Exercise performance testing in patients with pectus excavatum before and after Nuss procedure.

PURPOSE: To assess the changes in lung function and exercise performance due to minimal invasive pectus repair. METHODS: Fifty-nine patients with an average age of 16 years were included in this prospective investigation. After determination of body mass index (BMI) and body fat patients were subjected to pre-OP, post-OP and post-implant removal spirometry and bicycle ergospirometry. Forced vital capacity (FVC), performance capacity (PC) and relative oxygen uptake were determined. RESULTS: Post-OP FVC significantly decreased from 91% of normal value to 79%, but again increased to 88% after implant removal. PC showed a significant reduction (105-97% of normal value). Likewise, the relative oxygen uptake showed a significant decrease (43.8-42.2 ml/kg per min). These findings correlated to a significant increase of BMI and body fat. When calculating oxygen uptake per kilogram lean body weight, there were no significant changes (49.8 to 49.8 ml/kg per min). CONCLUSIONS: Pectus repair resulted in a temporary reduction of FVC, which resolved after implant removal. The drop in oxygen uptake and PC could be related to a significant increase of BMI and body fat. According to our data pectus repair is not followed by improvements in lung function and exercise performance.

The long-term course of panic disorder--an 11 year follow-up.

BACKGROUND: The purpose of this study was to assess the naturalistic long-term course of panic disorder over a period of 11 years. METHOD: Thirty DSM-III-R panic disorder patients, who had suffered from panic disorder for 6 years on average and who had taken part in an 8-week multicenter drug trial, were included in the intent-to-follow-up group to be reinterviewed 11 years after the end of the trial. At baseline and at follow-up the same instruments were used to assess frequency of panic attacks, level of phobic avoidance, and disabilities. Treatments received during the follow-up period and attempted suicides were assessed with a structured interview. Periods of well-being during the follow-up period were elicited retrospectively with a specifically designed longitudinal chart. RESULTS: Twenty-four patients could actually be reinterviewed after 11.3 years. While at baseline all patients had suffered from panic attacks and had been severely disabled on a number of measures, 66.7% had no panic attack during the year before follow-up. During the month before follow-up 87.5% had no panic attack, and 54% showed no or only mild phobic avoidance. In the areas of work and family life 90% showed no or only mild disabilities, whereas in the area of social life this percentage was lower (67%). Thirty-three percent of the patients were completely remitted according to a composite remission criterion. CONCLUSIONS: Panic disorder is not a uniformly chronic and progressing disorder. Over a period of 11 years there is a good chance of recovery from panic attacks and disabilities, and full remission is also possible.

Does psychiatric comorbidity increase the length of stay in general hospitals?

Several studies reported that in non-psychiatric hospital departments mentally ill patients have a longer length of hospital stay than mentally well. But their methods are often limited because other predictors of length of stay were excluded from statistical analyses. Using the Clinical Interview Schedule, research psychiatrists interviewed 993 patients of medical, surgical, gynecological, and rehabilitation departments in Austria. Using several multiple regression analyses, the influence of psychiatric comorbidity and other variables on length of stay was analyzed. 32.2% of all patients suffered from psychiatric morbidity. Of all psychiatric cases, 6.2% received more than one psychiatric diagnosis. Presence of psychiatric disorders, age, a diagnosis of neoplasms, number of all somatic diagnoses, and the number of previous non-psychiatric hospital admissions predicted length of stay. Patients with dementia, with substance abuse disorders, and with alcohol- and drug-related psychiatric disorders showed a significantly increased length of stay, while other psychiatric diagnoses did not differ from the mentally well. Even after controlling for confounding variables, dementia and substance related diagnoses increase the length of hospital stay. It is important to investigate interventions for early recognition and treatment of these disorders.

Recognition of psychiatric disorders in nonpsychiatric hospital wards.

