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1.
Objectives
We performed a systematic review to assess the benefits or risks of physical activity in patients with an acute or previous DVT of the leg.Data sources
PubMed, EMBASE and Science Citation Index were searched without language restrictions up to July 2007. Bibliographies of retrieved articles and personal files were also searched.Review methods
Randomized trials and prospective cohort studies that included patients with acute or previous DVT, described an exercise intervention or exercise exposure, and described any related clinical outcome were selected. Data were independently extracted by 2 investigators.Results
Seven randomized trials and two prospective observational studies were included. Early exercise, compared with bed rest, was associated with a similar short-term risk of pulmonary embolism in patients with acute DVT and led to more rapid resolution of limb pain. In patients with acute DVT, a 6 month daily walking program led to similar degrees of vein recanalization and improvement in quality of life as controls. In patients with previous DVT, 30 min of vigorous treadmill exercise did not worsen venous symptoms and improved calf muscle flexibility; a 6 month exercise training program improved calf muscle strength and pump function; and high levels of physical activity at one month tended to be associated with reduced severity of postthrombotic symptoms during the subsequent 3 months.Conclusions
Early walking exercise is safe in patients with acute DVT and may help to reduce acute symptoms. Exercise training does not increase leg symptoms acutely in patients with a previous DVT and may help to prevent or improve the postthrombotic syndrome. 相似文献2.
Jon Stone Alan Carson Robin Prescott Charles Warlow 《Journal of psychosomatic research》2009,66(5):383-390
Objectives
Conversion symptoms are currently conceptualized as physical symptoms induced by psychological trauma, conflict, or stress. Historical accounts also included physical injury as an important precipitant. We aimed to determine (a) the frequency of reported physical injury prior to onset in published studies of patients with motor or sensory conversion symptoms and (b) the clinical characteristics of patients in whom onset was associated with physical injury.Methods
Firstly, we employed a systematic review of all reports of adults with motor or sensory conversion symptoms published between 1965 and 2005. Secondly, we used a narrative review of the literature on this topic, especially possible mechanisms.Results
A total of 133 eligible studies, which recorded precipitating factors, including 869 patients, were found. Physical injury prior to symptom onset was reported in 324 patients (37%). Clinical features associated with physical injury included younger age, weakness (vs. movement disorder), paraparesis (vs. hemiparesis), and neurological versus psychiatric study settings.Conclusions
Despite the current dominance of a psychological view of conversion symptoms, physical injury prior to onset has been frequently reported in papers published since 1965. While the data are of low quality, they nevertheless suggest that physical trauma has a role in many patients in the onset of motor and sensory conversion symptoms. We discuss possible mechanisms for this association. 相似文献3.
Yvonne Bol Annelien A. Duits Raymond M.M. Hupperts Mariëlle J.L. Romberg-Camps Johan W.S. Vlaeyen 《Journal of psychosomatic research》2010,69(1):43-49
Background
Fatigue is one of the most common and troubling symptoms of multiple sclerosis (MS) and more severe and disabling than fatigue in other somatic populations. Although fatigue seems MS specific, its pathogenesis is still poorly understood.Objective
To study the disease specificity of fatigue in MS by comparing its level, its physical and psychological correlates to those of patients with ulcerative colitis (UC), a peripheral chronic auto-immune disease. We focused on the relative contribution of disease severity, depression and negative affectivity to fatigue in both patient samples.Methods
A total of 88 MS and 76 UC patients were included in this cross-sectional study. Fatigue, depression and negative affectivity were assessed respectively with the physical and mental fatigue subscales of the Multidimensional Fatigue Inventory, the depression subscale of the Hospital Anxiety and Depression Scale, and the neuroticism subscale of the Dutch NEO Five-Factor Inventory. The Expanded Disability Status Scale and the Colitis Activity Index were used to measure disease severity in MS and UC patients respectively.Results
While levels of both physical and mental fatigue were significantly higher in MS patients than in UC patients, there were no group differences in the contribution of disease severity, depression and negative affectivity to both physical and mental fatigue.Conclusion
Although levels of fatigue are higher for MS patients when compared with UC patients, the correlates of fatigue do not indicate MS specificity. As such our results support a transdiagnostic approach to fatigue in MS. 相似文献4.
