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White P, Abbey S, Angus B, Ball HA, Buchwald DS, Burness C, Carson AJ, Chalder T, Clauw DJ, Coebergh J, David AS, Dworetzky BA, Edwards MJ, Espay AJ, Etherington J, Fink P, Flottorp S, Garcin B, Garner P, Glasziou P, Hamilton W, Henningsen P, Hoeritzauer I, Husain M, Huys ACML, Knoop H, Kroenke K, Lehn A, Levenson JL, Little P, Lloyd A, Madan I, van der Meer JWM, Miller A, Murphy M, Nazareth I, Perez DL, Phillips W, Reuber M, Rief W, Santhouse A, Serranova T, Sharpe M, Stanton B, Stewart DE, Stone J, Tinazzi M, Wade DT, Wessely SC, Wyller V, Zeman A. Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis. J Neurol Neurosurg Psychiatry 2023; 94:1056-1063. [PMID: 37434321 DOI: 10.1136/jnnp-2022-330463] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/03/2023] [Indexed: 07/13/2023]
Abstract
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive-behavioural therapy should only be used to manage symptoms and reduce distress, not to aid recovery. This U-turn in recommendations from the previous 2007 guideline is controversial.We suggest that the controversy stems from anomalies in both processing and interpretation of the evidence by the NICE committee. The committee: (1) created a new definition of CFS/ME, which 'downgraded' the certainty of trial evidence; (2) omitted data from standard trial end points used to assess efficacy; (3) discounted trial data when assessing treatment harm in favour of lower quality surveys and qualitative studies; (4) minimised the importance of fatigue as an outcome; (5) did not use accepted practices to synthesise trial evidence adequately using GRADE (Grading of Recommendations, Assessment, Development and Evaluations trial evidence); (6) interpreted GET as mandating fixed increments of change when trials defined it as collaborative, negotiated and symptom dependent; (7) deviated from NICE recommendations of rehabilitation for related conditions, such as chronic primary pain and (8) recommended an energy management approach in the absence of supportive research evidence.We conclude that the dissonance between this and the previous guideline was the result of deviating from usual scientific standards of the NICE process. The consequences of this are that patients may be denied helpful treatments and therefore risk persistent ill health and disability.
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Affiliation(s)
- Peter White
- Wolfson Institute for Population Health, Queen Mary University Barts and The London School of Medicine and Dentistry, London, UK
| | - Susan Abbey
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brian Angus
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | | | - Alan J Carson
- Centre for Clinical Brain Sciences, Royal Infirmary, Edinburgh, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Daniel J Clauw
- Departments of Anesthesiology, Medicine and Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jan Coebergh
- Ashford St Peter's NHS Foundation Trust, Chertsey, St George's University Hospitals, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Barbara A Dworetzky
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark J Edwards
- Neuroscience Research Centre, St George's University, London, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Per Fink
- Research Clinic for Functional Disorders, Aarhus University, Aarhus, Denmark
| | - Signe Flottorp
- Centre for Epidemic Interventions Research, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Béatrice Garcin
- Hopital Avicenne, Universite Sorbonne Paris Nord - Campus de Bobigny, Bobigny, France
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Willie Hamilton
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Peter Henningsen
- Psychosomatic Medicine, University Hospital, Technical University Munich, Munich, Germany
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mujtaba Husain
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Hans Knoop
- Department of Medical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexander Lehn
- Brisbane Clinical Neuroscience Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew Lloyd
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ira Madan
- Faculty of Occupational Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical College, Nijmegen, Netherlands
| | - Alastair Miller
- Department of Medicine, Cumberland Infirmary Carlisle, Carlisle, UK
| | - Maurice Murphy
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Irwin Nazareth
- Primary Care & Population Science, University College London, London, UK
| | - David L Perez
- Neurology and Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Markus Reuber
- Department of Neuroscience, The Medical School, University of Sheffield, Sheffield, UK
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy Clinic, University of Marburg, Marburg, Germany
| | - Alastair Santhouse
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Tereza Serranova
- Dept. of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford, Oxford, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital, London, UK
| | - Donna E Stewart
- Centre for Mental Health, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Jon Stone
- Centre for Clinical Brain Sciences, Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Derick T Wade
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Simon C Wessely
- Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Vegard Wyller
- Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Adam Zeman
- Cognitve Neurology Research Group, University of Exeter Medical School, Exeter, UK
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Bègue I, Nicholson TR, Kozlowska K, LaFrance WC, Levenson JL, Rapaport MH, Carson AJ, Perez DL. Psychiatry's modern role in functional neurological disorder: join the renaissance. Psychol Med 2021; 51:1961-1963. [PMID: 34167595 DOI: 10.1017/s0033291721002038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Indrit Bègue
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Service of Neurology, Department of Clinical Neuroscience, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, Laboratory for Clinical and Experimental Psychopathology, University of Geneva, Geneva, Switzerland
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Psychiatry and Discipline of Child & Adolescent Health, University of Sydney Medical School, Sydney, Australia
- Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown Medical School, Providence, RI, USA
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Mark H Rapaport
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Fiedorowicz JG, Levenson JL, Leentjens AFG. When is lack of scientific integrity a reason for retracting a paper? A case study. J Psychosom Res 2021; 144:110412. [PMID: 33730636 DOI: 10.1016/j.jpsychores.2021.110412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The journal received a request to retract a paper reporting the results of a triple-blind randomized placebo-controlled trial. The present and immmediate past editors expand on the journal's decision not to retract this paper in spite of undisputable evidence of scientific misconduct on behalf of one of the investigators. METHODS The editors present an ethical reflection on the request to retract this randomized clinical trial with consideration of relevant guidelines from the Committee on Publication Ethics (COPE) and the International Committee of Medical Journal Editors (ICMJE) applied to the unique contextual issues of this case. RESULTS In this case, scientific misconduct by a blinded provider of a homeopathy intervention attempted to undermine the study blind. As part of the study, the integrity of the study blind was assessed. Neither participants nor homeopaths were able to identify whether the participant was assigned to homeopathic medicine or placebo. Central to the decision not to retract the paper was the fact that the rigorous scientific design provided evidence that the outcome of the study was not affected by the misconduct. The misconduct itself was thought to be insufficient reason to retract the paper. CONCLUSION Retracting a paper of which the outcome is still valid was in itself considered unethical, as it takes away the opportunity to benefit from its results, rendering the whole study useless. In such cases, scientific misconduct is better handled through other professional channels.
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Affiliation(s)
- Jess G Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada.
