Anxiety symptoms in patients admitted in medical intensive care unit: A cross-sectional study

Objective: Patients admitted to the medical intensive care unit (MICU) for various medical morbidities are prone to suffer various psychiatric symptoms. Common conditions for which psychiatric consultation is sought are anxiety, delirium, self-harm attempt, and adjustment disorder. Anxiety is a commonly encountered problem and can affect the treatment outcome and compliance. This study was carried out in the MICU of tertiary care hospital to assess the pattern of anxiety symptoms in patients admitted to the MICU. Material and Methods: Sixty patients admitted to MICU were included in the study and assessed using semi-structured pro forma, Hamilton Anxiety Rating Scale (HAM-A), Brief Psychiatric Rating Scale, and Faces Anxiety Scale. Data were statistically analyzed using mean, Chi-square test, t-test, and logistic regression test. Results: The majority of the participants were male, predominantly belonging to the age group of 40–59 years. Most of them had some physical, behavioral, or psychological symptoms of anxiety in a mild form. Although the extent of the anxiety symptoms in most of the patients was mild, a few also reported a moderate level of anxiety. Patients with cardiac and respiratory disorders had higher scores on anxiety rating scales than those with other diagnoses. Male gender, cardiorespiratory disease, and the presence or absence of anxiety had a negative correlation (r = ?1.79) whereas gender, disease, and presence of mild or moderate anxiety had no statistical significance. Conclusion: Most of the patients, especially those admitted with cardiac and respiratory disorders, had mild anxiety symptoms. Assessment of anxiety in MICU patients can be an important aspect to prevent or reduce the overall disease burden

Depression among physicians in a government-designated COVID-center hospital during the Coronavirus Disease-19 pandemic

OBJECTIVES@#This study aimed to determine the prevalence, most common symptoms and sociodemographic factors associated with depression among physicians in a government COVID-Center i.e. Southern Philippines Medical Center-Institute of Psychiatry & Behavioral Medicine in Bajada, Davao City@*METHODOLOGY@#This cross-sectional, survey-based study collected socio-demographic data and PHQ-9 scores using Google Forms, from resident physicians from July 1 to August 31 2020. Multinomial logistics regression analysis was used to identify risk factors of depression.@*RESULTS@#Two hundred fifty-one (251) out of 376 physicians responded (68.39% response rate). The average age was 30 years old, majority were female (58.57%, 147), single (78.88%,198), frontliners (77.29%, 194), with average hospital experience of 2.0 years. Ninety six (38.26%) were assigned in surgical departments while 155 (61.75%) worked in nonsurgical departments. There were twelve respondents (4.78%) who had a history of psychiatric illness and 31 (12.35%) had previous psychiatric intervention, while 66 (26.29%) had a history of medical illness. Eighty-five (33.86%) had depression using PHQ-9; 57 (22.71%) as mild, 19 (7.57%) moderate, 7 (2.79%) moderately severe and 2 (0.8%) severe. Out of 85 residents who were depressed, the most common symptoms were: low energy (81, 95.29%); anhedonia (76, 89.41%); and feeling depressed (72, 84.70%). Medical illness was associated with higher levels of depression. Physicians with a history of psychiatric illness, psychiatric intervention and medical illness had significantly higher levels of depression.@*CONCLUSION@#More than a third (33.86%) of physicians screened positive for depression. Current mental health programs must be strengthened and made specific, to prevent and address depression especially among those who have a history of psychiatric and medical illness.

A Comparative Study Regarding The Difference In Attitude Of Interns Towards Psychiatric Illness And Chronic Medical Illness

Attitude of doctors towards a specific illness play major role in the care of patients. Internship, the final stage in MBBS training is important in developing attitudes towards different diseases. Psychiatric illnesses itself have stigma among doctors too. In our country there are little studies comparing the medical illness and psychiatric illness. In this study we tried to explore the attitude of interns towards Psychiatric illness and a chronic medical illness (Diabetes Mellitus). Total 136 interns who had completed their Psychiatric posting were included in this study. Medical Condition Regard Scale was used to assess the attitude towards the specific illness. The attitude of interns towards Psychiatric illness was comparable with the attitude towards Diabetes Mellitus.

