Anaesthetists' and surgeons' estimation of preoperative anxiety by patients submitted for elective surgery in a university hospital.

BACKGROUND AND OBJECTIVE: Preoperative anxiety is a challenging concept in the preoperative care of patients. The hypothesis of this study was that the doctors are able to estimate their patients' preoperative anxiety. METHODS: A prospective clinical trial was performed on 67 adult patients and 26 paired anaesthetists and surgeons. The patients filled out two separate visual analogue scales for anxiety for the planned anaesthesia and surgery. After that the 'anxiety subscale' of the Hospital Anxiety and Depression's Scale was completed and a list of fearsome items was presented as the patients were asked to choose two conditions they considered the most frightening. Finally the patients were asked to select one or more items from a list of things, which they considered likely to relieve their preoperative anxiety. Similarly, the participating doctors were asked to estimate their patients' anxiety, guess their fearful conditions and their anxiety-relieving requests. RESULTS: Median scores for anxiety as estimated with visual analogue scales by anaesthetists, surgeons and patients for anaesthesia were 34, 36 and 6, respectively; and for surgery 53, 47 and 9, respectively. The anxiety subscale of the Hospital Anxiety and Depression's Scale 8.9 +/- 4.2, 8.6 +/- 4.6 and 6.5 +/- 4.5 (mean +/- SD), respectively. Doctors' scores were significantly higher than the patients' scores (P < 0.05). Thus, the anaesthetists and the surgeons were unable to estimate their patients anxiety on any of the scales used (Kendall's tau < 0.25; P < 0.05). The proportion of correct estimation of the fearsome items was 20% for both the anaesthetists and the surgeons. CONCLUSIONS: Both anaesthetists and surgeons overestimated their patients' preoperative anxiety by a wide margin and poorly predicted their patients' feared conditions and their desire for relief of anxiety.

Mixed anxiety-depressive disorder and major depressive disorder: comparison of the severity of illness and biological variables.

Mixed anxiety-depressive disorder (MADD) is a new diagnostic category defining patients who suffer from both anxiety and depressive symptoms of limited and equal intensity accompanied by at least some autonomic features. Patients do not meet the criteria for specific anxiety or depressive disorders. The emergence of the symptoms is independent of stressful life events. There are many issues presently under investigation about the validity of this clinical entity. In this study, a group of 29 patients with MADD was compared with a group of 31 patients with major depressive disorder (MDD) to assess the differences and similarities between these two disease categories in terms of severity measures and biological variables. The dexamethasone suppression test (DST) was employed, and thyroid hormones and thyrotropin (TSH) levels were measured for the evaluation of hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-thyroid (HPT) axes, respectively. The patients with MADD were found to be less depressive and more anxious compared to those with MDD. DST responses and thyroid functions were found to be similar in the two groups. When severity of depression was controlled, k(max) and 2300-h cortisol values were found to be significantly higher in the MADD group. Although the patients with MDD and MADD presented with relatively different clinical features, there is not enough biological evidence indicating that MADD represents a discrete diagnostic category. However, there may be relatively higher HPA activity in MADD patients.

Frontal lobe syndrome reassessed: comparison of patients with lateral or medial frontal brain damage.

Examination of mood and behaviour changes after frontal damage may contribute to understanding the functional role of distinct prefrontal areas in depression and anxiety. Depression and anxiety disorders, symptoms, and behaviour were compared in eight patients with single lateral and eight patients with single medial frontal lesions matched for age, sex, race, education, socioeconomic status, side, and aetiology of lesion 2 weeks and 3 months after brain injury. DSM IV major depressive and generalised anxiety disorders were more frequent in patients with lateral compared with medial lesions at 2 weeks but not at 3 months. At 3 months, however, patients with lateral damage showed greater severity of depressive symptoms, and greater impairment in both activities of daily living and social functioning. At initial evaluation depressed mood and slowness were more frequent, whereas at 3 months slowness, lack of energy, and social unease were more frequent in the lateral than the medial group. Patients with lateral lesions showed greater reduction of emotion and motivation (apathy) during both examinations. Medial frontal injury may fail to produce emotional dysregulation or may inhibit experience of mood changes, anxiety, or apathy. Lateral prefrontal damage may disrupt mood regulation and drive while leaving intact the ability to experience (negative) emotions.

Psychiatric symptoms among Turkish adolescents.

This research was planned to investigate psychiatric symptoms in a normal adolescent population. Four hundred and thirty-four students were selected randomly from three schools of different socioeconomic status. Symptom Check List 90-R was used to evaluate the psychiatric symptoms. The results were analyzed considering the effects of age, gender and socioeconomic status. It was concluded that being female, 15-16 years of age and having a lower socioeconomic status are risk factors for developing psychiatric symptoms.

Cerebral blood flow changes in patients with conversion disorder.

We evaluated regional cerebral blood flow in five patients with conversion disorder (three females, two males, mean age+/-S.D.: 29.8+/-9.5 years) with astasia-abasia. The patients underwent single photon emission computed tomography after the injection of 555 MBq of [99mTc]hexamethylpropyleneamine oxime. Uptake ratios between areas of decreased perfusion and normal brain regions were considered significantly decreased when there was a change > or = 10%. Four of the five patients had left temporal and one patient had left parietal perfusion decreases. Uptake ratios ranged from 0.72 to 0.88 (mean+/-S.D.: 0.81+/-0.08). Our findings suggest that alterations in regional brain perfusion may accompany conversion symptoms. Functional imaging may therefore offer a means of elucidating the neural correlates of conversion disorder.

The effect of clozapine on glucose metabolism.

Although there have been several reports that clozapine precipitated hyperglycemia and diabetic ketoacidosis in some patients, the mechanism by which clozapine impairs glucose metabolism is not known. This study investigated the effect of clozapine on glucose metabolism in six schizophrenic patients while they were free of medication and receiving 200 mg/d and 450 mg/d of clozapine. Clozapine increased mean levels of blood glucose, insulin and C-peptide. It is possible, based on these findings, that the glucose intolerance was due to increased insulin resistance.

Assessment of changes in regional cerebral blood flow in patients with major depression using the 99mTc-HMPAO single photon emission tomography method.

Regional cerebral blood flow was investigated in 14 patients with major depression diagnosed according to the DSM-III-R criteria (six patients with single and eight patients with recurrent episodes) and in ten healthy volunteers. The mean ages of the patients and the controls were 33.5 +/- 2.7 and 31.6 +/- 2.6 years, respectively. The severity of the depression was assessed using the 17-item Hamilton Depression Scale (mean: 23.2 +/- 1.5). None of the patients was under medication. After administration of 500 MBq technetium-99m hexamethylpropylene amine oxime, a single photon emission tomography study was performed and then transaxial, sagittal and coronal slices were obtained. For the semiquantitative analysis of the data, the ratios of the mean counts/pixel to the whole slice were calculated for 24 regions on three consecutive transaxial slices in the orbitomeatal plane. Additionally, left/right and frontal/occipital ratios were calculated. Both sides of the temporal region had a significantly decreased cerebral blood flow (CBF) when compared to the controls. The left/right ratio of the prefrontal region was also significantly lower in the patients than in the controls. The Hamilton score had a negative correlation with blood flow in the anterofrontal and left prefrontal regions. According to our results, regional CBF seems to be decreased in the left prefrontal and in both temporal regions in major depression. The severity of depression is correlated with the reduction in CBF in the regions of the anterofrontal and left prefrontal cortex.