Objective
To investigate the association between depressive symptoms and physical functioning in pulmonary hypertension (PH) patients.Methods
Fifty-two patients diagnosed with precapillary or postcapillary PH completed self-report questionnaires of depressive symptoms and physical functioning. Cardiac catheterization reports of patients were reviewed for hemodynamic variables.Results
Physical functioning was significantly associated with depressive symptoms on bivariate analysis. On multivariate analysis, after controlling for demographic and hemodynamic variables, depressive symptoms accounted for 9% of variance in physical functioning.Conclusion
The association of depressive symptoms with decreased physical functioning in PH patients indicates the need for longitudinal research regarding the possible effect of depression on disease outcomes in this population. 相似文献5.
6.
Wittmann L Moergeli H Martin-Soelch C Znoj H Schnyder U 《Comprehensive psychiatry》2008,49(5):430-440
Objective
Posttraumatic stress disorder (PTSD) is associated with high rates of psychiatric comorbidity. Existing theories consider comorbidity as a consequence of PTSD (model 1), PTSD and comorbidity as a consequence of shared factors of vulnerability (model 2), and comorbidity as a consequence of trauma-type specific mechanisms (model 3).Method
To compare the explanatory value of these models, we assessed PTSD (model 1), sense of coherence (model 2) and satisfaction with health (model 3) and symptoms of anxiety and depression as indicators of comorbidity 5 days (t1) and 6 months (t2) postaccident in 225 injured accident survivors. Structural equation models representing models 1 to 3 were tested separately and combined.Results
Combined, models 1 and 3 explained 82% of the variance of comorbid symptoms at t2. Posttraumatic stress disorder and satisfaction with health (t2) exerted strong influences on comorbid symptoms.Conclusion
Comorbidity besides PTSD is best described by an integration of competing explanatory models. 相似文献7.
Introduction
Disturbed interregional functional connectivity has been hypothesized to be a promising marker of schizophrenia. The relationship between working memory (WM) impairment, disturbed functional connectivity, and the characteristic symptoms of schizophrenia, however, remains elusive.Methods
We used functional MRI (fMRI) to investigate in patients with schizophrenia and matched controls the patterns of functional connectivity during the performance of different tasks selectively engaging subcomponent processes of working memory.Results
Compared with controls, patients showed reduced connectivity of the prefrontal cortex with the intraparietal cortex and the hippocampus and abnormal negative interactions between the ventrolateral and dorsolateral prefrontal cortex during the non-articulatory maintenance of phonological information. During the maintenance of visuospatial information, patients presented reduced connectivity between regions in the superior parietal and occipital cortex, as well as enhanced positive connectivity of the frontal eye field with visual processing areas.Discussion
Our findings suggest complex dysregulations within the networks supporting working memory functions in schizophrenia, which manifest as decreased positive and abnormal negative interactions. Correlations between the connection strength and WM performance suggest that these dysregulations may be neurofunctional correlates of the WM deficits seen in schizophrenia. Altered prefronto-hippocampal and parieto-occipital connectivity was further found to be associated with higher positive symptoms, providing a possible explanation for the development of delusions and disorganization symptoms.Conclusion
The present findings can help to better understand the relationship between altered patterns of synchronized brain activity and the cognitive and clinical symptoms of schizophrenia. 相似文献8.
