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Affective disorders among patients with borderline personality disorder.

https://arctichealth.org/en/permalink/ahliterature118152
Source
PLoS One. 2012;7(12):e50930
Publication Type
Article
Date
2012
Author
Hege Nordem Sjåstad
Rolf W Gråwe
Jens Egeland
Author Affiliation
Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway. hege.nordem.sjastad@siv.no
Source
PLoS One. 2012;7(12):e50930
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Bipolar Disorder - epidemiology - psychology
Borderline Personality Disorder - epidemiology - psychology
Comorbidity
Cross-Sectional Studies
Depressive Disorder - epidemiology - psychology
Female
Humans
Male
Middle Aged
Norway - epidemiology
Outpatients - psychology
Prevalence
Abstract
The high co-occurrence between borderline personality disorder and affective disorders has led many to believe that borderline personality disorder should be considered as part of an affective spectrum. The aim of the present study was to examine whether the prevalence of affective disorders are higher for patients with borderline personality disorder than for patients with other personality disorders.
In a national cross-sectional study of patients receiving mental health treatment in Norway (N?=?36 773), we determined whether psychiatric outpatients with borderline personality disorder (N?=?1 043) had a higher prevalence of affective disorder in general, and whether they had an increased prevalence of depression, bipolar disorder or dysthymia specifically. They were compared to patients with paranoid, schizoid, dissocial, histrionic, obsessive-compulsive, avoidant, dependent, or unspecified personality disorder, as well as an aggregated group of patients with personality disorders other than the borderline type (N?=?2 636). Odds ratios were computed for the borderline personality disorder group comparing it to the mixed sample of other personality disorders. Diagnostic assessments were conducted in routine clinical practice.
More subjects with borderline personality disorder suffered from unipolar than bipolar disorders. Nevertheless, borderline personality disorder had a lower rate of depression and dysthymia than several other personality disorder groups, whereas the rate of bipolar disorder tended to be higher. Odds ratios showed 34% lower risk for unipolar depression, 70% lower risk for dysthymia and 66% higher risk for bipolar disorder in patients with borderline personality disorder compared to the aggregated group of other personality disorders.
The results suggest that borderline personality disorder has a stronger association with affective disorders in the bipolar spectrum than disorders in the unipolar spectrum. This association may reflect an etiological relationship or diagnostic overlapping criteria.
Notes
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PubMed ID
23236411 View in PubMed
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Alcohol and drug use, smoking, and gambling among psychiatric outpatients: a 1-year prevalence study.

https://arctichealth.org/en/permalink/ahliterature114803
Source
Subst Abus. 2013;34(2):162-8
Publication Type
Article
Date
2013
Author
Christina Nehlin
Leif Grönbladh
Anders Fredriksson
Lennart Jansson
Author Affiliation
Department of Neuroscience, Psychiatry Unit, Uppsala University, Uppsala, Sweden. christina.nehlin.gordh@neuro.uu
Source
Subst Abus. 2013;34(2):162-8
Date
2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Alcohol drinking - epidemiology
Diagnosis, Dual (Psychiatry) - statistics & numerical data
Female
Gambling - epidemiology
Humans
Male
Mental Disorders - complications
Middle Aged
Outpatients - psychology
Prevalence
Sex Characteristics
Smoking - epidemiology
Substance-Related Disorders - epidemiology
Sweden - epidemiology
Abstract
Studies of alcohol habits in general psychiatric populations are scarce. The objective was to investigate alcohol and drug use, smoking, and gambling in a clinical sample of psychiatric outpatients. A further aim was to study age and gender differences in the rates of these habits.
Data were collected among psychiatric outpatients with mainly mood (47%) and anxiety (35%) disorders. A questionnaire package was distributed, including AUDIT (Alcohol Use Disorders Identification Test), DUDIT (Drug Use Disorders Identification Test), tobacco items, and gambling items. Two major drinking categories were formed: "Nonhazardous alcohol use" (NH) and "Alcohol use above hazardous levels" (AH).
In total, 2160 patients (65% females) responded to the questionnaire package. The AH rate was high among psychiatric outpatients (28.4%), particularly among young females (46.6%). Young female patients also reported a high prevalence of problematic drug use (13.8%). Problematic drug use, daily smoking, and problematic gambling were frequent. The unhealthy habits were linked to AH.
Alcohol and drug use, smoking, and gambling are all highly prevalent among psychiatric outpatients. Young females are in particular need of attention. Interventions should be tailored for co-occurring psychiatric disorders and applied within routine psychiatric care.
PubMed ID
23577911 View in PubMed
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Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression.