The Impact of General Medical Conditions in Obsessive-Compulsive Disorder

OBJECTIVE: The co-occurrence of general medical conditions (GMCs) and major psychiatric disorders is well documented. The aim of this study was to assess the prevalence of GMCs in patients with a primary diagnosis of obsessive-compulsive disorder (OCD) and, secondly, to investigate which clinical variables are associated with the presence of a GMC. METHODS: Subjects with a primary diagnosis of OCD were included. Socio-demographic and clinical characteristics were collected. GMCs were classified using the ICD-10 and grouped according to the Cumulative Illness Rating Scale (CIRS) in: cardiac, vascular, hematopoietic, respiratory, ear/nose/throat, upper and lower gastrointestinal, hepatic, renal, genitourinary, musculoskeletal, neurologic, endocrine/metabolic. The association between the presence of GMCs and demographic/clinical variables of OCD was investigated. RESULTS: A total of 162 patients with OCD were included. 78 (48.1%) patients had at least one comorbid GMC. Most frequent GMCs were endocrine/metabolic diseases (25.9%), followed by upper/lower gastrointestinal (20.5%) and cardio-vascular diseases (13.6%). The presence of a GMC was significantly associated with female gender, older age, duration of untreated illness (DUI), and absence of physical activity. CONCLUSION: Patients with OCD have high rates of comorbid GMCs. A longer DUI is associated with having at least one GMCs; this might be due to the long-lasting adoption of unhealthy lifestyles, not counterbalanced by appropriate treatment and psychoeducation.

Frecuencia de depresión en los pacientes que consultan en las policlínicas de medicina interna del Hospital de Clínicas Dr. Manuel Quintela / Frequency of depression in patients visiting the clinics of internal medicine at Hospital de Clínicas

La depresión es una de las enfermedades con mayor prevalencia en Uruguay y causa de una importante mortalidad por su estrecha vinculación con el suicidio. A su vez, existe una marcada vinculación entre la depresión y las enfermedades médicas. El objetivo de este estudio es conocer la frecuencia de depresión en los pacientes que consultan en las policlínicas de medicina del hospital universitario durante el período de un mes. Seestudió además la relación entre la presencia de depresión y distintas variables: autopercepción de la gravedad de la patología médica, tiempo de evolución de la patología médica y ocupación. Se utilizó la traducción española del inventario para la depresión de Beck (bdi) y un cuestionario que incluyó datos patronímicos y las variables mencionadas. El porcentaje de pacientes condepresión resultó mayor a los valores de referenciapara la población general, tanto en muestras locales como extranjeras

Assessment of depression in medical patients: A systematic review of the utility of the Beck Depression Inventory-II

To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II), which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions.

A comparative study of care giver burden in psychiatric illness & chronic medical illness

Background Caregivers of patients are at greater risk of mental and physical health problems.Aims To compare the caregiver burden in psychiatric illness and chronic medical illness.Methods. The caregiver burden was assessed on Montgomery Borgatta Caregiver Burden Scale.Results The caregiver burden in families of psychiatric clients is higher than that of other medical illness, & increaseswith the duration of illnessConclusion Interventions aiming at reduction of caregiver burden should be routinely incorporated in the managementof persons with mental illness.

