Biomedical subjects

A C Leon

Publications and source records attributed to A C Leon.

At least 73 records · Page 4Linked to original sources

PubMed1997

Poverty and fatal accidental drug overdoses of cocaine and opiates in New York City: an ecological study.

This ecological study examines the association of the poverty status of urban communities in New York City with their mortality rates of accidental drug overdoses. Mean annual age-adjusted rates of drug overdoses involving cocaine, opiates, or both (n = 1,684) were calculated for each of 59 residential community districts in New York City for 1990-1992. A linear regression analysis was performed to test the association of the mortality rate with the poverty status of the district as measured by the proportion of the district living below the 1989 U.S. poverty line. Poverty status accounted for 69% of the variance in the drug overdose mortality rates of communities (p < .001). This study suggests that mortality rates of overdoses involving cocaine and optiates are significantly associated with the poverty status of communities in New York City.

Adolescent↗

PubMed1997

HIV infection among victims of accidental fatal drug overdoses in New York City.

AIMS: To determine the factors associated with HIV seroprevalence rates for victims of drug overdoses. DESIGN: Descriptive epidemiologic survey of a complete 3-year sample of accidental fatal drug overdoses. SETTING: New York City (population 7,322,564). PARTICIPANTS: All people over 15 years of age (n = 2159) who died of accidental fatal drug overdoses during 1991-93. MEASUREMENTS: Using medical examiner data and logistic regression analyses were conducted to examine the association between HIV seroprevalence and gender, race, age and type of drug overdose. FINDINGS: There were 646 (29.9%) victims who were HIV positive. Women (37.5%) were more likely than men (27.9%) to be HIV positive. African-Americans (39.4%) had a higher rate of HIV infection than Latinos (27.5%), whites (19.2%) or Asians (8.3%). Victims residing in communities with higher levels of poverty had higher rates of HIV infection but poverty did not account for the high rates of HIV infection among African-Americans. The highest rates of HIV infection were found among victims aged 35-44 years (38.8%) and 45-54 years (33.7%). Dying from an opiate overdose was associated with a 2.4 times increase in the likelihood of being HIV positive. CONCLUSION: If opiate abuse continues to rise in the United States, HIV infection will increase in the next few years. Women who abuse drugs participate in risky sexual practices and are more likely than men to develop HIV infection from receptive sex as well as sharing of needles. Harm reduction programs should address risky sex as well as needle programs. There should be further study of why African-Americans who died of drug overdoses have the highest rates of HIV infection.

Adolescent↗

PubMed1997

HIV seroprevalence rates among homicide victims in New York City: 1991-1993.

This study assessed HIV seroprevalence in homicide victims killed in New York City in 1991-1993, using data from the Office of Chief Medical Examiner. Among 5852 homicide victims there were 344 (5.9%) victims who were HIV positive. Females were just as likely as males to be HIV positive. For females, the highest rates were in the 25-34 year (11.7%) and 35-44 year (12.6%) age categories. For males the highest rates were in the 35-44 year (13.7%) and 45-54 year (11.5%) age categories. Other than there being no HIV positive Asian victims, there were no differences in HIV rates among racial/ethnic groups. The highest rates of HIV infection for homicide victims were among those using both opiates and cocaine (males: 23.0%; females: 27.3%). Women, not men, using cocaine alone had a high HIV positive rate (18.4%). Victims not using these drugs had rates of HIV around 2%. The authors believe that the high risk of HIV among homicide victims, may be due to the use of cocaine and associated risky use of needles and risky sex practices.

Adolescent↗

PubMed1996

Personality traits in subjects with bipolar I disorder in remission.

This study compared the personality traits of subjects with bipolar I disorder in remission to the personality traits of subjects with no history of any mental illness. Subjects were assessed as part of a prospective, multicenter, naturalistic study of mood disorders. Diagnoses were rendered according to Research Diagnostic Criteria, through use of the Schedule for Affective Disorders and Schizophrenia - Lifetime Version. A total of 30 euthymic bipolar I subjects were compared to 974 never-ill subjects on 17 personality scales selected for their relevance to mood disorders. The subjects with bipolar I disorder in remission had more aberrant scores on 6 of the 17 personality measures, including Emotional Stability, Objectivity, Neuroticism, Ego Resiliency, Ego Control, and Hysterical Factor. These findings indicate that patients with bipolar I disorder in remission have personality traits that differ from those of normal controls.

