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Biomedical subjects

C I Cohen

Publications and source records attributed to C I Cohen.

At least 37 records · Page 2Linked to original sources
PubMed1998

Depression among African American nursing home patients with dementia.

The authors compared 218 black and 68 white nursing home patients with dementia for differences in the prevalence, recognition, and treatment of depression. There were no racial differences in depressive symptoms, but whites were significantly more likely to receive a diagnosis of "possible depression" and there were few racial differences in clinical, social, or demographic factors associated with depression. Depression was often unrecognized and undertreated in both racial groups; several depression instruments developed for use in dementia had good reliability and validity among blacks; and there were no significant differences in depressive symptoms or diagnosis between U.S.-born and Caribbean-born black patients. The absence of any appreciable interracial or intraracial differences in depression symptoms or diagnoses may reflect uniformity in nursing home selection criteria or lessening of mood differences that may have existed before admission.

Activities of Daily Living↗
PubMed1997

Relation between premorbid personality and patterns of emotion expression in mid- to late-stage dementia.

Twenty-seven nursing home patients with mid- to late-stage dementia participated in a study of the relation between preillness personality, as indexed by attachment and emotion regulation style, and current emotional behavior. Preillness measures were completed by family members and current assessments of emotion were supplied by nursing home aides and family members; in addition, emotion was coded during a family visit using an objective coding system for facial emotion expressions. Attachment style was found to be related to the expression of positive affect, with securely attached individuals displaying more positive affect than avoidantly attached individuals. In addition, high ratings on premorbid hostility were associated with higher rates of negative affect and lower rates of positive affect. These findings indicate that premorbid aspects of personality show continuity over time, even in mid- to late-stage dementia.

Affective Symptoms↗
PubMed1997

Predictors of becoming redomiciled among older homeless women.

The authors test a model to predict residential outcome among 201 homeless women aged 50 and over. On two-year follow-up, 47% were successfully domiciled. Of 12 variables examined using logistic regression analysis, only 2 variables, perceived support and number of community facilities attended were significant predictors of being domiciled on follow-up. Three additional variables-absence of psychosis, a lifetime history of less than one year of homelessness, and number of entitlements-attained near-significance. Although residential outcome is predicted by a few individual characteristics, what is most striking is the lack of suitable housing options.

Female↗
PubMed1997

"Mixed dementia": adequate or antiquated? A critical review.

Despite its importance and widespread usage, the term mixed dementia, referring to the coexistence of Alzheimer's disease (AD) and vascular dementia (VsD), has been ill-defined and poorly conceptualized. The authors review the use of the term mixed dementia in neuropathological and clinical research. As a result of recent developments in the categorization of dementias, they recommend discarding the term mixed dementia in favor of a more precise terminology based on AD and VsD concurrently meeting established criteria for each diagnosis.

Alzheimer Disease↗
PubMed1997

The impact of welfare reform as perceived by users of mental health services in New York City.

A total of 118 psychiatric outpatients, 43 percent of whom were foreign born, completed a 12-item questionnaire about the impact of the new federal welfare legislation. A majority of respondents were worried about the new law and believed that it would worsen their mental symptoms, their well-being, and the quality of life in their neighborhood. Nearly half felt that the law had already affected their mental symptoms. Foreign-born patients were significantly more worried about the law than U.S.-born patients. The results suggest that organized psychiatry and individual psychiatrists should become more involved in activities to diminish the impact of the welfare legislation on patients and their families.

Adult↗
PubMed1997

A comparison of US-born African-American and African-Caribbean psychiatric outpatients.

This study compares US-born African Americans with African Caribbeans attending an urban psychiatric outpatient clinic on various items pertaining to sociodemographics, psychiatric history, current psychiatric illness, and physical health. A structured chart review was performed on a sample comprised of 135 native-born African Americans and 91 African Caribbeans who had attended the clinic during an 11-year period. A total of 28 clinical variables were examined. Nine clinical variables were found to significantly differentiate the two groups in bivariate analysis, and these were entered along with three demographic control variables into a logistic regression analysis. Seven variables attained significant independent effects. African Americans were differentiated from African Caribbeans on history of greater alcoholic abuse or dependence, presence of more delusions, worse health, longer history of previous outpatient treatment, and greater clinical improvement at 6 months. African Caribbeans were found to have a greater frequency of depression and aggressivity. These data underscore the importance of examining intraracial differences in mental illness as well as pointing to the potential benefits of using intraracial comparisons to interpret interracial analyses.

Adult↗
PubMed1997

Predictors of subjective well-being among older, community-dwelling persons with schizophrenia.

This study tests a theoretical model of subjective well-being (SWB) for community-dwelling older persons with schizophrenia. The sample consisted of 117 persons age 55 and over (mean age = 63 years) who developed schizophrenia before age 45. With the use of bivariate analyses and then logistic regression, five variables attained significance as predictors of SWB: male gender, absence of loneliness, older age, reliable social contacts, and fewer perceived life difficulties. Although a comparison with their age-peers in the general population indicated that the sample was worse on several objective indicators of well-being, for example, income, clinical depression, physical limitations, and social network size, none of these variables was predictive of SWB. Rather, the data largely supported the "judgment" theory of SWB, which proposes that SWB is based on beliefs about oneself and others.

Age Distribution↗
PubMed1996

Depression among aging persons with schizophrenia who live in the community.

