jiddt
Abstract : Incidence of Anxiety in Patients with Multiple Sclerosis (MS)
|
|
Abstract: Objective: To investigate the (1) incidence of anxiety and (2) association of anxiety with disease duration, depression, and age in an outpatient Multiple Sclerosis (MS) Center. Background: The incidence of anxiety varies in the literature but is estimated to affect 44.5% of people with MS. Anxiety can be a predictor of poor Quality of Life, especially relevant in progressive illnesses, such as MS. Though research has shown that patients newly diagnosed experience higher anxiety levels, the relationship between anxiety and disease duration is unclear. Since anxiety can be comorbid with depression in MS populations, it is relevant to establish its association in this setting. Finally, though anxiety usually increases in older age, research for this relationship in MS populations is inconclusive. Design/Methods: The commonly used Hospital Anxiety and Depression Scale, was distributed once to patients with MS over a 3 month period to assess anxiety and depression scores. MS disease duration and age were confirmed by neurologists. Results: Out of 160 patients with MS who completed the HADS, 19% reported abnormal anxiety, 14% reported borderline cases of anxiety, and 67% did not report anxiety. After following up on significant correlations, depression and younger age were related to higher anxiety levels, (R2=.35, F(4,144)=19.26, p<0.001). The standardized partial regression coefficients indicated 2 statistically significant predictors, depression (β=.55, p=<.001) and age (β=-.25, p=<.001). Discussion: 33% of patients reported symptoms of anxiety, emphasizing the need to focus on treating anxiety, specifically, early in their disease course. Clinicians may also want to recognize that elevated depression scores predicted anxiety. Lastly, in our cohort, the younger population reported higher anxiety, demonstrating that progressive illnesses may affect anxiety levels in younger populations more. Since approximately one third of patients with MS expressed anxiety symptoms, it is important to incorporate this into treatment plans. Keywords: Multiple Sclerosis (MS), anxiety, disease duration, age, disability.Download Full Article |
Abstract : Strategies for Effective Management of Intellectually Disabled Patients on the Psychiatric Inpatient Unit
|
|
Abstract: The management of aggressive behavior remains a fundamental challenge when working on a psychiatric inpatient service. The task becomes far more daunting when the patient presents not only with mental illness but also has an intellectual disability (ID) or impulse control disorder (IC). Intellectual Disability is defined as “the impairment of general mental abilities that impact adaptive functioning in three domains: conceptual, social and practical.” Impulse control disorder, is defined as “a psychiatric disorder characterized by impulsivity- the failure to resist a temptation, urge or impulse that may harm oneself or others” [1]. Those with ID and or IC may present with varying degrees of impairment and social functioning. Numerous studies have identified an association with ID and psychiatric co-morbidities including: bipolar disorder, impulse control disorder, psychosis and depression. Due to budgetary cuts and the precipitous decline in available residential placements, inpatient psychiatric services are faced with the dilemma of managing these exceptionally complicated patients. While numerous studies have examined the utility of psychotropic medication to aid in the management of these patients, convincing evidence concerning the use of psychiatric medication in the management of this patient population remains elusive [2]. Therefore, this paper aims to explore the treatment strategies available to the multidisciplinary team on the inpatient service. Ultimately, future investigations will be necessary to better understand how to optimize the inpatient management of this complex patient population. Keywords: Intellectual Disability, Impulse control disorder, Agitation, Inpatient psychiatry.Download Full Article |
Abstract : Weight Loss Intervention in Young Adults with Severe Learning Disabilities:The Additive Effect of Cognitive Behavioral Treatment (a Pilot Study)
|
|
Abstract: The prevalence of obesity is reported to be higher among people with intellectual disabilities compared to the general population. Factors which were suggested to contribute to this increased prevalence include: low adherence to healthy diets, poor level of physical activity, intellectual disabilities and the lack of residential settings supporting independence. This study was designed to evaluate the additive effect of an intervention in the form of cognitive behavioral treatment (CBT) in a multi-strategy weight loss program for young adults with severe learning disabilities living in group residences in the community. The study population included 28 subjects (12 males) who were randomly assigned to one of two groups. Both groups had a weekly meeting with a dietician and were invited to take part in walking groups. One group (intervention group) had on top a weekly session of CBT. The results of our study indicate that adding a CBT component to a conventional program aiming at improved nutritional understanding (prudent diet, physical activity) of subjects with LD may improve the success for change in life habits, yet, in our study this effect was noticeable only on follow up few months after study termination. Neither group differences at baseline nor differences in the scoring for the locus of control questionnaire at baseline could predict this outcome. This delayed impact warrants further investigation. Keywords: Weight Loss, Learning Disabilities, Cognitive Behavioral Treatment Bazanno.Download Full Article |
Abstract : Medical Evaluation of Children with Intellectual Disability: Clinician Compliance with Published Guidelines
|
|
Abstract: Background: Children with intellectual disability (CWID) in the USA are typically referred to child neurologists (CN) and developmental-behavioral pediatricians (DBP) for medical evaluation. Although the American Academy of Neurology/Child Neurology Society (AAN/CNS) and the American Academy of Pediatrics (AAP) have published evaluation guidelines, experience suggests CN and DBP do not consistently follow them. Our goal was to assess CN’s and DBP’s approach to evaluating CWID and overall compliance with published guidelines. Methods: Questionnaires were mailed to CN and DBP in the U.S. (n=1897). Physicians were asked demographic information and which laboratory tests they would "routinely order" for the hypothetical case of a 3½ year old boy with Full Scale IQ=58 and unremarkable neurological history and exam. Chi-square tests were performed to compare sub-specialists’ ordering practices. Results: 127 CN and 140 DBP responded. 7.1% CN (n=9) and 11.4% DBP (n=16) complied with AAN/CNS and AAP guidelines, respectively. Although routinely indicated, 36.2% CN and 31.4% DBP would not routinely order chromosomal microarray (CMA), and 42.5% CN and 26.4% DBP would not routinely order DNA for Fragile X (χ2=7.67, p=0.006). 7.9% CN and 7.1% DBP would order a karyotype without CMA. Although not indicated, 7.1% CN and 0.7% DBP noted they would routinely order an EEG (χ2=7.50, p=0.006). A brain MRI is only recommended by AAN/CNS guidelines; 49.6% CN and 12.9% DBP reported they would routinely order it (χ2=42.55, p<.0001). Conclusion: Few CN and DBP follow published guidelines for laboratory evaluation of CWID. Relative to DBP, CN more frequently order EEGs and MRIs but less frequently order recommended genetic tests. Keywords: Intellectual disability, etiology, clinical practice guidelines, medical evaluation, chromosomal microarray.Download Full Article |
