Case series of extra pulmonary tuberculosis presenting as facial swelling.

In England there were 7,290 cases of tuberculosis (TB) reported in 2013. The area with the highest incidence of the disease in England is London, with hotspots in other urban areas. TB affecting the head and neck is rare. We present three such cases of TB presenting as pre-auricular swelling. Two of the patients were initially misdiagnosed as having dental infection, demonstrating the importance of taking a good history and considering the differential diagnosis of TB when appropriate. TB remains a potentially fatal disease that should be considered in patients presenting with facial swelling where common causes have been excluded.

Weight-related body image concerns among 18-24-year-old women in Canada and India: an empirical comparative study.

OBJECTIVE: Sociocultural factors are important in the pathogenesis of eating disorders. We examined some core (DSM IV) features of eating disorders, i.e., drive for thinness and dissatisfaction with the weight of the abdomen, hips, and thighs among women in Canada and India. METHODS: A total of 65 Canadian (mean+/-S.D. age: 21.4+/-2.0 years) and 47 Indian (mean+/-S.D. age: 18.7+/-4.1 years) women completed the Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales of the Eating Disorder Inventory (EDI) and in addition rated the degree to which they believed all major regions of their body were overweight. RESULTS: After the effects of body mass index (BMI) were partialled out statistically, the DT (EDI) and BD (EDI) scores were not significantly different between the two countries. In both groups, concerns about the weight of the abdomen, hips, thighs, and legs loaded on a factor that essentially described the 'body dissatisfaction' construct. After the effects of BMI were partialled out, however, the factor scores from this factor correlated with BD (EDI) in the Canadian but not the Indian sample. DISCUSSION: In contrast to the Canadian women, the Indian women did not overestimate the 'fatness' of their abdomen, hips, thighs, and legs. Among the Indian women, concerns about the weight of the upper torso (i.e., face, neck, shoulders, and chest) emerged as a distinct body image construct. In conclusion, after the effect of BMI was controlled for statistically, the Canadian and Indian women scored similarly on some of the core features of eating disorders, as measured by the DT (EDI) and BD (EDI) subscales, however, the nature of the underlying body image construct was different between the two groups.

Exaggerated TSH responses to TRH in depressed patients with "normal" baseline TSH.

BACKGROUND: Subclinical hypothyroidism (elevated thyroid-stimulating hormone [TSH] with normal thyroid hormone levels) can present with depression. This may be confirmed by an exaggerated TSH response to thyrotropin-releasing hormone (TRH) on the TRH stimulation test (TRH-ST). The objective of this study was to determine the prevalence of exaggerated TRH-ST results in a sample of depressed patients with "high-normal" screening TSH levels. METHOD: Depressed patients with TSH levels of 3.00-5.50 mIU/L underwent a TRH-ST. After baseline TSH was drawn, TRH 400 micrograms was injected intravenously, and TSH samples were drawn at +20 min, +30 min, and +40 min postinjection. A rise in TSH after TRH (peak value minus baseline) of > 25 mIU/L represented an exaggerated TSH response. RESULTS: Twenty-three (38%) of 60 patients had an exaggerated TSH response to TRH. The 38% prevalence is significantly (Chi 2 = 59.65, df = 1, p < .001) greater than the 6% prevalence of positive TRH-ST results reported in the euthyroid general population. The prevalence of positive TRH-ST results was not attributable to differential patterns of psychotropic or thyroid hormone treatment. Unexpected observations were a lack of correlation in TSH levels week to week (r = .17, N.S.) and a lack of correlation between screening TSH value and subsequent TRH-ST results (r = .28, N.S.). CONCLUSION: Subtle thyroid underfunction may be contributing to depression in some patients with TSH in the upper half of the range usually considered normal. If so, then the TRH-ST may be more sensitive in identifying this than measurement of TSH alone.

The relationship between length of vocational disability, psychiatric illness, life stressors and sociodemographic variables.

OBJECTIVE: The primary objective of this study was to examine the relationship between vocational disability, psychiatric illness, life stressors and sociodemographic factors. METHOD: Information on a variety of variables was obtained from insurance files of 147 subjects who had submitted claims for monetary compensation on grounds of psychiatric symptoms. RESULTS: The majority of subjects received a diagnosis of mood disorder or anxiety disorder. Extended vocational disability was associated with longer duration of psychiatric illness, rating of poorer prognosis by the treating physician, and lower income and occupational levels. Individuals with recent onset of disability reported more stressors than those experiencing extended disability. CONCLUSION: Although longer duration of psychiatric illness was associated with vocational disability, other variables play an important role in accounting for extended vocational disability.