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Centre, Maastricht, the Netherlands
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Abstract
Introduction Despite the paucity of studies evaluating short-acting parenteral second-generation antipsychotics in the medically ill, their use in this population has increased. The purpose of this study was to characterize the use of IM olanzapine and ziprasidone in the medically ill at an academic medical center. Methods This is a retrospective medical record review of all patients who received IM olanzapine or ziprasidone on nonpsychiatric inpatient units at a large academic medical center from August 1, 2015 to July 31, 2017. The primary endpoint characterized the indication for use. Secondary endpoints included safety, effectiveness, and prescribing patterns. Results After exclusion criteria, a total of 100 patients were included in this study, predominantly white males with a mean age of 56 years. Seventy-four percent of patients received IM ziprasidone and 26% received IM olanzapine. The most common indications for use were agitation of nonpsychotic origin (40%) and delirium (33%). Patients received IM olanzapine and ziprasidone when their use was contraindicated (26.9% vs 9.5%, respectively). Discussion Intramuscular second-generation antipsychotics are increasingly being used in the medically ill for delirium and agitation. Our study confirms these were the most common indications for IM second-generation antipsychotic use in this population. Additionally, their use appeared to be well-tolerated, and no patient developed Torsades de Pointes even when combined with other agents that putatively increase QTc. Given the retrospective, single-center, nonrandomized design of this study, the safety and effectiveness of these parenteral second-generation antipsychotics in common causes of acute agitation should continue to be further evaluated.
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Affiliation(s)
- Seema M Patel
- Associate Professor of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University Health System, Department of Pharmacy Services, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.,Rhona Arenstein Professor of Psychiatry, Virginia Commonwealth University Health System, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Ericka L Crouse
- Associate Professor of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University Health System, Department of Pharmacy Services, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - James L Levenson
- Rhona Arenstein Professor of Psychiatry, Virginia Commonwealth University Health System, Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Funk MC, Beach SR, Bostwick JR, Celano C, Hasnain M, Pandurangi A, Khandai AC, Taylor A, Levenson JL, Riba M, Kovacs RJ. QTc Prolongation and Psychotropic Medications. Am J Psychiatry 2020; 177:273-274. [PMID: 32114782 DOI: 10.1176/appi.ajp.2019.1760501] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Somatic symptom disorder (SSD) is defined by the prominence of somatic symptoms associated with abnormal thoughts, feelings, and behaviors related to the symptoms, resulting in significant distress and impairment. Individuals with these disorders are more commonly encountered in primary care and other medical settings, including dermatology practice, than in psychiatric and other mental health settings. What defines the thoughts, feelings, and behaviors as abnormal is that they are excessive, that is, out of proportion to other patients with similar somatic symptoms, and that they result in significant distress and impairment. SSD may occur with or without the presence of a diagnosable dermatologic disorder. When a dermatologic disorder is present, SSD should be considered when the patient is worrying too much about his or her skin, spending too much time and energy on it, and especially if the patient complains of many nondermatologic symptoms in addition. The differential diagnosis includes other psychiatric disorders, including depression, anxiety disorders, delusions of parasitosis, and body dysmorphic disorder. This paper describes SSD and its applicability in dermatologic practice, with illustrative cases.
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Affiliation(s)
- James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
| | - Aditi A Sharma
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University School of Medicine, Portland, Oregon
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Abstract
This article outlines psychosocial and ethical issues to be considered when evaluating potential living organ donors. Six types of living donors are described: genetically related, emotionally related, “Good Samaritan” (both directed and nondirected), vendors, and organ exchangers. The primary domains to be assessed in the psychosocial evaluation are informed consent, motivation for donating and the decision-making process, adequacy of support (financial and social), behavioral and psychological health, and the donor-recipient relationship. Obstacles to the evaluation process include impression management, overt deception, minimization of behavioral risk factors, and cultural and language differences between the donor and the evaluator. Ethical concerns, such as the right to donate, donor autonomy, freedom from coercion, nonmaleficence and beneficence in donor selection, conflicts of interest, “reasonable” risks to donors, and recipient decision making are also explored. To fully evaluate living organ donation, studying psychosocial as well as medical outcomes is crucial.
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Affiliation(s)
- M E Olbrisch
- Medical College of Virginia of Virginia Commonwealth University, Richmond, Va., USA
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Abstract
The name given to functional neurologic symptoms has evolved over time in the different editions of the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM), reflecting a gradual move away from an etiologic conception rooted in hysterical conversion to an empiric phenomenologic one, emphasizing the central role of the neurologic examination and testing in demonstrating that the symptoms are incompatible with recognized neurologic disease pathophysiology, or are internally inconsistent.
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Affiliation(s)
- J L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | - M Sharpe
- Department of Psychiatry, University of Oxford, Oxford, UK
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Levenson JL. Capacity Evaluations in Late-Stage Pregnancy. Psychosomatics 2015; 56:712. [PMID: 26674488 DOI: 10.1016/j.psym.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
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Levis AW, Leentjens AFG, Levenson JL, Lumley MA, Thombs BD. Comparison of self-citation by peer reviewers in a journal with single-blind peer review versus a journal with open peer review. J Psychosom Res 2015; 79:561-5. [PMID: 26337110 DOI: 10.1016/j.jpsychores.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/14/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Some peer reviewers may inappropriately, or coercively request that authors include references to the reviewers' own work. The objective of this study was to evaluate whether, compared to reviews for a journal with single-blind peer review, reviews for a journal with open peer review included (1) fewer self-citations; (2) a lower proportion of self-citations without a rationale; and (3) a lower ratio of proportions of citations without a rationale in self-citations versus citations to others' work. METHODS Peer reviews for published manuscripts submitted in 2012 to a single-blind peer review journal, the Journal of Psychosomatic Research, were previously evaluated (Thombs et al., 2015). These were compared to publically available peer reviews of manuscripts published in 2012 in an open review journal, BMC Psychiatry. Two investigators independently extracted data for both journals. RESULTS There were no significant differences between journals in the proportion of all reviewer citations that were self-citations (Journal of Psychosomatic Research: 71/225, 32%; BMC Psychiatry: 90/315, 29%; p=.50), or in the proportion of self-citations without a rationale (Journal of Psychosomatic Research: 15/71, 21%; BMC Psychiatry: 12/90, 13%; p=.21). There was no significant difference between journals in the proportion of self-citations versus citations to others' work without a rationale (p=.31). CONCLUSION Blind and open peer review methodologies have distinct advantages and disadvantages. The present study found that, in reasonably similar journals that use single-blind and open review, there were no substantive differences in the pattern of peer reviewer self-citations.
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Affiliation(s)
- Alexander W Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada; Departments of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada; Department of Psychology, McGill University, Montreal, QC, Canada; School of Nursing, McGill University, Montreal, QC, Canada.
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Witte MM, Foster NL, Fleisher AS, Williams MM, Quaid K, Wasserman M, Hunt G, Roberts JS, Rabinovici GD, Levenson JL, Hake AM, Hunter CA, Van Campen LE, Pontecorvo MJ, Hochstetler HM, Tabas LB, Trzepacz PT. Clinical use of amyloid-positron emission tomography neuroimaging: Practical and bioethical considerations. Alzheimers Dement (Amst) 2015; 1:358-67. [PMID: 27239516 PMCID: PMC4878065 DOI: 10.1016/j.dadm.2015.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Until recently, estimation of β-amyloid plaque density as a key element for identifying Alzheimer's disease (AD) pathology as the cause of cognitive impairment was only possible at autopsy. Now with amyloid-positron emission tomography (amyloid-PET) neuroimaging, this AD hallmark can be detected antemortem. Practitioners and patients need to better understand potential diagnostic benefits and limitations of amyloid-PET and the complex practical, ethical, and social implications surrounding this new technology. To complement the practical considerations, Eli Lilly and Company sponsored a Bioethics Advisory Board to discuss ethical issues that might arise from clinical use of amyloid-PET neuroimaging with patients being evaluated for causes of cognitive decline. To best address the multifaceted issues associated with amyloid-PET neuroimaging, we recommend this technology be used only by experienced imaging and treating physicians in appropriately selected patients and only in the context of a comprehensive clinical evaluation with adequate explanations before and after the scan.
