Anxiety and depression in chronic hemodialysis: some somatopsychic determinants.

AIMS: Depression and anxiety are so common in hemodialysis (HD) patients that we found it useful to study the respective contributions of the subjective somatic sensations and of the objective medical comorbidity to psychological distress. We also hypothesized that denial has a protective effect against anxiety and depression, and that alexithymia is, on the contrary, a risk factor. MATERIAL AND METHODS: In a cross-sectional design, we investigated relationships between psychological distress and somatic complaints, Charlson comorbidity index, denial and alexithymia, in a group of 54 patients on incenter HD. They filled psychometric self-rated questionnaires in (State Anxiety Inventory, Hospital Anxiety and Depression Scale, 13-item Short Beck Depression Inventory, Kidney Disease Quality of Life Short Form, 20-item Toronto Alexithymia Scale). A principal component analysis allowed us to focus on HADS-total score, which was confirmed to be representative of anxio-depression. Then, correlational analyses and a stepwise regression analysis were performed. RESULTS: HADS-total score is inversely associated with the use of denial as a psychological defence mechanism (p < 0.001), and positively correlated with difficulties in identifying emotions (p < 0.001), with difficulties in expressing feelings (p < 0.05), and with the intensity of subjective somatic complaints (p < 0.001). On the contrary, it is not related to the somatic comorbidity. In the stepwise regression, the somatic complaints, the denial and the difficulties in recognizing emotions emerge as the three main variables related to the HADS-total score (p < 0.001). CONCLUSIONS: Subjective physical complaints are here associated with psychological distress in chronic HD patients, while objective organic comorbidity does not seem to influence their mood and anxiety status. Denial is an efficient coping style against negative emotions, but it can diminish compliance. So, the subjective perception of the disease seems to have an important impact on the anxiety and mood levels, which can also be influenced by the emotional regulation abilities.

Contraception of women with intellectual disability: prevalence and determinants.

The contraception of women with intellectual disability (ID) is a major concern for caregivers. However, the prevalence of contraception and the frequency of use of different methods (e.g. sterilization) remain generally unknown. Moreover, indications specific to women with ID are controversial. The present authors conducted a population-based study among 97% of the women with ID aged between 18 and 46 years attending government-funded facilities in Brussels and the nearby province of Walloon Brabant in Belgium. Out of 397 subjects, 40.8% did not use any contraceptive method, 22.2% were sterilized, 18.4% used an oral contraceptive agent, 17.6% used depotmedroxyprogesterone acetate and 1% used an intrauterine device. These figures differ widely from those of the general Belgian population. Binary logistic regression for 'contraceptive utilization' showed the strong influence of institutional factors such as sleeping environment (i.e. institutional or parental), sexual relationship policy and contraception policy. Having or having had a boyfriend is also correlated with a stronger probability of contraceptive use. Other factors have a smaller influence (e.g. a milder level of ID). Very few factors, none of which are medical, are correlated with an increased use of a specific method. The present results are discussed in the light of the general medical application of contraception and the commonly assumed specific indications for women with ID.

Emergencies and somatization.

The article presents the clinical profile of 72 patients with somatization seen by a psychiatric team at the request of somaticians in a emergency service in St Luc hospital (Brussels-Belgium). These include 37.5% of mood disorders, 11% of psychotic disorders and 20% of serious anxiety disorders. The psychiatric antecedents of these patients are very poor. Only the combined intervention of the somatician and the psychiatrist can improve the compliance and the level of psychiatric care which is very low.

[Functional somatic complaints in the emergency service and 4 year outcome]. / Plaintes somatiques fonctionnelles dans un service des urgences et leur devenir à 4 ans.

The article presents the clinical profile of 72 somatizations taking in charge by a psychiatric team in a emergency room. They represent mood disorders (37.5%), psychotic disorders (11%) and anxiety disorders (20%). The psychiatric antecedents are very poor. Their outcome after 4 years is good on the health sickness rating scale of Luborsky in 35% and very bad in 25%, particularly for symptomatic score. After their taking in charge in the emergency room, these patients go not much in psychiatric hospitals and in psychiatric consultations. This observation gives to this first intervention in the emergency room a very important rule.

