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1.
J Affect Disord ; 280(Pt A): 121-126, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33207284

RESUMO

BACKGROUND: This study aimed to evaluate cognitive function in patients with anxious depression. METHODS: This was a part of the "Objective Diagnostic Indicators and Individualized Drug Intervention of Major Depressive Disorder (MDD)" study. All participants, including patients with MDD and healthy controls (HCs), completed the 17-item Hamilton Depression Scale (HAMD17) and the Hamilton Anxiety Scale (HAMA). Anxious depression was defined as a HAMD17 anxiety/somatization factor score ≥7. Cognitive function was assessed at baseline and at the end of week 8. HC cognitive function was assessed at baseline. RESULTS: A total of 1048 people were included in the analysis, including 328 patients in the anxious depression group (G1=328), 221 patients in the MDD without anxious depression group (G2=221), and 499 in the HC group (G3=499). There were significant differences in the HAMA at baseline (t=13.050, p<0.001), HAMD17 at baseline (t=16.722, p<0.001), and HAMA at weekend 8 (z=-3.477, p=0.001) between G1 and G2. Cognitive functioning on the Hopkins Verbal Learning Test-Revised (HVLT-R) (t=2.948, p=0.003) and the Brief Visual Memory Test-Revised (BVMT-R) (t=2.843, p=0.005) was better in G1 than in G2 at baseline. Cognitive functioning on the HVLT-R (OR=1.081, p=0.006) was better in G1 than in G2 at weekend 8. The Stroop-color-word test (SCWT) (OR=0.976, p=0.004) and the Continuous Performance Test (CPT) (OR=0.698, p=0.007) showed significant differences at baseline; however, after the acute treatment phase, there were no significant differences in executive function (assessed by SCWT) (p=0.148) or attention/vigilance (assessed by CPT) (p=0.416) between G1 and G3. CONCLUSIONS: Patients with anxious depression have more severe depressive symptoms but better cognitive function, especially for verbal learning, compared with nonanxious depression patients. After the acute treatment phase, executive function and attention/vigilance in anxious depression patients may be remitted.

2.
BMC Med Educ ; 20(1): 473, 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33243247

RESUMO

BACKGROUND: The doctor-patient relationship in China has deteriorated in recent years, and poor doctor-patient communication is one of the main reasons. How to effectively carry out doctor-patient communication training originated from the West among Chinese medical students still to be studied. In the past decade, Peking Union Medical College has adopted clinical scenario drama to teach doctor-patient relationship and clinical communication skills. The aim of this study was to introduce clinical scenario dramas and evaluate its effectiveness in promoting doctor-patient relationships and clinical communication skills through students' self-perceptions in Chinese medical students. METHODS: This study was a retrospective, self-controlled study and conducted from March 2009 to October 2018. Doctor-patient relationship and communication skills training were administered to all sixth-year medical students, which involved lectures and various clinical scenario dramas. The program totaled 24 h, of which each class session was 3 h, with 8 sessions in total. All students were requested to complete an anonymous 5 likert self-rating survey including self-confidence in using communication skills and self-perceived learning attitude and ability before and at the end of the course. In addition, they were requested to evaluate the curriculum after completion of the course. RESULTS: Clinical scenario dramas helped students improve their self-confidence in clinical communication skills except for psychosomatic history taking (p < 0.05). The interests for participation in clinical scenario dramas were higher compared to attending lectures (4.39 ± 0.610 Vs 4.07 ± 0.831, p<0.01). Study participants were highly satisfied in the course setting, teaching instructors and content (4.61 ± 0.546, 4.65 ± 0.535, 4.63 ± 0.534). The self-evaluation results demonstrated that clinical scenario dramas improved the learning ability of medical students (p < 0.05). CONCLUSION: The use of clinical scenario dramas was helpful in teaching doctor-patient communication skills.

