Speciality
Spotlight

 




 


Family Practice


 

 




Mental
Health and Psychiatry

 

  • Wind AW, Schellevis FG, [Vrije Universiteit Amsterdam]

    Limitations of the Mini-Mental State Examination in Diagnosing Dementia in General Practice

    Int J Geriatr Psychiatry 12: 101-108, 1997

      

    Increasing age of population is associated with dementia.

       

    After a detailed study of 214 men in the age group of 65 to 84 years a simple mode of testing is suggested. Day of the week, date, personal address and the present prime minister were considered adequate for evaluation of dementia or its absence in the elderly group. It proved to be specific to the tune of 93.3 percent.

       

  • Phillips CD, Sloane PD, Hawes C, et al [ Menorah Park Ctr for the Aging, Beachwood, Ohio; Univ of North Carolina, Chapel Hill; Research Triangle Inst, Research Triangle Park, NC]

    Effects of Residence in Alzheimer Disease Special Care Units on Functional Outcomes

    JAMA 278: 1340-1344, 1997

      

    Special care units [SCU] for patients of Alzheimer disease seem to be increasing; their usefulness for patients’ residence is being evaluated in this paper. A comparison between 77,337 residents in 800 nursing homes is made with 1288 in 48 SCUs. Evaluation quarterly for 1 year was done. Progressive decline in bodily functions and ability to look after oneself were used as parameters.

      

    No difference between SCU residents and those in general nursing homes was observed. This may have a financial importance.

          

  • Wimo A, Karlsson G, Nordberg A, et al [ Umea Univ, Sweden; Stockholm School of Economics; Karolinska Inst, Stockholm; et al]

    Treatment of Alzheimer Disease With Tacrine: A Cost-Analysis Model

    Alzheimer Dis Assoc Disord 11: 1191-200, 1997

      

    Low brain levels of acetylcholine cause deterioration of cognitive function in Alzheimer disease [AD]. A cholinesterase inhibitor such as tacrine logically prevents further destruction of acetylcholine hence is likely to be useful.

       

    The extra cost of treatment with tacrine is related to extra doses of the drug and monitoring. Benefits in management arise when treatment is started early [ Min- Mental State Examination Score at 24] rather than late. If nursing home care is delayed by one year and withdrawal of patients from institutions is carried out further cost reduction is achieved. Cost reductions would have country-wise differences e.g. 1.3% in Sweden and 17% in the US as pointed out in 1994.

           

  • Le Bars PL, for the North American EGb Study Group [New York Inst for Med Research, Tarrytown; et al]

    A Placebo-controlled, Double-blind, Randomized Trial of an Extract of Ginkgo Biloba for Dementia

    JAMA 278: 1327-1332, 1997

      

    Antioxidant effects of ginkgo biloba, EGb 761, are possible in its effects on dementia. Multi-infarct [MID] and Alzheimer disease [AD] were studied. 327 patients were taken this double blind placebo controlled trial. They had mild to moderate dementia and were evaluated for safety and efficacy periodically for 1 year. 120 mgm of the drug per day or a placebo were used. Daily living, cognitive change and social behaviour were used as parameters.

      

    Of the 327, 251 subjects had AD and 76 MID; of these 309 [AD 236 and 73 MID] were included in the intent-to-treat analysis [ITT]. 30% of each group had 1 adverse effect; two from the EGb group and 1 from the placebo group had to be dropped.

      

    Maintenance of a stable state or improvement in cognitive functions and social behaviour were observed in the treated patients. This was superior to the placebo group.

         

  • Drug and Alcohol Use

    Taj N, Devera-Sales A, Vinson DC [ Univ of Missouri-Columbia]

    Screening for Problem Drinking : Does a Single Question Work?

    J Fam Pract 46: 328-335, 1998

      

    Only 39% of patients were asked about alcohol drinking habits according to National Health Interview Survey of Health Promotion and Disease Prevention in 1991.