Clustering of psychiatric and somatic illnesses in the general population: multimorbidity and socioeconomic correlates

The distribution of psychiatric disorders and of chronic medical illnesses was studied in a population-based sample to determine whether these conditions co-occur in the same individual. A representative sample (N = 1464) of adults living in households was assessed by the Composite International Diagnostic Interview, version 1.1, as part of the São Paulo Epidemiological Catchment Area Study. The association of sociodemographic variables and psychological symptoms regarding medical illness multimorbidity (8 lifetime somatic conditions) and psychiatric multimorbidity (15 lifetime psychiatric disorders) was determined by negative binomial regression. A total of 1785 chronic medical conditions and 1163 psychiatric conditions were detected in the population concentrated in 34.1 and 20 percent of respondents, respectively. Subjects reporting more psychiatric disorders had more medical illnesses. Characteristics such as age range (35-59 years, risk ratio (RR) = 1.3, and more than 60 years, RR = 1.7), being separated (RR = 1.2), being a student (protective effect, RR = 0.7), being of low educational level (RR = 1.2) and being psychologically distressed (RR = 1.1) were determinants of medical conditions. Age (35-59 years, RR = 1.2, and more than 60 years, RR = 0.5), being retired (RR = 2.5), and being psychologically distressed (females, RR = 1.5, and males, RR = 1.4) were determinants of psychiatric disorders. In conclusion, psychological distress and some sociodemographic features such as age, marital status, occupational status, educational level, and gender are associated with psychiatric and medical multimorbidity. The distribution of both types of morbidity suggests the need of integrating mental health into general clinical settings.

A prospective study of risk factor profile & incidence of deep venous thrombosis among medically-ill hospitalized patients at a tertiary care hospital in northern India.

Background & objectives: Hospitalization for medical-illness is associated with an increased risk of deep venous thrombosis (DVT). However, there are no published data from India addressing at this issue. We sought to study the risk factor profile and the incidence of DVT among hospitalized medically-ill patients, a tertiary care hospital in northern India. Methods: All adults admitted to the medical wards and intensive care unit with level 1 or 2 mobility over a period of two years (July 2006 to July 2008) at the All India Institute of Medical Sciences hospital, New Delhi, were prospectively studied. Patients having DVT at admission or an anticipated hospital stay less than 48 h were excluded. The presence of clinical risk factors for DVT was recorded and laboratory evaluation was done for hypercoagulable state. A routine surveillance venous compression Doppler ultrasonography was performed 12 ± 8 days after hospital admission. Results: Of the 163 patients, 77 (47%) had more than one risk factor for DVT. Five (3%) patients developed DVT; none of them had symptomatic DVT. None of these patients received anticoagulation prior to the development of DVT. The mean age of those who developed DVT was 40 ± 13 (25-50) yr; two of five were male. The incidence rate of DVT was 2.7 per 1000 person-days of hospital stay [95% confidence interval (CI): 0.87 to 6.27]. None of the factors was found to be significantly associated with the risk of DVT. Interpretation & conclusions: In our setting, although many hospitalized medically-ill patients had risk factors for DVT, the absolute risk of DVT was low compared to the western population but clearly elevated compared to non hospitalized patients. Large studies from India are required to confirm our findings.

Evaluación de la depresión en pacientes hospitalizados por distintas enfermedades médicas en la ciudad deBucaramanga / Evaluation of depression in patients hospitalized for different illnesses in the city of Bucaramanga

El presente estudio pretendió evaluar la presencia de depresión en pacienteshospitalizados por distintas enfermedades médicas, en una muestra de 82pacientes con un rango de edades entre 22 y 76 años, a quienes se les aplicó elInventario de Depresión de Beck (BDI-II) y la escala de Ansiedad y DepresiónHospitalaria (HADS). Los datos fueron procesados a través SPSS 11.5, el cualarrojó los siguientes resultados: 1) Una prevalencia del 41.5% de depresión enla muestra, de acuerdo con el BDI-II. 2) Una prevalencia de trastorno depresivodel 11% de la muestra según el HADS. 3) Mayor prevalencia de síntomassomático-motivacionales, frente a los síntomas cognitivo-afectivos. Estoshallazgos corresponden a lo referido en la literatura al señalar la alta prevalenciade depresión en contexto hospitalario; igualmente, confirma la importancia de laevaluación de síntomas cognitivo-afectivos para determinar la presencia o no deepisodios depresivos en este tipo de pacientes.