OBJECTIVE: Although many studies have reported that many psychiatric cases are missed by their nonpsychiatric physicians, their methods are often limited because ward physicians' recognition has been assessed from potentially unreliable sources such as medical notes. The aim of the present study was to assess recognition by using direct questions to ward physicians. METHODS: Five hundred five (505) nonpsychiatric in-patients were interviewed using the Clinical Interview Schedule. Ward physicians' recognition of psychiatric disorders was assessed using a rating form for every patient. RESULTS: The psychiatric prevalence of the total sample was 37.3%. Overall, ward physicians' diagnostic sensitivity was 54.5%, but their sensitivity varied for the different diagnoses (31.3-89.5%). In addition to psychiatric symptoms and abnormalities, intake of psychotropics before admission significantly predicted identification of psychiatric disorders. CONCLUSIONS: In our study, physicians' sensitivity was higher than that reported from surveys based on medical notes. The fact that nearly half of all psychiatric disorders were missed by ward physicians suggests that better psychiatric training for nonpsychiatric doctors is necessary.

[Styles of interpersonal conflict in patients with panic disorder, alcoholism, rheumatoid arthritis and healthy controls: a cluster analysis study]. / Umgang mit Partnerkonflikten bei Panikpatienten, Alkoholikern, Rheumatikern und Gesunden-Eine clusteranalytische Studie.

OBJECTIVE: Conflict and conflict resolution in intimate relationships are not only among the most important factors influencing relationship satisfaction but are also seen in association with clinical symptoms. Styles of conflict will be assessed in patients suffering from panic disorder with and without agoraphobia, in alcoholics and in patients suffering from rheumatoid arthritis. METHODS: 176 patients and healthy controls filled out the Styles of Conflict Inventory and questionnaires concerning severity of clinical symptoms. RESULTS: A cluster analysis revealed 5 types of conflict management. Healthy controls showed predominantely assertive and constructive styles, patients with panic disorder showed high levels of cognitive and/or behavioral aggression. Alcoholics showed high levels of repressed aggression, and patients with rheumatoid arthritis often did not exhibit any aggression during conflict. CONCLUSIONS: 5 Clusters of conflict pattern have been identified by cluster analysis. Each patient group showed considerable different patterns of conflict management.

[Does psychiatric comorbidity increase length of stay in medical, surgical and gynecological departments?]. / Sind die Aufenthaltsdauern von psychisch Kranken an internen, chirurgischen und gynäkologischen Abteilungen länger?

Several studies from Anglo-American countries indicate that in non-psychiatric hospital departments mentally ill patients have a longer length of hospital stay than mentally well, while in Austria and Germany, until now, no studies concerning this question exist. Therefore, we investigated the influence of psychiatric comorbidity on the length of stay in 608 patients of medical, surgical and gynecological departments in Vienna and Tyrol. Based on the Clinical Interview Schedule, 28.1% of the patients in this sample suffered from psychiatric disorders. The presence of psychiatric disorders, as well as type of hospital department (medical department), higher age, more previous non-psychiatric treatment periods, and more somatic diagnoses predicted a longer duration of inpatient treatment. To avoid the influence of cofounding variables, psychiatric cases were matched with psychiatric non-cases. The mentally ill group was treated for a markedly longer period as inpatients than the mentally well. Patients with a diagnosis of dementia or of substance abuse showed a significantly increased length of stay, while we could not confirm this for other psychiatric diagnoses.

Panic disorder and cigarette smoking behavior.

Smoking has been discussed both as a risk factor for panic disorder and as a contributing factor to elevated cardiovascular risk in panic disorder patients. Smoking habits and their association with panic disorder were studied in a sample of 102 panic disorder patients. Both for female and for male patients, rates of smokers and of exsmokers were substantially higher than in the general population. However, a surprisingly high number of patients had succeeded in reducing or quitting cigarette smoking because of their panic disorder, although they experienced little benefit in regard to panic symptoms from doing so. We conclude that the motivation for changing smoking habits is high in this population with elevated smoking prevalence and should be taken into consideration by therapists.

[Patient suitability for discharge from psychiatric hospitals]. / Uber die Entlassbarkeit von Patienten in psychiatrischen Krankenhäusern.