[Outcome of 89 psychiatric emergencies managed by 3 mental health centers in an emergency service]. / Devenir de la prise en charge par 3 centres de santé mentale de 89 urgences psychiatriques à partir d'un service des urgences.

This paper deals with the assessment after 2 years of the outcome of 89 psychiatric emergencies taking in charge in Saint-Luc hospital's (Brussels) emergency room, by 3 community mental health services. After the triangulation of the demand, in the emergency room, 91% of the patients go to the community mental health service. In 92.5% of cases, the crisis intervention is carried out by the same therapists they met in the emergency room with the collaboration of other members of the outpatient team. Crisis interventions are brief (less than 3 months) in 50% of cases, less than 1 years in 11.5% of cases and lead in 35% of cases to long-term in charge (more than 2 years: psychiatric and social follow-up).

[Psychiatric commitment and current legislation of 26 June 1990 relative to mentally ill persons]. / Collocation et nouvelle loi du 26 juin 1990 relative à la protection de la personne des malades mentaux.

A study on the psychiatric confinements in the Walloon region in the year 1984 allows to define the patient's psychopathology and the context of the requests. The new law of the 26 June 1990 relating to the protection of the mentally ill person will probably be used mostly in such situations. Its conditions of implementation, positive aspects and the difficulties it could create are detailed.

[Knowledge about previous psychiatric care: is it a guaranty for therapeutic investment or a curse in psychiatric emergencies]. / Les antécédents de prise en charge: gage d'investissement thérapeutique ou de malédiction pour les urgences psychiatriques.

A sample of 755 psychiatric emergencies taken in charge in the emergency service of the St-Luc Hospital, Brussels, was divided into two groups: patients without psychiatric background (498) and patients having received previous psychiatric care (238). A background of psychiatric follow-up strongly influence the taking on and therapeutic decisions to be made by psychiatrists: its absence protects the patient and is seen as the guaranty of a good investment from the therapist while the existence of previous psychiatric treatment rather leads to hospital in lieu of crisis intervention, even when the crisis mechanisms are not significantly different in both samples.

[Evaluation of the fate of young patients treated in therapeutic communities]. / Evaluation du devenir des jeunes patients ayant été pris en charge par des structures intermédiaires.

This study was attempted to analyse the trajectories of patients who have left a therapeutic community centre since two and a half years. The statistical analysis has permitted us to show that a series of variables concerning personal, family or medical history have a repercussion on these trajectories. The study shows that patients who have become less dependent on assisting psychiatric networks are better integrated in the relational and social networks.

In vivo and in vitro effect of acyclovir on pseudorabies virus, infectious bovine rhinotracheitis virus and pigeon herpesvirus.

The effect of various concentrations of acyclovir on the mean plaque size of pseudorabies virus (SHV), infectious bovine rhinotracheitis virus (IBR virus) and pigeon herpesvirus (PHV) has been studied. Acyclovir significantly reduced the mean plaque size of SHV and PHV, whereas IBR virus was less affected and did only show a reduction of the mean plaque size at the highest concentration of acyclovir used (1000 microM). In vivo effect of acyclovir was tested using pigeons and budgerigars experimentally infected with PHV and rabbits experimentally infected with a very low dose of SHV. Intramuscular injections of acyclovir (100 mg/kg/day; three injections/day) did not prevent the appearance of clinical disease in infected pigeons nor did reduce the level of viral excretion. The same treatment applied, as for the pigeons, before infection protected most of the budgerigars as long as they were treated, but most of them died soon after the end of the treatment. Only one rabbit was protected by the treatment. SHV was recovered in the lung of only one of the treated animals, whereas it was isolated in the lungs of each control animal.

Propagation of bovine rotavirus by cats and dogs.

SPF cats were experimentally infected orally with bovine rotavirus. All of them excreted virus over a period of at least two weeks after inoculation. Seroconversion was observed after one week for all the animals, but it did not stop viral excretion or prevent further excretion of the same or another rotavirus strain given later. Cats or dogs kept in the same cage as inoculated animals became infected and excreted virus, but seroconversion was not observed in these contact animals. None of the animals developed diarrhoea during the experiment. Cats are thus able to multiply bovine rotavirus, and transmission of this virus occurs between cats or between dogs and cats. Therefore, cats, like dogs, may play a role in the epizootiology of rotavirus infection in calves.