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OBJECTIVE: To systematically evaluate the clinical effect and safety of acupuncture in the treatment of cardiac neurosis. METHODS: Chinese databases (including SinoMed, VIP, CNKI, and Wanfang Data) and English databases (including PubMed and The Cochrane Library) were searched for randomized controlled trials (RCTs) on acupuncture in the treatment of cardiac neurosis published up to March 2019. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of included studies, and then RevMan 5.3 was used to perform a meta-analysis. RESULTS: A total of 7 RCTs were included, with 491 patients with cardiac neurosis. The results of the meta-analysis showed that compared with the conventional western medicine group, the acupuncture group had a significantly higher total effective rate (risk ratio ï¼»RRï¼½=1.16, 95% CIï¼»1.05,1.28ï¼½, P=0.005) and had significantly greater improvements in Hamilton Anxiety Scale score (mean difference ï¼»MDï¼½=-3.22, 95% CIï¼»-6.05, -0.39ï¼½, P=0.03). There were no significant differences between the two groups in Hamilton Depression Scale score (MD=-1.92, 95% CIï¼»-4.76, -0.91ï¼½, P=0.18)ï¼traditional Chinese medicine symptom score (MD=-5.49, 95% CIï¼»-11.55, 0.56ï¼½, P=0.08), somatization symptom score (MD=-0.91, 95% CIï¼»-3.28, 1.46ï¼½, P=0.45), and adverse reactions (RR=0.67, 95% CIï¼»0.26,1.78ï¼½, P=0.42). CONCLUSION: Acupuncture can alleviate the symptoms and is safe in the treatment of cardiac neurosis.
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Terapia por Acupuntura , Astenia Neurocirculatoria , Humanos , Medicina Tradicional China , Astenia Neurocirculatoria/terapia , PubMed , Resultado del TratamientoRESUMEN
No disponible
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Humanos , Femenino , Persona de Mediana Edad , Anestésicos Locales/efectos adversos , Síndrome de Horner/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Adenomatosis Pulmonar/diagnóstico , Diarrea/etiología , Hematoma/diagnóstico , Astenia Neurocirculatoria/etiología , Toracotomía/efectos adversosAsunto(s)
Anestésicos Locales/efectos adversos , Síndrome de Horner/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Adenomatosis Pulmonar/diagnóstico , Diarrea/etiología , Femenino , Hematoma/diagnóstico , Humanos , Persona de Mediana Edad , Astenia Neurocirculatoria/etiología , Toracotomía/efectos adversosRESUMEN
OBJECTIVE: The relevance of the problem stated in the title of this article comes from the significant increase in the prevalence of the functional cardiovascular disorders having been documented during the past years especially such as circulatory asthenia that most frequently affects the young people of the working age suffering from the systemic neurogenic imbalance in the organism and can be seriously aggravated by the influence of biotropic weather conditions and be responsible for enhanced meteosensitivity that has negative effect on the quality of life and impairs the effectiveness of the therapeutic interventions. AIM: The objective of the present study was to provide the scientifically sound substantiation of the feasibility of the application of the non-medicamentous methods (including the interval hypoxic training and «dry¼ carbonic baths) for the prevention and treatment of neurocirculatory asthenia complicated by enhanced meteosensitivity and evaluate the therapeutic effectiveness of these approach. MATERIAL AND METHODS: A total of 50 patients with the verified diagnosis of neurocirculatory asthenia were recruited to participate in the study. All the patients were divided into two groups. 62% of them exhibited the well apparent meteosensitivity and were included in the study group 1. Group 2 was comprised of the remaining patients (38% of their total number) presenting with neurocirculatory asthenia who did not suffer appreciable changes in the general physical and mental state under the influence of varying weather conditions. The patients of both groups received the identical combined treatment consisting of interval hypoxic training and taking «dry¼ carbonic baths. Monitoring of the main meteorological parameters was carried out on a daily basis. It was combined with the assessment of the weather conditions from the medical perspective, the evaluation of the physical performance capability of the patients based on the results of the veloergometric testing, and the estimation of their functional state of the autonomous nervous system with the use of the data obtained in cardiointervalographic studies. In addition, the state of the microcirculatory system was evaluated by means of laser Doppler flowmetry and making use of a capillary blood flow analyzer. The psychological status of the patients was characterized using a computer-generated version