Biomedical subjects

D V Sheehan

Publications and source records attributed to D V Sheehan.

At least 37 records · Page 2Linked to original sources

PubMed1996

The measurement of disability.

The frequent occurrence of desynchrony between psychiatric symptoms and disability makes it necessary to measure disability/ functional impairment in addition to psychiatric symptoms when tracking treatment outcome. Existing disability measures in psychiatry are comprehensive but lengthy. There is a need for short, simple, cost-effective, sensitive measures of disability and functional impairment in psychiatric disorders. We developed a discretized analog disability scale (DISS) which uses visual-spatial, numeric and verbal descriptive anchors to assess disability across three domains: work, social life and family life. The DISS has proved to be very sensitive to change in drug treatment studies in psychiatry. The usefulness of the DISS in assessing disability in terms of work, social and family relationships is discussed.

Disability Evaluation↗

PubMed1996

The role of SSRIs in panic disorder.

This article reviews all available studies reported in the literature or presented at national or international meetings on the efficacy of serotonin selective reuptake inhibitors and less selective serotonin uptake inhibitors in panic disorder. The research data lags behind-rather than leads-experience in everyday clinical practice. The emerging data suggest that serotonin uptake inhibitors are superior to placebo and better tolerated than most of the older alternatives. As a result they are now becoming first-choice treatments in panic disorder.

1-Naphthylamine↗

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

Evaluation of screens for mental disorders in primary care: methodological issues.

Several brief screens are available to help identify mental disorders in primary care. In choosing among them, an investigator must consider the clinical research setting, the sampling framework, and the strategy used to assess the reliability and validity of the instruments. These issues are considered in the context of the study that revised the Symptom-Driven Diagnostic System for Primary Care (SDDS-PC) for the DSM-IV. The sample size determination strategy used in that study rendered a sample that was large enough to allow for a split-sample approach to data analysis. The screen algorithms were developed on an index sample, and the operating characteristics were cross-validated with data from a separate sample. Standard operating characteristics as well as chance-corrected, or quality operating characteristics were used to evaluate the construct validity of the screens. Criterion-related validity of the screens was evaluated by examining functional impairment. Screens such as these may be valuable clinical and research tools for psychiatric diagnosis in primary care.

Humans↗

PubMed1993

Serotonin in panic disorder and social phobia.

The role of serotonin in psychiatry has been the focus of speculation for several decades. The literature since 1966 is reviewed (and referenced) and five organizing questions are identified: (1) What are the major hypotheses regarding the involvement of the serotonin system in panic disorder? (2) Is there a serotonin system defect associated with panic disorder? (3) Is a serotonin system defect the cause of panic disorder? (4) Are the 5-HT1A agonists and the 5-HT2 antagonists effective in this condition? (5) Are serotonin selective uptake inhibitors (SSUIs) effective in panic disorder via the serotonin system or some other mechanism? Though the role of the serotonin system in panic disorder and social phobia is uncertain there is increasing agreement that SSUIs effectively treat panic disorder but further double-blind placebo-controlled studies are needed.

Anti-Anxiety Agents↗

PubMed1993

The relative efficacy of high-dose buspirone and alprazolam in the treatment of panic disorder: a double-blind placebo-controlled study.

This 8-week double-blind placebo-controlled trial investigated the relative efficacy and safety of alprazolam and buspirone in the treatment of panic disorder. Alprazolam (mean +/- SD dose 5.2 +/- 2.6 mg) produced a rapid and sustained improvement in panic attacks, anxiety, phobias, and disability and was superior to buspirone (mean +/- SD dose 61 +/- 26.5 mg) and placebo on all of these measures on completer (n = 85) and endpoint analysis (n = 92). Although higher doses of buspirone were used in this study than in previous trials, buspirone was not superior to placebo on any of the outcome measures. The results were disappointing in light of buspirone's benign side effect profile and low abuse potential.

Adolescent↗

PubMed1992

Prevalence of substance use among US physicians.