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Affiliation(s)
- Michael M Witte
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Norman L Foster
- Center for Alzheimer's Care, Imaging and Research, Department of Neurology, The Brain Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Monique M Williams
- IPC The Hospitalist Company, Inc., St. Louis, MO, USA; VITAS Innovative Hospice, St. Louis, MO, USA
| | - Kimberly Quaid
- Indiana University Center for Bioethics, Indianapolis, IN, USA
| | - Michael Wasserman
- Division of Geriatric Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Gail Hunt
- National Alliance for Caregiving, Bethesda, MD, USA
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Gil D Rabinovici
- Memory & Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Ann Marie Hake
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Craig A Hunter
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Luann E Van Campen
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Linda B Tabas
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Paula T Trzepacz
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
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Smith WR, McClish DK, Dahman BA, Levenson JL, Aisiku IP, de A Citero V, Bovbjerg VE, Roberts JD, Penberthy LT, Roseff SD. Daily home opioid use in adults with sickle cell disease: The PiSCES project. J Opioid Manag 2015; 11:243-253. [PMID: 25985809 DOI: 10.5055/jom.2015.0273] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Although opioid prescribing in sickle cell disease (SCD) can be controversial, little is published about patterns of opioid use. OBJECTIVE To report on home opioid use among adults with SCD. DESIGN Cohort study. PARTICIPANTS Adults with SCD (n=219) who completed daily pain diaries for up to 6 months and had at least one home pain day. MAIN MEASURES Use of long-acting or short-acting opioids, other analgesics, or adjuvants; the proportion of home days, home pain days, and home crisis days with opioid use; these two outcomes according to patient characteristics. KEY RESULTS Patients used opioids on 12,311 (78 percent) of 15,778 home pain days. Eighty-five patients (38.8 percent) used long-acting opioids with or without short-acting opioids and 103 (47.0 percent) used only short-acting opioids. Twenty-one (9.6 percent) patients used only non-opioid analgesics and 10 (4.6 percent) used no analgesics. Both pain intensity and pain frequency were higher among opioid users (analysis of variance [ANOVA], p<0.0001). Opioid users used hydroxyurea more often than nonusers, even when controlling for mean pain on pain days. Among all patients, significant relationships were found between any opioid use and somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL); the relationship with SCD stress and physical QOL remained when controlled for mean pain. Among opioid users, similar associations were found between frequency of opioid use and some disease-related and psychosocial variables. CONCLUSIONS In this adult SCD sample, opioids were used by the majority of patients. Pain was the overwhelming characteristic associated with use, but disease-related and psychosocial variables were also associated.
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Affiliation(s)
- Wally R Smith
- Florence Neal Cooper Smith Professor of Sickle Cell Disease, Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Donna K McClish
- Professor, Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Bassam A Dahman
- Assistant Professor, Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Imoigele P Aisiku
- Assistant Professor, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vanessa de A Citero
- Dept. de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Viktor E Bovbjerg
- Associate Professor, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - John D Roberts
- Professor, Section of Medical Oncology, Department of Medicine, Director, Yale Adult Sickle Cell Program, Smilow Cancer Hospital at Yale - New Haven, New Haven, Connecticut
| | - Lynne T Penberthy
- Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Susan D Roseff
- Chair, Division of Clinical Pathology, Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
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Stewart KE, Haller DL, Sargeant C, Levenson JL, Puri P, Sanyal AJ. Readiness for behaviour change in non-alcoholic fatty liver disease: implications for multidisciplinary care models. Liver Int 2015; 35:936-43. [PMID: 24521540 PMCID: PMC4266620 DOI: 10.1111/liv.12483] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 01/31/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Weight management is a cornerstone of treatment for overweight/obese persons with non-alcoholic fatty liver disease (NAFLD). This exploratory study sought to: (i) evaluate readiness to change weight-related behaviours; (ii) assess psychosocial characteristics that may interfere with weight loss; and (iii) evaluate how baseline psychosocial features associate with 6-month change in weight in persons with NAFLD receiving standard medical care. The purpose of this investigation was to develop hypotheses regarding relationships between psychosocial factors and weight for use in future fully powered studies and clinical interventions METHODS Fifty-eight overweight/obese participants with NAFLD completed baseline measures of personality, psychiatric symptoms and readiness for behaviour change and were followed up for 6 months in standard care. RESULTS One-third of participants (31.0%) were not interested in making weight-related behaviour changes; 58.6% were considering making a change, and 10.4% of individuals were actively working on or preparing to change. Six-month change in weight was non-significant and was not associated with baseline readiness for change. Depression, low conscientiousness and high neuroticism were associated with higher weight at 6-month follow-up with small to large effect sizes. CONCLUSIONS Although participants received nutritional education and guidance, very few individuals presented in the active stage of change. Although readiness for change did not predict subsequent change in weight, personality factors and psychiatric symptoms were associated with weight outcomes. Integrated multidisciplinary approaches that address psychiatric needs and provide behavioural support for weight loss may help patients with NAFLD implement sustained lifestyle changes.
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Affiliation(s)
- Karen E. Stewart
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University School of Medicine, Richmond, VA, USA,Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Carol Sargeant
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - James L. Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Puneet Puri
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Arun J. Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Thombs BD, Levis AW, Razykov I, Syamchandra A, Leentjens AFG, Levenson JL, Lumley MA. Potentially coercive self-citation by peer reviewers: a cross-sectional study. J Psychosom Res 2015; 78:1-6. [PMID: 25300537 DOI: 10.1016/j.jpsychores.2014.09.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 08/14/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Peer reviewers sometimes request that authors cite their work, either appropriately or via coercive self-citation to highlight the reviewers' work. The objective of this study was to determine in peer reviews submitted to one biomedical journal (1) the extent of peer reviewer self-citation; (2) the proportion of reviews recommending revision or acceptance versus rejection that included reviewer self-citations; and (3) the proportion of reviewer self-citations versus citations to others that included a rationale. METHODS Peer reviews for manuscripts submitted in 2012 to the Journal of Psychosomatic Research were evaluated. Data extraction was performed independently by two investigators. RESULTS There were 616 peer reviews (526 reviewers; 276 manuscripts), of which 444 recommended revision or acceptance and 172 rejection. Of 428 total citations, there were 122 peer reviewer self-citations (29%) and 306 citations to others' work (71%). Self-citations were more common in reviews recommending revision or acceptance (105 of 316 citations; 33%) versus rejection (17/112; 15%; p<0.001). The percentage of self-citations with no rationale (26 of 122; 21%) was higher than for citations to others' work (15 of 306; 5%; p<0.001). CONCLUSIONS Self-citation in peer reviews is common and may reflect a combination of appropriate citation to research that should be cited in published articles and inappropriate citation intended to highlight the work of the peer reviewer. Providing instructions to peer reviewers about self-citation and asking them to indicate when and why they have self-cited may help to limit self-citation to appropriate, constructive recommendations.