of the abridged multifactorial questionnaire for the elucidation of the manifest personality-scale anxiety (Spielbeger's State-Trait Anxiety Inventory). All these studies were carried out both before and after the course of non-medicamentous therapy. RESULTS: After the course of the combined non-medicamentous treatment had been completed the health status of the patients comprising the two groups was found to be improved as appeared from the decrease of the number and severity of subjective autonomous manifestations, the positive changes in the functional state of the cardiovascular system and the autonomic nervous system as well as in the general psychological status. The most clinically significant result of the treatment included the reduction in the incidence of the severe meteopathic reactions in the patients of group 2 (from 14% before to 3% after therapy). The frequency of moderately expressed meteopathic reactions likewise decreased (from 31% before to 14% after the treatment). CONCLUSIONS: The study has demonstrated that under the environmental and climatic conditions of the of Moscow region formation of biotropic weather factors of the hypoxic type (39%) constitutes a serious risk factor contributing to the development of imbalance in the vegetative nervous system and its exacerbations in response to variations of weather parameters. The application of the non-medicamentous therapeutic modalities (including interval hypoxic training and «dry¼ carbonic baths) for the management of the meteosensitive patients presenting with neurocirculatory asthenia is pathogenetically justified, and they can be recommended for both the treatment and prevention of weather- dependent pathological processes and their exacerbations.
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Conceptos Meteorológicos , Astenia Neurocirculatoria/terapia , Modalidades de Fisioterapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Astenia Neurocirculatoria/diagnósticoRESUMEN
Patients with chronic conditions like hypertension may experience many negative emotions which endorse the development of anxiety and depression symptomatology, thus they increase their risk for poor quality of life. Several studies have shown an association between symptoms of psychological distress and hypertension. In this study we aimed to quantify the link between depression, cardiophobia and quality of life in hypertensive patients. A cross-sectional design was employed. A sample of 197 hypertensive patients (89 men-108 women, mean age 53 years, SD=12 ranged 25-78) from a university outpatient hypertension clinic in Greece participated. Ninety-four (47.7%) of the participants suffered from essential grade I hypertension; 68 (34.5%) were grade II; 16 (8.1%) were categorized as grade III, while only 11 (5.6%) patients were recorded as normotensives with high normal values. The questionnaires included: (a) question for the recording of social-demographic characteristics and clinical features, (b) The Short Form (SF-36) Health Survey, (c) The Beck Depression Inventory -I, and (d) The Cardiac Anxiety Questionnaire. There were no significant differences between the two genders with exception of marital status (p=0.010), dyslipidemia (p=0.050), grade of hypertension (p=0.014), cardiac left ventricular hypertrophy (p=0.004), renal failure (p=0.043) and stroke (p=0.024). Lower levels of quality of life and higher levels of depression and cardiophobia were observed compared to the general population. There were no significant differences on psychological measures between the two sexes (p>0.05). Cardiophobia was positively related to depressive symptomatology (r=0.533, p=0.000) while negatively to both physical and mental health summary measures of SF-36 health survey (r=-0.467, p=0.000 r=-0.537, p=0.000 respectively). Multiple linear regression models found that for psychical health depression and cardiac anxiety, avoidance activities had an influence on levels of quality of life in hypertensive patients, after controlling for age and other socio-demographic variables and clinical characteristics (Beta=-0.133, p=0.007, Beta=-0.364 p=0.000 and Beta=-0.167 p=0.006, respectively). For mental component summary depression and cardiophobia, heart focused attention had also impact on mental health in hypertensives (Beta=-0.438, p=0.016, Beta=-0.564, p=0.000 and Beta=-0.223, p=0.037, respectively) after adjustments. Heart focused anxiety symptoms-as avoidance activities and/or attention and monitoring cardiac activity, are related to hypertensive patients' present deteriorated depressive symptoms and levels of quality of life. Both depressive symptomatology and heart focused anxiety may be a mechanism partly responsible for hypertensive patients' present impaired levels of quality of life.