OBJECTIVE: To estimate the prevalence of substance use among US physicians. DESIGN: A mailed, anonymous, self-report survey that assessed use of 13 substances and permitted comparison with results of the National Household Survey on Drug Abuse. Rates of physician substance use were weighted to provide national prevalence estimates. PARTICIPANTS: A national sample of 9600 physicians, stratified by specialty and career stage, and randomly selected from the American Medical Association master file. The response rate after three mailings was 59%. Demographic characteristics of respondents closely reflected those of the US physician population. MAIN OUTCOME MEASURES: Subjects' self-reported use of 13 substances in their lifetime, the past year, and the past month; reasons for use; self-admitted substance abuse or dependence; and whether treatment was received. For controlled prescription substances, respondents were asked to report only use "not prescribed by another physician for a legitimate medical or psychiatric condition." RESULTS: Physicians were less likely to have used cigarettes and illicit substances, such as marijuana, cocaine, and heroin, in the past year than their age and gender counterparts in the National Household Survey on Drug Abuse. They were more likely to have used alcohol and two types of prescription medications--minor opiates and benzodiazepine tranquilizers. Prescription substances were used primarily for self-treatment, whereas illicit substances and alcohol were used primarily for recreation. Current daily use of illicit or controlled substances was rare. CONCLUSIONS: Although physicians were as likely to have experimented with illicit substances in their lifetime as their age and gender peers in society, they were far less likely to be current users of illicit substances. The higher prevalence of alcohol use among respondents may be more a characteristic of their socioeconomic class than of their profession. A unique concern for physicians, however, is their high rate of self-treatment with controlled medications--a practice that could increase their risk of drug abuse or dependence. Uniform national guidelines are needed to sensitize medical students and physicians to the dangers of self-treatment with controlled prescription substances.

Adult↗

PubMed1992

Resident physician substance use, by specialty.

OBJECTIVE: This study compares substance use by medical specialty among resident physicians. METHOD: The authors estimated the prevalence of substance use of 11 medical specialties from a national sample of 1,754 U.S. resident physicians. RESULTS: Emergency medicine and psychiatry residents showed higher rates of substance use than residents in other specialties. Emergency medicine residents reported more current use of cocaine and marijuana, and psychiatry residents reported more current use of benzodiazepines and marijuana. Contrary to recent concerns, anesthesiology residents did not have high rates of substance use. Family/general practice, internal medicine, and obstetrics/gynecology were not among the higher or lower use groups for most substances. Surgeons had lower rates of substance use except for alcohol. Pediatric and pathology residents were least likely to be substance users. CONCLUSIONS: The authors' previous research indicates that residents overall have lower rates of substance use than their age peers in society. Yet resident substance use patterns do differ by specialty. Residents in some specialties are more likely to use specific classes of drugs, to use a greater number of drug classes, and to be daily users of alcohol or cigarettes.

Benzodiazepines↗

PubMed1992

Relations among stressors, strains, and substance use among resident physicians.

This study examined the relationship between work-related stress and substance use among resident physicians in the United States. Unlike previous studies of physician stress, this study distinguished between "stressors" (stressful job conditions) and "strains" (reactions to the work environment) and correlated each of these with substance use. Results indicated that relations among stressors, strains, and substance use were not strong. Strains, however, were more strongly related to substance use than stressors. Additionally, benzodiazepines were more strongly related to strains than other substances, suggesting that they may be used for self-treatment. Other implications of these findings and future research needs are discussed.

Adult↗

PubMed1991

Resident physician substance use in the United States.

A national survey was conducted to determine patterns of drug use among 3000 American resident physicians. Sixty percent (1785) of the residents surveyed responded. This report evaluates the prevalence of drug use among the respondents, when they initiated drug use, and their reasons for current use. Substance use rates are compared with other studies of resident physicians and with a sample of their nonphysician age peers surveyed the same year. Heavy substance use patterns were not observed among resident physicians. They had significantly lower rates of use for most psychoactive substances than their peers in the general population but did report higher rates of past-month use of alcohol and benzodiazepines. A sizable minority began using benzodiazepines and prescription opiates during their residency years-the stage in physicians' training when they first receive prescribing privileges. Current users of benzodiazepines and opiates used these drugs primarily for self-treatment rather than recreation. These two substances are often associated with impairment at later stages in the physician's career.

Adult↗

PubMed1991

Substance use among senior medical students. A survey of 23 medical schools.