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Affiliation(s)
- Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada; School of Nursing, McGill University, Montreal, Quebec, Canada.
| | - Alexander W Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Ilya Razykov
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Achyuth Syamchandra
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA
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Boland RJ, Becker M, Levenson JL, Servis M, Crone CC, Edgar L, Thomas CR. The milestones for psychosomatic medicine subspecialty training. Psychosomatics 2014; 56:153-67. [PMID: 25660433 DOI: 10.1016/j.psym.2014.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 11/06/2014] [Accepted: 11/06/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Accreditation Council of Graduate Medical Education Milestones project is a key element in the Next Accreditation System for graduate medical education. On completing the general psychiatry milestones in 2013, the Accreditation Council of Graduate Medical Education began the process of creating milestones for the accredited psychiatric subspecialties. METHODS With consultation from the Academy of Psychosomatic Medicine, the Accreditation Council of Graduate Medical Education appointed a working group to create the psychosomatic medicine milestones, using the general psychiatry milestones as a starting point. RESULTS This article represents a record of the work of this committee. It describes the history and rationale behind the milestones, the development process used by the working group, and the implications of these milestones on psychosomatic medicine fellowship training. CONCLUSIONS The milestones, as presented in this article, will have an important influence on psychosomatic medicine training programs. The implications of these include changes in how fellowship programs will be reviewed and accredited by the Accreditation Council of Graduate Medical Education and changes in the process of assessment and feedback for fellows.
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Affiliation(s)
- Robert J Boland
- Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (RJB).
| | | | | | - Mark Servis
- University of California, Davis, Davis, CA (MS)
| | | | - Laura Edgar
- Accreditation Council for Graduate Medical Education, Chicago, IL (LE)
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Leentjens AFG, Levenson JL. Ethical issues concerning the recruitment of university students as research subjects: reply to Lumley and Jasinski. J Psychosom Res 2013; 75:400. [PMID: 24119951 DOI: 10.1016/j.jpsychores.2013.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
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Hyphantis TN, Pappas AI, Vlahos AP, Carvalho AF, Levenson JL, Kolettis TM. Depressive symptoms and neurocardiogenic syncope in children: a 2-year prospective study. Pediatrics 2012; 130:906-13. [PMID: 23027165 DOI: 10.1542/peds.2012-1379] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate prospectively the relationship between neurocardiogenic syncope (NCS) and depressive symptoms in pediatric patients. METHODS Forty-five patients (aged 12.3 ± 2.9 years) with NCS (diagnosed as ≥ 1 syncopal episodes with typical symptoms, reproduced by tilt-table testing, in the absence of structural or primary electrical heart disease) were compared with 45 age- and gender-matched control subjects. Assessment was performed at baseline and 2 years thereafter. Depressive symptoms and self-perception profile of participants were evaluated, along with their parents' psychological distress, defensive profile and hostility. Family cohesion and adaptability, as well as the opinion of parents and teachers on children's strengths and difficulties, were also examined. RESULTS At baseline, patients showed more (P = .008) depressive symptoms than controls, correlating with the number of syncopal episodes, impaired relationship with parents and poor family cohesion. A conservative management strategy of NCS was adopted and psychological counseling was offered, focusing on patients with clinically significant depressive symptoms and their families. During follow-up, depressive symptoms decreased in patients (P < .001), but remained stable in controls. Child-parent relationship, family cohesion and family adaptability improved at follow-up in patients. No recurrent syncope was noted during follow-up and this along with improvement in child-parent relationship were associated with depressive symptoms improvement. CONCLUSIONS Depressive symptomatology is common in pediatric patients with NCS. Our findings call for additional investigation in larger controlled clinical interventional studies that will enhance understanding of the possible pathophysiological association between depressive symptomatology and NCS in pediatric populations.
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Affiliation(s)
- Thomas N Hyphantis
- Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.
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Abstract
Chronic illnesses incur a tremendous cost to American lives in dollars and quality of life. Outcomes in these illnesses are often affected by psychological, behavioral, and pharmacologic issues related to mental illness and psychological symptoms. This article focuses on psychological and psychiatric issues related to the treatment of obesity and nonalcoholic fatty liver disease (NAFLD), including available weight-loss interventions, the complex relationship between psychiatric disorders and obesity, and special considerations regarding use of psychiatric drugs in patients with or at risk for NAFLD and obesity. Recommendations for collaborative care of individuals with comorbid NAFLD and psychological disorders/symptoms are discussed.
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Stone J, LaFrance WC, Brown R, Spiegel D, Levenson JL, Sharpe M. Conversion disorder: current problems and potential solutions for DSM-5. J Psychosom Res 2011; 71:369-76. [PMID: 22118377 DOI: 10.1016/j.jpsychores.2011.07.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 07/10/2011] [Accepted: 07/19/2011] [Indexed: 11/16/2022]
Abstract
Conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) describes neurological symptoms, including weakness, numbness and events resembling epilepsy or syncope, which can be positively identified as not being due to recognised neurological disease. This review combines perspectives from psychiatry, psychology and neurology to identify and discuss key problems with the current diagnostic DSM-IV criteria for conversion disorder and to make the following proposals for DSM-5: (a) abandoning the label "conversion disorder" and replacing it with an alternative term that is both theoretically neutral and potentially more acceptable to patients and practitioners; (b) relegating the requirements for "association of psychological factors" and the "exclusion of feigning" to the accompanying text; (c) adding a criterion requiring clinical findings of internal inconsistency or incongruity with recognised neurological or medical disease and altering the current 'disease exclusion' criteria to one in which the symptom must not be 'better explained' by a disease if present, (d) adding a 'cognitive symptoms' subtype. We also discuss whether conversion symptoms are better classified with other somatic symptom disorders or with dissociative disorders and how we might address the potential heterogeneity of conversion symptoms in classification.
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Affiliation(s)
- Jon Stone
- Dept Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh EH4 2XU, UK.