      

    1435 subjects were asked a single question “On any single occasion during the past 3 months, have you had more than 5 drinks containing alcohol?” It was placed between nonspecific questions concerning tobacco use, seat belts etc. 1368 answered the question.

      

    A positive predictive value was 74%, and a negative one in 88% for problem alcohol intake. Specificity of 93% and sensitivity of 62% is claimed.

       

    A single question well couched between the more innocent ones seems a good way of sorting out this problem.

          

  • Thun MJ, Peto R, Lopez AD, et al [American Cancer Society, Atlanta, Ga; Univ of Oxford, England; World Health Organization, Geneva]

    Alcohol Consumption and Mortality Among Middle-aged and Elderly U.S. Adults

    N Engl J Med 337: 1705-1714, 1997

      

    The participating population was more likely to be white, married, middle class and college educated. 4,90,000 such subjects above the age of 30 completed a 4-page format. The study began in 1982 and ended 9 years later. Death caused by specific diseases and general ones were compared. 

       

    Drinking alcohol is associated with alcoholism, cirrhosis of the liver and cancer of the mouth, upper respiratory tract, esophagus, liver and breast in women. Injuries in men are more likely. The effects of 1 drink a day are 30% increase in breast cancers in women compared to non drinking women. Death from cardiovascular disease is 30-40% less in both sexes. Death as an overall phenomenon was less with 1 drink a day. With increasing alcohol consumption in population younger than 60 years a greater mortality from all causes except cardiovascular [which diminished] was noted. Tobacco doubled the mortality.

       

    Message of this work is clear; Smoke to die early; and have a drink or two without smoking to live longer.

          

  • Deev A, Shestov D, Abernathy J, et al [Natl Ctr for Preventive Medicine of the Russian Federation, Moscow; Russian Academy of Med Sciences, St Petersburg, Russia; Univ of North Carolina, Chapel Hill]

    Association of Alcohol Consumption to Mortality in Middle-aged U.S. and Russian Men and Women

    Ann Epidemiol 8: 147-153, 1998

      

    This paper compares the effect of alcohol consumption in the overall mortality as well as due to cardiovascular disease [ CVD] between U.S. and Russian men and women. The U.S. -Russian Lipid Research Clinics Prevalence Study was done between the years 1972 and 1982. Men in the age group of 40 and 59 and women between 40-69 were studied for 13 years.

      

    Moderate alcohol intake has a protective value from CVD mortality as well as general causes of death in the US. This effect was not seen in the Russian population. Higher mortality and hypertension in Russians may be responsible for this difference.

          

  • Ferris LE, for the Delphi Panel and for the Consulting Group [Univ of Toronto; Sunnybrook Health Science Centre, North York, Ont, Canada; Inst for Clinical Evaluative Sciences, North York; et al]

    Guidelines for Managing Domestic Abuse When Male and Female Partners Are Patients of the Same Physician

    JAMA 278: 851-857, 1997

       

    Domestic abuse is more often seen by family physicians. They are more likely to know the family background better than specialists. Apart from these social workers, psychologist the law and its enforcing arm may be involved and nurses too.

       

    Apart from an up-to-date information, the physician should treat them separately. Before discussing with the partner the lady’s consent should be taken. Both are to be assured of confidentiality. Joint counseling or interviews are interdicted. It is not unethical to treat both partners even in the same practice.

       

    Apart from the groups described above almost any medical speciality may be involved.

           

  • Marital Distress and Domestic Violence

    Wagner PJ, Mongan PF [Med College of Georgia, Augusta]

    Validating the Concept of Abuse: Women’s Perceptions of Defining Behaviours and the Effects of Emotional Abuse on Health Indicators

    Arch Fam Med 7 : 25-29, 1998

      

    Emergency services treat around 54% women for being subjects of violence. Equal numbers from a rural and urban zones comprised 407 women above the age of 18 years that were interviewed and had their medical records studied. 64% were black.

      

    Women emotionally but not physically abused developed a variety of symptoms e.g. difficulty in sleeping, weight loss, hyperhidrosis, feeling of tiredness, muscle cramps, feeling hot or cold irrespective of the ambient temperature.