Børge Sivertsen Steinar Krokstad Simon Øverland 《Journal of psychosomatic research》2009,67(2):109-116
Objective
The aim of the present study was to examine the association of insomnia symptoms with demographic and physical and mental conditions in a large population-based study.Methods
Cross-sectional data on insomnia and comorbid conditions were gathered from 47,700 individuals aged 20-89 in Norway. Comorbid conditions included anxiety and depression and the following physical conditions: asthma, allergy, cancer, hypertension, diabetes, migraine, headache, osteoporosis, fibromyalgia rheumatoid arthritis, arthrosis, Bechterew's disease, musculoskeletal disorders, and obesity (body mass index >30).Results
Insomnia symptoms were found in 13.5% of the population and were more prevalent among women, older adults, and in individuals with less education. Reporting insomnia symptoms significantly increased the associations with a range of conditions, especially mental conditions, pain conditions with uncertain etiology and, to a lesser extent, chronic pain conditions. These findings remained significant also when adjusting for a range of potential confounders, whereas the association between insomnia and somatic conditions was largely reduced to a nonsignificant level in the fully adjusted analyses.Conclusion
This study demonstrates that insomnia symptoms are associated with a range of different conditions. The findings suggest that the independent contribution of insomnia is strongest on conditions characterized by some level of psychological or psychosomatic properties. 相似文献9.
Dempster M McCorry NK Brennan E Donnelly M Murray LJ Johnston BT 《Journal of psychosomatic research》2011,70(5):432-439
Objective
To examine the extent to which the illness perceptions of Oesophageal cancer survivors and the illness perceptions of their carers explain the survivors' levels of psychological distress (in terms of anxiety and depression symptoms) relative to demographic and biomedical variables and patients' coping strategies.Method
Everyone registered with the Oesophageal Patients' Association in the UK was mailed a questionnaire booklet containing questions about medical and demographic variables, the Illness Perception Questionnaire-Revised, the Cancer Coping Questionnaire, and the Hospital Anxiety and Depression Scale. Patients were asked to pass a modified version of the Illness Perception Questionnaire-Revised to someone they identified as a carer. Complete responses were received from 317 dyads.Results
Regression models indicated that the variables measured could explain 56% of the variance in anxiety and 54% of the variance in depression. Patients' illness perceptions explained the majority of this variance. Positive focus coping strategies were also found to be important in explaining psychological well-being. Some of the carers' illness perceptions made a significant contribution to the explanation of the patients' levels of psychological distress, and in some instances, carer perceptions were found to moderate the relationship between patients' perceptions and psychological distress.Conclusion
The findings suggest that cognition-based interventions could potentially be most effective in minimizing emotional distress among survivors of Oesophageal cancer. This study also shows that these interventions could usefully be delivered at the level of the patient-carer dyad. 相似文献10.
Introduction
There is limited guidance regarding effective preventions for post-disaster mental health problems and what kind of support is preferred by disaster survivors.Aim
To describe the use of and satisfaction with support in three Scandinavian countries after the tsunami and analyzing the association between support and posttraumatic stress reactions.Method
The sample comprises 6772 responders who returned to Scandinavia from the tsunami-struck countries of Southeast Asia in 2004.Results
Most were satisfied with informal support on site. Support from embassies/consulates was not received well, leaving about 64% of the Danes/Norwegians and 73% of the Swedes dissatisfied. After returning home, support from close relatives rendered highest degree of satisfaction. Consultation with general practitioner (GP) was reported by 63% of Norwegians, 40% of Danes, and 16% of Swedes. Most responders (60-77%) were satisfied with their GP, although Norwegians were least satisfied. Using support was associated with higher levels of posttraumatic stress symptoms.Conclusions
Informal support was used to a high degree and rendered considerable satisfaction in all three countries, while the use of and satisfaction with formal support varied more. Lack of satisfaction with embassies and consulates may indicate deficiencies in the authorities’ preparedness in assisting disaster stricken citizens abroad. 相似文献11.
