Psychiatric morbidity in patients with alcoholic liver disease

Seventy one patients with alcoholic liver disease and an equal number with non-alcoholic liver disease were interviewed using the schedule for affective disorders and schizophrenia. Forty seven (66%) of the group with alcoholic liver disease had or had had psychiatric illnesses compared with 23 (32%) of the control group (p less than 0.001). Affective disorder, particularly major depression, neurotic disorders, and antisocial personality, were all more common among the patients with alcoholic liver disease than the controls. No patient had schizophrenia or other forms of psychosis. Among the patients with alcoholic liver disease 11 men (24%) and 14 women (54%) had an affective or a neurotic disorder that had antedated their heavy drinking, and 30 (77%) of those who had had such a problem at any time had symptoms at the time of interview. Abstinence from alcohol is essential for patients with severe alcoholic liver disease. In view of the high prevalence of psychiatric disorders in these patients psychiatric assessment is important to increase the patients' likelihood of complying with such advice.     

Psychiatric morbidity in patients with chronic airflow obstruction

Fifty consecutive patients with chronic airflow obstruction who were admitted to a respiratory unit were assessed medically and psychiatrically. A high rate of psychiatric morbidity (58%) was detected with panic and other anxiety disorders (34%) being particularly prevalent. Various physiological and psychological reasons for the high rate of anxiety disorders are discussed.     

Psychiatric morbidity among spouses of patients with stroke

The medium term psychiatric morbidity of spouses of patients with stroke was evaluated one to three years after the event. Compared with a control group the spouses were more likely to be depressed (p less than 0.005) and had more physical symptoms (p less than 0.01). Depression increased with the severity of the stroke in the spouse (p less than 0.05) and with time during the three years. Regular contact with friends and neighbours protected spouses (p less than 0.005). Depressed spouses were more likely to be taking tranquillisers than non-depressed spouses (p less than 0.0001) but no more likely to be taking antidepressants. Social rehabilitation after stroke was less successful when the spouse was depressed. Proper attention paid to spouses of patients with stroke might improve the prospects of these patients.     

Yoga for bronchial asthma: a controlled study

Fifty three patients with asthma underwent training for two weeks in an integrated set of yoga exercises, including breathing exercises, suryanamaskar, yogasana (physical postures), pranayama (breath slowing techniques), dhyana (meditation), and a devotional session, and were told to practise these exercises for 65 minutes daily. They were then compared with a control group of 53 patients with asthma matched for age, sex, and type and severity of asthma, who continued to take their usual drugs. There was a significantly greater improvement in the group who practised yoga in the weekly number of attacks of asthma, scores for drug treatment, and peak flow rate. This study shows the efficacy of yoga in the long term management of bronchial asthma, but the physiological basis for this beneficial effect needs to be examined in more detail.     

Psychiatric morbidity in breast cancer — a review

Clinicians have long observed a substantive relationship between cancer and psychological symptoms. As early as 200 A.D., Galen, a Roman physician, observed that “melancholic” women were more at risk of developing cancer than “sanguine” women¹. Nunn in 1822, published his widely quoted ‘Cancer of the Breast’ emphasising his belief that emotional factors can influence the growth of a neoplasm². Herbert Snow published the first statistical studies in the field in the late nineteenth century^3,4,5. However the idea of a psychosomatic concept vanished from the literature when surgical advances and the promise of radiation seemed to be the answer.     

Psychiatric morbidity in long-term renal transplant recipients and patients undergoing hemodialysis. A comparative study

This study assessed and compared psychiatric morbidity in long-term (five years or longer) renal transplant recipients and patients undergoing hemodialysis. Fifty-seven of 98 transplant recipients and 44 of 89 patients undergoing dialysis returned questionnaires designed to collect demographic information and to detect psychiatric morbidity. The two groups differed significantly only in that the patients undergoing dialysis were both older and medically sicker than the transplant recipients. Forty-six percent of the transplant group and 48% of the dialysis group could be identified as psychiatrically impaired either by their scores on the General Health Questionnaire or by a history of prior psychiatric treatment. The finding of nearly equivalent psychiatric morbidity in these two groups does not support the often-held notions about psychological advantages of transplantation over dialysis. We conclude that psychiatric morbidity in patients with chronic renal failure is high and appears not to be related to the choice of treatment.     

Improvement in bronchial hyper-responsiveness in patients with moderate asthma after treatment with a hypnotic technique: a randomised controlled trial

A prospective, randomised, single blind, and controlled trial of a hypnotic technique was undertaken in 39 adults with mild to moderate asthma graded for low and high susceptibility to hypnosis. After a six week course of hypnotherapy 12 patients with a high susceptibility score showed a 74.9% improvement (p less than 0.01) in the degree of bronchial hyper-responsiveness to a standardised methacholine challenge test. Daily home recordings of symptoms improved by 41% (p less than 0.01), peak expiratory flow rates improved by 5.5% (p less than 0.01), and use of bronchodilators decreased by 26.2% (p less than 0.05). The improvement in bronchial hyper-reactivity occurred without a change in subjective appreciation of the degree of bronchoconstriction. A control group 17 patients and 10 patients undergoing treatment with low susceptibility to hypnosis had no change in either bronchial hyper-responsiveness or any of the symptoms recorded at home. This study shows the efficacy of a hypnotic technique in adult asthmatics who are moderately to highly susceptible to hypnosis.     

