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Biomedical subjects

C S North

Publications and source records attributed to C S North.

At least 55 records · Page 3Linked to original sources
PubMed1993

A systematic study of mental health services utilization by homeless men and women.

Psychiatric illness is overrepresented among the homeless, but mental health services are underutilized in this population in proportion to their needs. The current study was concerned with 900 homeless men and women randomly sampled and systematically interviewed with the Diagnostic Interview Schedule; it focuses on psychiatric and substance abuse rehabilitation service patterns and stated needs of this population in relation to specific psychiatric disorders. Although rates of lifetime treatment utilization were fairly high in comparison with general population utilization patterns, rates of treatment in the current year were low. In particular, outpatient services have been neglected for reliance upon inpatient services. Although the major reason cited for not obtaining treatment by homeless persons with mental illness was lack of insurance and inability to pay for it, having health insurance was not associated with mental health services utilization, nor were other important predictors apparent. Mental health professionals serving mentally ill homeless populations would best serve them by focusing on creative and innovative ways to improve the availability and attractiveness of ambulatory care services.

Adolescent↗
PubMed1993

Is antisocial personality a valid diagnosis among the homeless?

OBJECTIVE: It has been argued that among the homeless many of the features of antisocial personality may be artifacts of homelessness and that strict application of the diagnostic criteria may be insensitive to social and cultural factors in this group. The authors studied a large group of homeless men and women to investigate the appropriateness of the diagnosis of antisocial personality disorder among the homeless. METHOD: Six hundred homeless men and 300 homeless women were randomly selected from shelters and street locations in St. Louis and interviewed with the National Institute of Mental Health Diagnostic Interview Schedule. RESULTS: In this sample of homeless men and women, most, but not all, adult symptoms of antisocial personality disorder were significantly associated with number of childhood conduct disorder symptoms. The onset of symptoms of antisocial personality disorder usually preceded the onset of homelessness. The rates of antisocial personality disorder were not significantly affected by discounting the antisocial disorder symptoms thought to be confounded with homelessness. CONCLUSIONS: Overall, the data support the appropriateness of the diagnosis of antisocial personality disorder among homeless populations. It cannot be said from these data that homelessness often leads to antisocial behaviors.

Adolescent↗
PubMed1993

Alcohol, drugs, and psychiatric comorbidity among homeless women: an epidemiologic study.

BACKGROUND: Very little is known about the mental health of homeless women. The present study is one of the first to focus on psychiatric diagnosis and comorbidity in a population of homeless women systematically interviewed with a structured instrument. METHOD: Three hundred homeless women randomly selected from St. Louis shelters were interviewed using the Diagnostic Interview Schedule (DIS). RESULTS: The population of homeless women in St. Louis is predominantly young adult, single, and black; most have young children and average nearly a high school education. Schizophrenia and bipolar affective disorder account for only a small portion of the mental illness in these women. Nearly one in three has a history of substance abuse, with drug abuse being more prevalent than alcoholism. One third of the sample met lifetime criteria for posttraumatic stress disorder. One fourth of the women have received inpatient psychiatric care, and the majority with a nonsubstance Axis I diagnosis have received some mental health treatment. CONCLUSION: Although major mental illness is overrepresented among these homeless women, the majority do not suffer from major mental illness. Despite the severity of the stressors these women face, the large numbers escaping psychiatric disorders speak to their resilience and to the likelihood that important factors other than mental illness contribute to their homelessness. Future studies to examine positive outcomes and investigate protective factors might provide a valuable source of information on coping with the stresses associated with homelessness and point to more effective interventions.

Adolescent↗
PubMed1993

Multiple personality disorder: scientific and medicolegal issues.

Despite the intense study it has received since its inclusion in DSM-III, multiple personality disorder (MPD) largely remains an unvalidated construct. Definitional problems remain (there is not even agreement in the field as to whether a diagnosis of MPD truly means the existence of more than one personality), while the vagueness and liberality of existing criteria give the clinician little guidance in diagnosis. In forensic settings, diagnosis of MPD is even more problematic, since there is substantial evidence that the disorder cannot currently be phenomenologically distinguished from malingering. It also remains to be demonstrated that evaluators can determine whether alter personalities, if they exist, are truly unaware of each other, lack control over other alters' behavior, or are unable to know right from wrong.

Dissociative Identity Disorder↗
PubMed1992

Posttraumatic stress disorder among homeless men and women.

