General hospital psychiatry
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Gen Hosp Psychiatry · May 1995
Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders.
A previous study of 22 medical patients with DSM-III-R-defined anxiety disorders showed clinically and statistically significant improvements in subjective and objective symptoms of anxiety and panic following an 8-week outpatient physician-referred group stress reduction intervention based on mindfulness meditation. Twenty subjects demonstrated significant reductions in Hamilton and Beck Anxiety and Depression scores postintervention and at 3-month follow-up. In this study, 3-year follow-up data were obtained and analyzed on 18 of the original 22 subjects to probe long-term effects. ⋯ A 3-year follow-up comparison of this cohort with a larger group of subjects from the intervention who had met criteria for screening for the original study suggests generalizability of the results obtained with the smaller, more intensively studied cohort. Ongoing compliance with the meditation practice was also demonstrated in the majority of subjects at 3 years. We conclude that an intensive but time-limited group stress reduction intervention based on mindfulness meditation can have long-term beneficial effects in the treatment of people diagnosed with anxiety disorders.
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Gen Hosp Psychiatry · May 1995
Recognition of emotional distress in physically healthy primary care patients who perceive poor physical health.
This study examines the recognition and treatment of emotional distress in physically healthy primary care patients who perceive themselves to be in fair or poor physical health. Patients (N = 892) from three private primary care practices completed a mental health screening form prior to their medical visit which included an overall assessment of their physical health (1 = excellent, 2 = good, 3 = fair, 4 = poor). Following the visit, their physicians completed a questionnaire that included the same physical health assessment item. ⋯ However, HPPPH were also significantly more likely than other patients to receive excellent emotional health ratings (p < 0.001) from their physicians and were less likely to receive mental health treatment (p < 0.05). Detection of emotional distress may be particularly difficult in physically healthy patients who have low physical health perceptions. Identification of pessimistic physical health perceptions may serve as an indicator for underlying emotional distress.
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This paper reviews various types of assessment instruments for delirium, including nursing screening scales, symptom checklists, an analog scale, an interview schedule, and symptom rating scales. Their structures and applicability to the clinical and research assessment of delirium are described. Despite the seeming plethora of assessment methods, only a few are suitable for use by researchers.
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Gen Hosp Psychiatry · Jul 1994
Review Case ReportsFamily dynamics in end-of-life treatment decisions.
The decision to withhold or withdraw life-sustaining treatment is now regularly weighed in chronic or terminal illness. Families are usually supportive advocates and concerned surrogate decision makers for patients, although they can also counter the wishes of the patient and disagree with the treatment team. Understanding the range of factors--internal and external, confronting the individual members and the family as a whole--that can influence family responses helps in working with families at this critical juncture in an illness. Interventions to assist the family and treatment team are discussed.