      

    Women consider many behavioral patterns as abusive. This is more so by the abused group rather than the non-abused ones. The abused lot have more medical consultations than the non-abused counterparts. A feeling of emotional abuse has a subjective feeling of lowered general health.

          

  • Oriel KA, Fleming MF [Univ of Wisconsin, Madison]

    Screening Men for Partner Violence in a Primary Care Setting : A New Strategy for detecting Domestic Violence

    J. Fam Pract 46: 493-498, 1998

      

    Violence in a family setting is being regarded in the last 10 years as a serious health issue. The abuser may be bothered by this and the issue may need a physician’s intervention or at least an inquiry. Three hundred and seventy five men were screened and 237 were included in the study. Violence was regarded as minor if it involved pushing, slapping or throwing; kicking, threatening use of a knife or gun constituted major violence.

        

    32 men reported physical violence against their partners in the previous year, 10 reported severe violence. Perpetrators of severe violence also indulged in minor violence. Increased intake of alcohol, depression and their own childhood abuse contributed to increase in violent behaviour. Physician intervention could improve the situation if asked for.

         

  • Baucom DH, Shoham V, Mueser KT, et al [ Univ of North Carolina, Chapel Hill; Univ of Arizona, Tucson; Dartmouth Univ, Hanover]

    Empirically supported Couple and Family Interventions for Marital Distress and Adult Mental Health Problems

    J Consult Clin Psychol 66: 53-88, 1998

      

    This paper reviews the empirical data on treatment of couples with marital distress and other mental health problems. A 3 decade period is involved in the review. Helping couples to resolve their destructive attitudes through understanding seems a better way than just waiting. Behavioral marital therapy, emotion-focussed treatment and insight-oriented marital treatment and others have been effective.

      

    It is not possible to say which therapy will prove useful in any given situation and sometimes nothing helps.

      

    Treatments for individuals may need family associated treatment. Thus couples with a marital problem and wife showing depression will certainly need treatment for both partners. Sexual difficulties and alcoholism seem better treated with both partners present together. Increasing understanding is required in the absence of research data.

          

  • Friedli K, King MB, Lloyd M, et al [ Royal Free Hosp, London]

    Randomized Controlled Assessment of Non-directive Psychotherapy Versus Routine General-Practioner Care

    Lancet 350: 1662-1665, 1997

      

    Patients trying to resolve their difficulties with brief psychotherapy and subsequent understanding is being practiced in England over a 20 year period. This paper deals with a question whether a general-practitioner could resolve this as competently as a psychiatrist. Between the years 1993 August and 1994 October patients [n=136] above the age of 18 years with emotional problems, were randomly divided into 2 groups. 70 females were treated by brief psychotherapy and 66 were handled in a general practice set up.

      

    Patients’ problems of depression or anxiety were usually the result of relationship and family induced.

       

    Both group of patients improved but those with psychotherapy were more satisfied at 3 and 9 months evaluation.

       

  • Krug Eg, Kresnow M-J, Peddicord JP, et al [Natl Ctr for Injury Prevention and Control, Ctrs for disease Control and Prevention, Atlanta, Ga]

    Suicide After Natural Disasters

    N Engl J Med 338: 373-378, 1998

      

    One and half million households suffer in the United States because of floods, earthquakes or hurricanes. A variety of Psychiatric disorders e.g. stress disorders, depression, domestic violence and symptoms referred to the respiratory cardiovascular and gastrointestinal systems continue to occur for 5 years or more after the event.

      

    Suicides: in the 4 year period after floods a 13.8% rise or 12.1 to 13.8 per 100,000 was recorded. Upto two years after a hurricane a rise of 31% or 12 to 15.7 per 100,000 was seen. In the first year after an earthquake 62.9% or 19.2 to 31.3 per 100,000 was noticed. In the later 4 years after earthquakes a further increase was not seen.

      

    All these suggest social help and other facilities to the affected population.