Psychiatric morbidity in a general practice in an Indian city

Psychiatric morbidity in an Indian general practice was studied using the 12 item version of the General Health Questionnaire to screen 882 patients who represented 9000 consecutive adult patients attending the practice. The questionnaire was valid with a cutting score of 1/2 when compared with section 1 of the standardised Indian Psychiatric Survey Schedule. The probable prevalence of psychiatric morbidity was 35.9%. The general practitioner identified only about 25% of patients. Five of the 12 questions on the General Health Questionnaire had a higher discriminatory capacity, and the performance of the patients on these five questions was valid when compared to section 1 of the Indian Psychiatric Survey Schedule.     

Psychiatric study of patients with severe burn injuries

About two-thirds of a consecutive series of patients severely injured with burns followed up one year after discharge were found to have psychological sequelae. Duration of hospital stay and the presence of certain mental illnesses were related to the incidence and severity of psychological symptoms. This relation did not apply to the site of the burn and the existence of a claim for compensation. The incidence of post-traumatic neurosis in patients with burn injuries could be reduced by identifying and treating, soon after the accident, those who need psychiatric help.     

Inhaled corticosteroid reduction and elimination in patients with persistent asthma receiving salmeterol: a randomized controlled trial

CONTEXT: Inhaled long-acting beta(2)-agonists improve asthma control when added to inhaled corticosteroid (ICS) therapy. OBJECTIVE: To determine whether ICS therapy can be reduced or eliminated in patients with persistent asthma after adding a long-acting beta(2)-agonist to their treatment regimen. DESIGN AND SETTING: A 24-week randomized, controlled, blinded, double-dummy, parallel-group trial conducted at 6 National Institutes of Health-sponsored, university-based ambulatory care centers from February 1997 through January 1999. PARTICIPANTS: One hundred seventy-five patients aged 12 through 65 years with persistent asthma that was suboptimally controlled during a 6-week run-in period of treatment with inhaled triamcinolone acetonide (400 microg twice per day). INTERVENTION: Patients continued triamcinolone therapy and were randomly assigned to receive add-on therapy with either placebo (placebo-minus group, n = 21) or salmeterol xinafoate, 42 microg twice per day (n = 154) for 2 weeks. The entire placebo-minus group was assigned and half of the salmeterol group (salmeterol-minus group) was randomly assigned to reduce by 50% (for 8 weeks) then eliminate (for 8 weeks) triamcinolone treatment. The other half of the salmeterol group (salmeterol-plus group) was randomly assigned to continue both salmeterol and triamcinolone for the remaining 16 weeks (active control group). MAIN OUTCOME MEASURE: Time to asthma treatment failure in patients receiving salmeterol. RESULTS: Treatment failure occurred in 8.3% (95% confidence interval [CI], 2%-15%) of the salmeterol-minus group 8 weeks after triamcinolone treatment was reduced compared with 2.8% (95% CI, 0%-7%) of the salmeterol-plus group during the same period. Treatment failure occurred in 46.3% (95% CI, 34%-59%) of the salmeterol-minus group 8 weeks after triamcinolone therapy was eliminated compared with 13.7% (95% CI, 5%-22%) of the salmeterol-plus group. The relative risk (95% CI) of treatment failure at the end of the triamcinolone elimination phase in the salmeterol-minus group was 4.3 (2.0-9.2) compared with the salmeterol-plus group (P<.001). CONCLUSIONS: Our results indicate that in patients with persistent asthma suboptimally controlled by triamcinolone therapy alone but whose asthma symptoms improve after addition of salmeterol, a substantial reduction (50%) in triamcinolone dose can occur without a significant loss of asthma control. However, total elimination of triamcinolone therapy results in a significant deterioration in asthma control and, therefore, cannot be recommended.     

以共济失调为主要表现的布氏杆菌病1例

<正>患者,男,30岁。因左眼复视伴进行性双下肢行走不稳6个月入院。自诉于2018年12月左右无明显诱因逐渐出现左眼外展时复视,伴排尿困难,尿等待时间长,在当地县医院以前列腺炎治疗,效果不佳。2019年4月出现双下肢行走僵硬不稳,如踩棉花,不能走直线,大便费力,听力减退,复视情况同前,就诊于外院,查泌尿彩色超声膀胱腔内沉积物,前列腺钙化斑,双肾结构、输尿管未见明显异常,头颅CT平扫未见明显异常,未明确诊断。