https://arctichealth.org/en/permalink/ahliterature138809
Source
Arch Gen Psychiatry. 2010 Dec;67(12):1256-64
Publication Type
Article
Date
Dec-2010
Author
Zindel V Segal
Peter Bieling
Trevor Young
Glenda MacQueen
Robert Cooke
Lawrence Martin
Richard Bloch
Robert D Levitan
Author Affiliation
Centre for Addiction and Mental Health, Toronto, ON, Canada. zindel_segal@camh.net
Source
Arch Gen Psychiatry. 2010 Dec;67(12):1256-64
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antidepressive Agents - administration & dosage - therapeutic use
Attention
Cognitive Therapy - methods
Combined Modality Therapy - methods
Depressive Disorder, Major - drug therapy - prevention & control - psychology
Diagnostic and Statistical Manual of Mental Disorders
Drug Administration Schedule
Female
Follow-Up Studies
Humans
Male
Middle Aged
Ontario
Outpatients - psychology
Psychiatric Status Rating Scales
Psychotherapy, Group - methods
Recurrence - prevention & control
Treatment Outcome
Young Adult
Abstract
Mindfulness-based cognitive therapy (MBCT) is a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse.
To compare rates of relapse in depressed patients in remission receiving MBCT against maintenance antidepressant pharmacotherapy, the current standard of care.
Patients who met remission criteria after 8 months of algorithm-informed antidepressant treatment were randomized to receive maintenance antidepressant medication, MBCT, or placebo and were followed up for 18 months.
Outpatient clinics at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and St Joseph's Healthcare, Hamilton, Ontario.
One hundred sixty patients aged 18 to 65 years meeting DSM-IV criteria for major depressive disorder with a minimum of 2 past episodes. Of these, 84 achieved remission (52.5%) and were assigned to 1 of the 3 study conditions.
Patients in remission discontinued their antidepressants and attended 8 weekly group sessions of MBCT, continued taking their therapeutic dose of antidepressant medication, or discontinued active medication and were switched to placebo.
Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression on module A of the Structured Clinical Interview for DSM-IV.
Intention-to-treat analyses showed a significant interaction between the quality of acute-phase remission and subsequent prevention of relapse in randomized patients (P = .03). Among unstable remitters (1 or more Hamilton Rating Scale for Depression score >7 during remission), patients in both MBCT and maintenance treatment showed a 73% decrease in hazard compared with placebo (P = .03), whereas for stable remitters (all Hamilton Rating Scale for Depression scores =7 during remission) there were no group differences in survival.
For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy. Our data also highlight the importance of maintaining at least 1 long-term active treatment in unstable remitters.
Notes
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PubMed ID
21135325 View in PubMed
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Assessing and treating different suicidal states in a danish outpatient sample.

https://arctichealth.org/en/permalink/ahliterature108420
Source
Arch Suicide Res. 2013;17(3):302-12
Publication Type
Article
Date
2013
Author
Christopher D Corona
David A Jobes
Ann C Nielsen
Christian M Pedersen
Keith W Jennings
René M Lento
Katherine A Brazaitis
Author Affiliation
Department of Psychology, The Catholic University of America, Washington, DC 20064, USA. 18corona@cardinalmail.cua.edu
Source
Arch Suicide Res. 2013;17(3):302-12
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Denmark
Female
Humans
Interview, Psychological - methods
Middle Aged
Outpatients - psychology
Risk Assessment - methods
Self Report
Suicidal ideation
Suicide, Attempted - psychology - statistics & numerical data
Young Adult
Abstract
The studies presented compare two methodologies for categorizing suicidal patients based on clinical data. Discussion follows regarding implications for risk assessment and treatment. In these studies, 52 outpatient subjects were placed into different groups based on coding their "suicidal motivation" (Study 1) and their "internal struggle" ratings (Study 2) using data collected at intake. Self-report ratings of 6 Suicide Status Form (SSF) Core Constructs (Psychological Pain, Stress, Agitation, Hopelessness, Self-Hate, and Overall Risk of Suicide) recorded both at intake and at completion of treatment were then compared to determine differences in Core Construct ratings among groups at different time points. In Study 1, overall differences among motivation groups (Life-motivated, Ambivalent, and Death-motivated) were significant for ratings at treatment completion of Overall Risk of Suicide, Self-Hate, and Psychological Pain. In Study 2, overall differences among groups (Wish to live, Ambivalent, and Wish to die) were significant for ratings at intake of Overall Risk of Suicide. At completion of treatment, overall differences among groups were significant for ratings of Overall Risk of Suicide, Hopelessness, and Self-Hate. In addition, significant interactions were found between test time and group for Overall Risk of Suicide and Self-Hate. Results suggest that categorizing suicidal patients by motivation and by the nature of their internal struggle could be beneficial to differential risk assessment with implications for clinical treatment.
PubMed ID
23889578 View in PubMed
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Assessing quality of life in a clinical study on heart rehabilitation patients: how well do value sets based on given or experienced health states reflect patients' valuations?