Introduction
Described in 1890, Uhthoff's symptom corresponds to a transient blurred vision provoked by physical exercise or an increase of temperature. It is a frequent symptom occurring during the course of multiple sclerosis.Patients and method
We report here four cases of patients presenting isolated Uhthoff phenomenon preceding multiple sclerosis by several years.Results
These four patients presented transient neurological symptoms induced by intensive sporting activity for 1 to 6 years before diagnosis of multiple sclerosis. These symptoms were often visual but sometimes motor or sensorial. All symptoms appeared above a certain threshold specific to each patient, after 15 to 30 minutes of intense physical exercise (bike, running or handball) and all disappeared after a few minutes to one hour rest with full recovery to baseline.Discussion
Uhthoff's phenomenon is explained by a conduction block. It is due to axonal demyelization that provokes a reorganization of sodium channels induced by a decrease in a safety factor highly sensitive to temperature, or by release of soluble blocking substances (oxide nitric or cytokines).Conclusion
Without being specific, this symptom is strongly suggestive of this disease. Our case reports confirm the existence of “infraclinic multiple sclerosis”. 相似文献12.
Sabra S. Inslicht Shannon E. McCaslin Thomas J. Metzler Clare Henn-Haase Stacey L. Hart Thomas C. Neylan Charles R. Marmar 《Journal of psychiatric research》2010,44(1):22-50
Background
Family history of psychiatric and substance use disorders has been associated with posttraumatic stress disorder (PTSD) in cross-sectional studies.Method
Using a prospective design, we examined the relationships of family history of psychiatric and substance use disorders to posttraumatic stress symptoms in 278 healthy police recruits. During academy training, recruits were interviewed on family and personal psychopathology, prior cumulative civilian trauma exposure, and completed self-report questionnaires on nonspecific symptoms of distress and alcohol use. Twelve months after commencement of active duty, participants completed questionnaires on critical incident exposure over the previous year, peritraumatic distress to the worst critical incident during this time, and posttraumatic stress symptoms.Results
A path model indicated: (1) family loading for mood and anxiety disorders had an indirect effect on posttraumatic stress symptoms at 12 months that was mediated through peritraumatic distress to the officer’s self-identified worst critical incident, (2) family loading for substance use disorders also predicted posttraumatic stress symptoms at 12 months and this relationship was mediated through peritraumatic distress.Conclusion
These findings support a model in which family histories of psychopathology and substance abuse are pre-existing vulnerability factors for experiencing greater peritraumatic distress to critical incident exposure which, in turn, increases the risk for development of symptoms of posttraumatic stress disorder. Replication in other first responders, military and civilians will be important to determine generalizability of these findings. 相似文献13.
C. HaleyE. O’Callaghan S. HillN. Mannion B. DonnellyA. Kinsella A. Murtagh N. Turner 《European psychiatry》2011,26(5):302
Objective
Despite the scientific evidence, most families of people with schizophrenia in Europe never receive a carer education programme. We evaluated whether a carer education course delivered by telepsychiatry was as effective as a carer education course delivered in situ.Method
We delivered the carer education course for schizophrenia simultaneously to a carers group in rural north west Ireland (remote) via three ISDN lines and live to a carers group in a city (host). We compared knowledge gains using the Knowledge Questionnaire before and after each course.Results
Fifty-six carers of people with schizophrenia participated in the trial. At baseline, participants at the remote and host centers did not differ in terms of knowledge about schizophrenia. After the course, carers at both centers improved significantly and the knowledge gains between groups were equivalent at 6 weeks.Conclusion
Telepsychiatry can deliver effective carer education programmes about schizophrenia and may provide one solution to bridging the chasm between scientific evidence and clinical reality. 相似文献14.
Objective
The Chalder Fatigue Scale (CFQ) is a widely used instrument to assess fatigue in both clinical and nonclinical settings. Psychometric properties of the scale and discriminative abilities were examined.Methods
A total of 361 patients with CFS and 1615 individuals in the community were assessed with the CFQ. Principal component analysis (PCA) was used to explore the structure of the scale. Receiver-operating characteristic curve (ROC) was used to investigate the discriminative properties.Results
Two components, physical and mental fatigue, were identified in the CFS patient group and in the general population samples. Area under the curve for ROC was .91. The fatigue scale effectively discriminates, at high scores, between CFS patients and the general population.Conclusion
Physical and mental fatigue are clearly separable components of fatigue. The CFQ can discriminate reliably between clinical and nonclinical conditions. 相似文献15.