Adult↗

PubMed1996

Maintenance therapy for chronic depression. A controlled clinical trial of desipramine.

BACKGROUND: Previous studies have shown the efficacy of antidepressants in the treatment of chronic depression. We report the results of a long-term study comparing desipramine hydrochloride and placebo for maintenance therapy of remitted patients with chronic depression. METHODS: Outpatients who met DSM-III-R diagnostic criteria for "pure" dysthymia (n = 51), dysthymia with current major depression ("double depression") (n = 64), or chronic major depression (n = 14) were treated on an open basis with desipramine. Full and partial remitters after 10 weeks entered a continuation phase of open treatment with desipramine for 16 weeks. Remitted patients then were randomized to continue desipramine treatment or tapered to placebo treatment for a maintenance phase of up to 2 years. Relapse rates and time to relapse during maintenance therapy were compared between the two treatment groups. RESULTS: Acute-phase treatment results did not differ significantly according to chronic depression subtype. Remission persisted with a high degree of stability during the continuation phase. Relapse rates during the maintenance phase were 52% for the placebo group and 11% for the active desipramine group (chi 2 = 8.1, P = .004). Most placebo relapses occurred during the first 6 months of maintenance therapy. Active medication was significantly more effective than placebo in that subgroup entering the maintenance phase in full remission and in those patients who fulfilled criteria for a diagnosis of pure dysthymia or double depression on entry to the study. CONCLUSION: Long-term maintenance treatment with desipramine appeared to be effective in the prevention or postponement of relapse of depression in patients who responded to desipramine during the acute and continuation phases.

Adult↗

PubMed1996

Recovery after 5 years of unremitting major depressive disorder.

BACKGROUND: The long-term course of depression in patients who present for treatment carries prognostic and therapeutic implications. This study presents prospective data on the time to recovery from an episode of major depressive disorder of 5 years' duration among patients followed up since 1978 in the National Institutes of Mental Health Collaborative Program on the Psychobiology of Depression. METHODS: Survival analysis was used to examine the 10-year course of the 431 probands with major depressive disorder with a specific focus on the 35 probands who were observed to be continuously ill for the first 5 years. Univariate analytic techniques were used to describe the demographic and clinical variables in the group that recovered and the group that did not. By study design, somatic treatment was assessed but not controlled by the investigators. RESULTS: By year 10, 93% (Kaplan-Meier estimate) of probands had recovered from their intake episode of major depressive disorder. In those ill for the first 5 years, 38% had recovered within the next 5 years. Shorter duration of illness prior to intake and being married were associated with the group that recovered. Pharmacological treatment dosages averaged 100 mg of imipramine hydrochloride equivalent in the chronically ill group. CONCLUSIONS: Despite lengthy periods of illness, people continued to recover from major depressive disorder for up to 10 years of prospective follow-up. Few demographic and clinical variables distinguished those who recovered from those who did not. Treatment, as observed in this naturalistic study, was at a low level despite lengthy illness.

Adult↗

PubMed1996

Subthreshold psychiatric symptoms in a primary care group practice.

BACKGROUND: The authors define 6 groups of subthreshold psychiatric symptoms that do not meet the full criteria for a DSM-IV Axis I disorder and examine the clinical significance of these symptoms in an outpatient primary care sample. METHODS: The subjects were 1001 adult primary care patients in a large health maintenance organization. Data on sociodemographic characteristics and functional impairment, including scores on the Sheehan Disability Scale, were collected at the time of the medical visit, and a structured diagnostic interview for DSM-IV disorders was completed by telephone within 4 days of the visit. Subthreshold symptoms were defined for depressive, anxiety, panic, obsessive-compulsive, drug, and alcohol symptoms. RESULTS: Subthreshold symptoms were as or more common than their respective Axis I disorders: panic (10.5% vs 4.8%), depression (9.1% vs 7.3%), anxiety (6.6% vs 3.7%), obsessive-compulsive (5.8% vs 1.4%), and alcohol (5.3% vs 5.2%) and other drug (3.7% vs 2.4%) cases. Patients with each of the subthreshold symptoms had significantly higher Sheehan Disability Scale scores (greater impairment) than did patients with no psychiatric symptoms. Many patients (22.6%-53.4%) with subthreshold symptoms also met the full criteria for other Axis I disorders. After adjusting for the confounding effects of other Axis I disorders, other subthreshold symptoms, age, sex, race, marital status, and perceived physical health status, only depressive symptoms, major depressive disorder, and, to a lesser extent, panic symptoms were significantly correlated with the impairment measures. CONCLUSIONS: In these primary care patients, the morbidity of subthreshold symptoms was often explained by confounding mental, physical, or demographic factors. However, depressive symptoms and, to a lesser extent, panic symptoms were disabling even after controlling for these factors. Primary care clinicians who detect subthreshold psychiatric symptoms should consider a broad psychiatric assessment.

