Journal of psychosomatic research
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To critically evaluate the interpretation of the findings reported in the peer-reviewed literature concerning the association of state and trait anxiety with surgical recovery and response to surgery. ⋯ Associations between preoperative measures of anxiety and postoperative mood and pain have been consistently reported. Associations with regard to other recovery variables are less consistent. The existing evidence does not rule out an interpretation of the results as reflecting consistent self-reporting bias rather than causal association.
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To test the theory that postoperative fatigue is an aspect of the emotional, not physiological, response to surgery, we examined whether fatigue is a component of subjective experience after surgery and whether it is related to subjective physical or emotional state. ⋯ In surgical patients, the language of fatigue and energy describes empirically distinct components of emotional state. Explanations for postoperative fatigue should therefore be sought in emotional, not physiological, mechanisms.
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Comparative Study
Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: a comparison with routine attenders.
Seventy-seven frequent attenders at an emergency department (ED) in an inner-city hospital in the UK (defined as seven or more visits in the previous 12 months) were compared with 182 patients who were attending the same department on a routine basis. Patients completed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Short Form (SF)-36. Information was obtained on 64% of the frequent attenders and 45% underwent a detailed psychiatric assessment. ⋯ Compared with routine attenders, frequent attenders reported lower health status, had more psychiatric disorder (odds ratio: OR=8.2, 95% confidence interval: CI=3.8--18.1), had more general hospital admissions (OR=19.9, 95% CI=8.3--47.8), more psychiatric admissions (OR=167.5, 95% CI=9.5--2959.0), and more GP visits (95% CI for difference=-10.2 to -5.7). There was no evidence that frequent attenders had more somatisation than routine attenders. Specific treatment and management strategies need to be developed for this group of patients, although a substantial proportion may be difficult to engage in the treatment process.
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Deliberate self-harm (DSH) patients, despite their risk of suicide, are often discharged directly from accident and emergency (A&E) departments without undergoing a psychiatric assessment. The aims of this study were to determine the characteristics and outcome of these patients. ⋯ A substantial proportion of DSH patients discharged directly from A&E departments do not receive a psychiatric assessment. Nonassessed patients may be at greater risk of further DSH and completed suicide than those who are assessed. Hospital services need to be organised such that DSH patients managed in A&E departments can receive an assessment of psychosocial problems and risk.
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To determine whether psychological variables such as preoperative anxiety can serve as predictors for the postoperative pain response. ⋯ The results of this study indicate that preoperative anxiety may have a critical role in the chain-of-events that controls the postoperative pain response.