Six hundred homeless men and 300 homeless women in St. Louis were systematically interviewed using the revised Diagnostic Interview Schedule that includes a module for assessment of posttraumatic stress disorder (PTSD). Most subjects with PTSD had an additional life-time psychiatric diagnosis. No consistent pattern of association was apparent, however, between individual diagnoses and either traumatic events or PTSD. In almost three-fourths of both men and women, the onset of PTSD had preceded the onset of homelessness. Childhood histories of abuse and family fighting were predictive of both traumatic events and PTSD. The results suggest that factors leading to PTSD in the study sample began long before the onset of homelessness and may overlap with factors operative in the genesis of homelessness.

Adolescent↗
PubMed1992

Thanatology: a new clinical specialty to help confront death.

The complexities, widespread ramifications and uncertainties surrounding decisions dealing with the process of dying call for a specialty of clinical thanatology. The need for such a specialty grows out of medical technological progress, which has permitted the prolongation of life without parallel guidelines for its termination. The further functions and roles of a thanatologist would evolve with the passage of time.

Decision Making↗
PubMed1991

Do life events or depression exacerbate inflammatory bowel disease? A prospective study.

OBJECTIVE: To determine whether depressed mood or life events are associated with an exacerbation of inflammatory bowel disease. DESIGN: A prospective study of a consecutive sample of patients with relapsing inflammatory bowel disease, followed by monthly questionnaires and periodic office visits. SETTING: A referral-based gastroenterology clinic at a medical school. PATIENTS: A consecutive sample of 32 patients with inflammatory bowel disease who had had at least one relapse in a 2-year period after entry into the study. MEASUREMENTS AND MAIN RESULTS: The Social Readjustment Rating Scale (measuring life events), the Beck Depression Inventory (a visual analog scale for depressed mood) and an inventory of intestinal symptoms were completed monthly by each subject with a 78% rate of compliance. A mean of 2.2 exacerbations was seen per subject during the study period. Life events were not temporally associated with changes in intestinal symptoms. Significant associations were found between intestinal symptoms and the two mood scales (P less than 0.05 for each), but no directionality in symptom occurrence could be detected in a time-lagged analysis. The results were similar when the months preceding exacerbations of inflammatory bowel disease were analyzed separately. CONCLUSIONS: Although these findings suggest that mood changed concurrently with exacerbation of inflammatory bowel disease, no evidence indicated that stressful life events or depressed mood precipitated exacerbations in this study group.

Colitis, Ulcerative↗
PubMed1990

Acute postdisaster psychiatric disorders: identification of persons at risk.

This study examined the prevalence of four psychiatric disorders--posttraumatic stress disorder, major depression, generalized anxiety disorder, and alcohol abuse/dependence--in survivors of a jet plane crash into a hotel. Forty-six subjects were interviewed with the Diagnostic Interview Schedule/Disaster Supplement within 4-6 weeks of the event. More than half of the subjects met criteria for a psychiatric disorder after the disaster. More than two-thirds of the cases of acute postdisaster psychiatric disorders were predicted by identifying the subjects who had predisaster psychiatric histories. Predisaster psychiatric disorder predicted postdisaster psychopathology with a sensitivity of 72% and a specificity of 90%.

Adult↗
PubMed1990

The relation of ulcerative colitis to psychiatric factors: a review of findings and methods.

The authors reviewed all known English-language literature on the association between psychiatric factors and ulcerative colitis to ascertain the evidence for such an association and evaluate the methods used in these studies. Most of the 138 studies contained serious flaws in research design, such as lack of control subjects, unspecified manner of data collection, and absence of diagnostic criteria. Analysis revealed that methodological flaws were significantly related to the finding of a positive association between psychiatric factors and ulcerative colitis. Seven studies represented solid systematic investigation, and all seven failed to find such an association.

Adult↗
PubMed1990

Post-traumatic stress disorder in disaster survivors.

In spite of the difficulties inherent in the study of traumatic stress in disaster victims, the benefit of obtaining more knowledge on the subject is potentially great, especially considering the numbers of individuals affected. Recent estimates of the frequency of world-wide traumatic events have determined that almost two million households annually experience damages and/or injuries from fire, floods, hurricanes, tornadoes, and earthquakes alone. The population that is at risk is expected to grow exponentially with our expanding technology, making it even more vital to acquire knowledge to help the growing number of future disaster victims. Additionally, disaster research can contribute to a better understanding of PTSD and human coping processes that can be generalized to more ordinary stress situations. In the meantime, survivors of major catastrophes who experience acute symptoms of PTSD such as insomnia, nightmares, and jumpiness should be observed for nonresolution of symptoms over time, especially if there is a premorbid history of psychopathology or character problems. Otherwise, survivors may benefit from reassurance that PTSD symptoms are common in the short-term postdisaster period and that they can usually be expected to dissipate with time.