Mesial temporal lobe seizures presenting as anxiety disorders.

Five patients had brief simple partial seizures that mimicked panic disorder. The following features assisted diagnosis: Seizures were briefer and more stereotyped than panic attacks; some progressed to typical complex partial seizures; and aphasia and dysmnesia occurred during seizures in some patients. Each patient had one mesial temporal structural lesion. Routine waking EEG was normal in 2 patients. Inadequate response to anti-epileptics necessitated partial temporal lobectomy in 4 patients, 3 of whom remain seizure free.

Anxiety disorder in a case of Arnold-Chiari malformation.

This report describes a patient who suffered concurrently from panic disorder with agoraphobia and Arnold-Chiari malformation. Surgical correction of the neuroanatomical anomaly altered the patient's symptom pattern, enabling a more clear delineation of her anxiety disorder.

The impact of AIDS education among elementary school students.

We report the results of a controlled prospective study designed to assess the impact of education on AIDS among elementary school students. 1,825 students from 3 school boards participated; 848 students were assigned to the trial group and 778 to the comparison group. Overall, the results showed a significant increase in students' level of knowledge of AIDS following their classroom lessons on AIDS. The students exposed to AIDS education expressed more accurate and appropriate beliefs about the transmission of AIDS. The students' reports indicated that television and magazines were their main outside sources of information about AIDS. Generally, the students demonstrated a positive attitude toward the AIDS curriculum. We conclude that classroom education on AIDS is effective in imparting knowledge and changing students' beliefs about AIDS. Further periodic assessments of AIDS education programs would be required at a variety of educational levels to determine if this change will lead to alteration in behaviour. Such assessments would help in the development of more comprehensive and cohesive programs in AIDS education.

The AIDS dilemma: worry and concern over AIDS.

Information was collected from 148 homosexual men to examine their current sexual practices, knowledge of acquired immunodeficiency syndrome (AIDS), perception of risk for this disease and change in sexual behaviour. The data were analyzed to investigate the relationship of these variables to the degree of worry and concern about AIDS expressed by most respondents. Overall, a decline in high-risk sexual behaviour was reported. Measures of worry and concern were significantly related to the subjects' perception of risk for AIDS and reduction in risk behaviours. However, the measures of Health Locus of Control, knowledge about AIDS and sociodemographic characteristics did not significantly predict the degree of worry and concern. The data are discussed in light of the current AIDS epidemic.

PIP: 224 Canadian homosexual men were asked to complete self-report questionnaires on sexual behavior for 1) subjective assessment of the risk of aids, 2) concern about AIDS, 3) subjective perception of risk, 4) knowledge of AIDS, and 5) Multidimensional Health Locus of Control (MHLC). The final sample consisted of 148 men aged 19-66: 30% had a university degree, 27% were professionals, and 45% were blue collar workers. Only collar workers. Only 7 (5%) were HIV positive. Although 40% had more than 1 partner a month, the rest had either 1 partner or no partners. Receptive hand-anus with receptive anal intercourse was assigned a value of 3; receptive anal intercourse with no receptive hand-anus a value of 2; active oral and/or anilingus a value of 1; having more than 11 partners a month were assigned a value of 4. The scores of 119 respondents (80.5%) ranged from 0 to 3, while 29 men (19.6%) scored 4 to 7. 77% stated that they changed their sexual behavior to mitigate risks; 38% used the condom more frequently; 39% reduced the incidence of receptive anal intercourse; and 48% had fewer partners. 80% were occasionally or often thinking about AIDS; 70% were concerned about getting AIDS; and 36% were preoccupied with this concern. 59% deemed their risk greater than that of heterosexuals, and 87% thought that the combined risk of gays was also greater when compared to heterosexuals. Increased worry was significantly associated with the reduction of risk behavior, but only 1 of the 3 indicators of subjective assessment of risk were statistically significant set against concern about AIDS. Findings indicate that behavior was modified as a consequence of an affective response to the threat of this disease.

A prospective study of psychosocial aspects of gastric stapling surgery.

Sixteen patients who underwent gastric stapling procedure for morbid obesity were assessed pre- and post-operatively on several psychosocial dimensions using a number of self-report questionnaires including the Eating Disorders Inventory, Locus of Control, and Millon's Clinical Multi-Axial Inventory. Subjects' responses to questions regarding their socialization, lifestyle and sexual relations were also compared for the two periods. The mean interval between surgery and completion of follow-up questionnaires was 13.6 months. Eighty-one percent of the patients showed an improvement in their psychosocial profile as measured by the MCMI. Although some residual difficulties were reported, generally patients were pleased with their physical appearance and experienced an improvement in current relationships and sexual functioning. Overall, the results indicate a favorable psychosocial outcome following gastric stapling surgery.