Adult↗

PubMed1996

Psychiatric symptoms in clients presenting for commercial weight reduction treatment.

OBJECTIVE: To study the prevalence and severity of psychiatric symptoms in a group of clients presenting to a commercial weight reduction program, compared with a group of patients seeking outpatient medical treatment. METHOD: Sixty-six clients presenting for commercial weight loss treatment and 52 patients presenting for general outpatient medical treatment were given self-report measures of anxiety (Spielberger State and Trait Inventory), depression (Beck Depression Inventory), body dissatisfaction (Body Shape Questionnaire), and overall impairment in functioning (Sheehan Disability Scale). RESULTS: Weight loss clients had significantly higher rates of depressive symptomatology and psychosocial disability than patients presenting for medical treatment. Weight loss clients were also more likely to demonstrate body dissatisfaction regardless of actual weight. Levels of anxiety were not significantly different, despite the medical group reporting themselves to be in poorer health as compared with the weight loss group. DISCUSSION: Regular screening for psychiatric symptoms in clients presenting for commercial weight reduction treatment may be valuable as this group may constitute an as yet unidentified cohort requiring psychiatric intervention.

Adult↗

PubMed1996

Childhood abuse and subsequent sexual assault among female inpatients.

The relationship between a history of childhood abuse and subsequent sexual assault was assessed among 409 consecutive female inpatient admissions. A total of 45% of the sample reported a history of some form of childhood abuse and 22% reported at least one adulthood sexual assault. A hierarchical logistic regression indicated that, after controlling for sociodemographic and diagnostic variables, women with a history of childhood abuse were 3.1 times more likely to have experienced an adult sexual assault compared to those without abuse. There was a higher prevalence of adult sexual assault among women reporting only physical abuse or physical and sexual abuse than those reporting only sexual abuse, indicating the significance of physical abuse as a potential risk factor for adult sexual assault.

Adolescent↗

PubMed1996

Suicidal ideation in primary care.

OBJECTIVE: To describe the prevalence and clinical characteristics of primary care patients who report suicidal ideation during the month before their medical visit. DESIGN: Analysis of a self-administered suicidal ideation screening item using sociodemographic data, treatment history, and clinical data from structured interviews. SETTING: Three Rhode Island private family practices, a South Carolina family medicine residency, and a California prepaid internal medicine group practice. PATIENTS: Adult primary care patients (N = 2,749), 18 to 70 years old, who are able to read and write English, able to complete study forms, and willing to provide informed consent. RESULTS: Sixty-seven (2.44%) of the patients reported suicidal ideation ("feeling suicidal") during the past month, and most of those patients (58.2%) received no mental health care during that time. The adjusted risk of suicidal ideation was significantly elevated for patients with self-reported fair or poor physical health (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5, 4.1), fair to poor emotional health (OR 18.0; 95% CI 8.8, 37.0), marital distress (OR 4.4; 95% CI 2.2, 8.8), and recent mental health-related work loss (OR 6.3; 95% CI 3.7, 10.5). In the California sample, patients with major depression (R 31.2; 95% CI 12.8, 76.1). generalized anxiety disorder (OR 23.4; 95% CI 8.1, 67.1), and drug abuse or dependence (OR 9.6; 95% CI 2.9, 31.6) were at increased risk of suicidal ideation. The "feeling suicidal" item identified 10 of 12 patients who acknowledged a recent plan to kill themselves. CONCLUSIONS: In these primary care patients, suicidal ideation is strongly associated with mental disorder and mental health-related functional impairment, and can be detected with a single self-report "feeling suicidal" item.

Adolescent↗

PubMed1996

Brief screens for mental disorders in primary care.