The aim of this study was to evaluate the level of depression in patients hospitalizedwith different illnesses. A sample was taken of 82 patients of ages ranging from 22 to 76, to whom the Beck Depression Inventory (BDI-II) and the Hospitaland Anxiety Depression Scale (HADS) were applied. The data were processedwith SPSS 11.5, which produced the following results: 1) A prevalence of 41.5%depression in the sample according to BDI-II. 2) A prevalence of depressivedysfunction of 11% in the sample, according to the HADS. 3) higher prevalenceof somatic-motivational symptoms compared with cognitive-affective symptoms.These findings correspond to those mentioned in publications, highlighting thehigh prevalence of depression in hospitals; equally, they confirm the importanceof the evaluation of cognitive-affective symptoms to determine the presence orotherwise of depression in this type of patient.

O presente estudo pretendeu avaliar a presença de depressão em pacienteshospitalizados por diferentes doenças médicas numa amostra de 82 pacientescom uma categoria de idades entre 22 e 76 anos, a que se aplicou o Inventáriode Depressão de Beck (BDI-II) e a escala de Ansiedade e Depressão NosHospitais (HADS). Os dados foram processados através do SPSS 11.5 o qualapresentou os seguintes resultados: 1) uma prevalência do 41.5% de depressãona amostra de acordo com o BDI-II. 2) uma prevalência de transtorno depressivode 11% da amostra segundo o HADS. 3) Maior prevalência de sintomassomático-motivacionais fronte aos sintomas cognitivo-afetivos. Estes achadoscorrespondem ao referido na literatura ao sinalar a alta prevalência de depressãoem contexto nos hospitais, igualmente, confirma a importância da avaliaçãode sintomas cognitivo-afetivos para determinar a presença ou não de episódiosdepressivos neste tipo de pacientes.

Life event,stress and illness

The relationship between stress and illness is complex. The susceptibility to stress varies from person to person. Among the factors that influenced the susceptibility to stress are genetic vulnerability, coping style, type of personality and social support. Not all stress has negative effect. Studies have shown that short-term stress boosted the immune system, but chronic stress has a significant effect on the immune system that ultimately manifest an illness. It raises catecholamine and suppressor T cells levels, which suppress the immune system. This suppression, in turn raises the risk of viral infection. Stress also leads to the release of histamine, which can trigger severe broncho-constriction in asthmatics. Stress increases the risk for diabetes mellitus, especially in overweight individuals, since psychological stress alters insulin needs. Stress also alters the acid concentration in the stomach, which can lead to peptic ulcers, stress ulcers or ulcerative colitis. Chronic stress can also lead to plaque buildup in the arteries (atherosclerosis), especially if combined with a high-fat diet and sedentary living. The correlation between stressful life events and psychiatric illness is stronger than the correlation with medical or physical illness. The relationship of stress with psychiatric illness is strongest in neuroses, which is followed by depression and schizophrenia. There is no scientific evidence of a direct cause-and-effect relationship between the immune system changes and the development of cancer. However, recent studies found a link between stress, tumour development and suppression of natural killer (NK) cells, which is actively involved in preventing metastasis and destroying small metastases.

The Relationship between Depressive Symptoms in Outpatients with Chronic Illness and Health Care Costs

