Psychosomatics
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Antipsychotic drugs are the primary treatment for symptoms of delirium, but their side effects can be problematic. Treatment of delirium with aripiprazole has yet to be evaluated. The authors report on 14 patients with delirium treated with aripiprazole. ⋯ There was a low rate of adverse side effects. Aripiprazole may be an appropriate first-line agent for the treatment of delirium because of its minimal effect on QTc interval, weight, lipids, and glucose levels. Controlled comparison studies should be performed to confirm this impression.
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Dyspnea is a common symptom of heart failure frequently relied upon to assess clinical functioning. The purpose of this study is to explore a broad range of medical, psychological, and social factors that correlate with dyspnea in heart failure patients. Seventy-six participants ranged from well-compensated, ambulatory subjects to those with recent hospitalization for acutely decompensated heart failure. ⋯ Correlation analysis revealed that dyspnea significantly correlated with depression, fatigue, and overall health perception. Standard regression analyses indicated that depression, fatigue, and overall health perception uniquely contributed to dyspnea, explaining 38.0% of the total variance. The present study confirms that dyspnea is multifactorial, with links to psychological distress and overall health perception.
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A close association between tinnitus and psychiatric disorders has been demonstrated, but little is known about how the severity of tinnitus is related to these disorders. The authors investigated the strength of the association between tinnitus and both the prevalence and severity of anxiety and depressive disorders. One study group consisted of 80 consecutive patients and another of 144 patients who were deemed by screening to be at high risk for severe and disabling tinnitus. ⋯ There was a correlation between the severity of tinnitus and depression in both study groups; however, the corresponding correlations for anxiety disorders were lower, and reached statistical significance only in the high-risk group. Various measures found significant correlations between the severity of tinnitus and the severity of depression and anxiety. We conclude that the severity of tinnitus is associated with psychiatric disorders, as well as with the severity of anxiety and depression in tinnitus patients, and may account for approximately 20% of the variance of the observed association.
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Delirium is presumed to be the same syndrome in all ages. Comparing pediatric and adult studies, the authors found many of the same symptoms reported, but often at significantly different rates. ⋯ These may represent true differences in the presentation of delirium across the life-cycle, or may be attributable to inconsistent methodologies. Prospective studies are needed to resolve this question.
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The purpose of the study was to investigate the prevalence of posttraumatic stress disorder (PTSD) after prolonged intensive care unit (ICU) treatment and to study the differences between trauma patients and patients who were admitted with other diagnoses. Survivors of surgical intensive care of at least 30 days' duration underwent follow-up examination at about 35 months after discharge from the ICU. Thirty-seven patients were investigated. ⋯ Patients with trauma were at significantly higher risk for developing PTSD than were non-trauma patients. After prolonged ICU treatment, PTSD seems more likely to occur when the reason for admission to the ICU was severe physical injury. The prevalence of PTSD does not seem to be related to injury severity or duration of ICU treatment.