Gender and perceived nurse caring in nurse-patient dyads.

The effect of nurse gender on nurse and patient perceptions of nurse caring was explored. Members of nurse-patient dyads (N = 145), equally distributed among the four possible gender combinations, completed matching forms of the Caring Questionnaire immediately following a shift. Perceptions of nurse caring that actually occurred during the preceding shift, as well as usual preferences about nurse caring, were measured. Results of two-factor ANOVAS showed no significant differences in actual caring according to nurse gender from either the nurse or the patient perspective. Expectations of certain nurse caring behaviours, however, were significantly lower for male nurses from both nurse and patient perspectives. The results suggest implications for nursing practice, education and further research.

Social support and patterns of adjustment to breast cancer.

The effect of marital support and support from other adults on the emotional and physical adjustment of 128 women with breast cancer was examined. Role function and satisfaction with health care also were evaluated as predictors of adjustment. Intact data series were obtained at 7-10 days, at 1, 2, 3, and 6 months, and 1 year postsurgery. Emotional adjustment could be predicted by satisfaction with a spouse's response to interactional and emotional needs and by support from other adults. The relationships were significant at concurrent times, across contiguous times, and predicting from the 7-10 day postsurgical period to both the 6-month and 1-year end points. Physical adjustment was not predicted by support but satisfaction with health care was predictive of perceived overall health status. Functional status in vocational, domestic, and social roles was significantly related to emotional and physical adjustment at all phases with few exceptions.

Neuroendocrine effects of intravenous clomipramine in depressed patients and healthy subjects.

OBJECTIVE: Neuroendocrine challenge paradigms have been used to asses serotonergic systems in depression, but limitations in the specificity of many of these tests have been noted. In this study, the neuroendocrine responses to acute intravenous administration of the serotonin (5-HT) reuptake inhibitor clomipramine were assessed in depressed patients and matched control subjects. METHODS: Thirty hospitalized patients who met DSM-III-R criteria for major depression, and 30 healthy control subjects who were matched for age, sex, and season of year for the time of study, received 12.5 mg of intravenously administered clomipramine. RESULTS: The depressed patients demonstrated significant blunting of prolactin responses to clomipramine, as well as trends toward blunted ACTH and cortisol responses. There was no difference between the patient and control groups in growth hormone responses, plasma clomipramine levels, or self-reports of side effects. CONCLUSIONS: These data support the hypothesis that depressed patients have abnormal neuroendocrine responses to the intravenous administration of the 5-HT reuptake inhibitor clomipramine. Further study is required to delineate the mechanisms responsible for the abnormal response to intravenously administered clomipramine in depression.

The detection of depression by patient self-report in women with gynecologic cancer.

We examined the utility of patient self-report forms in identifying those gynecologic oncology patients who would be diagnosed by an experienced consultation-liaison psychiatrist as suffering from major depression. Sixty-five women with gynecologic tumors were evaluated by a consultation-liaison psychiatrist, using standardized (DSM-III) criteria. Each patient also completed a Carroll Rating Scale for Depression (CRS). The CRS demonstrated sensitivity and specificity of 87 percent and 58 percent, respectively. Used as a screening instrument to rule out depression, the CRS yielded a negative predictive value of 94 percent. We identified a priori forty items from the CRS which should not be influenced by the non-psychiatric biologic effects of gynecologic tumors, and compared the performance of this non-cancer related symptoms subscale (NCSG) to that of the CRS. The NCSG did not significantly outperform the CRS; its sensitivity and specificity were 87 percent and 62 percent, respectively. Because our study population was relatively homogeneous (i.e., non-ovarian gynecologic oncology patients without severe debilitation who were not receiving chemotherapy, radiation therapy, or other invasive procedures), the findings should not be generalized to other oncologic populations at this time. Our results suggest that patient self-report forms can be effective screening devices for identifying those non-ovarian, gynecologic oncology patients who should then be carefully evaluated for coexisting clinical depression.

Statistical analysis of repeated measures in psychiatric research.

We examined the statistical methods applied to research studies that used parallel-groups repeated measures designs. Sixty-three of the 343 articles that were published in four major psychiatry research journals during a 6-month period contained data of this type. Seven (11%) of the 63 articles applied a multivariate analysis of variance. Four (6%) used a univariate analysis of variance with an adjustment for correlated measures. Ten (16%) used a univariate analysis of variance without an adjustment for correlated measures. Twenty (32%) either reduced their repeated measurements to a single value, such as a maximum-change score in each group, or carried out multiple tests at several time points. Twenty-two (35%) of the reports did not provide enough information to allow readers to determine the type of analysis that was applied. We discuss the appropriate selection of analytical techniques for repeated measures designs.

Impaired effortful cognition in depression.

Depressed patients have been reported to have deficits in "effortful," but not effortless, cognitive functions compared to healthy volunteers. To test the hypothesis that the effortful cognitive deficits in major depression are not simply a function of psychiatric illness or hospitalization, we administered both effort-demanding and effortless cognitive tasks to 17 inpatients with major affective disorder and 17 hospitalized psychiatric controls. The depressed patients performed significantly more poorly than the controls on the effort-demanding task. The groups did not differ on the effortless task. These findings suggest that depressed patients are impaired in performing effort-demanding cognitive tasks compared to nondepressed psychiatric patients.

Abnormal neuroendocrine responsivity to acute i.v. clomipramine challenge in depressed patients.

The neuroendocrine responsivity to an acute serotonergic challenge with low-dose i.v. clomipramine was studied in seven drug-free depressed patients and seven age-matched healthy control subjects. The depressed patients had higher baseline prolactin concentrations than the healthy subjects, and their prolactin response to clomipramine, assessed as either the percent of baseline or the log-transformed concentration, was significantly different (delayed and blunted peak response) compared to healthy controls. The growth hormone response was exaggerated in the depressed patients, and there were also trends toward blunting in their cortisol and adrenocorticotropic hormone responses. These results are consistent with previous findings of altered neuroendocrine responses to a variety of putative serotonin agonists in depressed patients.

Introduction of a standardized report form improves the quality of mental status examination reports by psychiatry residents.

The quality of mental status examination (MSE) reports in consecutive admission notes by psychiatric residents was compared before and after the introduction of a structured, pre-printed MSE form that had been designed for teaching and quality of care purposes. We found the use of the form to be associated with a marked improvement in the quality of the reports; however, an important item not on the form was less likely to be recorded than with an unstructured record of the MSE. We conclude that the use of structured MSE forms leads to a significant improvement in the comprehensiveness of MSE records. We therefore recommend that some version of a comprehensive, structured MSE form be adopted for use on adult inpatient psychiatry units where residents are being trained.

Filter feeding in the hermit crab : Pagurus bernhardus.

The hermit crab, Pagurus bernhardus is able to remove both Artemia nauplii and unicellular algae from suspension. Crabs with wet weights of 1.1-9.2 g consumed all of the 300 Artemia nauplii contained in 200 ml of sea water within 1 h. Crabs weighing 0.7-1.1 g wet weight filtered suspended Dunaliella algae (8 µm) from concentrations of 10-350 million cells per liter at a rate of 26% and 47% within 2 and 5 h, respectively. A similar result was obtained with an 11 g crab. During filter feeding activity a water current is generated by the flagella of the exopods of the second and third maxillipeds. Artemia nauplii are caught by grasping movements of the endopods of the third maxillipeds, whereas filtering of unicellular algae is probably achieved by the two maxillae. It is assumed that filter feeding activity depends on the same structures and behavior as in deposit feeding. P. bernhardus is one more example of a benthic marine animal which may use any food source which becomes available in the course of the seasons.