        

  • West CG, Reed DM, Gildengorin GL [Buck Ctr for Research in Aging, Novato, Calif]

    Can Money Buy Happiness? Depressive Symptoms in an Affluent Older Population

    J Am Geriatr Soc 46: 49-57, 1998

      

    Low income and depression in old people are regarded as normal companions. In this paper affluent community-dwelling older subjects were studied. They included 1948 non-institutionalized individuals over the age of 55 years. Questionnaire were filled and physical testing was carried out. Dominant complaint was depression.

         

    Social isolation, poor health and physical deficiency are important causes of depression. Reverse relationship between symptoms and income does not seem to be relevant.

       

  • Waddell C [McMaster Univ, Hamilton, Ont, Canada]

    Creativity and Mental Illness : Is There a Link?

    Can J Psychiatry 43: 166-172, 1998

       

    Despite an extensive MEDLINE search 29 empirical articles dealing with the subject were found.

       

    If a person is gifted with creativity and analyses his own mental problems the link is established by others!

      

    There seems no relationship between the two phenomena.

        

  • Davis P, McClure RJ, Rolfe K, et al [ Univ of Wales, Cardiff; St James’s Univ Hosp, Leeds, England]

    Procedures, Placement , and risks of Further Abuse After Munchausen Syndrome by Proxy, Non-accidental Poisoning, and Non-accidental Suffocation

    Arch Dis Child 78: 217-221, 1998

       

    An adult taking care of a child poisons or suffocates it or causes other harm to seek medical attention simulating a disease. This constitutes the munchausen syndrome by proxy. The condition may be best regarded as a severe form of child abuse. Milder forms of child abuse subjects when sent home again suffered abuse.

       

    It is of interest that 29% of adult victimizers were prosecuted and convicted. The non-accidental phenomena described above have high death rates, high rates of injury, family disruption as well as a bad effect on siblings. 

          

    The question that remains unanswered is how are children to be protected against their parents.

        



 

 

Speciality Spotlight

 

 

Mental Health and Psychiatry
 

  • Wind AW, Schellevis FG, [Vrije Universiteit Amsterdam]
    Limitations of the Mini-Mental State Examination in Diagnosing Dementia in General Practice
    Int J Geriatr Psychiatry 12: 101-108, 1997
      
    Increasing age of population is associated with dementia.
       
    After a detailed study of 214 men in the age group of 65 to 84 years a simple mode of testing is suggested. Day of the week, date, personal address and the present prime minister were considered adequate for evaluation of dementia or its absence in the elderly group. It proved to be specific to the tune of 93.3 percent.
       

  • Phillips CD, Sloane PD, Hawes C, et al [ Menorah Park Ctr for the Aging, Beachwood, Ohio; Univ of North Carolina, Chapel Hill; Research Triangle Inst, Research Triangle Park, NC]
    Effects of Residence in Alzheimer Disease Special Care Units on Functional Outcomes
    JAMA 278: 1340-1344, 1997
      
    Special care units [SCU] for patients of Alzheimer disease seem to be increasing; their usefulness for patients’ residence is being evaluated in this paper. A comparison between 77,337 residents in 800 nursing homes is made with 1288 in 48 SCUs. Evaluation quarterly for 1 year was done. Progressive decline in bodily functions and ability to look after oneself were used as parameters.
      
    No difference between SCU residents and those in general nursing homes was observed. This may have a financial importance.
          

  • Wimo A, Karlsson G, Nordberg A, et al [ Umea Univ, Sweden; Stockholm School of Economics; Karolinska Inst, Stockholm; et al]
    Treatment of Alzheimer Disease With Tacrine: A Cost-Analysis Model
    Alzheimer Dis Assoc Disord 11: 1191-200, 1997
      
    Low brain levels of acetylcholine cause deterioration of cognitive function in Alzheimer disease [AD]. A cholinesterase inhibitor such as tacrine logically prevents further destruction of acetylcholine hence is likely to be useful.
       