OBJECTIVE: To assess the possibility of discharging psychiatric inpatients of two large Mental Hospitals in Lower Austria. METHODS: A point prevalence study was performed in 1992. Treating psychiatrists were asked to evaluate the possibility to discharge patients under the hypothetical assumption that a broad range of residential facilities were available. RESULTS: The inpatient proportion had decreased from 2179 in 1974 to 1032 in 1992. Of the 1992 population 75.7% might be discharged. Most patients (41.5%) were regarded as needing a permanently staffed home. CONCLUSIONS: Although the inpopulation of the two large Mental Hospitals studied had decreased over a period of 18 years already by over 50 percent, the results of this study show that there is a large potential for further reform. Since the evaluation was carried out by the treating psychiatrists in the hospital, who might have been in a conflict of interests or might have preferred the treatment they are providing themselves, this finding is particularly remarkable.

Embarrassment about the first panic attack predicts agoraphobia in panic disorder patients.

In order to find out whether contextual variables of the first panic attack and the person's reaction to it predict the development of agoraphobia in panic disorder patients, 60 patients with a DSM-III-R diagnosis of panic disorder with agoraphobia and 30 patients suffering from panic disorder without agoraphobia were interviewed about their first panic attack. Single comparisons between groups of agoraphobic and non-agoraphobic patients were carried out and a logistic regression model was applied. Occurrence of the first panic attack in public and the feeling of embarrassment were found to be significantly associated with the development of agoraphobia. It is concluded that eliciting this specific form of social concern at an early stage might help to identify patients at risk for later agoraphobia, which could, in turn, help to further specify early therapeutic interventions and concentrate therapeutic efforts on a high-risk group of panic disorder patients.

[The first panic attack: a missed chance for prevention of panic disorder and its complications]. / Die erste Panikattacke: eine ungenützte Chance zur Prävention der Panikstörung und ihrer Komplikationen.

OBJECTIVE: Assessment and analysis of first medical consultations and their significance in panic disorder patients. METHODS: 90 panic disorder patients were interviewed concerning their experiences with the medical system at the time of their first panic attack. RESULTS: Panic disorder patients contacted mostly non-psychiatric medical services at the time of their first panic attack. The correct diagnosis was established in only 4 cases (5.6%). CONCLUSIONS: An important chance for secondary prevention of the development of panic disorder is missed, probably due to the poor education of physicians on panic attacks.

High frequency of EEG and MRI brain abnormalities in panic disorder.

The frequency and quality of brain abnormalities in panic disorder (PD) were assessed with magnetic resonance imaging (MRI). The use of electroencephalography (EEG) to detect PD patients with a high probability of morphologic brain abnormalities was also explored. Consecutive PD patients (n = 120) were screened with routine EEG examinations and were divided into the following subgroups on the basis of their EEG findings: patients with non-epileptic EEG abnormalities (EEG-A group, n = 28), matched patients with normal EEG results (EEG-N group, n = 28) and matched healthy controls (n = 28). PD patients showed a higher than expected rate of non-epileptic EEG abnormalities (29.2%; 35 of 120). EEG screening was effective in identifying patients with a high probability of morphologic brain abnormalities. MRI abnormalities were found in 60.7% of the EEG-A patients, 17.9% of the EEG-N patients, and only 3.6% of the controls. A high frequency of septo-hippocampal abnormalities was found. Further research should focus on attempts to subtype PD on the basis of neuroanatomic and functional brain abnormalities.

Is there a pathophysiological and therapeutic link between panic disorder and epilepsy?

Relations between panic disorder (PD) and epilepsy (E) have repeatedly been discussed. Three patients with juvenile E who had been free of seizures under anticonvulsant medication for many years and developed PD are presented. Increasing anticonvulsant medication resulted in complete and stable remission of PD. It is hypothesized that, in a subgroup of patients with PD, there is a pathophysiological relation to E. Further research into the usefulness of anticonvulsants in the treatment of PD, especially in therapy-refractory cases, is suggested.