4.
Psychosom Med ; 82(3): 337-344, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32058460

RESUMO

OBJECTIVE: This study aimed to validate the Chinese version of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in an outpatient sample from Chinese general hospitals and to determine the diagnostic performance of the SSD-12 as a screening tool for somatic symptom disorder (SSD). METHODS: The Chinese version of the SSD-12 was completed by 699 outpatients from nine general hospitals during a 16-month period (2016-2018). The SSD section of the Structured Clinical Interview for DSM Disorders, Fifth Edition, Research Version, was used to determine diagnostic accuracy (criterion validity). The construct validity of the SSD-12 was evaluated by examining correlations with the Whiteley Index-7, Patient Health Questionnaire-15, Patient Health Questionnaire-9, General Anxiety Disorder-7, World Health Organization Disability Assessment Schedule, and Medical Outcome Study 12-item Short Form Health Survey (SF-12). RESULTS: The SSD-12 had excellent internal consistency in this sample (Cronbach α = .95). Confirmatory factor analyses replicated a three-factor structure that reflects the cognitive, affective, and behavioral aspects (Comparative Fit Index = 0.963, Tucker-Lewis Index = 0.952, root mean square error of approximation = 0.08, 90% confidence interval = 0.08-0.09), but was also consistent with a general one-factor model of the SSD-12 (Comparative Fit Index = 0.957, Tucker-Lewis Index = 0.948, root mean square error of approximation = 0.09, 90% confidence interval = 0.08-0.10). The optimal cutoff point for the Structured Clinical Interview for DSM Disorders-based diagnosis of SSD was 16 (sensitivity = 0.76, specificity = 0.80). The SSD-12 sum score was significantly associated with somatic symptom burden (Patient Health Questionnaire-15: r = 0.52, p < .001), health anxiety (Whiteley Index-7: r = 0.82, p < .001), depressive symptoms (Patient Health Questionnaire-9: r = 0.63, p < .001), general anxiety (General Anxiety Disorder-7: r = 0.64, p < .001), health-related quality of life (physical component score of SF-12: r = -0.49, p < .001; mental component score of SF-12: r = -0.61, p < .001), and health-related disabilities (World Health Organization Disability Assessment Schedule: r = 0.56, p < .001). CONCLUSIONS: Initial assessment indicates that the Chinese version of the SSD-12 has sufficient reliability and validity to warrant further testing in both research and clinical settings.

5.
Gen Hosp Psychiatry ; 62: 63-71, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31841874

RESUMO

OBJECTIVE: We aimed to explore the prevalence of somatic symptom disorder (SSD) according to DSM-5 criteria in Chinese outpatients from general hospital departments. METHODS: This multicentre cross-sectional study enrolled 699 patients from outpatient departments, including the neurology, gastroenterology, Traditional Chinese Medicine [TCM] and psychosomatic medicine departments, in five cities in China. The structured clinical interview for DSM-5 (SCID-5) for SSD was administered by trained clinical professionals to diagnose SSD. RESULTS: SSD was diagnosed in 33.8% (236/697) of all enrolled patients. The prevalence of SSD differed significantly among the departments (χ2 = 34.049, df = 2, p ≤0.001). No differences were found between SSD patients and non-SSD patients in terms of gender, residence, marital and living statuses, family income, education, employment status and lifestyle factors. However, patients with SSD reported higher levels of depression, health-related and general anxiety, lower physical and mental quality of life, higher frequency of doctor visits, increased time devoted to physical symptoms and longer duration of somatic symptoms. In a binary linear regression analysis, SSD was significantly associated with an increase in health-related anxiety, time devoted to symptoms and impact of somatic symptoms on daily life. The explained variance was Nagelkerke R2 = 0.45. CONCLUSION: There is a high prevalence of SSD in Chinese general hospital outpatient clinics. The diagnosis is associated with high levels of emotional distress and low quality of life. There is a danger of over-diagnosis if we include the mild and moderate forms of SSD. Future studies are warranted to investigate the prevalence of SSD in inpatient departments and the development of psychological interventions for these patients.