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Sogutlu A, Levenson JL, McClish DK, Rosef SD, Smith WR. Somatic symptom burden in adults with sickle cell disease predicts pain, depression, anxiety, health care utilization, and quality of life: the PiSCES project. Psychosomatics 2011; 52:272-9. [PMID: 21565599 DOI: 10.1016/j.psym.2011.01.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 10/18/2010] [Accepted: 10/19/2010] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Somatic symptoms have been extensively studied in primary care, but infrequently in diseases causing pain in multiple sites. We therefore examined the impact of somatic symptom burden (SSB) on pain, depression, anxiety, health-care utilization, and quality-of-life in adults with sickle cell disease (SCD). METHODS Subjects were 230 adults in the prospective Pain in Sickle Cell Epidemiology Study (PiSCES). Baseline data included demographics, genotype, Patient Health Questionnaire (PHQ), and SF-36 health-related quality of life (HRQOL). In daily diaries for 6 months, patients recorded SCD pain and SCD health-care utilization. To exclude common SCD pain sites, we abridged the PHQ's 15 somatic symptoms to 11 (PHQscd). We divided subjects into two groups: PHQscd≥11 (high SSB), and PHQscd<11 (low SSB). RESULTS High SSB occurred in 18.3% of subjects and was more frequent in women than men (24.6% vs. 9.1%, p=0.0033). Sixty percent of subjects with anxiety and 37.5% of those with depression had comorbid high SSB. Percentage of pain days not in crisis pain was significantly higher in somatizers, but crisis pain did not differ between groups. The high SSB group's hospitalization, scheduled doctor visits, and overall utilization, particularly on non-crisis days were significantly higher than the low SSB group's (p values < 0.05). All SF-36 subscales were significantly negatively correlated with PHQscd (p<0.0001). CONCLUSIONS Even after excluding common SCD pain complaints, high somatic symptom burden was 1.5 to 2 times more prevalent in SCD patients than in primary care. High SSB in SCD predicts more non-crisis pain and healthcare utilization for pain, and is associated with depression, anxiety, and poorer HRQOL.
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Affiliation(s)
- Aslihan Sogutlu
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA
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Affiliation(s)
- James L Levenson
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, Ricmond, VA 23298, USA.
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Gurrera RJ, Caroff SN, Cohen A, Carroll BT, DeRoos F, Francis A, Frucht S, Gupta S, Levenson JL, Mahmood A, Mann SC, Policastro MA, Rosebush PI, Rosenberg H, Sachdev PS, Trollor JN, Velamoor VR, Watson CB, Wilkinson JR. An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method. J Clin Psychiatry 2011; 72:1222-8. [PMID: 21733489 DOI: 10.4088/jcp.10m06438] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The lack of generally accepted diagnostic criteria for neuroleptic malignant syndrome (NMS) impedes research and clinical management of patients receiving antipsychotic medications. The purpose of this study was to develop NMS diagnostic criteria reflecting a broad consensus among clinical knowledge experts, represented by an international multispecialty physician panel. PARTICIPANTS Eleven psychiatrists, 2 neurologists, 2 anesthesiologists, and 2 emergency medicine specialists participated in a formal Delphi consensus procedure. EVIDENCE A core bibliography consisting of 12 prominent, current reviews of the NMS literature was identified by an objective, comprehensive electronic search strategy. Each panel member was given a copy of these references and asked to examine them before commencing the survey process. CONSENSUS PROCESS After reviewing the core bibliography, panel members were asked to list any clinical signs or symptoms or diagnostic studies that they believed, on the basis of their knowledge and clinical experience, were useful in making a diagnosis of NMS. In subsequent survey rounds, panel members assigned priority points to these items, and items that failed to receive a minimum priority score were eliminated from the next round. Information about individual panel member responses was fed back to the group anonymously in the form of the group median or mean and the number of members who had ranked or scored each survey item. The a priori consensus endpoint was defined operationally as a change of 10% or less in the mean priority score for any individual item, and an average absolute value change of 5% or less across all items, between consecutive rounds. The survey was conducted from January 2009 through September 2009. RESULTS Consensus was reached on the fifth round regarding the following criteria: recent dopamine antagonist exposure, or dopamine agonist withdrawal; hyperthermia; rigidity; mental status alteration; creatine kinase elevation; sympathetic nervous system lability; tachycardia plus tachypnea; and a negative work-up for other causes. The panel also reached a consensus on the relative importance of these criteria and on the following critical values for quantitative criteria: hyperthermia, > 100.4°F or > 38.0°C on at least 2 occasions; creatine kinase elevation, at least 4 times the upper limit of normal; blood pressure elevation, ≥ 25% above baseline; blood pressure fluctuation, ≥ 20 mm Hg (diastolic) or ≥ 25 mm Hg (systolic) change within 24 hours; tachycardia, ≥ 25% above baseline; and tachypnea, ≥ 50% above baseline. CONCLUSIONS These diagnostic criteria significantly advance the field because they represent the consensus of an international multispecialty expert panel, include critical values, provide guidance regarding the relative importance of individual elements, and are less influenced by particular theoretical biases than most previously published criteria. They require validation before being applied in clinical settings.
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Affiliation(s)
- Ronald J Gurrera
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
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Olbrisch ME, Levenson JL, Newman JD. Children as living organ donors: current views and practice in the United States. Curr Opin Organ Transplant 2010; 15:241-4. [DOI: 10.1097/mot.0b013e328337352a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Levenson JL, Bialer P. An anonymous survey of psychosomatic medicine fellowship directors regarding breaches of contracts and a proposal for prevention. Acad Psychiatry 2010; 34:54-56. [PMID: 20071729 DOI: 10.1176/appi.ap.34.1.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The authors studied how often applicants accept positions at more than one program, or programs offer positions to applicants who have already signed contracts with other programs. METHODS An anonymous survey was distributed to all psychosomatic medicine fellowship program directors. RESULTS It is fairly common for applicants to sign contracts for fellowship positions and then back out of the contracts. Only one program reported ever knowingly offering a contract to an applicant who had accepted a position elsewhere. Programs are divided over whether there are extenuating circumstances under which it would be acceptable to offer a position to an applicant who has already signed a contract with another program. CONCLUSION Guidelines for fellowship programs that do not use the National Resident Match Program can improve the recruitment process.
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Affiliation(s)
- James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, P.O. Box 980268, Richmond, VA 23298. USA.
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Worley LLM, Levenson JL, Stern TA, Epstein SA, Rundell JR, Crone CC, Wise TN, Rummans TA, Muskin PR, Bourgeois JA, Saravay SM, Pao M, Alter C, Steinberg M, Wulsin L, Breitbart W, Fricchione GL, Boland R, Epstein LA, Winstead D, Gitlin DF. Core competencies for fellowship training in psychosomatic medicine: a collaborative effort by the APA Council on Psychosomatic Medicine, the ABPN Psychosomatic Committee, and the Academy of Psychosomatic Medicine. Psychosomatics 2009; 50:557-62. [PMID: 19996225 DOI: 10.1176/appi.psy.50.6.557] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Linda L M Worley
- University of Arkansas Medical School, Little Rock, AR 72205, USA.
