Effects of psychological and pharmacological interventions on anxiety symptoms in patients with bipolar disorder in full or partial remission: A systematic review.

BACKGROUND: Anxiety symptoms are prevalent in bipolar disorder (BD) even during periods of remission and impede treatment efficacy, prognosis and functional capacity. This highlights a pressing clinical need to identify novel effective anxiety treatments. This systematic review aimed to evaluate the evidence within the field. METHODS: Following PRISMA guidelines, we conducted a systematic search on PubMed, PsycInfo, EMBASE and Cochrane Library for randomised controlled trials (RCTs) targeting anxiety in remitted BD patients. RESULTS: We identified 10 RCTs investigating the effects of psychological or pharmacological treatments on anxiety in remitted BD patients. Two studies of transdiagnostic personalised cognitive behavioural therapy (CBT) found a treatment-related reduction in anxiety. This evidence was preliminary given small sample size and use of self-report measures in a single-blind trial design, respectively. The remaining six psychological intervention trials provided more preliminary evidence due to several methodological challenges. The two pharmacological studies found anxiolytic effects of add-on olanzapine or methylene blue to lithium treatment, respectively. Nevertheless, this evidence should be interpreted with caution given high drop-out rates and substantial side-effects that may have impeded blinding. LIMITATIONS: We did not conduct a quantitative meta-analysis. CONCLUSIONS: There is preliminary evidence for beneficial effects of modified CBT and add-on pharmacotherapy on residual anxiety in BD. Future trials should pre-screen participants for anxiety, define one clinician-rated anxiety measurement as a primary outcome, and employ intention-to-treat analysis to assess treatment effect. This will advance treatment development and enable personalised approaches to address residual anxiety in BD, which has great clinical relevance.

Predictors for referral to physiotherapy from general practice.

OBJECTIVE: The aim of the study was to describe the referral rates from general practice to physiotherapists and to investigate possible predictors for referral. METHODS: Referral rates per 100 patients per year were obtained from the health insurance register of the county of Aarhus. General Practitioner (GP) characteristics were obtained via a questionnaire to all GPs in the county. RESULTS: A total of 38 231 referred patients from 260 practices were included. Twice as many women as men were referred. Referral rates varied from 1.6% to 13.2% between practices. Of the explored predictors "practice location", "female GP practices" and "GPs reporting frequent contact with physiotherapist regarding the treatment of individual patients" were statistically significant, but explained little of the variance in referral rates. CONCLUSION: The examined practice and GP characteristics explain little of the substantial variation in referral rates. In view of increasing health care expenses and the need for quality assurance, the large variation in referral rates warrants reflection and further research on indications for and possible benefit from physiotherapy.

Patients in general practice in Denmark referred to physiotherapists: a description of patient characteristics based on general health status, diagnoses, and sociodemographic characteristics.

BACKGROUND AND PURPOSE: Both musculoskeletal illness and mental illness characterized by somatic symptoms are common in primary care, and it is hypothesized that many patients with musculoskeletal illness have relatively poor mental health. The purpose of this study was to describe the characteristics of patients in general practice in Denmark who are referred to physiotherapists with signs and symptoms of musculoskeletal illness. SUBJECTS AND METHODS: One hundred ninety-four general practitioners, representing 124 practices, participated in a survey of 2,042 consecutive patients with musculoskeletal illness. RESULTS: The diagnoses were generally poorly defined. Compared with the general population, patients with musculoskeletal illness had markedly poorer physical health and poorer mental health. Patients with poorly defined diagnoses did not differ from patients with well-defined diagnoses in terms of physical health, but they scored lower on the mental health component summary scale of the Danish version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). CONCLUSION AND DISCUSSION: Of patients referred to physiotherapists by general practitioners in Denmark, the subgroup with poorly defined diagnoses had lower mental health scores than those with well-defined diagnoses, suggesting that a biopsychosocial approach to care may be appropriate for this group of patients.

Psychological distress and somatisation as prognostic factors in patients with musculoskeletal illness in general practice.