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Trastorno Depresivo/psicología , Hipertensión/psicología , Astenia Neurocirculatoria/psicología , Calidad de Vida/psicología , Adulto , Anciano , Comorbilidad , Estudios Transversales , Trastorno Depresivo/diagnóstico , Femenino , Grecia , Encuestas Epidemiológicas , Humanos , Hipertensión/diagnóstico , Masculino , Persona de Mediana Edad , Astenia Neurocirculatoria/diagnóstico , Estrés Psicológico/complicaciones , Estrés Psicológico/psicologíaRESUMEN
STUDY OBJECTIVES: Whereas both insomnia and altered interoception are core symptoms in affective disorders, their neural mechanisms remain insufficiently understood and have not previously been linked. Insomnia Disorder (ID) is characterized by sensory hypersensitivity during wakefulness and sleep. Previous studies on sensory processing in ID addressed external stimuli only, but not interoception. Interoceptive sensitivity can be studied quantitatively by measuring the cerebral cortical response to one's heartbeat (heartbeat-evoked potential, HEP). We here investigated whether insomnia is associated with increased interoceptive sensitivity as indexed by the HEP amplitude. METHODS: Sixty-four participants aged 21-70 years were recruited through www.sleepregistry.nl including 32 people suffering from ID and 32 age- and sex-matched controls without sleep complaints. HEPs were obtained from resting-state high-density electroencephalography (HD-EEG) recorded during evening wakeful rest in eyes-open (EO) and eyes-closed (EC) conditions of 5-minute duration each. Significance of group differences in HEP amplitude and their topographical distribution over the scalp were assessed by means of cluster-based permutation tests. RESULTS: In particular during EC, and to a lesser extent during EO, people with ID had a larger amplitude late HEP component than controls at frontal electrodes 376-500 ms after the R-wave peak. Source localization suggested increased neural activity time-locked to heartbeats in people with ID mainly in anterior cingulate/medial frontal cortices. CONCLUSIONS: People with insomnia show insufficient adaptation of their brain responses to the ever-present heartbeats. Abnormalities in the neural circuits involved in interoceptive awareness including the salience network may be of key importance to the pathophysiology of insomnia.
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Interocepción/fisiología , Astenia Neurocirculatoria/fisiopatología , Astenia Neurocirculatoria/psicología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Adulto , Anciano , Nivel de Alerta/fisiología , Concienciación/fisiología , Mapeo Encefálico , Corteza Cerebral/fisiopatología , Electrocardiografía , Electroencefalografía , Potenciales Evocados/fisiología , Femenino , Corazón/fisiología , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
No disponible
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Intoxicación/complicaciones , Intoxicación/epidemiología , Intoxicación por Monóxido de Carbono/epidemiología , Intoxicación por Monóxido de Carbono/prevención & control , Carboxihemoglobina/toxicidad , Oxigenoterapia Hiperbárica/instrumentación , Oxigenoterapia Hiperbárica/métodos , Astenia/complicaciones , Astenia/diagnóstico , Astenia/terapia , Astenia Neurocirculatoria/complicaciones , Tamizaje Masivo/métodos , Tamizaje Masivo/prevención & control , Oxigenoterapia Hiperbárica/normas , Oxigenoterapia Hiperbárica/tendencias , Oxigenoterapia HiperbáricaAsunto(s)
Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/complicaciones , Electrocardiografía , Estado de Salud , Hiperpotasemia/diagnóstico , Debilidad Muscular/etiología , Astenia Neurocirculatoria/etiología , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana EdadRESUMEN
As a result of examination 147, patients with traumatic encefalopatìû (TE) were explained the features of cognitive disorders, selected major psihopatologìcnì syndromes. The moderate cognitive disorders (KP) in patients THOSE, were observed in 40%bolnykh with the psikhorganicheskim syndrome, in 90.6% of patients with the asthenic syndrome, in 90.4%--by likvorodistsirkulyatornym syndrome and 76.1% in patients are cerebral--by focus syndrome. CD complicates, the progress of any post traumatic syndrome, in which they were presented. Moderate cognitive disorders are included in the structure of post traumatic psihorganìcnoo syndrome and is a significant dezadaptuûcim factor for the patient.