OBJECTIVES: The study used the social antecedent model of depression in later life proposed by Linda K. George to develop a multifactorial model of predictors of depression among aging persons with schizophrenia living in the community. METHODS: The SHORT-CARE and the Network Analysis Profile, along with supplemental items, were administered to 117 outpatients age 55 and older who received DSM-III-R diagnoses of schizophrenia before age 45. Bivariate and multivariate analyses examined associations between 27 variables derived from George's model and the presence of depression. A cutoff score for the depression scale of the SHORT-CARE was used to detect clinically significant depression. RESULTS: Forty-four percent of the sample had probable pervasive depression. Bivariate analysis indicated that 16 variables were significantly associated with depression, and logistic regression showed that six variables were strong predictors. Depression was associated with the presence of positive symptoms, physical limitations interfering with activities, younger age, diminished linkage of members of the social network, lower income, and a smaller proportion of social network members who provided sustenance such as food and money. An 11-variable model correctly classified 81 percent of cases. CONCLUSIONS: The level of depression among older outpatients with schizophrenia is approximately one and a half to three times the level in the general older population. Depression in this patient group is associated with nonclinical variables that are independent of psychoses and that resemble patterns found among general older populations. Several of the variables are potentially alterable and therefore afford opportunities to enhance the well-being of persons with schizophrenia who live in the community.

Activities of Daily Living↗
PubMed1994

Down and out in New York and London: a cross-national comparison of homelessness.

OBJECTIVE: This study compared homelessness in New York City and London to examine the relative roles of individual pathology and structural forces in causing homelessness, the effect of sociopolitical and cultural differences on policy decisions toward solving homelessness, and the effect of broader structural forces on service programs for the homeless. METHODS: A review of the scholarly literature and news reports was combined with interviews of staff members and homeless persons associated with various community agencies in London and New York City. Homelessness in the two cities was compared in relation to definition, demography, nonpsychiatric and psychiatric etiological factors, public policy, governmental responses, financial support, service strategies, and the practicalities of securing services and entitlements. RESULTS AND CONCLUSIONS: The results indicate that characterizations of homelessness as a trait rather than a state reflect the tensions between social justice, public concepts, and a nation's economic resources. The absolute numbers of homeless persons, including those who are mentally ill, primarily reflect structural factors such as the availability of low-cost housing and public benefits. The commonalities that mentally ill homeless persons share with other vulnerable groups generally outweight their differences. The statutory rights to entitlements may be vitiated in times of shortage, especially for the least capable citizens. In both countries, efforts have been made to use the voluntary sector to serve the homeless, although it has been used much more extensively in Britain.

Cost Allocation↗
PubMed1993

The biomedicalization of psychiatry: a critical overview.

The biomedical model currently dominates psychiatric clinical practice and research. Unfortunately, this dominance had led increasingly to biological reductionism. This paper examines the historical and sociopolitical underpinnings of the biomedical model, and illustrates some of the common scientific distortions of reductionistic thinking. These observations are applied to recent directions in mental health policy and are used to provide a basis for alternative perspectives of mental illness and psychiatric research.

Biological Psychiatry↗
PubMed1993

Progressive psychiatry: a research agenda.

It is possible to create a new research agenda based on an alternative perspective of human behavior and mind. After describing the theoretical tenets of this alternative perspective, illustrations of a new research agenda are presented. Such a research agenda would: (1) create new points of departure; (2) examine social relations underlying all variables; (3) more fully explore "unexplained variance;" (4) focus on the adaptive interaction of individuals within their world. Such research aims towards enhancing human uniqueness, action, and spirit.

Biological Psychiatry↗
PubMed1993

Poverty and the course of schizophrenia: implications for research and policy.

Interest in the relationship between social class and schizophrenia has diminished in recent years. However, these issues can usefully be reconsidered in light of increased recognition that schizophrenia has a protean course, that deinstitutionalization and community support of persons with schizophrenia are linked to welfare programs, and that conceptualizations and measurements of social class and its impact on the daily life of persons with schizophrenia have been rudimentary. The author examines the role that social class, especially poverty, plays in the course and outcome of schizophrenia. He reviews literature on the contributions of social structure and policy to the economic status of persons with schizophrenia, identifies variables associated with poverty that are found disproportionately among persons with schizophrenia, and examines the psychological significance of those variables. The overview is used to develop three approaches to research: examining the role of the chronic stress of poverty in the vulnerability model of schizophrenia, using poverty as a point of departure for investigation by considering persons with schizophrenia as primarily indigent rather than primarily mentally ill, and delineating how poverty and elements of schizophrenia influence each other.

Causality↗
PubMed1993

Racial differences in clinical and social variables among patients evaluated in a dementia assessment center.

Despite increased interest in dementia and the concomitant creation of dementia assessment centers, there has been a paucity of reports examining racial differences in the social and clinical presentation of dementia. Such information can enhance knowledge about dementia and assist in the planning of diagnostic centers located in areas with large minority populations. This study reviewed the charts of patients evaluated at a dementia assessment center in New York City. The sample comprised 102 white and 68 black patients. There were no racial differences in types of dementia nor reported length of illness. However, bivariate analysis revealed many significant differences between the groups in social, medical, and psychiatric variables. Most notably, a stepwise discriminant analysis identified seven variables--Medicaid recipient, gender, age, sleep disturbances, delusions of stealing, hypertension, and concentration--as correctly being able to classify 75% of cases. Racial differences in cognitive and behavioral symptoms may reflect the interaction of dementia with physical health, premorbid history, environment, or some basic difference in disease course.

Aged↗