Assuntos
Hospitais Gerais/estatística & dados numéricos , Sintomas Inexplicáveis , Pacientes Ambulatoriais/estatística & dados numéricos , Angústia Psicológica , Transtornos Somatoformes/epidemiologia , Adulto , China/epidemiologia , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida
6.
BMC Psychiatry ; 19(1): 353, 2019 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703657

RESUMO

BACKGROUND: Bipolar disorder is associated with complicated medical comorbidities. The risk-taking behavior of bipolar disorder patients may lead to many problems. CASE PRESENTATION: A 40-year-old male patient had gastrointestinal symptoms for 4 months. He was talkative, agitative, and grandiose but showed poor cognition. Multisystem injury required multidepartment, multidisciplinary consultation. Repeated fecal examination found multiple infections of Opisthorchis sinensis, Heterophyes, and Echinostomatidae. The diagnostic criteria for parasitic infections, bipolar disorder and organic mental disorder were met. After treatment with a mood stabilizer and helminthic, his mood became stable, but risky dietary behavior continued. CONCLUSIONS: The case describes persistent risky dietary behaviors in a bipolar patient even after affective symptoms were under control, which ultimately led to diverse parasitic infections and chronic encephalopathy. We call for clinical and scientific attention to possible dangerous behavior changes in bipolar patients even after their emotions are stabilized.


Assuntos
Transtorno Bipolar/psicologia , Dieta/psicologia , Comportamento Alimentar/psicologia , Assunção de Riscos , Adulto , Afeto , Sintomas Afetivos/psicologia , Emoções , Humanos , Masculino
7.
J Affect Disord ; 256: 1-7, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31154087

RESUMO

BACKGROUND: This study aimed to evaluate the effect of short-term use of benzodiazepines (BZDs) on cognitive function of major depressive disorder (MDD) patients being treated with antidepressants (ADs). METHODS: This was a part of a multi-center, multi-stage and prospective study of "Objective Diagnostic Indicators and Individualized Drug Intervention of Major Depressive Disorder (OIMDD)". Three hundred and fifty-three patients treated with the selective serotonin reuptake inhibitors (SSRIs) alone (Group 1) and 49 patients treated with SSRIs combined with short-term use of BZDs (Group 2) during the acute treatment period were included in the analysis. Cognitive function and depressive and anxiety symptoms were assessed at baseline, weekend 8 and 48. A cognitive test battery included 5 domains: information processing speed assessed by the Animal Verbal Fluency Scale (AVFS), Digit Symbol Coding Test (DSCT) and Color Trial Test (CTT), verbal learning assessed by the Hopkins Verbal Learning Test-Revised (HVLT-R), visual learning assessed by the Brief Visual Memory Test-Revised (BVMT-R), executive function assessed by the Stroop Color Word Test (SCWT), and attention or vigilance assessed by the Continuous Performance Test (CPT). RESULTS: Significant differences were found in education level (χ2 = 5.442, p = 0.020), the severity of depressive (t = -1.982, p = 0.048) and anxiety symptoms (t = -2.629, p = 0.009) between Group 1 and 2 at baseline. There were no significant differences between G1 and G2 in cognitive functions at baseline. After Multiple correction, DSCT was better in patients treated with BZDs combined with ADs than in patients with ADs alone at weekend 8 without controlling education level, depressive and anxiety symptoms at baseline (F = -2.747, p = 0.042). After controlling these factors at baseline, the DSCT was still slightly high in patients treated with ADs combined with BZDs than in patients with ADs alone at weekend 8 (OR = 1.052, 95%CI:1.000-1.105). The repeated measurement analysis of variance showed that the DSCT could be improved by the treatment of BZDs combined with ADs at 1-year follow-up compared to baseline (F = 7.569, p = 0.006). CONCLUSIONS: The findings suggest that short-term use of BZDs does not impair cognitive function of MDD patients; conversely, it could improve the information processing speed after acute treatment and at 1 year follow up.


