ABSTRACT
BACKGROUND: This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED, an instrument to assess case complexity. METHODS: Of 885 rheumatology inpatients and diabetes outpatients who were assessed for eligibility, 247 were identified as complex (INTERMED score >20) and randomized to the intervention (n = 125, 84 rheumatology and 41 diabetes patients) or care as usual (n = 122, 78 rheumatology and 44 diabetes patients). For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and/or of referral to a liaison psychiatrist, followed by advice to the treating physician or organization of a multidisciplinary case conference. Baseline and follow-up at months 3, 6, 9 and 12 measured prevalence of major depression (Mini-International Neuropsychiatric Interview), depressive symptoms (Center for Epidemiological Studies Depression Rating Scale), physical and mental health (SF-36), quality of life (EuroQol), health care utilization and HbA(1c) levels (diabetic patients). RESULTS: Prevalence of major depression was reduced from 61% (T0) to 28% (T4) in the intervention group and remained stable in care as usual (57% at T0 to 50% at T4). Compared to care as usual, significant improvement over time was observed in the intervention group with regard to depressive symptoms (F = 11.9; p = 0.001), perception of physical (F = 5.7; p = 0.018) and mental health (F = 3.9; p = 0.047) and quality of life (F = 21.8; p < 0.001). Effects tended to be stronger in diabetes patients, in patients with baseline major depression and in patients with moderate INTERMED scores. Finally, hospital admissions occurred less often in the intervention group, reaching statistical significance for the period between 6 and 9 months of follow-up (p = 0.02). CONCLUSIONS: The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes.
Subject(s)
Arthritis, Rheumatoid/psychology , Arthritis, Rheumatoid/therapy , Depression/psychology , Depression/therapy , Depressive Disorder, Major/psychology , Depressive Disorder, Major/therapy , Diabetes Mellitus, Type 1/psychology , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 2/psychology , Diabetes Mellitus, Type 2/therapy , Osteoarthritis/psychology , Osteoarthritis/therapy , Patient Care Team , Referral and Consultation , Adult , Combined Modality Therapy , Comorbidity , Depression/diagnosis , Depressive Disorder, Major/diagnosis , Female , Humans , Male , Mass Screening , Middle Aged , Personality Assessment , Psychotherapy/methods , Quality of Life/psychologyABSTRACT
Antiphospholipid antibodies may play and important role in the pathogenesis of retinal vascular occlusions; investigated the prevalence among 33 patients with retinal vein and artery occlusions and 80 controls. Prevalence was 33% and 5% respectively. Ophthalmic examination and fluorescein angiography showed that occlusions were due to ischaemic events. The 11 patients were diagnosed with antiphospholipid syndrome: 9 patients were treated successfully with laser photocoagulation and anticoagulant and anti-aggregant therapy. Two patients with antiphospholipid antibodies associated with resistance to activated protein C had unfavourable outcomes. Our results suggest a correlation between antiphospholipid syndrome and retinal vein occlusions; we recommend a systematic search for antiphospholipid antibodies in occlusions of unexplained origin and laser photocoagulation treatment and long-term oral anticoagulant and anti-aggregant therapy.
Subject(s)
Antiphospholipid Syndrome/complications , Retinal Vein Occlusion/etiology , Administration, Oral , Adult , Aged , Antibodies, Antiphospholipid/blood , Anticoagulants/therapeutic use , Antiphospholipid Syndrome/diagnosis , Antiphospholipid Syndrome/epidemiology , Antiphospholipid Syndrome/therapy , Case-Control Studies , Chi-Square Distribution , Female , Fluorescein Angiography , Humans , Laser Coagulation , Male , Mass Screening , Middle Aged , Ophthalmoscopy , Prevalence , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/epidemiology , Retinal Vein Occlusion/therapy , Surveys and Questionnaires , Treatment Outcome , Tunisia/epidemiologyABSTRACT
Antiphospholipid antibodies may play and important role in the pathogenesis of retinal vascular occlusions; investigated the prevalence among 33 patients with retinal vein and artery occlusions and 80 controls. Prevalence was 33% and 5% respectively. Ophthalmic examination and fluorescein angiography showed that occlusions were due to ischaemic events. The 11 patients were diagnosed with antiphospholipid syndrome: 9 patients were treated successfully with laser photocoagulation and anticoagulant and anti-aggregant therapy. Two patients with antiphospholipid antibodies associated with resistance to activated protein C had unfavourable outcomes. Our results suggest a correlation between antiphospholipid syndrome and retinal vein occlusions; we recommend a systematic search for antiphospholipid antibodies in occlusions of unexplained origin and laser photocoagulation treatment and long-term oral anticoagulant and anti-aggregant therapy
