Effects of a stress management program on third year medical students' anxiety depression and somatization.

This article was migrated. The article was marked as recommended. Background: Transition from the medical school classroom to the clinical training years requires students to adapt in many ways. Schedules are more variable, with longer clinic hours and travel to affiliated hospitals. Students are also faced with emotional needs of patients coincident with meeting demands from attending physicians. The prevalence of anxiety, depression and overall distress increases during the four years of medical school and particularly during difficult transitions. Methods: Forty medical students entering their first clinical year enrolled in a two session stress management program focused on mindfulness and coping strategies. Sessions were interactive, conducted by a psychologist, social worker and a counselor and comprised evidenced based components. Results: Twenty nine students completed the program. Baseline comparisons between dropouts and eventual completers showed that dropouts were more likely to screen positive for depression, anxiety and somatic tendencies. Program completers evidenced short term increased knowledge about mindfulness and coping and demonstrated significant decreases in anxiety and somatization at the end of the program. Conclusion: Though scheduling of any additional programs during the clinical years of medical school presents significant challenges, students who complete such a program sustain important benefits and evaluate the program positively.

A Stress Management Program for Higher Risk Medical Students: Preliminary Findings.

Approximately 10 % of first year medical students have clinically relevant anxiety or depression which may affect academic success and quality of life. This study tested the effects of a stress management intervention on indicators of anxiety, depression and self-efficacy in self-selected first year medical students. Forty two medical students volunteered to participate and provided informed consent. An eight session intervention was offered and focused on building relaxation skills, adaptive coping, and basic nutrition. Anxiety, depression, and self-efficacy were assessed pre and post intervention. This group of students had significantly higher baseline values of depression and anxiety but lower self-efficacy compared to a previous study of medical students at the same institution (p < 0.03). After the intervention, statistically significant improvements were observed in anxiety (p < 0.05), and self-efficacy (p < 0.05), but not in depression. The entering levels of anxiety and depression in this group suggested that these students were at risk for later clinical syndromes. Intervention directed to decreasing the effects of stress was associated with improvement in indicators of distress and may modify the longer term risk.

A Descriptive Analysis of Factors Leading to a 1-Year Remission in Bipolar Disorder.

BACKGROUND: Bipolar spectrum disorders are associated with symptomatic and functional disability in many patients. Other studies have examined predictors of outcome with variable results. The goal of this retrospective study was to identify medications associated with a minimum of 12 consecutive months of symptomatic, functional, and syndromal remission. METHODS: The charts of 121 patients with confirmed bipolar disorder were reviewed. Data on medical regimen and demographic and adherence factors were gathered using standardized data collection sheets approved by the University of Toledo Institutional Review Board. The criterion for improvement was set at 12 consecutive months of Clinical Global Impressions Improvement ratings of ≤2, which is a far higher standard of syndromal and functional remissions than the usual 8 consecutive weeks used by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. RESULTS: In this sample of 121 patients, 43.8% achieved a minimum of 12 consecutive months of remission, whereas 56.2% did not. When bipolar disorder was divided into its subtypes, 45.5% of our cohort were diagnosed with bipolar I disorder, 27.3% were diagnosed with bipolar II disorder, and 27.3% were diagnosed with bipolar disorder, not otherwise specified. Of the 55 patients with bipolar I disorder, 27 remitted and 28 did not. Of the 33 patients with bipolar II disorder, 12 remitted and 21 did not. Of the 33 patients with bipolar disorder, not otherwise specified, 14 remitted and 19 did not. The treatment regimen that was most closely associated with remission was a combination of atypical antipsychotics (primarily aripiprazole), mood stabilizers (primarily lamotrigine), and an antidepressant. In addition, the patients who achieved remission were more likely to be adherent to medication and with appointments. CONCLUSIONS: The chart review showed that 12 consecutive months of symptomatic remission was achieved in our clinic in 43.8% of patients with bipolar disorder when they were treated with tailored medication regimens. The remainder (56.2%) failed to achieve 12 consecutive months of remission based on real-time Clinical Global Impressions Improvement ratings. The combination of an atypical antipsychotic, a mood stabilizer, and an antidepressant was highly correlated with 1-year remission.

Comparing treatment outcomes of bipolar patients between psychiatry residents and attending physicians.

OBJECTIVE: The authors sought to compare the outcomes of patients treated by psychiatric residents and attending psychiatrists. METHOD: Charts of 121 outpatients meeting criteria for bipolar spectrum disorder were analyzed. Residents treated 41, and attending physicians 80, of 121 patients. Improvement was defined as at least 12 consecutive months of the following: Remission--euthymic mood; Response--much improved mood, not meeting DSM-IV criteria for mild illness; Relapse--remission or response followed by recurrence. The Active Illness group contained patients who did not have 12 months of Remission or Response. RESULTS: The percentage of improved patients was similar between residents (46.3%; 19/41) and attending physicians (42.5%; 34/80). There was a significant difference in the number of patients in the Remission or Response categories between attending physicians: (26.5%; 21/80) and residents (12.2%; 5/41). CONCLUSION: Similar numbers of residents' and attending physicians' patients achieved improvement for 12 months, but twice the number of attending physicians' patients achieved and maintained euthymia.

A wellness program for first year medical students.

Entering medical students experience distress symptoms due to the demands of the intensive curriculum, adjustment to new environments and increased responsibilities. The purpose of this controlled, randomized study was to determine the effects of a structured wellness program on measures of anxiety, depression and frequency of acute illness in 449 first year medical students. The effects of eight sessions of stress management were compared to a wait list control group. High risk students were identified based on scores on psychological inventories and number of recent life events (WLE). Results showed that depression, anxiety scores and frequency of acute illness were higher in women than in men, and were higher in students with multiple life events. Significant decreases were observed in depression in the intervention group students when WLE was the covariate (p = .045). Further, the high risk group showed consistently lower depression scores after the intervention compared to high risk wait list controls (p = .003), and these changes were maintained at the end of school year. There were no significant changes in anxiety or frequency of acute illness. Wellness programs can be implemented in medical school and may be particularly useful for entering students with elevated psychological distress.