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Lesiones Encefálicas/fisiopatología , Enfermedades Cerebelosas/fisiopatología , Epilepsia/fisiopatología , Astenia Neurocirculatoria/fisiopatología , Trastornos Neurocognitivos/fisiopatología , Adulto , Lesiones Encefálicas/diagnóstico , Enfermedades Cerebelosas/diagnóstico , Epilepsia/diagnóstico , Femenino , Humanos , Masculino , Astenia Neurocirculatoria/diagnóstico , Trastornos Neurocognitivos/diagnóstico , Pruebas NeuropsicológicasRESUMEN
AIM: To evaluate the efficacy of cytoflavin in the treatment of patients with hypertensive encephalopathy (HE). SUBJECTS AND METHODS: One hundred and forty patients aged 39 to 73 years, diagnosed with HE, were examined and randomized to 2 groups. A study group (n = 74) received cytoflavin in a dose of 2 tablets b.i.d. on days 1 to 25 days inclusive during standard basic therapy. A comparison group (n = 66 persons) had standard basic therapy only. A control group consisted of 30 apparently healthy individuals. The investigators studied the frequency of headache, dizziness, and other complaints and the intensity of cephalalgic syndrome, by using a visual analog scale, the quality of life by the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36) questionnaire, that of sleep by the subjective sleep characteristics questionnaire elaborated at the Moscow City Somnological Center, the level of asthenia by a subjective asthenia rating scale (Multidimensional Fatigue Inventory (MFI-20), and autonomic status, by applying objective and subjective scales on days 1 and 25 of therapy. RESULTS: The study has shown that cytoflavin used in the above dose for 25 days reduces the frequency and magnitude of complaints of headache, dizziness, "venous" complaints, the degree of autonomic and asthenic disorders, and impairments in the quality of sleep and life in the patients with HE at all disease stages. A stepwise discriminant analysis has indicated that the degree of cephalgic syndrome, and autonomic disorders, and worse sleep quality are the most effective points for using the energy-modifier cytoflavin. CONCLUSION: HE treatment based on the current pathogenetic principles may have a preventive impact on the development of HE or slow down the rate of its progression.
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Mononucleótido de Flavina/administración & dosificación , Cefalea , Encefalopatía Hipertensiva , Inosina Difosfato/administración & dosificación , Astenia Neurocirculatoria , Niacinamida/administración & dosificación , Trastornos del Sueño-Vigilia , Succinatos/administración & dosificación , Administración Oral , Adulto , Anciano , Relación Dosis-Respuesta a Droga , Combinación de Medicamentos , Monitoreo de Drogas , Metabolismo Energético/efectos de los fármacos , Femenino , Cefalea/diagnóstico , Cefalea/tratamiento farmacológico , Cefalea/etiología , Humanos , Encefalopatía Hipertensiva/complicaciones , Encefalopatía Hipertensiva/tratamiento farmacológico , Encefalopatía Hipertensiva/metabolismo , Encefalopatía Hipertensiva/fisiopatología , Encefalopatía Hipertensiva/psicología , Masculino , Persona de Mediana Edad , Astenia Neurocirculatoria/diagnóstico , Astenia Neurocirculatoria/tratamiento farmacológico , Astenia Neurocirculatoria/etiología , Dimensión del Dolor/métodos , Polisomnografía , Calidad de Vida , Índice de Severidad de la Enfermedad , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/tratamiento farmacológico , Trastornos del Sueño-Vigilia/etiología , Resultado del Tratamiento , Escala Visual Analógica , Complejo Vitamínico B/administración & dosificaciónRESUMEN
The article gives information about the results of research of characteristics of post traumatic stress disorder (PTSD) in the participants of the anti-terrorist operation (ATO), and refugees. Drawn attention to the fact that the demonstration took place in the study of PTSD patients, in the form of the following options: invasion (penetration); avoiding (displacement); hyperactivation. In the study took part 71 serviceman (69 men and 2 women) aged from 22 to 35 years (average age 26,2 years) that have closed traumatic brain injury , in the form of a brain concussions, contusions and suffered on PTSD (main group), studies conducted in 3-6 months after received closed traumatic brain injury. In the group of comparison included 37 patients (34 women and 3 men) aged 27-42 years (average age 32,2 years) that have had PTSD. In a group that included military personnel, in which in addition to PTSD, the clinical picture had existing consequences of craniocerebral injury observed in asthenic symptom complex--27 patients (38.1%); the anxious-phobic--in 19 patients (26.7%); hysterical--in 8 patients (11.3%); a depressive--in 17 patients (23.9%). In a group of patients and refugees from the ATO was: asthenic symptom complex--in 12 patients (32.4%), the anxious-phobic--in 11 patients (29.7%), hysterical--in 6 patients (16.2%), a depressive--in 8 patients (21.7%).