We evaluated a set of diagnostic screens for mental disorders in primary care. A self-administered screening questionnaire containing 26 items testing for multiple mental disorders was completed by 1,001 patients. Brief diagnostic modules, structured for psychiatric diagnoses, were subsequently administered to each patient by a research nurse. Operating characteristics of the screens were as follows: alcohol dependence (sensitivity [SE] 0.75; positive predictive value [PPV] 0.58; [kappa] 0.63), drug dependence (SE 0.50; PPV 0.50; kappa 0.50), generalized anxiety disorder (SE 0.74; PPV 0.44; kappa 0.44), major depressive disorder (SE 0.71; PPV 0.52; kappa 0.50), obsessive compulsive disorder (SE 0.71; PPV 0.15; kappa 0.21), and panic disorder (SE 0.71; PPV 0.43; kappa 0.48). Other chance-corrected measures of agreement are also reported, and criterion validity of the screens is examined. The results provide evidence that the screens discriminate between patients with symptomatology meeting established diagnostic criteria and those without. They detected previously unrecognized cases in this study and may prove to be valuable tools for psychiatric diagnosis in primary care.

Adolescent↗

PubMed1996

Recovery, chronicity, and levels of psychopathology in major depression.

Major depression is a chronic and recurrent disorder for many people who are afflicted by it. There is a wealth of literature addressing the course of this disorder with follow-up times varying from several months to several decades, which gives a remarkably consistent picture in treated and untreated populations. Fortunately, most people who develop major depression recover from their initial episode; unfortunately, a significant minority do not recover fully and a near majority develop additional episodes. This article examines a selected group of studies that have examined the course of depression, with a focus on a large naturalistic longitudinal prospective study of affective disorders--the NIMH Collaborative Depression Study.

Adult↗

PubMed1996

The role of drug and alcohol abuse in recent increases in depression in the US.

Previous studies have reported an increase in depression among recent birth cohorts. Concurrent with the increase in rates of depression, there have been increases in rates of drug and alcohol abuse and dependence. This study sought to determine if the recent increase in rates of depression could be attributed to co-morbid alcohol and drug abuse. The data derived from two studies: (1) a sample of relatives of probands with affective disorder; and (2) a community survey of the US population. The piecewise exponential statistical model was applied to evaluate the association of gender, age, period and birth cohort with rates of major depressive disorder (MDD) separately for those with, and without, diagnoses of alcohol or drug abuse. Elevated rates of MDD occurred among those with co-morbid drug and alcohol abuse in both the family and community samples. However, there were also temporal increases in rates of MDD in those with no such co-morbidity. Specifically there were effects of age and gender for both studies; in addition, there was a period effect in the family study and a birth cohort effect in the community sample. The recent increases in depression in the US cannot be accounted for solely by concurrent increases in co-morbid drug and alcohol abuse. Temporal (period and cohort) effects on rates of depression occur in addition to the contribution of co-morbid drug and alcohol abuse or dependence.

Adolescent↗

PubMed1996

Does major depression result in lasting personality change?

OBJECTIVE: Individuals with a history of depression are characterized by high levels of certain personality traits, particularly neuroticism, introversion, and interpersonal dependency. The authors examined the "scar hypothesis," i.e., the possibility that episodes of major depression result in lasting personality changes that persist beyond recovery from the depression. METHOD: A large sample of first-degree relatives, spouses, and comparison subjects ascertained in connection with the proband sample from the National Institute of Mental Health Collaborative Program on the Psychobiology of Depression were assessed at two points in time separated by an interval of 6 years. Subjects with a prospectively observed first episode of major depression during the interval were compared with subjects remaining well in terms of change from time 1 to time 2 in self-reported personality traits. All subjects studied were well (had no mental disorders) at the time of both assessments. RESULTS: There was no evidence of negative change from premorbid to postmorbid assessment in any of the personality traits for subjects with a prospectively observed first episode of major depression during the interval. The results suggested a possible association of number and length of episodes with increased levels of emotional reliance and introversion, respectively. CONCLUSIONS: The findings suggest that self-reported personality traits do not change after a typical episode of major depression. Future studies are needed to determine whether such change occurs following more severe, chronic, or recurrent episodes of depression.

Adult↗

PubMed1996

Predictors of missed appointments for psychiatric consultations in a primary care clinic.