https://arctichealth.org/en/permalink/ahliterature276518
Source
Health Qual Life Outcomes. 2016;14:48
Publication Type
Article
Date
2016
Author
Reiner Leidl
Bernd Schweikert
Harry Hahmann
Juergen M Steinacker
Peter Reitmeir
Source
Health Qual Life Outcomes. 2016;14:48
Date
2016
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - psychology - rehabilitation
Adult
Aged
Aged, 80 and over
Female
Humans
Inpatients - psychology
Male
Middle Aged
Outpatients - psychology
Patient satisfaction
Quality of Life - psychology
Regression Analysis
Self Report
Surveys and Questionnaires
Sweden
Abstract
Quality of life as an endpoint in a clinical study may be sensitive to the value set used to derive a single score. Focusing on patients' actual valuations in a clinical study, we compare different value sets for the EQ-5D-3L and assess how well they reproduce patients' reported results.
A clinical study comparing inpatient (n = 98) and outpatient (n = 47) rehabilitation of patients after an acute coronary event is re-analyzed. Value sets include: 1. Given health states and time-trade-off valuation (GHS-TTO) rendering economic utilities; 2. Experienced health states and valuation by visual analog scale (EHS-VAS). Valuations are compared with patient-reported VAS rating. Accuracy is assessed by mean absolute error (MAE) and by Pearson's correlation ?. External validity is tested by correlation with established MacNew global scores. Drivers of differences between value sets and VAS are analyzed using repeated measures regression.
EHS-VAS had smaller MAEs and higher ? in all patients and in the inpatient group, and correlated best with MacNew global score. Quality-adjusted survival was more accurately reflected by EHS-VAS. Younger, better educated patients reported lower VAS at admission than the EHS-based value set. EHS-based estimates were mostly able to reproduce patient-reported valuation. Economic utility measurement is conceptually different, produced results less strongly related to patients' reports, and resulted in about 20 % longer quality-adjusted survival.
Decision makers should take into account the impact of choosing value sets on effectiveness results. For transferring the results of heart rehabilitation patients from another country or from another valuation method, the EHS-based value set offers a promising estimation option for those decision makers who prioritize patient-reported valuation. Yet, EHS-based estimates may not fully reflect patient-reported VAS in all situations.
Notes
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PubMed ID
27005466 View in PubMed
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Association between self-reported care needs and the allocation of care in Norwegian home nursing care recipients.

https://arctichealth.org/en/permalink/ahliterature134023
Source
Int J Older People Nurs. 2012 Mar;7(1):20-8
Publication Type
Article
Date
Mar-2012
Author
Hans Inge Saevareid
Elin Thygesen
Torill Christine Lindstrom
Harald A Nygaard
Author Affiliation
Faculty of Health and Sport Sciences, University of Agder, Arendal, Norway. hans.i.savareid@uia.no
Source
Int J Older People Nurs. 2012 Mar;7(1):20-8
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adaptation, Psychological
Aged
Aged, 80 and over
Aging - psychology
Community Health Nursing - methods - standards
Cross-Sectional Studies
Female
Geriatric Nursing - methods - standards
Housing for the Elderly
Humans
Male
Needs Assessment
Norway
Outpatients - psychology
Self Report
Social Support
Socioeconomic Factors
Abstract
This study investigated the relationship between patients' self-reported illness, daily afflictions, and the frequency of home nursing care, and whether patients' coping resources influenced the allocation of care. DESIGN, SAMPLE AND MEASUREMENTS: A cross-sectional survey was adopted. Two hundred and forty-two people aged 75 years and above receiving home nursing care participated in the study. Binary logistic regression model was used to test the effects of the independent variables on home nursing care.
Poor capacity to perform activities of daily living and high level of education were directly associated with a high frequency of home nursing care. Lack of perceived social support affected the amount of home nursing care allocated only when feelings of loneliness were connected with poor activities of daily living functioning. Interaction effects revealed that perceived social support influenced the amount of home nursing care in persons with higher education, in persons with low education, no such association were found. No associations were found between coping resources and home nursing care.
Impaired capacity to perform activities of daily living was the main reason for care allocation. Education was associated with more formal care. Patients with low perceived social support combined with a low education level was a particularly vulnerable group.
PubMed ID
21631880 View in PubMed
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Attachment style among outpatients with substance use disorders in psychological treatment.