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Worley LL, Levenson JL, Stern TA, Epstein SA, Rundell JR, Crone CC, Wise TN, Rummans TA, Muskin PR, Bourgeois JA, Saravay SM, Pao M, Alter C, Steinberg M, Wulsin L, Breitbart W, Fricchione GL, Boland R, Epstein LA, Winstead D, Gitlin DF. Core Competencies for Fellowship Training in Psychosomatic Medicine: A Collaborative Effort by the APA Council on Psychosomatic Medicine, the ABPN Psychosomatic Committee, and The Academy of Psychosomatic Medicine. Psychosomatics 2009. [DOI: 10.1016/s0033-3182(09)70856-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Levenson JL. Response to "The guideline 'consultation psychiatry' of the Netherlands Psychiatric Association". J Psychosom Res 2009; 66:538-9. [PMID: 19446715 DOI: 10.1016/j.jpsychores.2009.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 02/24/2009] [Accepted: 02/24/2009] [Indexed: 11/19/2022]
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Levenson JL, Olbrisch ME. An opportunity to correct an error and any misimpressions. Prog Transplant 2009; 18:231. [PMID: 19186574 DOI: 10.1177/152692480801800403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Aisiku IP, Smith WR, McClish DK, Levenson JL, Penberthy LT, Roseff SD, Bovbjerg VE, Roberts JD. Comparisons of high versus low emergency department utilizers in sickle cell disease. Ann Emerg Med 2008; 53:587-93. [PMID: 18926599 DOI: 10.1016/j.annemergmed.2008.07.050] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 07/12/2008] [Accepted: 07/30/2008] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Patients with sickle cell disease often receive a substantial amount of their health care in the emergency department (ED) and some come to the ED frequently, seeking treatment for pain. As a result, patients with sickle cell disease are often stigmatized as opioid-seeking ED overutilizers. We describe the proportion of sickle cell disease patients who are high utilizers of the ED and compare them with other sickle cell disease patients on demographics, pain characteristics, health data, psychosocial characteristics, and quality of life. METHODS Two hundred thirty-two patients completed baseline data and at least 30 days of daily diary data. Baseline data included demographics, health data, and quality of life (Medical Outcome Study 36 Item Short Form). Daily diary data included ED utilization for sickle cell pain and descriptors of pain and distress. RESULTS Eighty-two (35.5%) patients were found to be high ED utilizers. Clinically important and statistically significant differences were found between high ED utilizers and all other sickle cell disease patients: lower hematocrit level, more transfusions, more pain days, more pain crises, higher mean pain and distress, and worse quality of life on Medical Outcome Study 36 Item Short Form physical function summary scales. After controlling for severity and frequency of pain, high ED utilizers did not use opioids more frequently than other sickle cell disease patients. CONCLUSION A substantial minority of sickle cell disease patients are high ED utilizers. However, high ED utilizers with sickle cell disease are more severely ill as measured by laboratory variables, have more pain, more distress, and have a lower quality of life.
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Affiliation(s)
- Imoigele P Aisiku
- Department of Anesthesiology, Virginia Commonwealth University Reanimation Engineering Shock Center, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Lynch AM, Pandurangi AK, Levenson JL. Electroconvulsive Therapy in a Candidate for Heart Transplant With an Implantable Cardiovertor Defibrillator and Cardiac Contractility Modulator. Psychosomatics 2008; 49:341-4. [DOI: 10.1176/appi.psy.49.4.341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
We report a case of recurrent factitious wound infections in an altruistic living liver donor. Costs for the infections after donation were billed to the recipient, creating a threat to the recipient's lifetime benefits. This case illustrates the importance of obtaining previous medical records on living donors.
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Affiliation(s)
- James L. Levenson
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Rodolfo Valverde
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Smith WR, Penberthy LT, Bovbjerg VE, McClish DK, Roberts JD, Dahman B, Aisiku IP, Levenson JL, Roseff SD. Daily assessment of pain in adults with sickle cell disease. Ann Intern Med 2008; 148:94-101. [PMID: 18195334 DOI: 10.7326/0003-4819-148-2-200801150-00004] [Citation(s) in RCA: 408] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Researchers of sickle cell disease have traditionally used health care utilization as a proxy for pain and underlying vaso-occlusion. However, utilization may not completely reflect the amount of self-reported pain or acute, painful episodes (crises). OBJECTIVE To examine the prevalence of self-reported pain and the relationship among pain, crises, and utilization in adults with sickle cell disease. DESIGN Prospective cohort study. SETTING Academic and community practices in Virginia. PATIENTS 232 patients age 16 years or older with sickle cell disease. MEASUREMENTS Patients completed a daily diary for up to 6 months, recording their maximum pain (on a scale of 0 to 9); whether they were in a crisis (crisis day); and whether they used hospital, emergency, or unscheduled ambulatory care for pain on the previous day (utilization day). Summary measures included both simple proportions and adjusted probabilities (for repeated measures within patients) of pain days, crisis days, and utilization days, as well as mean pain intensity. RESULTS Pain (with or without crisis or utilization of care) was reported on 54.5% of 31 017 analyzed patient-days (adjusted probability, 56%). Crises without utilization were reported on 12.7% of days and utilization on only 3.5% (unadjusted). In total, 29.3% of patients reported pain in greater than 95% of diary days, whereas only 14.2% reported pain in 5% or fewer diary days (adjusted). The frequency of home opiate use varied and independently predicted pain, crises, and utilization. Mean pain intensity on crisis days, noncrisis pain days, and total pain days increased as the percentage of pain days increased (P < 0.001). Intensity was significantly higher on utilization days (P < 0.001). However, utilization was not an independent predictor of crisis, after controlling for pain intensity. LIMITATIONS The study was done in a single state. Patients did not always send in their diaries. CONCLUSION Pain in adults with sickle cell disease is the rule rather than the exception and is far more prevalent and severe than previous large-scale studies have portrayed. It is mostly managed at home; therefore, its prevalence is probably underestimated by health care providers, resulting in misclassification, distorted communication, and undertreatment.
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Affiliation(s)
- Wally R Smith
- Division of Quality Health Care, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
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Aisiku IP, Penberthy LT, Smith WR, Bovbjerg VE, McClish DK, Levenson JL, Roberts JD, Roseff SD. Patient satisfaction in specialized versus nonspecialized adult sickle cell care centers: the PiSCES study. J Natl Med Assoc 2007; 99:886-90. [PMID: 17722665 PMCID: PMC2574305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) patients can receive their ambulatory care from either SCD specialists (caregivers with sickle cell-only clinics) or nonspecialized care centers. Patient satisfaction, an important factor that may influence compliance and outcome, can differ between the two groups because of the perceived quality of care, outcomes or practice style. METHODS We administered a patient satisfaction survey to 308 participants in an SCD prospective cohort study. Of the 308 patients, 133 (43.2%) received the majority of their SCD care at specialized centers, 152 (49.3%) received their care from nonspecialized centers and 26 (7.5) did not provide information. The satisfaction surveys measured general satisfaction (GS), technical quality (TQ), interpersonal manner (IM), communication (CM), financial aspects (FA), time spent with doctor (TA), and accessibility and convenience (AC). Patients reported their levels of satisfaction using a five-point Likert scale. We compared unadjusted group means, as well as means adjusted for potential confounders such as marital status, on patient satisfaction between specialized and nonspecialized centers. RESULTS SCD patients who received their care from specialized centers had significantly higher mean satisfaction scores, compared to those who received their care from nonspecialized centers: GS 4.00(+/-0.93) vs. 3.66 (+/- 01.16, p=0.0326), TQ 3.98 (+/- 0.77) vs. 3.65 (+/- 0.91, p=0.0058), AC 3.83 (+/-0.79) vs. 3.51 (+/- 1.02, p=0.0142) , FA 3.88 (+/-0.96) vs. 3.49 (+/-1.25, p=0.0120). There were no statistically significant group differences in IM, TA and CM. CONCLUSION SCD patients who received most of their SCD care from specialized centers had somewhat higher satisfaction scores in some areas when compared with patients who received their care from nonspecialized centers.
