Investigating fatigue of less than 6 months' duration. Guidelines for family physicians.
OBJECTIVE: To develop an evidence-based systematic approach to assessment of adult patients who present to family physicians complaining of fatigue of less than 6 months' duration. The guidelines present investigative options, making explicit what should be considered in all cases and what should be considered only in specific situations. They aim to provide physicians with an approach that, to the extent possible, is based on evidence so that time and cost are minimized and detection and management of the cause of the fatigue are optimized. QUALITY OF EVIDENCE: MEDLINE was searched from 1966 to 1997 using the key words "family practice" and "fatigue." Articles about chronic fatigue syndrome were excluded. Articles with level 3 evidence were found, but no randomized trials, cohort studies, or case-control studies were found. Articles looking specifically at the epidemiology, demographics, investigations, and diagnoses of patients with fatigue were chosen. Articles based on studies at referral and specialty centres were given less weight than those based on studies in family physicians' offices. MAIN MESSAGE: Adherence to these guidelines will decrease the cost of investigating the symptom of fatigue and optimize diagnosis and management. This needs to be proved in practice, however, and with research that produces level 1 and 2 evidence. CONCLUSIONS: Adults presenting with fatigue of less than 6 months' duration should be assessed for psychosocial causes and should have a focused history and physical examination to determine whether further investigations should be done. The guidelines outline investigations to be considered. The elderly require special consideration. These guidelines have group validation, but they need to be tested by more physicians in various locations and types of practices. (+info)
Admission and adjustment of residents in homes for the elderly.
This paper discusses the relationship between psychological variables, a brief cognitive measure and a behavioural rating scale, and the subsequent adjustment of a group of elderly people newly admitted to a social services home for the elderly. It shows that, in this sample, three groups can be identified: a fairly independent group of people who show no apparent deterioration in functioning during the first year of admission; a more dependent group who show loss of functioning during the same period; and a third group who show an immediate negative effect from admission, and who have a poor outcome. We comment on the lack of evidence in support of a general negative relocation effect, and on the value of the procedures used. (+info)
Coping with refractory epilepsy.
We investigated the coping behaviour and its correlation with demographic and illness-related data, depression, locus of control and psychosocial adaptation in 40 patients with intractable epilepsy with primarily or secondarily generalized tonic-clonic seizures. Three standardized self-reporting questionnaires were applied, which are the Freiburg Questionnaire of Coping with Illness (FKV), the von Zerssen Depression Scale (D-S), and the IPC-questionnaire measuring generalized locus of control beliefs; the Social Interview Schedule (SIS), a semi-structured interview, was used to measure the psychosocial adaptation. Active, problem-focused and compliance strategies were predominantly used and regarded as most helpful. Hence, the epileptic patients use similar coping patterns reported in patients with other non life-threatening chronic diseases. The level of depression was moderate and in the range of other chronic somatic diseases. The use of coping patterns, which are regarded as maladaptive, was correlated with distinct depression, a small degree of internal locus of control beliefs and poor psychosocial adaption. These results indicate the possibility to improve psychosocial adjustment by supporting effective strategies. (+info)
Technique evaluation of foster care in chronic psychiatric disorders.
Foster care received by 178 patients with chronic psychiatric disorders discharged from Hamilton Psychiatric Hospital in the years 1966 through 1969 was studied by technique evaluation. Residents were followed for 3 years by means of health records. The achievement of operational objectives of the program (Homes for Special Care) was compared with two types of outcome--emergency readmission to hospital and discharge to the community. Emergency readmission was associated with rural location of the foster home, inferior quality of the home operator and smaller size (i.e., fewer residents) of the home. Discharge to the community was more common among younger, female residents whose previous psychiatric hospitalization had been relatively brief. In general, prescription audit was not a fruitful way of evaluating quality of health care. (+info)
Tay-Sachs screening: social and psychological impact.
Participants in two Tay-Sachs screening programs were generally satisifed with the organization of the tests and the results. There was no evidence of adverse impact on reproductive plans or interpersonal relations, and the respondents professed to believe in the value of screening. While the carriers discussed their condition freely with others and were no less favorable to the idea of screening than the noncarriers, about one-half of their number expressed discomfort in being told they were heterozygotes. These feelings were allayed by counseling, but there was evidence of some residual unease. It is suggested that this anxiety would be less prominent and more easily reduced if screening were done under conditions of ordinary primary medical care rather than outside the conventional system. (+info)
Assessing the psychosocial consequences of epilepsy: a community-based study.
BACKGROUND: Few studies have measured, using validated scales, the psychosocial handicap of epilepsy in a general practice setting. AIM: To assess the prevalence of psychosocial problems associated with epilepsy. METHOD: A survey was undertaken of 309 subjects, with one or more non-febrile epileptic seizures, drawn from two general practices in the United Kingdom (UK). The outcome measures were the Subjective Handicap of Epilepsy Scale (SHE), the SF-36, and the Hospital Anxiety and Depression scale (HAD). RESULTS: One-third of persons with active epilepsy were significantly handicapped by their condition. The severity of subjective handicap was related to seizure frequency and to the duration of remission of seizures. Between one-third and one-half of subjects scored as 'cases' on the HAD scale and on the mental health subscale of the SF-36. Only one-third of the psychiatric morbidity revealed by the questionnaires had been recognized by the general practitioner (GP). Scores on the SF-36 indicated that people with active seizures perceived themselves as significantly less healthy than those in remission, and that, for persons in remission, drug treatment had a detrimental effect on certain aspects of well-being. CONCLUSIONS: The occurrence of seizures, even at low frequencies, is associated with psychosocial handicap, and this may remain covert in general practice. (+info)
Follow-up of psychogenic, non-epileptic seizures: a pilot study - experience in a Dutch special centre for epilepsy.
A follow-up study was performed in 33 patients with proven (ictal EEG-CCTV) psychogenic, non-epileptic seizures (PNES). These patients received a questionnaire to evaluate seizures, treatment and rehabilitation. The response group consisted of 21 females (80% response) and seven males (100% response). Follow-up after diagnosis varied from 23-67 months. Seven patients (25%) reported that seizures had ceased and of the patients not seizure-free seven did report a seizure-free period after diagnosis of an average 6.7 months. Eight patients were on antiepileptic drugs again. Of 13 patients referred for psychotherapy, who also did receive treatment, six became free of seizures and seven did not. Of seven patients also referred, but who did not receive psychotherapy, all continued to have seizures. On a self-rating scale to compare "overall function" at the time of diagnosis and follow-up, 75% considered themselves to have "improved", but no improvement could be detected in psychosocial functioning. (+info)
Building momentum: an ethnographic study of inner-city redevelopment.
OBJECTIVES: One factor contributing to the decay of inner-city areas, and to consequent excess mortality, is the massive loss of housing. This report studied the effects of a redevelopment project on social functioning in an inner-city community. METHODS: This ethnographic study included the following elements: a longitudinal study of 10 families living in renovated housing, repeated observations and photographing of the street scene, focus groups, and informal interviews with area residents. The project was located in the Bradhurst section of Harlem in New York City and was focused on a redevelopment effort sponsored by local congregations. RESULTS: Those who were able to move into newly renovated housing found that their living conditions were greatly improved. Neighborhood revitalization lagged behind the rehabilitation of individual apartment houses. This uneven redevelopment was a visual and sensory reminder of "what had been." Residents missed the warmth and social support that existed in Harlem before its decline. CONCLUSIONS: Rebuilding damaged housing contributes greatly to the well-being of inner-city residents. The current pace and scope of rebuilding are insufficient to restore lost vitality. (+info)