PURPOSE: To evaluate the relationship between depressive symptoms and health care costs in outpatients with chronic medical illnesses in Korea, we screened for depressive symptoms in 1,118 patients with a chronic medical illness and compared the severity of somatic symptoms and health care costs. PATIENTS AND METHODS: Data were compared between outpatients with depressive symptoms and those without depressive symptoms. Depression and somatic symptoms were measured by Zung's Self-rating Depression Scale (SDS) and Patient Health Questionnaire (PHQ)-15, respectively. We also investigated additional data related to patients' health care costs (number of visited clinical departments, number of visits made per patients, and health care costs). A total of 468 patients (41.9%) met the criteria for depressive disorder. RESULTS: A high rate of severe depressive symptoms was found in elderly, female and less-educated patients. A positive association between the severity of somatic symptoms and depressive symptoms was also identified. The effects of depressive symptoms in patients with chronic illnesses on three measures of health services were assessed by controlling for the effects of demographic variables and the severity of somatic symptoms. We found that the effects of depressive symptoms on the number of visited departments and number of visits made per patients were mediated by the severity of somatic symptoms. However, for health care costs, depressive symptoms had a significant main effect. Furthermore, the effect of gender on health care costs is moderated by the degree of a patient's depressive symptoms. CONCLUSION: In summary, there is clearly a need for increased recognition and treatment of depressive symptoms in outpatients with chronic medical illnesses.

Prevalence and Correlates of Depressive Symptoms among Community-Dwelling Low Income Elderly / 신경정신의학

OBJECTIVES: This study aimed to investigate the prevalence and correlates of depressive symptoms in community-dwelling low income elderly. METHODS: A community survey of 1,351 low income residents aged 65 or over was conducted in Buk district of Gwangju, Korea. Depressive symptom was evaluated by the Korean Form of the Geriatric Depression Scale (KGDS). Their sociodemographic factors, the precence of chronic physical illness, and cognitive functions were investigated. RESULTS: The prevalence rate of depressive symptoms was 69.8%. In multiple logistic regression, chronic physical illness (Odds Ratio:2.68, 95% Confidence Interval : 1.98-3.63), low education (Odds Ratio : 1.84, 95% Confidence Interval : 1.39-2.43), and cognitive impairment (Odds Ratio : 1.61, 95% Confidence Interval : 1.20-2.16) were independently associated with depressive symptoms. CONCLUSION: Depressive symptoms in community-dwelling low income elderly were very common, particularly related to current chronic physical illnesses. The results of this study can be useful for the development of community-based prevention and management programs for depression. Of elderleg.

Prevalence and Correlates of Depressive Symptoms among Community-Dwelling Low Income Elderly / 신경정신의학

OBJECTIVES: This study aimed to investigate the prevalence and correlates of depressive symptoms in community-dwelling low income elderly. METHODS: A community survey of 1,351 low income residents aged 65 or over was conducted in Buk district of Gwangju, Korea. Depressive symptom was evaluated by the Korean Form of the Geriatric Depression Scale (KGDS). Their sociodemographic factors, the precence of chronic physical illness, and cognitive functions were investigated. RESULTS: The prevalence rate of depressive symptoms was 69.8%. In multiple logistic regression, chronic physical illness (Odds Ratio:2.68, 95% Confidence Interval : 1.98-3.63), low education (Odds Ratio : 1.84, 95% Confidence Interval : 1.39-2.43), and cognitive impairment (Odds Ratio : 1.61, 95% Confidence Interval : 1.20-2.16) were independently associated with depressive symptoms. CONCLUSION: Depressive symptoms in community-dwelling low income elderly were very common, particularly related to current chronic physical illnesses. The results of this study can be useful for the development of community-based prevention and management programs for depression. Of elderleg.

Psychopharmacologic Treatment of Depression in Patients with Medical Illness / 대한정신약물학회지

While in the past the almost sole availability of tricyclic antidepressants had limited antidepressant drug selection, newer drugs such as selective serotonin reuptake inhibitors, bupropion, mirtazapine and venlafaxine have vastly simplified treating depression in patients with medical illness. Appropriate selection of an antidepressant agent in medically ill patients requires a careful risk-benefit assessment of the antidepressant treatment considering the pharmacokinetic and pharmacodynamic properties of drugs, potential for drug interaction, the patient's general medical conditions, and primary symptoms of the patient's depression. The effective and safe approach to antidepressant treatment is to reduce initial dosage, to titrate upward more slowly, and to monitor closely adverse effects in patients with medical illness.