    The extra cost of treatment with tacrine is related to extra doses of the drug and monitoring. Benefits in management arise when treatment is started early [ Min- Mental State Examination Score at 24] rather than late. If nursing home care is delayed by one year and withdrawal of patients from institutions is carried out further cost reduction is achieved. Cost reductions would have country-wise differences e.g. 1.3% in Sweden and 17% in the US as pointed out in 1994.
           

  • Le Bars PL, for the North American EGb Study Group [New York Inst for Med Research, Tarrytown; et al]
    A Placebo-controlled, Double-blind, Randomized Trial of an Extract of Ginkgo Biloba for Dementia
    JAMA 278: 1327-1332, 1997
      
    Antioxidant effects of ginkgo biloba, EGb 761, are possible in its effects on dementia. Multi-infarct [MID] and Alzheimer disease [AD] were studied. 327 patients were taken this double blind placebo controlled trial. They had mild to moderate dementia and were evaluated for safety and efficacy periodically for 1 year. 120 mgm of the drug per day or a placebo were used. Daily living, cognitive change and social behaviour were used as parameters.
      
    Of the 327, 251 subjects had AD and 76 MID; of these 309 [AD 236 and 73 MID] were included in the intent-to-treat analysis [ITT]. 30% of each group had 1 adverse effect; two from the EGb group and 1 from the placebo group had to be dropped.
      
    Maintenance of a stable state or improvement in cognitive functions and social behaviour were observed in the treated patients. This was superior to the placebo group.
         

  • Drug and Alcohol Use
    Taj N, Devera-Sales A, Vinson DC [ Univ of Missouri-Columbia]
    Screening for Problem Drinking : Does a Single Question Work?
    J Fam Pract 46: 328-335, 1998
      
    Only 39% of patients were asked about alcohol drinking habits according to National Health Interview Survey of Health Promotion and Disease Prevention in 1991.
      
    1435 subjects were asked a single question “On any single occasion during the past 3 months, have you had more than 5 drinks containing alcohol?” It was placed between nonspecific questions concerning tobacco use, seat belts etc. 1368 answered the question.
      
    A positive predictive value was 74%, and a negative one in 88% for problem alcohol intake. Specificity of 93% and sensitivity of 62% is claimed.
       
    A single question well couched between the more innocent ones seems a good way of sorting out this problem.
          

  • Thun MJ, Peto R, Lopez AD, et al [American Cancer Society, Atlanta, Ga; Univ of Oxford, England; World Health Organization, Geneva]
    Alcohol Consumption and Mortality Among Middle-aged and Elderly U.S. Adults
    N Engl J Med 337: 1705-1714, 1997
      
    The participating population was more likely to be white, married, middle class and college educated. 4,90,000 such subjects above the age of 30 completed a 4-page format. The study began in 1982 and ended 9 years later. Death caused by specific diseases and general ones were compared. 
       
    Drinking alcohol is associated with alcoholism, cirrhosis of the liver and cancer of the mouth, upper respiratory tract, esophagus, liver and breast in women. Injuries in men are more likely. The effects of 1 drink a day are 30% increase in breast cancers in women compared to non drinking women. Death from cardiovascular disease is 30-40% less in both sexes. Death as an overall phenomenon was less with 1 drink a day. With increasing alcohol consumption in population younger than 60 years a greater mortality from all causes except cardiovascular [which diminished] was noted. Tobacco doubled the mortality.
       
    Message of this work is clear; Smoke to die early; and have a drink or two without smoking to live longer.
          

  • Deev A, Shestov D, Abernathy J, et al [Natl Ctr for Preventive Medicine of the Russian Federation, Moscow; Russian Academy of Med Sciences, St Petersburg, Russia; Univ of North Carolina, Chapel Hill]
    Association of Alcohol Consumption to Mortality in Middle-aged U.S. and Russian Men and Women
    Ann Epidemiol 8: 147-153, 1998
      
    This paper compares the effect of alcohol consumption in the overall mortality as well as due to cardiovascular disease [ CVD] between U.S. and Russian men and women. The U.S. -Russian Lipid Research Clinics Prevalence Study was done between the years 1972 and 1982. Men in the age group of 40 and 59 and women between 40-69 were studied for 13 years.
      