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Affiliation(s)
- Imoigele P Aisiku
- Department of Anesthesia/Critical Care & Emergency Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Abstract
A 74-year-old widowed white man with chronic rheumatoid arthritis presented with nausea and weight loss. He was diagnosed with failure to thrive and admitted for hydration. Misoprostol was determined to be the etiology of his symptoms and he was discharged home. Three days later, he killed himself with a gunshot to the head. Clinicians often fail to recognize those at high risk for suicide. Suicidal risk is increased in both psychiatric and physical illness, and particularly when both are present. Psychiatric illness, particularly depression, often underlies chronic medical illness. The purpose of this case report is to remind health care providers of the strong association between depression and chronic medical illness, and to consider this in all patients, including those who present solely with physical symptoms. Recognizing this association and screening for it, as recommended by the U.S. Preventive Services Task Force, may prevent the unnecessary tragedy of suicide.
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Affiliation(s)
- Tammy R. Copsey Spring
- Division of General Internal Medicine, Virginia Commonwealth University (VCU) Medical Center, PO Box 980102, 1200 East Broad St., Richmond, VA 23298 USA
| | - Leanne M. Yanni
- Division of General Internal Medicine, Virginia Commonwealth University (VCU) Medical Center, PO Box 980102, 1200 East Broad St., Richmond, VA 23298 USA
| | - James L. Levenson
- Department of Psychiatry, Virginia Commonwealth University (VCU) Medical Center, PO Box 980268, Richmond, VA 23298 USA
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Citero VDA, Levenson JL, McClish DK, Bovbjerg VE, Cole PL, Dahman BA, Penberthy LT, Aisiku IP, Roseff SD, Smith WR. The role of catastrophizing in sickle cell disease--the PiSCES project. Pain 2007; 133:39-46. [PMID: 17408858 DOI: 10.1016/j.pain.2007.02.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 02/14/2007] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
In several types of chronic pain, catastrophizing has been related to higher pain intensity, and health care utilization but it has not been explored extensively in sickle cell disease (SCD). The objective of the study was to identify the role of catastrophizing in SCD, specifically in relation to painful crises, non-crisis pain, and responses to pain. Two hundred and twenty SCD adults were enrolled in a prospective cohort study of pain and completed between 30 and 188 daily diaries in 6 months. The Catastrophizing subscale (CAT) of the Coping Strategy Questionnaire (CSQ) was administered at baseline and at study exit. Depression and quality of life were measured by the Patient Health Questionnaire and SF-36, respectively, at baseline. The CAT mean was 13.6 (SD=8.4) and higher CAT was correlated with greater depression severity (r=0.48; p<0.001) and poorer quality of life in all domains (r=-0.24 to -0.47; p<0.001). There was no significance difference between CAT mean baseline and exit scores, and the measures were strongly correlated within patients (r=0.69; p<0.001). No difference was found between higher and lower catastrophizers in intensity of pain, distress, interference, and health service utilization, both on crisis or non-crisis SCD-related pain days, after controlling for depression. Adults with SCD had a higher mean catastrophizing score than found in studies of other chronic pain conditions that are not lifelong and life-threatening. CAT scores were not correlated with pain parameters or utilization. The role of catastrophizing in other conditions cannot be generalized to SCD.
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Affiliation(s)
- Vanessa de A Citero
- Department of Psychiatry, Division of Consultation-Liaison, Virginia Commonwealth University, Richmond, VA, USA.
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Levenson JL, McClish DK, Dahman BA, Penberthy LT, Bovbjerg VE, Aisiku IP, Roseff SD, Smith WR. Alcohol Abuse in Sickle Cell Disease: The Pisces Project. Am J Addict 2007; 16:383-8. [PMID: 17882609 DOI: 10.1080/10550490701525434] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Alcohol abuse is common in patients with chronic painful medical disorders, but it has not been studied in sickle cell disease (SCD). In a prospective cohort study of SCD adults, 31.4% were identified as abusing alcohol. There were no significant differences between alcohol abusers and nonabusers on demographics, biological variables, depression, anxiety, measures of crisis and noncrisis pain, or opioid use, but abusers reported more pain relief from opioids than nonabusers did. Alcohol abusers had fewer unscheduled clinic visits, emergency room visits, hospital days, and any health care utilization for SCD, but this was only significant for emergency room visits. Quality of life was similar between both groups, except that alcohol abusers unexpectedly had better overall physical summary scores. Alcohol abusers were more likely to report coping by ignoring pain, diverting attention, and using particular self-statements.
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Affiliation(s)
- James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Affiliation(s)
- James L Levenson
- Department of Psychiatry, VA Commonwealth University, Box 980268, Richmond, VA 23298-0268, USA.
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Lyketsos CG, Huyse FJ, Gitlin DF, Levenson JL. Psychosomatic medicine: A new psychiatric subspecialty in the U.S. focused on the interface between psychiatry and medicine. Eur J Psychiat 2006. [DOI: 10.4321/s0213-61632006000300004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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McClish DK, Levenson JL, Penberthy LT, Roseff SD, Bovbjerg VE, Roberts JD, Aisiku IP, Smith WR. Gender Differences in Pain and Healthcare Utilization for Adult Sickle Cell Patients: The PiSCES Project. J Womens Health (Larchmt) 2006; 15:146-54. [PMID: 16536678 DOI: 10.1089/jwh.2006.15.146] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many studies have found gender differences in frequency and intensity of pain. Women often report lower pain thresholds, higher pain ratings, and lower tolerance for pain. People with sickle cell disease (SCD) experience both chronic and acute pain throughout life. OBJECTIVES To compare adult men and women with SCD in terms of reported pain, crises, healthcare utilization, and opioid usage. METHODS Two hundred twenty-six adults with SCD in Virginia were enrolled in a prospective cohort study of pain and completed daily diaries for 1-6 months. Subjects reported for the previous day their maximum SCD-related pain, distress, and interference (0-9 scale), whether they were in a sickle cell crisis, had unplanned utilization (clinic, emergency room, or hospitalization), or used opioids. Episodes of pain, crisis, or utilization were defined as consecutive days of such. Men and women were compared, using analysis of covariance (ANCOVA), controlling for age, SCD genotype, depression, and education. RESULTS There were no significant differences between men and women in the percentage of days subjects experienced pain (men 58.6% vs. women 56.5%) or the number of pain episodes/6 months (7.7 vs. 9.6). Mean pain scores were comparable, when subjects were in crisis (5.5 vs. 5.6) or not (2.5 vs. 2.2). Distress and interference results were similar. Men with the SS genotype reported a higher percentage of days with crisis(18.5% vs. 11.6%) and utilization (5.1% vs. 2.7%) than women with the SS genotype. CONCLUSIONS Contrary to many studies of pain, particularly chronic pain, men and women with SCD reported generally similar pain experiences.
