The Journal of nervous and mental disease
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J. Nerv. Ment. Dis. · Mar 2005
Comparative StudyIs the cutoff to define remission on the Hamilton Rating Scale for Depression too high?
The Hamilton Rating Scale for Depression (HRSD) is the most frequently used measure of outcome in antidepressant efficacy trials. More than a decade ago, a consensus panel recommended that remission be defined on the 17-item version of the HRSD as a cutoff
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J. Nerv. Ment. Dis. · Feb 2005
Multicenter Study Comparative StudySomatization revisited: diagnosis and perceived causes of common mental disorders.
The assessment of somatoform disorders is complicated by persistent theoretical and practical questions of classification and assessment. Critical rethinking of professional concepts of somatization suggests the value of complementary assessment of patients' illness explanatory models of somatoform and other common mental disorders. We undertook this prospective study to assess medically unexplained somatic symptoms and their patient-perceived causes of illness and to show how patients' explanatory models relate to professional diagnoses of common mental disorders and how they may predict the short-term course of illness. ⋯ In this last group, among patients with similar levels of symptom severity, organic perceived causes were related to a lower physical health sum score on the MOS Short Form, and psychosocial perceived causes were related to less severe depressive symptoms, assessed with the Hospital Anxiety and Depression Scale at 6 months. Among patients meeting criteria for comorbid somatoform with anxiety and/or depressive disorders, complementary assessment of patient-perceived causes, a key element of illness explanatory models, was related to levels of functional impairment and short-term prognosis. For such patients, causal attributions may be particularly useful to clarify clinically significant features of common mental disorders and thereby contribute to clinical assessment.
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J. Nerv. Ment. Dis. · Jan 2005
Modes of remembering in patients with chronic pain: relation to current pain.
The objective of our study was to assess the relation of current pain ratings to observer versus field modes of memory retrieval in patients with chronic pain. Memories from an observer perspective involve seeing oneself in the original event as if from an external point of view; memories from a field perspective involve recalling the event as if viewing it through one's own eyes. Sixty-one patients with chronic pain were asked to (1) recall a painful memory, (2) indicate whether they saw themselves in the memory (observer mode) or re-experienced events of the memory from the first-person perspective (field mode), and (3) rate various phenomenologic properties of the memory. ⋯ Memory retrieval in the field mode was associated with (a) significantly higher self-reported pain scores on the McGill Pain Questionnaire, (b) nonright-handedness, and (c) poorer performance on the tests of frontal function. Patients with chronic pain who adopt the field mode of memory retrieval when recalling painful memories experience greater current pain severity than chronic pain patients who adopt observer retrieval strategies. Those adopting field retrieval strategies may also evidence frontal system neuropsychologic anomalies.
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J. Nerv. Ment. Dis. · Oct 2004
Comparative StudyPerceived relationship between military service and homelessness among homeless veterans with mental illness.
This study examined the perceived relationship between military service and the risk of homelessness after discharge and identified specific aspects of military service that homeless veterans experience as having increased their risk for becoming homeless. A cross-sectional survey was conducted among 631 homeless veterans enrolled in the VA Therapeutic Employment Placement and Support Program from January 2001 through September 2003. ⋯ Among those veterans who perceived military service as increasing their risk for becoming homeless, the three aspects of military service most commonly identified included a) substance abuse problems that began in the military (75%), b) inadequate preparation for civilian employment (68%), and c) loss of a structured lifestyle. The relatively small proportion of homeless veterans who attributed homelessness to their military service, coupled with the long 14-year average lag time between discharge and their first episode of homelessness, is consistent with epidemiological data suggesting that military service itself does not substantially increase the risk for becoming homeless among veterans.
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J. Nerv. Ment. Dis. · Sep 2004
Trauma, change in strength of religious faith, and mental health service use among veterans treated for PTSD.
One of the most pervasive effects of traumatic exposure is the challenge that people experience to their existential beliefs concerning the meaning and purpose of life. Particularly at risk is the strength of their religious faith and the comfort that they derive from it. The purpose of this study is to examine a model of the interrelationships among veterans' traumatic exposure, posttraumatic stress disorder (PTSD), guilt, social functioning, change in religious faith, and continued use of mental health services. ⋯ We conclude that veterans' pursuit of mental health services appears to be driven more by their guilt and the weakening of their religious faith than by the severity of their PTSD symptoms or their deficits in social functioning. The specificity of these effects on service use suggests that a primary motivation of veterans' continuing pursuit of treatment may be their search for a meaning and purpose to their traumatic experiences. This possibility raises the broader issue of whether spirituality should be more central to the treatment of PTSD, either in the form of a greater role for pastoral counseling or of a wider inclusion of spiritual issues in traditional psychotherapy for PTSD.