    Moderate alcohol intake has a protective value from CVD mortality as well as general causes of death in the US. This effect was not seen in the Russian population. Higher mortality and hypertension in Russians may be responsible for this difference.
          

  • Ferris LE, for the Delphi Panel and for the Consulting Group [Univ of Toronto; Sunnybrook Health Science Centre, North York, Ont, Canada; Inst for Clinical Evaluative Sciences, North York; et al]
    Guidelines for Managing Domestic Abuse When Male and Female Partners Are Patients of the Same Physician
    JAMA 278: 851-857, 1997
       
    Domestic abuse is more often seen by family physicians. They are more likely to know the family background better than specialists. Apart from these social workers, psychologist the law and its enforcing arm may be involved and nurses too.
       
    Apart from an up-to-date information, the physician should treat them separately. Before discussing with the partner the lady’s consent should be taken. Both are to be assured of confidentiality. Joint counseling or interviews are interdicted. It is not unethical to treat both partners even in the same practice.
       
    Apart from the groups described above almost any medical speciality may be involved.
           

  • Marital Distress and Domestic Violence
    Wagner PJ, Mongan PF [Med College of Georgia, Augusta]
    Validating the Concept of Abuse: Women’s Perceptions of Defining Behaviours and the Effects of Emotional Abuse on Health Indicators
    Arch Fam Med 7 : 25-29, 1998
      
    Emergency services treat around 54% women for being subjects of violence. Equal numbers from a rural and urban zones comprised 407 women above the age of 18 years that were interviewed and had their medical records studied. 64% were black.
      
    Women emotionally but not physically abused developed a variety of symptoms e.g. difficulty in sleeping, weight loss, hyperhidrosis, feeling of tiredness, muscle cramps, feeling hot or cold irrespective of the ambient temperature.
      
    Women consider many behavioral patterns as abusive. This is more so by the abused group rather than the non-abused ones. The abused lot have more medical consultations than the non-abused counterparts. A feeling of emotional abuse has a subjective feeling of lowered general health.
          

  • Oriel KA, Fleming MF [Univ of Wisconsin, Madison]
    Screening Men for Partner Violence in a Primary Care Setting : A New Strategy for detecting Domestic Violence
    J. Fam Pract 46: 493-498, 1998
      
    Violence in a family setting is being regarded in the last 10 years as a serious health issue. The abuser may be bothered by this and the issue may need a physician’s intervention or at least an inquiry. Three hundred and seventy five men were screened and 237 were included in the study. Violence was regarded as minor if it involved pushing, slapping or throwing; kicking, threatening use of a knife or gun constituted major violence.
        
    32 men reported physical violence against their partners in the previous year, 10 reported severe violence. Perpetrators of severe violence also indulged in minor violence. Increased intake of alcohol, depression and their own childhood abuse contributed to increase in violent behaviour. Physician intervention could improve the situation if asked for.
         

  • Baucom DH, Shoham V, Mueser KT, et al [ Univ of North Carolina, Chapel Hill; Univ of Arizona, Tucson; Dartmouth Univ, Hanover]
    Empirically supported Couple and Family Interventions for Marital Distress and Adult Mental Health Problems
    J Consult Clin Psychol 66: 53-88, 1998
      
    This paper reviews the empirical data on treatment of couples with marital distress and other mental health problems. A 3 decade period is involved in the review. Helping couples to resolve their destructive attitudes through understanding seems a better way than just waiting. Behavioral marital therapy, emotion-focussed treatment and insight-oriented marital treatment and others have been effective.
      
    It is not possible to say which therapy will prove useful in any given situation and sometimes nothing helps.
      
    Treatments for individuals may need family associated treatment. Thus couples with a marital problem and wife showing depression will certainly need treatment for both partners. Sexual difficulties and alcoholism seem better treated with both partners present together. Increasing understanding is required in the absence of research data.
          

