Depression and post-traumatic stress disorder after aneurysmal subarachnoid haemorrhage in relation to lifetime psychiatric morbidity.

INTRODUCTION: Little is known about the roles that lifetime psychiatric disorders play in psychiatric and vocational outcomes of aneurysmal subarachnoid haemorrhage (SAH). MATERIALS AND METHODS: Eighty-three SAH patients without apparent cognitive dysfunction were assessed using the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) after their SAH. Diagnoses were assessed for three time periods, 'lifetime before SAH', '12 months before SAH' and '7 months after SAH'. RESULTS: Forty-five percentage of patients with SAH reported at least one lifetime psychiatric disorder. After SAH, symptoms of depression and/or post-traumatic stress disorder (PTSD) were seen in 41%, more often in those with a psychiatric history prior to SAH (p = 0.001). In logistic regressions, depression after SAH was associated with a lifetime history of major depression, or of anxiety or substance use disorder, as well as with lifetime psychiatric comorbidity. Subsyndromal or full PTSD was predicted by a lifetime history of major depression. After the SAH, 18 patients (22%) had received psychotropic medication and/or psychological treatment, 13 of whom had a disorder. Those with a lifetime history of major depression or treatment with antidepressants before SAH had lower return to work rates than others (p = 0.019 and p = 0.031, respectively). This was also true for those with symptoms of depression and/or PTSD, or with antidepressant treatment after SAH (p = 0.001 and p = 0.031, respectively). CONCLUSIONS: Depression and PTSD are present in a substantial proportion of patients 7 months after SAH. Those with a history of psychiatric morbidity, any time before the SAH, are more at risk and also constitute a risk group for difficulties in returning to work.

Coping strategies, health-related quality of life and psychiatric history in patients with aneurysmal subarachnoid haemorrhage.

PURPOSE: Subarachnoid haemorrhage (SAH) reduces health-related quality of life (HRQoL) and increases the risk of psychiatric sequels such as depression and posttraumatic stress disorder. Especially those with a psychiatric history and those using maladaptive coping strategies are at risk for such sequels. The extent to which HRQoL after SAH was related to a history of psychiatric morbidity and to the use of various coping strategies was assessed. METHODS: Patients admitted to the Uppsala University Hospital with aneurysmal SAH (n = 59) were investigated prospectively. Seven months after SAH, data were collected using the Structured Clinical Interview for DSM-IV axis I disorders, the Short Form-36 (SF-36) Health Survey and the Jalowiec Coping Scale. RESULTS: Patients with SAH had lower HRQoL than the general Swedish population in all eight domains of the SF-36. The lower HRQoL was almost entirely in the subgroup with a psychiatric history. HRQoL was also strongly correlated to the use of coping. Physical domains of SF-36 were less affected than mental domains. Those with a psychiatric history used more coping than the remainder with respect to all emotional coping scales. Coping and the presence of a psychiatric history were more strongly related to mental than to physical components of HRQoL. CONCLUSIONS: A psychiatric history and the use of maladaptive emotional coping were related to worse HRQoL, more to mental than to physical aspects.

Perceived recovery after aneurysmal subarachnoid haemorrhage in individuals with or without depression.

AIMS: The aims of the study were to describe what patients with no or only minor neurological deficits after aneurysmal subarachnoid haemorrhage (SAH) perceived to be important for recovery, and perceived consequences of the illness. BACKGROUND: Quantitative studies indicates unfavourable outcomes after aneurysmal SAH, concerning for example mental health and return to everyday life, among patients expected to recover completely. Thus, it is important to investigate the perceptions of patients and to give them the opportunity to communicate what they consider important for recovery. DESIGN: Qualitative descriptive design. METHOD: Semi-structured interviews with 20 aneurysmal subarachnoid haemorrhagic patients were conducted approximately 12 months after the onset. Analyses were carried out in two steps, beginning with a qualitative content analysis. Due to the findings in the initial content analysis, a structured clinical interview for psychiatric disorders was used as a second step to verify the presence or absence of depression in the participants. RESULTS: Two patterns were identified. One pattern revealed that informants without depression experienced a 'confident perception of recovery', which included perceptions of meaningfulness. Another pattern revealed that depressed informants experienced a 'pessimistic perception of recovery', which included perceptions of hopelessness. Expectations regarding care after departure from the neurointensive care unit were not met. CONCLUSIONS: Individuals suffering from depression after aneurysmal SAH have a pessimistic view of their recovery in contrast to those without depression. These findings highlight the importance of better recognition and treatment of depression in the aftermath of SAH. RELEVANCE TO CLINICAL PRACTICE: These findings highlight the importance of better recognition and treatment of depression after aneurysmal SAH, where nurses play an active role. Nurses should seek to take actions to better meet patient's needs after departure from neurointensive care units.

Evaluation of negative emotional care experiences in burn care.

