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Biomedical subjects

C L Rich

Publications and source records attributed to C L Rich.

12 recordsLinked to original sources
PubMed1992

Similarities in diagnostic comorbidity between suicide among young people in Sweden and the United States.

A significant difference in the prevalence of personality disorders was reported between similar studies of suicide among young people (under age 30) performed in San Diego, California (10% of 133 cases), and Göteborg, Sweden (34% of 58 cases). The difference was due entirely to the absence of borderline personality disorder (BPD) reported in the San Diego sample. In this study, we used preselected variables to reassess the suicides from the San Diego study for criteria consistent with BPD. We found that 41% met the criteria, which was now not significantly different from the Göteborg sample. Comparisons among a number of other demographic, social, and diagnostic variables revealed many similarities in the two samples, particularly Axis I comorbidity with depression and/or substance abuse and Axis II comorbidity with antisocial personality disorder. We conclude that the characteristics associated with BPD identify similar young persons who committed suicide in Sweden and the United States. Questions remain as to whether or not Axis I and II disorders are independent in relation to suicide. The comorbidity pattern described here must be considered seriously in the clinical setting for its fatal implications.

Adolescent↗
PubMed1991

Secular trends in psychiatric diagnoses of suicide victims.

Post-mortem psychiatric diagnoses are compared in two cohorts of male suicides from St. Louis (1956-1957) (Robins, 1981) and San Diego (1981-1982) (Rich et al., 1986). Similar structured interviews and diagnostic criteria had been used in both assessments. Substance/alcohol abuse has remained the major diagnosis in suicides under age 60. Rates of depressive disorder alone have decreased overall, due mostly to decreased rates in the elderly. Thus, depression occurs more frequently in younger ages. Comorbid depression and substance/alcohol abuse has also increased in younger ages. Implications in terms of the so-called 'cohort effect' are discussed.

Adolescent↗
PubMed1979

Suicide among U.S. women physicians, 1967-1972.

The authors examined AMA records of the deaths of 751 women physicians during 1967-1972. Forty-nine (6.56%) committed suicide. The suicide rate for women physicians (40.7 per 100,000 per year) was higher than for men physicians and about four times that for white American women of the same age. From the known morbid risk for suicide among women with primary affective disorder, the authors calculated that about 65% of American women physicians have primary affective disorder.

Adult↗
PubMed1978

Self-induced vomiting. Psychiatric considerations.

Self-induced vomiting has been associated with the psychiatric diagnosis of anorexia nervosa and a newly proposed disorder named bulimia. Two patients with a self-induced vomiting compulsion did not fulfill criteria for either of these diagnoses. One patient had an affective disorder, and the other had no psychiatric illness, but the habit had developed as a weight control measure. Systematic studies of these symptoms are not available. Clinical diagnostic decisions should not be base on one outstanding sign or symptom, eg, self-induced vomiting, unless research clearly relates the sign or symptom to only one disorder.

Adult↗
PubMed1978

Borderline diagnoses.

The author describes the development of the borderline concept and the apparent inaccuracy of the original hypothetical framework. The signs and symptoms used to describe a "borderline syndrome" are often shared with other psychiatric illnesses. The author recommends that clinicians consider patients with only those features as "undiagnosed" until further research determines whether a distinct syndrome exists.

Humans↗
PubMed1978

General psychiatry in a subspecialty setting.

Reorganization of outpatient services at Western Psychiatric Institute and Clinic identified a small percentage of patients who did not fit into the subspecialty framework. This necessitated the reestablishment of a General Psychiatry Clinic. A review of 100 patients in the Clinic revealed that they represented the most difficult diagnostic and management problems in the system. General Psychiatry in this subspecialty setting has practically become a subspecialty in its own right, rather than fulfilling a more traditional role of providing general care to the least complicated patients.

Delivery of Health Care↗
PubMed1977

CPK: relationship of psychological and physical stress.

In the past few years, the finding of elevated serum levels of creatine phosphokinase in some acutely psychotic patients has commanded a great deal of interest. Although structural abnormalities in nerve and muscle of some of these patients have been described, the cause remains obscure. Physical stress will raise CPK, but the role of psychological stress has been unclear. CPK levels of medical students were measured before and after an academic examination, but no relationship between examination stress and changes in CPK was found. A significantly higher number of CPK elevations were reported in association with vigorous exercise. These findings are consistent with a hypothesis that psychological stress plays an insignificant role in the CPK elevations seen in some acutely psychotic patients. The importance of physical activity in elevated CPK values was reconfirmed.

Adult↗
PubMed1975

The effect of modified ECT on serum creatine phophokinase, I. With intravenous atropine.

Interpretation of serum creatine phosphokinase (CPK) levels is frequently difficult because of complicating circumstances known themselves to raise CPK; for instance, intramuscular injections. One such circumstance among psychiatric patients is said to be administration of electroconvulsive therapy (ECT). In a series of 22 patients who received drug modified ECT, four had CPK elevations beyond the normal range. These findings indicate that CPK elevations among patients receiving ECT should be interpreted cautiously.

Adolescent↗
PubMed1975

The effect of modified ECT on serum creatine phosphokinase. II. With subcutaneous atropine.

In the previous study, the effect of modified ECT on serum CPK was investigated. In that study, atropine was administered intravenously two minutes prior to ECT being given. In this study, the more usual clinical procedure in which atropine is administered subcutaneously is investigated. In a series of nineteen patients, four had CPK elevations beyond the normal range. These findings resemble the findings of the previous study closely, and indicate again that elevations of CPK in patients receiving ECT should be interpreted with caution.

Atropine↗