Greater Medical Comorbidity Research Articles

Treating Depressed Primary Care Patients Improves Their Physical, Mental, and Social Functioning

This study describes the functioning of primary care patients with major depressive disorder, the relationship of medical comorbidity to functional status, and the effects of depression-specific treatment on functional status after 8 months. Patients were randomized to a protocol intervention (nortriptyline hydrochloride or interpersonal psychotherapy) or to usual care with the patient's physician in a clinical trial of primary care treatments of depression. Their functional status was evaluated using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Global Assessment Scale. Medical comorbidity was assessed with the Duke Severity of Illness Checklist. The Hamilton Rating Scale for Depression and Beck Depression Inventory were used to measure depressive severity. Assessments were conducted at baseline and at 1, 2, 4, and 8 months after randomization. At baseline, patients reported substantial impairments in the functional domains as assessed by the SF-36 and Global Assessment Scale. Severity of general medical illness and depression were not correlated. Greater medical comorbidity was associated with diminished physical, but not psychological, functioning. Mean scores on SF-36 scales and the Global Assessment Scale improved significantly during the 8 months of follow-up. Patients assigned to protocol treatments showed greater improvement, compared with those assigned to usual care, on the SF-36 mental summary scale and most individual scales but not on the SF-36 physical summary scale. However, patients who completed protocol treatment also experienced significant improvement on the physical summary scale. Medical comorbidity was only a weak predictor of outcome. Primary care patients with major depressive disorder report substantial impairments in physical, psychological, and social functioning on initial assessment. Severity of baseline medical comorbidity did not correlate with severity of depression and only weakly correlated with functional status at 8 months. Functional impairments improve with time, but standardized depression-specific treatment is associated with greater improvement in more domains of functioning than is a physician's usual care.

Clinical Epidemiology of Nocturnal Leg Cramps in Male Veterans

AbstractThis article describes patients with nocturnal leg cramps concerning their age, medical problems, and medications, and reviews any medical evaluation performed for the complaint of nocturnal leg cramps. Provided is a retrospective chart review of 50 patients who took quinine sulfate for nocturnal leg cramps. These patients were identified through computerized pharmacy records. A control group was chosen from age-matched patients who took medications other than quinine during the study period. In a university- affiliated Veterans Administration hospital, patients with nocturnal leg cramps had a significantly higher median number of medical problems than controls. Cardiovascular diseases and neurological diseases were significantly more common in patients with nocturnal leg cramps (cases) than in those without (controls) (82% versus 64% and 36% versus 18%, respectively). The most striking differences between patients with cramps and controls were peripheral vascular disease (34% versus 12%, P = 0.09) and peripheral neurological deficit (12% versus 0%, P =0.012). Patients with nocturnal leg cramps were prescribed significantly more medications than were controls, but no specific medication or type of medication was prescribed more frequently to patients with cramps (other than quinine). Results suggested that men with nocturnal leg cramps have greater medical comorbidity and are prescribed more medications than age- matched control patients. Unlike in previous studies, no evidence was found that specific medications, such as diuretics, betaagonists, or calcium-channel antagonists are associated with nighttime cramps. The significantly in-creased frequency of peripheral vascular disease and peripheral neurologic deficits in patients with nocturnal leg cramps raised the possibility that these problems contribute to the occurrence of cramps. Although the size of the study and its methodologic limitations preclude definitive conclusions, areas for research to clarify the clinical epidemiology of nocturnal leg cramps are suggested.

Clinical epidemiology of nocturnal leg cramps in male veterans.

This article describes patients with nocturnal leg cramps concerning their age, medical problems, and medications, and reviews any medical evaluation performed for the complaint of nocturnal leg cramps. Provided is a retrospective chart review of 50 patients who took quinine sulfate for nocturnal leg cramps. These patients were identified through computerized pharmacy records. A control group was chosen from age-matched patients who took medications other than quinine during the study period. In a university-affiliated Veterans Administration hospital, patients with nocturnal leg cramps had a significantly higher median number of medical problems than controls. Cardiovascular diseases and neurological diseases were significantly more common in patients with nocturnal leg cramps (cases) than in those without (controls) (82% versus 64% and 36% versus 18%, respectively). The most striking differences between patients with cramps and controls were peripheral vascular disease (34% versus 12%, P = 0.09) and peripheral neurological deficit (12% versus 0%, P = 0.012). Patients with nocturnal leg cramps were prescribed significantly more medications than were controls, but no specific medication or type of medication was prescribed more frequently to patients with cramps (other than quinine). Results suggested that men with nocturnal leg cramps have greater medical comorbidity and are prescribed more medications than age-matched control patients. Unlike in previous studies, no evidence was found that specific medications, such as diuretics, betaagonists, or calcium-channel antagonists are associated with nighttime cramps. The significantly increased frequency of peripheral vascular disease and peripheral neurologic deficits in patients with nocturnal leg cramps raised the possibility that these problems contribute to the occurrence of cramps. Although the size of the study and its methodologic limitations preclude definitive conclusions, areas for research to clarify the clinical epidemiology of nocturnal leg cramps are suggested.