General hospital psychiatry
Authors: Ramati A, Rubin LH, Wicklund A, Pliskin NH, Ammar AN, Fink JW, Bodnar EN, Lee RC, Cooper MA, Kelley KM,
This study examines the prevalence of psychiatric morbidity in a large sample of electrical injury (EI) patients in three phases of recovery and its effects on cognitive functioning.
Eight-six self-referred EI patients received psychiatric and neuropsychological evaluations. Descriptive statistics were conducted to examine the prevalence of psychiatric morbidity. Polytomous logistic regression was used to identify predictors of psychiatric diagnosis. Between-subjects analysis of variances (ANOVA) was conducted to examine the effects of psychiatric morbidity on cognitive functioning.
Seventy-eight percent of subjects warranted a psychiatric diagnosis. Long-term patients compared to acute patients were more likely to be diagnosed with two diagnoses than not having any diagnosis (OR=14.30, 95% CI 1.40-38.71). Patients with two diagnoses performed worse than both patients with a single or no diagnosis on all cognitive outcome measures (P<.05). Voltage level, chronic pain and litigation status did not predict psychiatric morbidity.
Psychiatric difficulties commonly emerge and persist following EI. EI patients with psychiatric conditions exhibited poorer cognitive performance as compared to EI patients with no post-injury psychiatric difficulties. Health care professionals need to devote careful attention to psychiatric and cognitive status when treating survivors of EI.
PMID: 19555797 [PubMed - as supplied by publisher]
Journal of neurotrauma 2009 Oct
Authors: Ramati A, Pliskin NH, Keedy S, Erwin RJ, Fink JW, Bodnar EN, Lee RC, Cooper MA, Kelley K, Sweeney JA,
Neuropsychological studies in electrical injury patients have reported deficits in attention, learning, and working memory, but the neural substrates of these deficits remain poorly characterized. In this study we sought to examine whether electrical injury subjects demonstrate abnormal patterns of brain activation during working memory and procedural learning tasks. Fourteen electrical injury subjects and fifteen demographically matched healthy control subjects performed a spatial working memory paradigm and a procedural learning paradigm during functional MRI studies. For the spatial working memory task, electrical injury patients exhibited significantly greater activation in the middle frontal gyrus and motor and posterior cingulate cortices. Increased activation in EI subjects also was observed on a visually-guided saccade task in several sensorimotor regions, including the frontal and parietal eye fields and striatum. On the procedural learning task, electrical injury patients exhibited significantly less activation in the middle frontal gyrus, anterior cingulate cortex, and frontal eye fields than controls. This is the first study to document task-dependent, system-level cortical and subcortical dysfunction in individuals who had experienced an electrical shock trauma.
PMID: 19323610 [PubMed - as supplied by publisher]
Journal of the International Neuropsychological Society : JINS 2006 Jan
Authors: Pliskin NH, Ammar AN, Fink JW, Hill SK, Malina AC, Ramati A, Kelley KM, Lee RC,
The clinical presentation of electrical injury commonly involves physical, cognitive, and emotional complaints. Neuropsychological studies, including case reports, have indicated that electrical injury (EI) survivors may experience a broad range of impaired neuropsychological functions, although this has not been clarified through controlled investigation. In this study, we describe the neuropsychological test findings in a series of 29 EI patients carefully screened and matched to a group of 29 demographically similar healthy electricians. Participants were matched by their estimated premorbid intellectual ability. Multivariate analysis of variance was used to assess group differences in the following neuropsychological domains: attention and mental speed, working memory, verbal memory, visual memory, and motor skills. EI patients performed significantly worse on composite measures of attention/mental speed and motor skills, which could not be explained by demographic differences, injury parameters, litigation status, or mood disturbance. Results suggest that cognitive changes do occur in patients suffering from electrical injury.
PMID: 16433940 [PubMed - as supplied by publisher]
Health psychology : official journal of the Division of Health Psychology, American Psychological Association 2004 Nov
Authors: Zakowski SG, Ramati A, Morton C, Johnson P, Flanigan R,
The aims of the present study were to examine whether written emotional disclosure would reduce distress among cancer patients and whether it would buffer the effects of high levels of social constraint (negative social responses to patients' expressions of emotion regarding their cancer) on distress. Cancer patients (N=104) were randomly assigned to write about their emotions regarding their cancer 20 min a day for 3 days or to write about a nonemotional topic. They completed questionnaires at baseline and 6 months postintervention. Results showed that written disclosure buffered the effects of social constraints on stress at the 6-month follow-up and that avoidance partly mediated these effects. The present data reinforce the notion that interventions should be tailored to patients' needs.
PMID: 15546223 [PubMed - as supplied by publisher]
Journal of anxiety disorders 2002
Authors: Amir M, Ramati A,
The present study is a preliminary study assessing long-term psychological effects in survivors of breast cancer. Thirty-nine long-term female survivors of breast cancer were compared with 39 matched women who had not been exposed to any chronic disease regarding post-traumatic stress disorder (PTSD), quality of life (QoL), emotional distress and coping styles. Survivors revealed significantly higher rates of full and partial PTSD, scored significantly higher on emotional distress, scored significantly lower on physical and psychological QoL and exhibited coping styles significantly different from those of the control group. PTSD was associated with the coping style of suppression. Multiple regression analysis showed that receiving chemotherapy and disease stage, as well as the interaction between chemotherapy and disease stage, were significant predictors of hyperarousal. The findings show that post-traumatic symptoms are a common sequel after recovery from cancer. Furthermore, finding suggest a conceptual distinction between PTSD symptoms and QoL in the study of long-term effects of cancer.
PMID: 12194544 [PubMed - as supplied by publisher]