Objective
Somatoform disorders (SFD) are defined by symptoms that lack medical explanation. This study examined the type and pattern of patients' causal attributions using a new semistructured interview techniqueMethods
The Causal Attributions Interview allows to assess and weigh 15 common explanations of physical symptoms. Attributions given by 79 patients with SFD were compared with those obtained from 187 chronic pain patients.Results
The test-retest reliabilities of the interview-elicited attributions were satisfactory to good. SFD patients attributed most of their symptoms to mental/emotional problems (46.9%) and somatic disease (41.1%), while the pain sample preferred physical overloading/exhaustion (56.1%), daily hastiness/time pressure (41.7%), somatic disease (39.6%), and weather influence (39.0%). On average, SFD patients chose 2.57 and pain patients 3.86 different attributions for each symptom. These numbers were substantially larger than those of initial spontaneous attributions. Correspondence analysis revealed underlying dimensions with three groups labeled “environmental,” somatic,” and “psychological/stress.” While pure environmental attributions were rare (1.1%), somatic factors were chosen for 28.3% of the symptoms, psychological/stress for 22.1%, and the combination of both for 25.6%. Approximately 10% were attributed in a multicausal sense to all three groups. Depression was found to correlate positively with psychological/stress and negatively with somatic attributions.Conclusion
The results do not support the perspective that SFDs generally result from poor acknowledgement of emotional factors. SFD and chronic pain showed distinguishable attributional patterns. 相似文献16.
Maher-Edwards L Fernie BA Murphy G Wells A Spada MM 《Journal of psychosomatic research》2011,70(4):311-317
Objective
Chronic fatigue syndrome (CFS) describes a condition that is primarily characterized by fatigue and flu-like symptoms that are not alleviated by rest. This study investigated the relationship among metacognitions, negative emotions, and symptom severity in CFS.Methods
A total of 96 patients who had received a diagnosis of CFS according to the Oxford Criteria completed a battery of self-report measures that consisted of the Depression Anxiety Stress Scales, the 30-Item Metacognitions Questionnaire, the Chalder Fatigue Questionnaire (CFQ), and the RAND 36-Item Short-Form Health Survey-Physical Functioning.Results
Correlation analyses showed that negative emotions and metacognitions were positively correlated with measures of symptom severity and that metacognitions were a better predictor of symptom severity than anxiety and depression. Hierarchical regression analyses indicated that (1) lack of cognitive confidence predicted both mental and physical factors of the CFQ and physical functioning independently of negative emotions and (2) beliefs about the need to control thoughts predicted the mental factor of the CFQ independently of negative emotions and lack of cognitive confidence.Conclusion
The data support the potential application of the metacognitive model of psychological disorder to understanding CFS. 相似文献17.
Objective
Fatigue is a common and distressing complaint among people with diabetes and likely to hinder the ability to perform daily diabetes self-management tasks. A review of the literature about diabetes-related fatigue was conducted with an eye toward creating a framework for beginning to conduct more focused studies on this subject.Methods
A literature search containing the terms diabetes, fatigue, tiredness, and symptoms was conducted to search for literature that addressed diabetes-related fatigue.Results
Diabetes presents many potential pathways for fatigue, but focused studies on this symptom are rare. Furthermore, research on diabetes-related fatigue is limited by fatigue's nonspecific symptoms and because fatigue researchers have yet to agree on standardized definition, measurement, or diagnostic criteria. Additionally, few diabetes randomized clinical trials included measurement of patient-reported outcomes, such as symptoms or health-related quality of life in their study designs, although one that did provided some meaningful finding that symptom-focused education improved self-management practices, HbA1c levels, quality of life, and symptom distress.Conclusion
There is a need to standardize the definition, measurement, and diagnostic criteria of fatigue in diabetes. We present a model that can guide focused studies on fatigue in diabetes. The model capitalizes on the multidimensional phenomena (physiological, psychological, and lifestyle) associated with fatigue in diabetes. 相似文献18.