AIM AND OBJECTIVE: To assess recollection of negative emotional experiences during burn care. BACKGROUND: Patients in intensive care frequently report negative emotional experiences. Patients with severe burns who are treated in intensive care units undergo painful care procedures, but there have been no recent evaluations of their care experiences. DESIGN: Former burn patients (n = 42) were randomly assigned to three groups: postal questionnaire, telephone interview and face-to-face interview. METHODS: Assessments included negative care experiences (feelings of uncertainty, powerlessness, being afraid, insecure, being a nuisance, or neglected), severity of injury, patient satisfaction, personality traits and psychological symptoms. RESULTS: Overall, the degree of recalled negative experiences was low and associated with greater severity of injury, more symptoms of post-traumatic stress disorder and lower satisfaction with care. The feeling of powerlessness was the most common, as 67% of participants had such feelings to some extent. CONCLUSIONS: Overall, negative care experiences were uncommon and most prevalent among the severely injured. Such experiences were also associated with psychological symptoms and lower patient satisfaction. RELEVANCE TO CLINICAL PRACTICE: Although relatively uncommon, negative emotional care experiences should be monitored more closely during care.

From monitoring physiological functions to using psychological strategies. Nurses' view of caring for the aneurysmal subarachnoid haemorrhage patient.

AIMS: The aims of this study were: (1) to describe nurses' views of the physical and supportive needs of patients who have suffered a subarachnoid haemorrhage (SAH), (2) to describe nurses' views of changes in social circumstances and (3) changes in the mental condition of patients after SAH. BACKGROUND: As patients with SAH are generally younger and predominantly female compared with other stroke groups they may have different needs of nursing support to facilitate adaptation. Caring for persons surviving stroke involves advanced nursing skills such as monitoring neurological functions in neurointensive care and providing physical care during rehabilitation. DESIGN: Explorative descriptive design. METHOD: Semi-structured interviews were performed with 18 nurses in neurointensive and rehabilitation care. A qualitative latent content analysis was conducted. RESULTS: Nurses viewed patients' need for support as a process ranging from highly advanced technological care to 'softer' more emotional care. However, shortages in the communication between neurointesive and rehabilitation nurses regarding this support were acknowledged. Changes in social circumstances and mental conditions were viewed both as obstacles and advantages regarding return to everyday life. Nurses also viewed that the characteristics of the group with SAH was not particularly different from the group with other types of stroke. CONCLUSIONS: Support to patients with SAH is viewed as a process carried out by nurses at neurointensive care units and rehabilitation units. Shortages in communication, regarding this support, were acknowledged. Obstacles and advantages with respect to returning to everyday life could apply to any stroke group, which could make it more difficult for nurses to detect the specific needs of patients with SAH. RELEVANCE TO CLINICAL PRACTICE: The communication between neurointensive nurses and rehabilitation nurses regarding support to patients with SAH is not satisfactory. Occasionally the specific needs of patients with SAH are not recognized.

Diagnostic agreement between a doctor and a nurse for psychiatric disorders: a pilot study.

The objective of the study was to examine inter-rater agreement for psychiatric disorders by means of a structured interview performed by a psychiatrist and a nurse. Sixteen psychiatric inpatients with a mean age of 38.9+/-12.9 years were assessed independently by a psychiatrist and a nurse using a structured psychiatric interview, Strukturert Psykiatrisk Intervju for Allmennpraksis (SPIFA). For most diagnoses, agreement was substantial to perfect (kappa = 1 for the diagnoses major depression, generalized anxiety disorder, obsessive-compulsive disorder and substance abuse). Fair to moderate kappa values were found for personality disturbances and dysthymia. The results of this study indicate that after adequate training nurses can perform structured psychiatric interviews with a high inter-rater agreement.

[Depression common among young people with somatic disorders. Fatigue, lack of emotional engagement, increased need of sleep are some of the warning signals]. / Depressioner vanligt hos unga som söker för kroppsliga besvär. Trötthet, minskat känsloengagemang, ökat sömnbehov varningssignaler.

During Depression Screening Day in Uppsala, Sweden, 127 adolescents, 23 boys and 104 girls, in the ages 13-20 years were investigated. We found that 44 (34.6%) fulfilled the criteria for a major depression according to DSM-IV criteria and 42 (40.4%) of the girls and 2 (9.5%) of the boys had an ongoing depression. All depressive symptoms, except increased appetite, were significantly more common in the depressed as compared to the non-depressed adolescents. The most common symptoms were fatigue, decreased interest and concentration difficulties. When the adolescents with major depression were compared to adults with major depression, rated by means of self-rating with the Montgomery Asberg Depression Rating Scale, depressions among adolescents and adults were very similar. However, sleep disturbances and decreased initiative were less frequent among the adolescents while decreased appetite was more common. Many of the patients with major depression found had mild symptoms but 21 (44.7%) were regarded being in need for medical treatment.