https://arctichealth.org/en/permalink/ahliterature298631
Source
Psychol Psychother. 2018 12; 91(4):490-508
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
12-2018
Author
Ylva Gidhagen
Rolf Holmqvist
Björn Philips
Author Affiliation
Department of Behavioural Sciences and Learning, Linköping University, Sweden.
Source
Psychol Psychother. 2018 12; 91(4):490-508
Date
12-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Aged
Female
Health Knowledge, Attitudes, Practice
Humans
Interpersonal Relations
Male
Middle Aged
Object Attachment
Outpatients - psychology
Psychotherapy - methods
Regression Analysis
Stress, Psychological
Substance-Related Disorders - psychology - therapy
Sweden
Young Adult
Abstract
To explore the associations between self-rated attachment style, psychological distress and substance use among substance use disorder (SUD) outpatients in psychological treatment.
In this practice-based study, 108 outpatients were asked to fill in the Experiences in Close Relationships - Short form, the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), the Alcohol Use Disorders Identification Test (AUDIT), and the Drug Use Disorders Identification Test (DUDIT) at treatment start and end. Patients were given psychological treatments with a directive, reflective or supportive orientation.
An insecure attachment style was more common among the SUD outpatients, compared to non-clinical groups. Patients with a fearful attachment style scored higher on psychological distress than patients with a secure attachment style. The associations between the attachment dimensions and psychological distress were stronger than those between attachment and SUD. Significantly more patients had a secure attachment style at treatment end.
This study shows significant relations between patients' attachment style and their initial psychological distress. The causal relationship between attachment style and psychological distress is, however, not clear and can likely go in both directions. The psychological treatment of patients with SUD contributed significantly to changes from insecure to secure attachment style.
We found among patients with SUD a strong relation between patients' attachment style and their psychological distress. Knowledge of the patient's attachment style may help the therapist to tailor the treatment to the patient's needs. A change from insecure to secure attachment style can be an important goal for a SUD treatment, as it may prevent the patient from using defence strategies involving substance use for regulating emotions and interpersonal relationships.
PubMed ID
29399945 View in PubMed
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Changes in inpatient and postdischarge suicide rates in a nationwide cohort of Danish psychiatric inpatients, 1998-2005.

https://arctichealth.org/en/permalink/ahliterature105250
Source
J Clin Psychiatry. 2013 Dec;74(12):e1190-4
Publication Type
Article
Date
Dec-2013
Author
Trine Madsen
Merete Nordentoft
Author Affiliation
Psychiatric Center Copenhagen, Copenhagen University Hospital, Bispebjerg Bakke 23, Bldg 13A, 2400 Copenhagen, Denmark trine.madsen@regionh.dk.
Source
J Clin Psychiatry. 2013 Dec;74(12):e1190-4
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Denmark - epidemiology
Female
Hospitalization - statistics & numerical data
Hospitals, Psychiatric - statistics & numerical data
Humans
Incidence
Inpatients - psychology - statistics & numerical data
Longitudinal Studies
Male
Mental Disorders - epidemiology - psychology - therapy
Mentally Ill Persons - psychology - statistics & numerical data
Middle Aged
Outpatients - psychology - statistics & numerical data
Patient Discharge - statistics & numerical data
Proportional Hazards Models
Risk factors
Suicide - prevention & control - psychology - statistics & numerical data
Abstract
A reduction in the number of inpatient beds as well as shorter admissions have aroused concern that tendencies to deinstitutionalize may increase the suicide rate for psychiatric patients who have been hospitalized. One study indicates that a decreasing inpatient suicide rate may actually reflect a transfer to an increasing postdischarge suicide rate; however, uncertainties exist about this transfer, since it is not well studied. The objectives of this study were to estimate adjusted changes over time in suicide rates among psychiatric inpatients and recently discharged psychiatric patients and to estimate changes in these rates by gender and diagnosis.
Data on all psychiatric patients admitted from 1998 through 2005 in Denmark were extracted from the Danish Psychiatric Central Register and merged with information from the Danish Cause of Death Register. Calendar year was applied as an independent continuous variable in Cox survival analyses modeling the hazard of suicide during inpatient treatment and during the 3-month postdischarge period. Analyses were adjusted for sex, age, educational status, primary diagnosis, and previous suicide attempt.
The overall inpatient suicide rate declined in psychiatric patients admitted from 1998 through 2005 (hazard ratio [HR] = 0.93 [95% CI, 0.88-0.99]), particularly among women (HR = 0.87 [95% CI, 0.79-0.96]). The overall rate of suicide in the 3-month postdischarge period also declined significantly (HR = 0.94 [95% CI, 0.91-0.98]), which was explained mostly by a falling rate among men (HR = 0.94 [95% CI, 0.90-0.98]) as well as among patients who were discharged with a diagnosis of schizophrenia (HR = 0.90 [95% CI, 0.83-0.99]).
Although our results show a decreasing trend in suicide rates, the sizes of the rates emphasize that focus on suicide in mental health care settings must continue and be improved, as the rates are still very high.
PubMed ID
24434107 View in PubMed
Less detail