OBJECTIVE: The purpose of the study was to determine predictors of missed appointments for psychiatric consultations among patients in a general medical clinic. METHODS: The charts of 180 patients consecutively referred for psychiatric consultations at a university-affiliated primary care clinic were reviewed. Ninety patients missed appointments for these consultations. Parametric and nonparametric tests were used to compare patients who missed and did not miss appointments on demographic and clinical variables, as well as measures related to patients' interactions with the clinic and the referring clinician. RESULTS: Logistic regression analysis revealed three significant predictors of missed appointments. Patients with mild distress and those with significant resistance to seeing a psychiatrist were more likely to miss appointments, as were those who had to wait longer between the referral and the appointment date. CONCLUSIONS: The results suggest that shortening the wait for a psychiatric consultation, reserving consultation for more severe cases, and working to reduce patients' resistance to consultation will reduce the number of missed appointments.

Adolescent↗

PubMed1996

Accidental fatal drug overdoses in New York City: 1990-1992.

This study of all accidental fatal drug overdoses (N = 1,986) in New York City from 1990 to 1992, using medical examiner data, found that cocaine, often with opiates and ethanol, caused almost three-fourths of deaths, while opiates without cocaine caused roughly one-fourth of fatal overdoses. Only 5% of accidental drug fatalities were caused by drugs other than cocaine or opiates. This is a marked departure from the results of studies in the early 1980s when opiates prevailed as a cause of accidental fatal overdoses. In this study the highest cocaine overdose rates were found among males, African-Americans, and Latinos. Rates of opiate overdose without cocaine did not differ in regard to race/ethnicity except for low rates among Asians and other ethnic groups. There was a marked increase in the rate of combined cocaine and opiate overdoses from 1990 to 1992 and a more gradual but steady increase of overdoses due to opiates without cocaine during that time period. Overdoses due to drugs other than cocaine or opiates showed no increase during that time period.

Accidents↗

PubMed1996

Psychotic symptoms in primary care.

BACKGROUND: Psychotic symptoms include a variety of disturbances in perception, reality testing, speech, and behavior. We examine the prevalence, distribution, treatment, and functional impairment associated with psychotic symptoms in primary care patients. METHODS: Data are drawn from a recent study of adult primary care patients (N = 1001) in a large, urban, prepaid group practice. At the medical visit, patients completed a questionnaire that probed demographic characteristics, health status, and mental health care utilization. Following the visit, patients received a telephone-administered, structured psychiatric interview that included 11 psychotic symptoms. Medication prescription data were also available. Comparisons are presented of patients with and without psychotic symptoms. RESULTS: Thirty-seven (3.7%) patients reported one or more psychotic symptoms, most commonly a belief that others were spying on or following them (n = 16). As compared with patients without psychotic symptoms, a larger proportion of the patients with psychotic symptoms reported mental health-related work loss (54.1% vs 17.9%, P < .0001), suicidal ideation (21.6% vs 2.6%, P < .0001), major depressive disorder (32.4% vs 6.3%, P < .0001), bipolar disorder (29.7% vs 1.2%, P < .0001), and several other mental disorders. An antipsychotic medication had been prescribed during the previous 17 to 20 months for only two (5.4%) of the patients with psychotic symptoms. CONCLUSIONS: Psychotic symptoms were relatively common (3.7%) in this practice and were strongly associated with functional impairment and affective, anxiety, or substance use disorders. Primary care physicians are encouraged to examine patients with these mental disorders for the presence of psychotic symptoms.

Adult↗

PubMed1996

Lithium treatment of bipolar affective disorders under naturalistic followup conditions.

A naturalistic followup was conducted on 41 bipolarmanic inpatients who sought ongoing treatment after hospital discharge. Standardized interviews were conducted 2 and 4.5 years after hospitalization to assess medication use, outcome, and relapse. At followup, 41 percent of the bipolar patients taking lithium had poor outcome. Nearly half met criteria for relapse and had been rehospitalized. Patients on lithium had the same work and overall functioning as those who were not taking it. Patients on lithium alone, however, had significantly better adjustment and fewer relapses compared with those taking lithium plus neuroleptics. A subgroup of good-prognosis bipolar patients may respond to lithium monotherapy under typical clinical conditions, however, those requiring adjunctive maintenance neuroleptics may be at higher risk for poor outcome. Lithium prophyliaxis may be less effective in routine clinical practice than in specialized treatment centers, possibly due to less rigorous treatment monitoring, medication noncompliance, complex affective symptoms, and poorer surveillance to defect recurrent prodromal illness.

Adult↗