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Ansiedad/fisiopatología , Trastorno Depresivo/fisiopatología , Astenia Neurocirculatoria/fisiopatología , Trastornos Fóbicos/fisiopatología , Trastornos por Estrés Postraumático/fisiopatología , Estrés Psicológico/fisiopatología , Adulto , Ansiedad/diagnóstico , Ansiedad/patología , Lesiones Encefálicas/patología , Lesiones Encefálicas/fisiopatología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/patología , Femenino , Humanos , Masculino , Personal Militar , Astenia Neurocirculatoria/diagnóstico , Astenia Neurocirculatoria/patología , Trastornos Fóbicos/diagnóstico , Trastornos Fóbicos/patología , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/patología , Estrés Psicológico/diagnóstico , Estrés Psicológico/patología , Ucrania , Exposición a la GuerraAsunto(s)
Fístula Arteriovenosa/complicaciones , Glomerulonefritis/complicaciones , Hipertensión/complicaciones , Hipertensión/terapia , Astenia Neurocirculatoria/etiología , Fístula Arteriovenosa/terapia , Progresión de la Enfermedad , Glomerulonefritis/terapia , Insuficiencia Cardíaca/complicaciones , Humanos , Ligadura , Masculino , Persona de Mediana Edad , Diálisis Renal , Insuficiencia del TratamientoRESUMEN
OBJECTIVE: General anxiety symptoms are common in patients with cardiac disease and considered to have an adverse effect on cardiac prognosis. The role of specific cardiac anxiety, however, is still unknown. The aim of this study is to examine the factor structure, reliability, and validity of the Dutch version of the Cardiac Anxiety Questionnaire (CAQ), which was specifically designed to assess heart focused anxiety. METHODS: Two hundred thirty-seven patients admitted for an acute coronary syndrome (ACS) and a control group of 49 patients admitted for an exacerbation of rheumatoid arthritis (RA) completed the CAQ, the Agoraphobic Cognitions Questionnaire, Mobility Inventory, Beck Depression Inventory, Beck Anxiety Inventory, and the State-Trait Anxiety Inventory. RESULTS: Although the original three-factor solution (fear, avoidance, and attention) was acceptable (model fit parameters: CFI = 0.89 and TLI = 0.87), our data were best explained by a four-factor model including safety seeking behaviors. Internal consistency and test-retest reliability were good. The CAQ had moderate correlations with the other anxiety and depression questionnaires. Recently admitted ACS patients had significantly higher scores than RA patients, even after controlling for general anxiety and depressive symptoms (p < 0.001). CONCLUSION: The CAQ is a reliable and valid instrument to assess cardiac anxiety in patients hospitalized with ACS. These results enable longitudinal studies to examine the relationship of heart-focused anxiety with cardiac prognosis and to evaluate interventions specifically targeted at anxiety in cardiac patients.
