Social press and its influence on psychiatric treatment goals

Summary Patients and staff differ markedly in their goals for inpatient treatment. Staff regard insight as the most important goal for therapy; patients rate insight as their last choice. Despite a considerable amount of social press on the patient, this disagreement persists throughout the patients' hospitalization. Patients change their outward behavior but hold to their original ideologies regarding treatment goals.     

Contribution of functional neuroimaging to understanding neuropsychiatric side effects of interferon in hepatitis C

Patients with hepatitis C who are treated with interferon may develop neuropsychiatric symptoms, including fatigue and depression. The authors discuss the potential use of functional neuroimaging in the identification and treatment of these patients. The authors provide an overview of functional neuroimaging studies of fatigue and depressive symptoms in various medical and psychiatric conditions and suggest future directions for research that may increase understanding of the specific neural substrates of neuropsychiatric side effects associated with hepatitis C and interferon treatment. This knowledge may help consultation-liaison psychiatrists identify patients at high risk for developing side effects related to hepatitis C and interferon, which would allow for implementation of validated strategies for prophylactic treatment of these patients.     

Airway intervention in adult supraglottitis

Background The timing of aggressive airway intervention in adult epiglottitis is controversial. Aims To correlate Friedman’s staging of epiglottitis on admission with the airway interventions undertaken. Methods A retrospective study of 23 adult patients, mean age 51 years (range 29–81 years), who had been admitted with acute supraglottitis between March 1988 and December 2000 was undertaken. Results Three patients (13%) had airway interventions; two with tracheostomy and one with tracheal intubation. All were Friedman stage III and had rapid symptom progression during the 24 hours prior to admission. Three other stage III patients with symptom progression longer than 24 hours and all the remaining patients (stage II or less) were managed with observation and intravenous therapy. Conclusions Friedman originally advocated airway intervention in any patient stage II or worse, but this intubation threshold should probably be lowered to those patients with rapid-onset stage III (moderate respiratory distress, stridor, respiratory rate >30 per minute, pCO₂ >45mmHg) disease.     

Sleep apnea: a model for studying cytokines, sleep, and sleep disruption

Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. The sleep fragmentation and accompanying hypoxemia lead to many negative consequences including cardiac arrhythmias, nocturnal hypertension, confusion, cognitive impairment, daytime sleepiness, as well as depressive symptoms. From the perspective of psychoneuroimmunology (PNI), OSA holds promise as a model for studying sleep and cytokines because of its many relevant characteristics, including neuroimmune interactions, mood changes, and behaviors that directly affect the course of the disorder. In this minireview we briefly summarize the existing literature on cytokines and sleep and then discuss work on cytokines and OSA. We believe that the study of OSA presents researchers with an excellent opportunity to tease apart the many complex and interwoven components of sleep that are relevant to PNI.     

Psychologic correlates of compliance with continuous positive airway pressure

STUDY OBJECTIVES: To explore the relationship between psychologic variables measured prior to continuous positive airway pressure (CPAP) treatment and subsequent CPAP compliance. DESIGN: Participants were assigned to a CPAP treatment group. Psychologic questionnaires administered prior to the start of treatment assessed depression, anxiety, stress, anger or hostility, social support, social desirability, and coping. Polysomnography was performed on admission (prior to start of treatment) and at the end of 1 week of treatment. Compliance was measured nightly by an intemal clock counter in the CPAP unit and averaged over the 1-week treatment period. SETTING: N/A. PARTICIPANTS: Twenty-three CPAP-naive patients with obstructive sleep apnea were enrolled in a study of the effects of CPAP on sympathetic nervous system functioning, quality of life, and psychologic functioning. Interventions: N/A MEASUREMENTS AND RESULTS: Objectively measured average daily compliance was significantly associated with a measure of coping strategies. Multiple regression analyses revealed that Active Ways of Coping accounted for a significant amount of variance in CPAP compliance, even after the respiratory disturbance index, daytime sleepiness, and Passive Ways of Coping were taken into account. No other psychologic variable assessed prior to CPAP treatment was associated with subsequent CPAP compliance. CONCLUSIONS: These results suggest that individuals who engage in active coping strategies with new and difficult situations used CPAP more. It may be that encouraging patients to use coping techniques, such as planful problem solving, will help to improve compliance with CPAP.