  • Friedli K, King MB, Lloyd M, et al [ Royal Free Hosp, London]
    Randomized Controlled Assessment of Non-directive Psychotherapy Versus Routine General-Practioner Care
    Lancet 350: 1662-1665, 1997
      
    Patients trying to resolve their difficulties with brief psychotherapy and subsequent understanding is being practiced in England over a 20 year period. This paper deals with a question whether a general-practitioner could resolve this as competently as a psychiatrist. Between the years 1993 August and 1994 October patients [n=136] above the age of 18 years with emotional problems, were randomly divided into 2 groups. 70 females were treated by brief psychotherapy and 66 were handled in a general practice set up.
      
    Patients’ problems of depression or anxiety were usually the result of relationship and family induced.
       
    Both group of patients improved but those with psychotherapy were more satisfied at 3 and 9 months evaluation.
       

  • Krug Eg, Kresnow M-J, Peddicord JP, et al [Natl Ctr for Injury Prevention and Control, Ctrs for disease Control and Prevention, Atlanta, Ga]
    Suicide After Natural Disasters
    N Engl J Med 338: 373-378, 1998
      
    One and half million households suffer in the United States because of floods, earthquakes or hurricanes. A variety of Psychiatric disorders e.g. stress disorders, depression, domestic violence and symptoms referred to the respiratory cardiovascular and gastrointestinal systems continue to occur for 5 years or more after the event.
      
    Suicides: in the 4 year period after floods a 13.8% rise or 12.1 to 13.8 per 100,000 was recorded. Upto two years after a hurricane a rise of 31% or 12 to 15.7 per 100,000 was seen. In the first year after an earthquake 62.9% or 19.2 to 31.3 per 100,000 was noticed. In the later 4 years after earthquakes a further increase was not seen.
      
    All these suggest social help and other facilities to the affected population.
        

  • West CG, Reed DM, Gildengorin GL [Buck Ctr for Research in Aging, Novato, Calif]
    Can Money Buy Happiness? Depressive Symptoms in an Affluent Older Population
    J Am Geriatr Soc 46: 49-57, 1998
      
    Low income and depression in old people are regarded as normal companions. In this paper affluent community-dwelling older subjects were studied. They included 1948 non-institutionalized individuals over the age of 55 years. Questionnaire were filled and physical testing was carried out. Dominant complaint was depression.
         
    Social isolation, poor health and physical deficiency are important causes of depression. Reverse relationship between symptoms and income does not seem to be relevant.
       

  • Waddell C [McMaster Univ, Hamilton, Ont, Canada]
    Creativity and Mental Illness : Is There a Link?
    Can J Psychiatry 43: 166-172, 1998
       
    Despite an extensive MEDLINE search 29 empirical articles dealing with the subject were found.
       
    If a person is gifted with creativity and analyses his own mental problems the link is established by others!
      
    There seems no relationship between the two phenomena.
        

  • Davis P, McClure RJ, Rolfe K, et al [ Univ of Wales, Cardiff; St James’s Univ Hosp, Leeds, England]
    Procedures, Placement , and risks of Further Abuse After Munchausen Syndrome by Proxy, Non-accidental Poisoning, and Non-accidental Suffocation
    Arch Dis Child 78: 217-221, 1998
       
    An adult taking care of a child poisons or suffocates it or causes other harm to seek medical attention simulating a disease. This constitutes the munchausen syndrome by proxy. The condition may be best regarded as a severe form of child abuse. Milder forms of child abuse subjects when sent home again suffered abuse.
       
    It is of interest that 29% of adult victimizers were prosecuted and convicted. The non-accidental phenomena described above have high death rates, high rates of injury, family disruption as well as a bad effect on siblings. 
          
    The question that remains unanswered is how are children to be protected against their parents.
        

 

By |2022-07-20T16:44:30+00:00July 20, 2022|Uncategorized|Comments Off on Mental Health and Psychiatry

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