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Síndrome Coronario Agudo/psicología , Trastornos de Ansiedad/psicología , Infarto del Miocardio/psicología , Astenia Neurocirculatoria/psicología , Encuestas y Cuestionarios , Síndrome Coronario Agudo/diagnóstico , Anciano , Trastornos de Ansiedad/diagnóstico , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Países Bajos , Astenia Neurocirculatoria/diagnóstico , Psicometría/estadística & datos numéricos , Valores de Referencia , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Panic disorder (PD) is a common, often unrecognized condition among patients presenting with chest pain to the emergency departments (ED). Nevertheless, psychological treatment is rarely initiated. We are unaware of studies that evaluated the efficacy of brief cognitive-behavioural therapy (CBT) for this population. AIM: Evaluate the efficacy of two brief CBT interventions in PD patients presenting to the ED with chest pain. METHOD: Fifty-eight PD patients were assigned to either a 1-session CBT-based panic management intervention (PMI) (n = 24), a 7-session CBT intervention (n = 19), or a usual-care control condition (n = 15). A structured diagnostic interview and self-reported questionnaires were administered at pre-test, post-test, 3- and 6-month follow-ups. RESULTS: Statistical analysis showed significant reduction in PD severity following both interventions compared to usual care control condition, but with neither showing superiority compared to the other. CONCLUSIONS: CBT-based interventions as brief as a single session initiated within 2 weeks after an ED visit for chest pain appear to be effective for PD. Given the high prevalence of PD in emergency care settings, greater efforts should be made to implement these interventions in the ED and/or primary care setting.
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Dolor en el Pecho/psicología , Terapia Cognitivo-Conductual/métodos , Servicio de Urgencia en Hospital , Astenia Neurocirculatoria/terapia , Trastorno de Pánico/psicología , Trastorno de Pánico/terapia , Psicoterapia Breve/métodos , Adulto , Anciano , Anciano de 80 o más Años , Agorafobia/diagnóstico , Agorafobia/psicología , Agorafobia/terapia , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Entrevista Psicológica , Masculino , Persona de Mediana Edad , Astenia Neurocirculatoria/diagnóstico , Astenia Neurocirculatoria/psicología , Trastorno de Pánico/diagnóstico , Quebec , Adulto JovenRESUMEN
The authors present the results of clinical, physiological and psychological examination of 31 patients with neurocirculatory asthenia with arterial hypertension syndrome. There was an increase in the levels of state and trait anxiety correlated with a number of physiological traits that confirmed a leading role of psycho-emotional sphere in the formation of hypertensive reactions. An evaluation of the efficacy of the drug Adaptol used in daily dosage 1500 mg during 8 weeks in the treatment of these patients revealed its high efficacy (the improvement was seen in 74% of cases) confirmed by the data of clinical and psychological studies.
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Ansiolíticos/uso terapéutico , Biureas/uso terapéutico , Hipertensión/tratamiento farmacológico , Astenia Neurocirculatoria/tratamiento farmacológico , Adulto , Ansiolíticos/administración & dosificación , Biureas/administración & dosificación , Femenino , Humanos , Hipertensión/fisiopatología , Hipertensión/psicología , Masculino , Astenia Neurocirculatoria/fisiopatología , Astenia Neurocirculatoria/psicología , Síndrome , Resultado del TratamientoRESUMEN
The present study assesses the psychometric properties and factor structure of the Greek version of the Cardiac Anxiety Questionnaire (CAQ). The questionnaire was administered to 598 healthy individuals from 15 different regions of Greece with a measure of socioeconomic characteristics and the Symptom Checklist-90-Revised (SCL-90-R). The sample was split into two random halves, and exploratory factor analysis indicated a three-factor solution. This solution was tested using a confirmatory factor analysis on the second half of the sample. In terms of latent dimensions, the Greek version retains the three-factor structure as proposed by the initial authors. However, adequate fit was achieved only after omitting eight items. The shorter (10-item) version was submitted to further analysis. The shorter version provided satisfactory internal reliability and evidence indicating the validity of the scale with respect to SCL-90-R subscales. The stability of the questionnaire was verified by a high test-retest reliability over a 3-mo. period (r = .86). Sex and age differences were assessed. The 10-item version appears to be a practical, brief tool for clinical use.