent abnormal illness behaviour.