BACKGROUND: Musculoskeletal illness is a common cause of absenteeism from work, workers' compensation, and disability retirement, and accounts for 9.3% to 17% of patient contacts in general practice. To understand the increase in self-reported musculoskeletal illness and to improve treatment and prevention, it is important to know which factors to target when dealing with these patients. AIM: To investigate whether the prognosis for patients with musculoskeletal illness referred to physiotherapy from general practice can be predicted by the presence of psychological distress and somatisation identified by a general practitioner (GP) and standard questionnaires. METHOD: A multi-practice survey based on questionnaires (index and three-month follow-up). Nine hundred and five consecutive patients referred to physiotherapy from 124 different general practices in Denmark were included. Outcome measures were physical health change, sick leave, patient self-rated improvement, and change in use of medication. RESULTS: Psychological distress and somatisation rated by both GPs and standard questionnaires acted with almost no exception as significant predictors of all four outcome measures. CONCLUSION: Psychological distress and somatisation are important factors when considering preventive initiatives and treatment of patients with musculoskeletal illness in general practice.

Psychological distress among patients with musculoskeletal illness in general practice.

The authors investigated the importance of psychological distress and somatization among patients with musculoskeletal illness in general practice. The authors used the Hopkins Symptom Check List (SCL-8) and the Whiteley Index to rate 1,720 patients with musculoskeletal illness referred to physiotherapy from general practice. General practitioners (GPs), patients, and physiotherapists often noted stress or psychological distress to be a possible cause of the patient's musculoskeletal illness, but agreement between them was low. If the GP included the patient's own view on psychological distress, the result of the SCL-8 did not add much to the detection of distress. The results emphasize the importance of discussing psychological distress when dealing with patients with musculoskeletal illness.

[Somatization in general practice]. / Somatisering i almen laegepraksis.

Patients with unexplained physical symptoms are very common in primary care. Some patients attribute these symptoms to physical disease (somatizing patients). Somatization can be a symptom of psychiatric disorder, which is found in 1/4 to 1/3 of the patients in a primary care setting. This form of somatization makes diagnosing difficult and is the main reason why psychiatric disorders are underdiagnosed. Simple techniques for diagnosing and treating somatizing patients are available to general practitioners. However, to improve diagnostic sensitivity and treatment, further teaching and development in primary care settings are necessary.

[Consultations in ophthalmological practice. A multi-practice study of referrals to private ophthalmologists in Denmark]. / Patientkontakter til øjenlaegepraksis. En multipraksisunderøgelse af kontakter til privat øjenloegepraksis i Danmark.

In Denmark the GPs act as gatekeepers for secondary health care services except for ophthalmologists and ear-nose-throat specialists. The aim of this study was to describe consultations and referral patterns to ophthalmologists in private practice in Denmark. Forty-four out of 143 practising ophthalmologists agreed to fill out a short questionnaire on a random sample of their patients. They recorded 1844 consultations. Forty percent of contacts were appointments arranged by the ophthalmologist, 35% were self-referred, 13% were referred by their GP and 12% by others. Cataract, glaucoma and refraction anomalies accounted for 51% of all diagnoses. The distribution of reasons for encounter and diagnoses among self-referred patients and patients referred by their GP does not argue in favour of a change from the present system with free self-referral to a system with gatekeeping by GPs.

Validation of automated forms processing. A comparison of Teleform with manual data entry.

We have used the computer program Teleform for automated forms processing (AFP) and have compared error rates, time consumption, and expenses with those of single or double manual data entry. For choice fields the error rate for AFP was very low and comparable to double manual data entry, while for numeric recognition the error rate was higher than for both single and double manual data entry. AFP reduced processing time, but we found that a very large number of forms need to be processed in order to recover the initial investment. A considerable amount of time and computer expertise was required for implementation of AFP.

Optical-fiber temperature sensor based on upconversion-excited fluorescence.

The codoping of a heavy-metal fluoride glass by two rare-earth ions, erbium and ytterbium, permits the semiconductor laser infrared excitation of two visible neighboring fluorescence lines of erbium by upconversion, the intensity ratio of which is a single variable function of temperature.