AIDS epidemic, emotional strain, coping and psychological distress in homosexual men.

This study examined the process by which emotional strain imposed by the threat of AIDS may manifest itself as psychological distress, assessed by depressive symptomatology, in a sample of homosexual men. Specifically, the study examined the extent to which the perceived threat of AIDS is related to depression, and how coping resources, such as locus of control and social support, influence this process. Results highlight the role of social support and locus of control. These factors were found to be the strongest correlates of depression, and appear to exert a considerable influence on the associations between strain measures and depressive symptomatology.

Factors influencing medical students' intentions to choose psychiatry as a career.

Information was collected and analyzed to test a theoretical model of the interaction of previously reported correlates of intention to specialize in psychiatry. Ninety-nine first-year medical students completed a four-part questionnaire designed to demonstrate reasons for such an intention. The three main predictors of intention to specialize in this field were shown to be, in order: perception of others' views of a psychiatric career, students' attitude to psychiatry and their willingness to comply with the views of others. Although sociodemographic and personality characteristics also forecast intention to specialize in psychiatry, they did so only by operating through the three main predictors. The implications of these findings in relation to previous findings are discussed.

Bulimia and dissociative states: a case report.

The case history of a 17 year old girl, who initially presented with symptoms of bulimia and later developed dissociative states, is described. The possible relationship between bulimia and dissociative states is discussed in the context of psychometric tests and the underlying family dynamics.

Eating attitudes as related to demographic and personality characteristics: a high school survey.

A survey of 577 high school students was conducted to assess attitudes toward eating and their relationship to demographic and personality characteristics. Students completed a demographic questionnaire, and Eating Attitude Test (EAT-26) and the Basic Personality Inventory (A-BPI). When a cut-off score of 20 on EAT-26 was applied, overall prevalence of disordered eating attitude was found to be 7.5%. Groups scoring in pathological versus normal ranges showed no significant difference in mean age, socioeconomic status or race. The former group reported significantly shorter height and lower body weight. Of the subjects, 6.06% reported weight below the 10th percentile. This subgroup did not vary from those above the 10th percentile on sociodemographic and psychopathological variables, nor in prevalence of abnormal eating attitudes. Analysis of the A-BPI data showed subjects with abnormal eating attitudes had increased psychopathology in several areas, with greater neurotic tendencies, lower self-esteem and higher levels of deviant thinking and behaviour.

The evaluation of a consultation-liaison service.

The demographics, referral patterns, and diagnoses of a psychiatric consultation-liaison service during a 1-year period are reported. A comparison with data from a similar evaluation of the same service 10 years previously showed stability in most variables. The data suggest that mere availability of a consultation-liaison service does not necessarily lead to increased utilization and highlights the need to forge specific links with other specialties. The use of DSM-III diagnoses in a consultation-liaison service is discussed.

Psychosocial considerations in gastric stapling surgery.

Thirty-one morbidly obese patients awaiting gastric stapling and 31 similar patients who had already undergone this procedure were evaluated using four psychological self-report questionnaires: Eating Disorder Inventory, Millon Clinical Multiaxial Inventory, Locus of Control, and a questionnaire developed by the authors. The subjects were predominantly female, had a strong family history of obesity, and reported anxiety in the pathological range. The overall results suggest that, while not a panacea, gastric stapling does confer significant benefit to morbidly obese individuals.

The detection of psychiatric morbidity and associated factors in patients with rheumatoid arthritis.

Eighty-six patients with a confirmed diagnosis of rheumatoid arthritis were surveyed to assess the extent of psychiatric morbidity as indicated by two screening questionnaires, the General Health Questionnaire and the Hospital Anxiety and Depression Scale. In addition to an investigation of the concordance of the screening questionnaires, a description of demographic characteristics and measures of disability were taken. Disability due to arthritis was indicated by measures of years of chronicity, pain, duration of morning stiffness, functional level, active treatment involvement, and presence of coexisting medical problems. The relationship of physical symptoms to level of psychiatric distress was investigated. Psychiatric cases were identified using recommended cut off scores on results of the screening questionnaires. GHQ cut off scores of 6/7 identified as "cases" 31.8% of the sample. HADS subscale cut off scores of 8/9 identified 21.4% of subjects with "anxiety" and 19.0% with "depression" scores in the morbid range. Nineteen percent of patients were found to have scores on both tests concurrently in the pathological range.