Background The purpose of our study was to determine the rate of carpal tunnel decompression (CTD) following local corticosteroid injection for carpal tunnel syndrome (CTS), as well as identifying predictors of requiring further intervention and eventual decompression. Methods All patients diagnosed with CTS in our unit over a 6-year period were prospectively assessed. Patients were diagnosed using a combination of clinical presentation and nerve conduction studies. Patients were managed with open carpal tunnel decompression or corticosteroid injection. There were 1,564 consecutive patients diagnosed with CTS over the study period, of whom 824 (53%) underwent a corticosteroid injection as their primary treatment. We performed a survivorship analysis of these patients and used Kaplan-Meier survivorship methodology to determine the 5-year rate of re-intervention. Risk factors for re-intervention were also determined. Results The overall 5-year Kaplan-Meier rate of secondary CTD was 15% at 1 year and 33% at 5 years. The need for secondary CTD was independently associated with female gender, diabetes mellitus and positive nerve conduction studies at diagnosis. Conclusions Steroid injection is an appropriate treatment in carefully selected patients. Those who are female, diabetic and have neurophysiological confirmation of diagnosis have the highest risk of relapse. These results may be used to guide initial treatment and counsel patients about the risk relapse.
Introduction: Feelings and emotions are influenced by cultural factors. There are no specific words to refer to the emotional states of individuals in some cultures and sub-cultures around the world.Somatic metaphors and complains are the main outlets for emotional discharge in these cultures. Objectives: Analysis of presenting symptoms of the patients suffering from depression referred to the psychiatric clinic of Shiraz university of Medical Sciences. Aim: Better understanding of distribution of the patient´s chief complaints among people with different sex, marital status, place of residency and education. Method: 300 patients with major depressive disorders referred to our clinic were selected by simple sampling. Diagnosis of the disorder was made based on the DSM-IV-TR criteria after a psychiatric interview. These patients had no history of any substance abuse or dependence. Also, their symptoms could not be explained by a general medical condition or other psychiatric conditions. Through psychiatric interview, we assessed the chief complaints and other presenting symptoms of these patients and then compared them according to such variables as sex, age, marital status, place of residency and education. Results: The most frequent complaints of the patients was headache and pain in other areas of body. Also this study showed a significant relationship between the chief complaint (physical vs. mental) and sex, marital status and place of residency. Conclusion: Pain and other somatic complaints are important presenting problem among depressive patients.Paying proper attention to somatic complaints in some cultures, can lead to better understanding of patients and prevent unnecessary expensive interventions.
Introduction:In some cultures, including ours, direct explanation of inner psychic world is inhibited and stigmatized, therefore finding alternative modes of expression.Aims and objectives:The aim of this cross-sectional study was to reach to an estimation of the frequency of somatization in the depressed patients.Method:500 patients with major depressive disorder referred to the outpatient clinic of Shiraz University of Medical Sciences were recruited and diagnosed based on DSM-IV-TR. Through psychiatric interview, we assessed the presenting complaints of these patients. the presenting symptoms were divided into three main categories namely: mental symptoms, pain, and physical symptoms other than pain. Statistical analysis (chi-square and logistic regression) were performed to assess the relationship between presenting symptoms and some demographic variables such as age, gender, marital status, educational level and cultural background.Results:Physical symptoms other than pain in 193 (38.6%), mental symptoms in 186 (37.2%) and pain in 121 (24.2%) of the patients were seen. Pain and physical complaints were more common in patients with rural cultural background, lower education, women and the married ones. Headache (15.2%), irritability (10.6%) and pain in other areas of the body (10.4%) were the most frequent chief complaints the patients had stated. the symptoms of hypochondriasis, suicidal idea, crying, irritability and insomnia were significantly associated with the complaint of somatization.Conclusion:Somatic symptoms, especially pain, have a significant weight in the chief complaints of depressed patients. Physicians need to pay proper attention to this important issue in order to better understand their patients.
This article introduces two cases of pathological hand disorder, a rare category associated with contractures of fingers and abnormal posture of the hand. Both of these patients had history of traumatic life experiences in the past and their hand deformity could not be explained by a general medical condition. Psychopathological hand disorders including clenched fist syndrome and psychoflexed hand are somatoform conditions which represent "conversion" of emotional turmoil to physical symptoms in a symbolic manner. Prognosis seems to be poor. This fact is partly related to the interdisciplinary nature of the problem. The patient needs simultaneous psychiatric, neurologic and surgical help to reach both the proper diagnosis and management. Without considering the underlying psychological conflicts, invasive procedures are not helpful. Involvement of the key family members can be helpful for the patient to overcome the feeling of loneliness and helplessness. On the other hand, unnecessary and too much attention can be a rewarding response which keeps the situation unchanged. The patients need consistent, supportive care by their therapist to help them to get more adaptive solution for their problems. The therapist needs to know the protective role of the symptom and the patient's need to keep and maintain this posture. In some patients , the symptoms protect them from more destructive behaviors. This behavior shows the need to cope with unbearable psychological distress and to regain a sense of stability. These needs have to be addressed before any corrective intervention.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.