Adaptation, Psychological↗
PubMed1989

Current concepts of schizophrenia.

Although the specific etiology of schizophrenia is still unknown, the recent explosion in the technology of brain research has pointed to several lines of compelling evidence for biologic factors of causation. As research progresses, antiquated theories of psychosocial causation are gradually being discarded in favor of a biological-stress model.

Humans↗
PubMed1987

Risk factors for sleep disordered breathing in heterogeneous geriatric populations.

This cross-sectional, multivariate study investigated associations between sleep disordered breathing (SDB) and putative risk factors in a heterogeneous group of 720 individuals over the age of 50 years studied during all-night in-lab polysomnography. Results indicated that: aged men were more likely to show impaired respiration during sleep than aged women; excessive daytime somnolence and parasomniac symptoms (snoring, gasping during sleep) were associated with SDB but insomnia was not; obesity accounted for more variance in SDB than age per se, implying that the prevalence of SDB in some elderly persons could be related to the deposition of body fat seen as individuals grow older. All four risk factors (age, sex, obesity, and symptomatic status) were statistically significant and independent predictors of impaired respiration in sleep in the elderly.

Age Factors↗
PubMed1980

Depression in family practice: some effects on spouses and children.

Medical complaints and office visits of spouses and children of depressed patients were examined and compared to a matched comparison group of spouses and children of nondepressed patients. Both spouses and children of depressed patients showed increased numbers of visits and complaints which returned to control levels one year after the depression was diagnosed and treated. Infection, pain, functional, and anxiety complaints showed significant increases in spouses over controls. Definite diagnoses, infections, pain, and anxiety complaints were significantly increased in children compared to controls. In both spouses and children these complaints returned to control levels by the third period of the study, one year after the depression had been diagnosed (and treatment for depression started). The pain, functional, and anxiety complaints of spouses and children were very similar qualitatively to those of the depressed patients. The results demonstrate the validity of the family as a unit of medical care.

Anxiety↗
PubMedDate not supplied

Familial subtypes of depression: a longitudinal perspective.

An 11-year follow-up of depressed women systematically interviewed and classified by familial subtypes during hospitalization tended to confirm findings of a gradation in severity of illness with depressive spectrum disease being a milder form. Depressive spectrum subjects had shorter subsequent episodes of depression than the other depressives and were less likely to require hospitalization for depression. Depressive spectrum subjects were at greater risk than the others for the development of alcoholism and they experienced more social maladjustment, which suggests implications for treatment strategies and future research.

Adult↗
PubMedDate not supplied

Irritable bowel syndrome in a psychiatric patient population.

The prevalence of irritable bowel syndrome (IBS) in psychiatric practice was studied in 41 consecutive psychiatric outpatients. Different criteria for IBS were applied to the data set to determine the effects on the rates of IBS obtained. Depending on an option in the Rome criteria, IBS rates varied from 13% using the "and" requirement for combining abdominal pain and altered bowel function symptoms, to 41% using the "and/or" option described in the formal definition statement in 1990. The resultant prevalence rates of IBS varied greatly according to which published criteria were applied, with a maximum of 71%. This wide variation in rates depending on the criteria underscores the critical importance of standardizing diagnostic research criteria for IBS. An exemplary model of empirically based validation has been developed for psychiatric disorder criteria which, like IBS, are symptom-based and lack physiological determinants. Validated diagnostic criteria for IBS await similar study.

Adult↗
PubMedDate not supplied

Nonpsychotic thought disorder: objective clinical identification of somatization and antisocial personality in language patterns.

This report describes a new method of using language patterns to identify somatization and antisocial personality (ASPD) disorders in clinical practice. A set of definitions describing characteristic speech patterns was developed to identify "nonpsychotic thought disorder" (NPTD). Speech patterns of subjects with somatization disorder and/or ASPD were compared with those of controls. Blind raters assessed audiotaped samples of speech obtained through open-ended interviews for instances of elements of NPTD. Women with somatization or ASPD had significantly more NPTD speech responses than controls, and women with both disorders showed the greatest amount. Antisocial men did not demonstrate more NPTD than controls, nor was somatization in men associated with NPTD. Clinical attention to speech patterns in patients may help alert clinicians to these disorders in women and serve as indicators for screening for these disorders. More study is needed to develop psychometric properties of the instruments on larger samples, and to identify speech indicators of personality disorder in men. It is likely that other personality disorders, e.g., borderline personality disorder, can be identified through speech patterns, and they deserve study with these methods.

Adult↗