Characteristics of out-patient adolescents with suicidal tendencies.

https://arctichealth.org/en/permalink/ahliterature209404
Source
Acta Psychiatr Scand. 1997 Feb;95(2):100-7
Publication Type
Article
Date
Feb-1997
Author
M. Pelkonen
M. Marttunen
E. Pulkkinen
P. Laippala
H. Aro
Author Affiliation
Tampere School of Public Health, University of Tampere, Finland.
Source
Acta Psychiatr Scand. 1997 Feb;95(2):100-7
Date
Feb-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Comorbidity
Female
Finland - epidemiology
Humans
Male
Mental Disorders - epidemiology - psychology - therapy
Outpatients - psychology
Prospective Studies
Referral and Consultation - statistics & numerical data
Risk factors
Sex Factors
Social Adjustment
Suicide - prevention & control - psychology - statistics & numerical data
Suicide, Attempted - prevention & control - psychology - statistics & numerical data
Abstract
Suicidal adolescent out-patients were compared with non-suicidal subjects with respect to background factors, psychopathology and treatment received. Data for suicidal ideation, suicide attempts, psychiatric diagnoses (DSM-III-R) and other patient-related factors were collected prospectively during treatment of 122 male and 138 female out-patients aged 12-22 years. In total, 42% of subjects displayed suicidal tendencies, and 18% had attempted suicide. According to polychotomous regression, mood disorder, previous psychiatric treatment and low level of psychosocial functioning at treatment entry were associated with suicide attempts and with suicidal ideation for both sexes. Suicidal patients were more often receiving psychotropic medication and had more total appointments (mean number 15 vs. 9) than non-suicidal patients. Suicidal and non-suicidal patients kept their scheduled appointments to the same extent (66% vs. 65%). Treatments which meet the needs of disordered suicidal adolescents need to be developed.
PubMed ID
9065673 View in PubMed
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Cognitive function in outpatients with perceived chronic stress.

https://arctichealth.org/en/permalink/ahliterature162966
Source
Scand J Work Environ Health. 2007 Jun;33(3):223-32
Publication Type
Article
Date
Jun-2007
Author
Lena Ohman
Steven Nordin
Jan Bergdahl
Lisbeth Slunga Birgander
Anna Stigsdotter Neely
Author Affiliation
Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden. lena.ohman@psy.umu.se
Source
Scand J Work Environ Health. 2007 Jun;33(3):223-32
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Adult
Burnout, Professional - complications - psychology
Case-Control Studies
Chronic Disease
Cognition Disorders - diagnosis - etiology - psychology
Female
Humans
Logistic Models
Male
Memory
Mental Recall
Outpatients - psychology
Psychological Tests
Psychomotor Performance
Questionnaires
Stress, Psychological - etiology - psychology
Sweden
Abstract
The number of employees on sick leave due to stress-related syndromes has increased drastically in many industrialized countries. Cognitive dysfunction is a common complaint among patients suffering from chronic stress. Previous research on chronic stress has mainly focused on its interpersonal, attitudinal, psychological, organizational, and physical effects. Less attention has been allocated to effects of chronic stress on cognitive functioning. Hence the aim of the present study was to investigate the relationship between chronic stress and cognition.
The cognitive performance of 19 chronic stress outpatients and 19 matched controls was studied. A battery of standard and experimental cognitive tests assessing processing speed, attention, working memory, and episodic and semantic memory were administered.
Performance deficits of the chronic stress patients relative to the performance of the controls were found for some but not all cognitive tasks, indicating a selective deficit. Deficits were found for episodic memory, particularly for learning across repeated trials and for tasks requiring divided attention during either the encoding or retrieval of words. Performance differences were also found for aspects of working memory, mental tempo, semantic access, and prospective memory, but not for basic perceptual speed measures.
These findings may suggest suboptimal executive functioning (eg, strategic or attentional control) among chronic stress patients. Particularly, poor performance in letter fluency and prospective memory were significantly associated with chronic stress, the finding suggesting the usefulness of these tests as clinical tools in evaluations of chronic stress states.
PubMed ID
17572832 View in PubMed
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