Assuntos
Antidepressivos/uso terapêutico , Benzodiazepinas/uso terapêutico , Cognição/efeitos dos fármacos , Transtorno Depressivo Maior/tratamento farmacológico , Adulto , Ansiedade , Atenção , Função Executiva , Feminino , Humanos , Masculino , Memória , Pessoa de Meia-Idade , Estudos Prospectivos , Inibidores de Captação de Serotonina/uso terapêutico
8.
BMC Psychiatry ; 17(1): 361, 2017 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-29115965

RESUMO

BACKGROUND: The aim of this study was to test the operationalization of DSM-5 somatic symptom disorder (SSD) psychological criteria among Chinese general hospital outpatients. METHODS: This multicenter, cross-sectional study enrolled 491 patients from 10 general hospital outpatient departments. The structured clinical "interview about cognitive, affective, and behavioral features associated with somatic complaints" was used to operationalize the SSD criteria B. For comparison, DSM-IV somatoform disorders were assessed with the Mini International Neuropsychiatric Interview plus. Cohen's к scores were given to illustrate the agreement of the diagnoses. RESULTS: A three-structure model of the interview, within which items were classified as respectively assessing the cognitive (B1), affective (B2), and behavioral (B3) features, was examined. According to percentages of screening-positive persons and the receiver operator characteristic (ROC) analysis, a cut-off point of 2 was recommended for each subscale of the interview. With the operationalization, the frequency of DSM-5 SSD was estimated as 36.5% in our sample, and that of DSM-IV somatoform disorders was 8.2%. The agreement between them was small (Cohen's к = 0.152). Comparisons of sociodemographic features of SSD patients with different severity levels (mild, moderate, severe) showed that mild SSD patients were better-off in terms of financial and employment status, and that the severity subtypes were congruent with the level of depression, anxiety, quality of life impairment, and the frequency of doctor visits. CONCLUSIONS: The operationalization of the diagnosis and severity specifications of SSD was valid, but the diagnostic agreement between DSM-5 SSD and DSM-IV somatoform disorders was small. The interpretation the SSD criteria should be made cautiously, so that the diagnosis would not became over-inclusive.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Pacientes Ambulatoriais/psicologia , Transtornos Somatoformes/diagnóstico , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Ansiedade/psicologia , China , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Adulto Jovem
9.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 38(4): 422-7, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27594155

RESUMO

Objective To analyze liaison psychiatric service in a geriatric ward in a big general hospital and explore the way to improve accessibility of geriatric psychiatric service in general hospitals. Methods Elderly inpatients aged 65 years old or more admitted to a geriatrics ward in Peking Union Medical College Hospital in 7 years duration (January 2008 to December 2014) were enrolled in the study. Liaison psychiatrists attended ground round combined with psychiatric consultation from January 2008 to December 2009 (T1 period). Comprehensive geriatric assessment,geriatric interdisciplinary team services and psychiatric consultation were conducted from January 2010 to December 2014 (T2 period). Consultation rate,reasons for referral,psychiatric diagnoses,length of stay,and medical expense were compared between different periods.Results Among 1230 geriatric inpatients,383 patients were enrolled in liaison psychiatric service,and 511 individual consultations happened.The consultation rate for T1 and T2 were 19.7% and 33.8%,respectively (P=0.000).The dominating reasons for referral were current emotional symptoms (30.4%) and current psychiatric symptoms (28.3%) in T1 and current emotional symptoms (65.3%) and medically unexplained symptoms (12.8%) in T2 (P=0.000). For length of stay,consultation group lasted for (199.2±40.0) days,and non-consultation group lasted for (71.3±16.6) days(P=0.004) in T1;(22.0±2.4) days and (22.6±1.6) days(P=0.834) in different groups in T2 respectively. The medical expense were (243 000±44 000) RMB for consultation group and (79 000±18 000) RMB for non-consultation group(P=0.040) in T1 and (18 000±2 000) RMB and (21 000±1 000) RMB (P=0.302) in different groups in T2 respectively. The prevalence rate for psychiatric disorders revealed by liaison psychiatrists was 15.8% in T1 and 29.8%in T2 (P=0.000) in the geriatric ward. Conclusions Elderly inpatients are vulnerable population for psychiatric disorders. Therefore,psychiatrist should be an important member in geriatric interdisciplinary team. Combination of comprehensive geriatric assessment,psychiatric consultation and geriatric interdisciplinary team is very efficient model in general hospital settings to improve the accessibility of psychiatric services in elderly in China.