Andrea Riedl Julia Maass Herbert Fliege Andreas Stengel Marco Schmidtmann Burghard F. Klapp Hubert Mnnikes 《Journal of psychosomatic research》2009,67(5):449-455
Objectives
Patients' ideas about the nature, cause, and treatment of their illnesses are part of the complex process of coping with illness. To date, limited research on subjective theories of illness in patients with irritable bowel syndrome (IBS) has been performed. The aim of the study was to investigate patients' subjective theories of illness and how these are related to clinical and psychological outcome criteria, in particular IBS symptom severity and quality of life.Methods
Eighty-eight patients with IBS, as defined by Rome III criteria, were administered a battery of questionnaires to collect the following data: sociodemographic variables, subjective theories of illness (Subjektive Krankheitstheorien, Cause Questionnaire), anxiety (Hospital Anxiety and Depression Scale), depression (Beck Depression Inventory), quality of life (SF-12), and IBS symptoms (Questionnaire for Gastrointestinal Symptoms).Results
Almost all patients reported theories of illness reflecting their subjective causal assumptions. The most frequently mentioned causal factors were physical illness, intrapsychic factors, and stress.Patients with mainly somatic attributions had higher IBS symptoms scores (P<.05) and reduced physical quality of life. Intrapsychic attributions were associated with reduced mental quality of life and enhanced physical quality of life (P<.01). All correlations were independent of gender, age, and irritable bowel subgroups.Conclusions
Subjective theories of illness can have significant implications for IBS symptom severity, as well as for physical and mental quality of life. 相似文献19.
Célyne H. Bastien Geneviève St-Jean Isabelle Turcotte Charles M. Morin Mélanie Lavallée Daniel Forget 《Journal of psychosomatic research》2009,67(2):117-1260
Objective
Spontaneous K-complexes are electroencephalographic features unique to non-rapid eye movement sleep. It has been suggested that this phasic event is a sleep-protective mechanism. Because insomnia sufferers report poor sleep quantity and quality, the objective of this study was to document the occurrence of spontaneous K-complexes in Stage 2 sleep of individuals with chronic insomnia. Specifically, the number and density of spontaneous K-complexes were studied in psychophysiological insomnia sufferers.Setting
This study took place in a sleep and event-related potentials laboratory.Design
Spontaneous K-complexes were scored during Stage 2 sleep on the second and third nights of a four-consecutive-nights protocol of polysomnographic recordings.Participants
The sample included 14 participants suffering from psychophysiological insomnia (INS group; mean age=44.1 years) and 14 good sleepers (mean age=38.1 years). Participants underwent sleep and psychological evaluations. INS group participants met the diagnostic criteria for primary psychophysiological insomnia (mean duration of insomnia=9.6 years).Intervention
Not applicable.Results
The total number of spontaneous K-complexes and the density according to the total time spent in Stage 2 sleep (spontaneous K-complexes per minute) were compiled. Repeated-measures analyses of variance showed no significant difference in the number and density of spontaneous K-complexes between the INS group (313.98 and 2.66) and the GS group (361.10 and 2.88), respectively.Conclusion
These results suggest no deficiency in the sleep-protective mechanism of psychophysiological insomnia sufferers in comparison with good sleepers, as measured by the spontaneous K-complexes' number and density. 相似文献20.
Constanze Hausteiner Dorothea Huber Susanne Bornschein Martine Grosber Esther Bubel Sylvie Groben Claas Lahmann Bernd Löwe Florian Eyer Bernadette Eberlein Johannes Ring Heidrun Behrendt Ulf Darsow Peter Henningsen 《Journal of psychosomatic research》2010,69(3):259-266