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Background The Anticoagulation Therapy in Selected Cancer Patients at Risk of Recurrence of Venous Thromboembolism (SELECT‐D) trial demonstrated reduction in recurrent venous thromboembolism (VTE) but increased bleeding with rivaroxaban compared with dalteparin for treatment of acute VTE in cancer patients, at 6 months. Uncertainty remains around optimal duration of anticoagulation. Objectives To assess VTE recurrence and bleeding, with anticoagulation or not, beyond 6 months. Patients/Methods In SELECT‐D, after 6 months of trial treatment for VTE, patients with active cancer and residual deep vein thrombosis (RDVT) or index pulmonary embolism (PE) were eligible for randomization to a further 6 months of rivaroxaban or placebo. Patients with no RDVT stopped anticoagulation. Primary outcome was VTE recurrence at 12 months. The second randomization closed prematurely because of low recruitment when 92 of the planned 300 patients were recruited. Results Ninety‐two of 136 eligible patients were randomized to rivaroxaban or placebo. The cumulative VTE recurrence after 6 months from the second randomization was 14% with placebo and 4% with rivaroxaban (hazard ratio, 0.32; 95% confidence interval [CI], 0.06‐1.58). The major and clinically relevant non‐major bleeding rates were 0% and 0% with placebo; and 5% (95% CI, 1‐18) and 4% (95% CI, 1‐17) with rivaroxaban. In an exploratory analysis, 7 (15%) of 46 placebo patients with RDVT or an index PE experienced recurrent VTE compared to none in the 35 patients in the RDVT‐negative cohort (P = .03). Conclusion The SELECT‐D trial was underpowered to detect a statistically significant reduction in recurrent VTE with extended anticoagulation. The absence of RDVT and/or index PE, defined a population at low risk of recurrence.

Objective: There is increasing evidence and awareness that rheumatoid arthritis symptoms, such as joint pain and activity limitations, are strongly influenced by psychosocial variables. We hypothesized that depression is significantly associated with functional capabilities in rheumatoid arthritis (RA) patients. Method: We examined in a cross-sectional, retrospective data-based study the role of depression, pain severity, and self-efficacy in daily functioning in forty-five adult male veterans aged 55 and older who were patients with RA. Results: The overall RA disablement model of depression, pain severity, and self-efficacy accounted for 67% of predicted variance in disability. All independent variables were significantly associated with functional impairment in RA patients. Conclusions: Psychosocial factors, such as depression and self-efficacy, contribute greatly to disability in RA patients. Clinicians should carefully assess psychiatric and non-disease factors during medical evaluation in p...

As many World War II and Korean Conflict veterans suffering from posttraumatic stress disorder (PTSD) grow older, increasing numbers will be diagnosed with dementia. We retrospectively analyzed patients with dementia, comparing the behavioral disturbances of those with PTSD to those without PTSD. We hypothesized that due to the additive effect of the neurobiological and behavioral changes associated with PTSD and dementia, the dementia with PTSD group would show more agitation and disinhibition than the dementia without PTSD group. Sixteen patients with diagnoses of dementia and PTSD were matched on age and Mini-Mental States Examination (MMSE) scores to 16 patients with dementia without PTSD. Demographic characteristics, co-morbid diagnoses, global Assessment of Functioning (GAF), Cohen-Mansfield Agitation Inventory (CMAI), and paranoid items of Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale for Schizophrenia (PANSS) were assessed. The patients with diagnoses of dementia with PTSD did not differ significantly in their clinical presentation, hospital course, and condition at discharge from patients with dementia without PTSD. Chi-square analysis showed that significantly more subjects in the PTSD group were prescribed anti-depressants compared to the non-PTSD group. Interestingly, within the PTSD group, the subgroup of patients who were former prisoners of war had a significantly higher mean score for paranoia and significantly less verbal agitation. This pilot study reveals that a diagnosis of PTSD alone is not sufficient to influence behavior in veterans with dementia; however, we also present provocative results that patients with more severe trauma (POW) do have changes in their behavior.

This study evaluated the separate and additive contributions of direct violent victimization, witnessed violence, and community chaos to children's posttraumatic stress reactions and behavior problems. Participants were 181 African American youths residing in low-income urban communities. Regression analyses revealed direct victimization to be most predictive of behavior problems and community chaos most predictive of posttraumatic stress reactions in children. Path models established community chaos as a mediator of the relation between witnessed violence and posttraumatic stress reactions and the relation between witnessed violence and behavior problems. Community chaos did not mediate the relation between direct victimization and posttraumatic stress reactions or behavior problems; however, a significant direct contribution of violent victimization to behavior problems was established. Findings support the emphasis placed on community chaos and instability in exacerbating stress reactions in the presence of interpersonal violence. Findings are discussed in terms of risk minimization and distress management.

Objective Cross-cultural differences in treatment and diagnosis exist in several psychiatric disorders. This study examines phenomenological and treatment differences between Caucasian and African-American patients presenting to a geropsychiatric unit for treatment of behavioral disturbances associated with dementia. Methods One hundred and forty-one Caucasian patients were compared to 56 African-American patients consecutively admitted to a VA geropsychiatric inpatient unit. At admission, differences in behavior disturbances between the two groups were examined using the Mini-Mental State Examination (MMSE), Cohen-Mansfield Agitation Inventory (CMAI), Hamilton Rating Scale for Depression (HAM-D), Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). Differences in treatment were assessed by comparing medication types and doses between the two groups. Results and Conclusion Results showed that Caucasian and African-American patients with dementia and behavioral disturbances presented and responded similarly to like treatment on an inpatient geropsychiatric unit. The similarity between the two groups may be explained by the multi-ethnic make-up of the interdisciplinary treatment team and by the use of standardized scales to measure symptomatology and response. Copyright © 1999 John Wiley & Sons, Ltd.

Researchers have alternately suggested selective attention, impaired stimulus filtering, and affective language deficiency models as accounting for multiple somatic complaints in persons with chronic pain disorder. The purpose of the present study was to establish the comparative usefulness of these three models for explaining somatic focus in a chronic pain population. Nine chronic pain patients evidencing high somatic focus (somatizing chronic pain patients), 10 chronic pain patients evidencing low somatic focus (nonsomatizing chronic pain patients), and 10 healthy control subjects were administered a computerized version of the emotional Stroop test as a test of these models. A total of 105 pain-, depression-, and neutral-content words were used as Stroop test stimuli. Stroop test color-naming response latencies were submitted to a two-way Group × Word Type mixed-model ANOVA, with Word Type as the repeated measure. Results reveal that neither the selective attention model nor the affective language deficiency model adequately explain Stroop test performance in somatizing chronic pain patients. Findings provide tentative support for the impaired stimulus filtering model, with somatizing chronic pain patients evidencing similar Stroop test response delays across all words. These results suggest that chronic pain sufferers misinterpret bodily sensations. Findings are discussed in terms of a bilevel approach for treatment of somatizing chronic pain patients that would include assisting the patient in accurate appraisal and interpretation of physical symptoms.

This study examined the outcomes associated with shortening hospital stays for geriatric inpatients with dementia at a Veterans Administration medical center. Thirty-three patients who were admitted after January 1997, when the hospital decided to reduce patients' lengths of stay, were matched with 33 patients who were admitted before January 1997. Despite significant differences in lengths of stay, no differences were found between the groups on measures of agitation or overall functioning. Despite significantly shorter stays since January 1997, the results of our study indicate that the cognitive and emotional status of patients discharged since that time are equivalent to those of patients discharged after longer hospital stays.