Senior students at 23 regionally distributed medical schools received an anonymous questionnaire designed to examine current and prior use of tobacco, alcohol, and nine other drugs. The overall response rate was 67% (N = 2046). Substance use prevalence rates during the 30 days preceding the survey included alcohol, 87.5%; marijuana, 10.0%; cigarettes, 10.0%; cocaine, 2.8%; tranquilizers, 2.3%; opiates other than heroin, 1.1%; psychedelics other than LSD (lysergic acid diethylamide), 0.6%; amphetamines, 0.3%; barbiturates, 0.2%; LSD, 0.1%; and heroin, 0.0%. Compared with national, age-related comparison groups, senior medical students reported less use of all substances during the past 30 days and the past 12 months, except for alcohol, tranquilizers, and psychedelics other than LSD. Substantial new drug use after entry into medical school was reported only for tranquilizers. Seven students (0.2%) admitted to current dependence on a substance other than tobacco, four of these implicating marijuana. Thirty-three students (1.6%) believed that they currently needed help for substance abuse. Only 25.7% were aware of any policy on substance abuse at their own school.

Adult↗

PubMed1991

Behavioral consequences of job-related stress among resident physicians: the mediating role of psychological strain.

This study examined the correlations among stressors, psychological strain, and behavioral reactions in a national sample of 1785 resident physicians, 27 to 33 years old. Consistent with previous studies of resident physicians, analysis showed that those experiencing high job-related stressors experienced high psychological strain in both their personal and professional lives. Stressors were also correlated with behavioral reactions. Hierarchical regression suggested that psychological strain mediated the relations between two of the stressors and behavioral reactions to some extent. This was consistent with recent research suggesting that psychological reactions may mediate the relations between stressors and outcomes. Further research on both medical residency and the stressing process was suggested.

Adult↗

PubMed1991

Snorting benzodiazepines.

Two cases of intranasal benzodiazepine use are presented. The methods of preparation and administration of the powder and accounts of the pharmacological effects of the drugs used are described. The pattern of development and progress of the habit and its associated features are delineated. Snorting benzodiazepines appears to be more common than is currently appreciated, and the clinical complications and implications of this habit are discussed.

Administration, Intranasal↗

PubMed1990

A pilot study of medical student 'abuse'. Student perceptions of mistreatment and misconduct in medical school.

A pilot survey of one third-year medical school class was carried out to explore student perceptions of mistreatment and professional misconduct in medical school training. Students were asked to rate the frequency and cite sources of mistreatment and misconduct among classmates, faculty, residents, and interns. They were also asked to assess the effects of such episodes on their physical health, emotional well-being, social and family life, and attitudes toward becoming a physician. The results indicate that students perceive mistreatment (particularly verbal abuse and unfair tactics) to be pervasive and professional misconduct all too common. As many as three fourths of the students report having become more cynical about academic life and the medical profession as a result of these episodes. Two thirds feel they are worse off than their peers in other professions. More than a third have considered dropping out of medical school and one fourth report they would have chosen a different profession had they known in advance about the extent of mistreatment they would experience. Rather than dismiss these problems as isolated events, we need to examine this issue more closely.

Adult↗

PubMed1990

A double-blind comparison of fluvoxamine, desipramine and placebo in outpatients with depression.

1. The efficacy of fluvoxamine is compared to that of desipramine in a multicenter double blind placebo controlled six-week flexible dose trial of 90 outpatients with major depressive disorder. 2. Although overall drug effects were relatively weak, there were trends suggesting separation of both active drugs from placebo at week six. Both drugs were well tolerated. 3. Studies of major depression ought to be designed to last 8-10 weeks in order to demonstrate placebo active drug differences and the stability of such a difference should it occur in the first six weeks.

Adult↗

PubMed1990

Mitral valve prolapse and panic disorder.

The literature and clinical experience suggest a higher-than-normal incidence of mitral valve prolapse in patients with panic disorder, although the relationship between these two conditions is currently a matter of speculation. Patients with panic disorder are likely to first consult their family practitioner or internist, who may then refer them to a psychiatrist. Hence psychiatrists should be familiar with the signs, symptoms, and management of mitral valve prolapse. The authors describe mitral valve prolapse, panic disorder, and their association, then suggest a strategy for evaluation and treatment of these conditions.

Anxiety Disorders↗

PubMed1990

Is buspirone effective for panic disorder?

Buspirone was compared with imipramine and placebo in the treatment of panic disorder in an 8-week, double-blind controlled study of 52 randomly assigned patients. The side effect profile of buspirone was less disruptive than that of imipramine. Buspirone was not significantly superior to placebo in its antipanic or anxiolytic effects in panic disorder patients.

Adult↗

PubMed1989

Cocaine use by senior medical students.

The authors studied 589 senior medical students' attitudes about and use of cocaine. Reported use was 36% in the students' lifetimes, 17% in the past year, and 6% in the past month. Overall, these rates were lower than those of an age-matched cohort.

Adult↗