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Affiliation(s)
- Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, 23298-0032, USA.
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McClish DK, Penberthy LT, Bovbjerg VE, Roberts JD, Aisiku IP, Levenson JL, Roseff SD, Smith WR. Health related quality of life in sickle cell patients: the PiSCES project. Health Qual Life Outcomes 2005; 3:50. [PMID: 16129027 PMCID: PMC1253526 DOI: 10.1186/1477-7525-3-50] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Accepted: 08/29/2005] [Indexed: 11/16/2022] Open
Abstract
Background Sickle cell disease (SCD) is a chronic disease associated with high degrees of morbidity and increased mortality. Health-related quality of life (HRQOL) among adults with sickle cell disease has not been widely reported. Methods We administered the Medical Outcomes Study 36-item Short-Form to 308 patients in the Pain in Sickle Cell Epidemiology Study (PiSCES) to assess HRQOL. Scales included physical function, physical and emotional role function, bodily pain, vitality, social function, mental health, and general health. We compared scores with national norms using t-tests, and with three chronic disease cohorts: asthma, cystic fibrosis and hemodialysis patients using analysis of variance and Dunnett's test for comparison with a control. We also assessed whether SCD specific variables (genotype, pain, crisis and utilization) were independently predictive of SF-36 subscales, controlling for socio-demographic variables using regression. Results Patients with SCD scored significantly worse than national norms on all subscales except mental health. Patients with SCD had lower HRQOL than cystic fibrosis patients except for mental health. Scores were similar for physical function, role function and mental health as compared to asthma patients, but worse for bodily pain, vitality, social function and general health subscales. Compared to dialysis patients, sickle cell disease patients scored similarly on physical role and emotional role function, social functioning and mental health, worse on bodily pain, general health and vitality and better on physical functioning. Surprisingly, genotype did not influence HRQOL except for vitality. However, scores significantly decreased as pain levels increased. Conclusion SCD patients experience health related quality of life worse than the general population, and in general, their scores were most similar to patients undergoing hemodialysis. Practitioners should regard their HRQOL as severely compromised. Interventions in SCD should consider improvements in health related quality of life as important outcomes.
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Affiliation(s)
- Donna K McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Lynne T Penberthy
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Viktor E Bovbjerg
- Department of Health Evaluation Sciences, University of Virginia, Charlottesville, VA, USA
| | - John D Roberts
- Division of Hematology/Oncology, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Imoigele P Aisiku
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Susan D Roseff
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | - Wally R Smith
- Division of Quality Health Care, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Smith WR, Bovbjerg VE, Penberthy LT, McClish DK, Levenson JL, Roberts JD, Gil K, Roseff SD, Aisiku IP. Understanding pain and improving management of sickle cell disease: the PiSCES study. J Natl Med Assoc 2005; 97:183-93. [PMID: 15712781 PMCID: PMC2568749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Until recent decades, sickle cell disease (SCD) was associated with recurrent, disabling pain, organ failure and death in childhood or early adulthood. SCD treatment advances have now decreased pain and prolonged survival, but episodic or chronic pain may still require substantial analgesic use and frequent hospitalization for pain episodes. This pain is poorly characterized and often poorly treated. Adult patients may face barriers to comprehensive SCD care, stigmatization of their care-seeking behavior by providers and lack of family support, forcing them into maladaptive coping strategies. The Pain in Sickle Cell Epidemiology Study (PiSCES) attempts to develop and validate a biopsychosocial model of SCD pain, pain response and healthcare utilization in a large, multisite adult cohort. PiSCES participants complete a baseline survey and six months of daily pain diaries in which they record levels of SCD-related pain and related disability and distress as well as responses to pain (e.g., medication use, hospital visits). PiSCES will advance methods of measuring pain and pain response in SCD by better describing home-managed as well as provider-managed pain. PiSCES will assess the relative contributions of biological (disease-related), psychosocial and environmental (readiness to utilize) factors to overall pain and pain response in SCD, suggesting targets for biobehavioral interventions over time. Importantly, PiSCES will also identify "triggers" of SCD pain episodes and healthcare utilization in the moment of pain, suggesting targets for timely care that mutes pain episodes.
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Affiliation(s)
- Wally R Smith
- Virginia Commonwealth University, Division of Quality Health Care, Box 980306, Richmond, VA 23298, USA.
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Simon RI, Levenson JL, Shuman DW. On sound and unsound mind: the role of suicide in tort and insurance litigation. J Am Acad Psychiatry Law 2005; 33:176-82. [PMID: 15985659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Suicide continues to be a recognized as a crime by common law in a few states. In those jurisdictions, the beneficiary of a claim must prove that the individual who attempted or committed suicide was of unsound mind, to avoid having the patient's act declared illegal, which would bar recovery of the claim. In malpractice and insurance cases, expert testimony is required regarding the mental state of the individual who attempted or committed suicide. Psychiatric testimony varies widely, depending on the legal definition of "unsound mind" and the highly subjective interpretation of legal definitions. Some experts equate suicide with an unsound mind, whereas others apply M'Naghten criteria. Some psychiatrists who disagree with criminalizing suicide refuse to participate in these proceedings. In suicide malpractice cases, the appropriate function of the expert witness is to provide testimony about the standard of care. When experts attempt to testify about "sound or unsound" mind, they must be mindful of the imperfect fit between psychiatry and the law.
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Affiliation(s)
- Robert I Simon
- Program in Psychiatry and the Law, Georgetown University School of Medicine, Washington, DC, USA.
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Affiliation(s)
- James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
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Abstract
OBJECTIVE Psychosomatic medicine, also known as consultation-liaison psychiatry, received approval as a subspecialty field of psychiatry by the American Board of Medical Specialties in the spring of 2003. This represents a crucial step in the development of the field of psychosomatic medicine and recognition by leaders in the fields of medicine and psychiatry of its importance. METHODS The field was developed in response to evidence suggesting that a high prevalence of psychiatric disorders exists in patients with complex medical illnesses and that diagnosis and management of these disorders in this population is critical yet frequently complicated by the medical illnesses themselves. RESULTS Psychosomatic medicine psychiatrists have developed specialized expertise in addressing these issues. CONCLUSION The approval of subspecialty status for psychosomatic medicine will help promote the psychiatric care of patients with complex medical, surgical, obstetrical and neurological conditions, as well as foster further improvements in the quality of training and research in this important area.
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Affiliation(s)
- David F Gitlin
- Brigham and Women's/Faulkner Hospitals, Boston, Massachusetts 01776, USA.
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