Assuntos
Hospitais Gerais , Pacientes Internados , Transtornos Mentais/diagnóstico , Encaminhamento e Consulta , Idoso , China , Feminino , Avaliação Geriátrica , Geriatria , Hospitalização , Humanos , Tempo de Internação , Masculino , Unidade Hospitalar de Psiquiatria , Estudos Retrospectivos
10.
Zhonghua Yi Xue Za Zhi ; 95(23): 1833-6, 2015 Jun 16.
Artigo em Chinês | MEDLINE | ID: mdl-26712401

RESUMO

OBJECTIVE: The purpose of this study was to explore the barriers existing in medical settings behind the phenomenon that few suicide attempters were provided by mental health services when they got treatment in the general hospital ED. METHODS: An anonymous and voluntary survey was administered among two groups: ED physicians and psychiatrists. Two tertiary general hospitals and one psychiatric hospital were chosen through convenience sampling. Suicide Behavior Attitude Questionnaire and a self-made questionnaire to evaluate barriers were used. RESULTS: The response rate was 68.7% for ED physicians, and 87.0% for psychiatrists. ED physicians generally scored unfavorably than psychiatrists on many items in SBAQ (P < 0.001), but on the item about whether the suicide attempters should have access to mental health services, the median of the scores = 10 for both group (P = 0.059), meaning highly agree. Some consistent barriers could be summarized from the self-made questionnaire. CONCLUSIONS: The majority of ED physicians in general hospitals still hold some misunderstanding about the suicide attempters, but they fully agree that the suicide attempters should have access to mental health services. The barriers for psychiatrists are clear.The barriers for ED physicians are complicated but workable.


Assuntos
Serviço Hospitalar de Emergência , Tentativa de Suicídio , Clínicos Gerais , Hospitais Gerais , Humanos , Serviços de Saúde Mental , Inquéritos e Questionários
12.
Zhonghua Yi Xue Za Zhi ; 91(23): 1621-4, 2011 Jun 21.
Artigo em Chinês | MEDLINE | ID: mdl-21914396

RESUMO

OBJECTIVE: To explore the significance of sleep problems in the diagnosis of depressive and anxiety disorders. METHODS: A cross-sectional study was conducted through stratified convenient sampling in outpatients at our hospital from November 19, 2009 to January 19, 2010. A total of 203 outpatients (≥ 16 years old) were recruited from Department of Internal Medicine, Department of Surgery, Department of Obstetrics & Gynecology and other departments. Sleep Questionnaire was used as a screening tool for depressive and anxiety disorders. Composite international diagnostic interview (CIDI) was conducted by trained interviewers. According to diagnostic and statistical manual of mental disorders, Fourth Edition (DSM-IV) using the outcome from the logistic diagnostic procedure of CIDI as a golden standard for depressive and anxiety disorders, the validities of Sleep Questionnaire were calculated. RESULTS: According to the Sleep Questionnaire, the 12-month prevalence of any sleep problem was 31.0% (63/203). The Cronbach's α coefficient of the questionnaire was 0.764 and the area under the ROC (receiver operating characteristic) curve 0.741. With a cut-off point of 1, the sensitivity was 68.0% and the specificity 74.2% respectively. And it achieved the best composite diagnostic capacity. The positive predictive values were at least 27.0%. CONCLUSION: Sleep problem is a common complaint at a general hospital. When the duration and severity of sleep problem meet the standards of Sleep Questionnaire, a physician should be aware of possible depressive and anxiety disorders and more detailed information should be collected.


Assuntos
Transtornos de Ansiedade/diagnóstico , Transtorno Depressivo/diagnóstico , Transtornos do Sono-Vigília/complicações , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Ansiedade/complicações , Estudos Transversais , Transtorno Depressivo/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sono , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Adulto Jovem
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