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Biomedical subjects

Donald W Black

Publications and source records attributed to Donald W Black.

17 recordsLinked to original sources
PubMed2004

Compulsive disorders.

Compulsive disorders include a diverse group of conditions characterized by excessive thoughts or preoccupations combined with poorly controlled behaviors. They include trichotillomania, kleptomania, pathologic gambling, compulsive buying disorder, compulsive sexual behavior, and compulsive computer use. Some investigators have suggested that these conditions constitute a spectrum of disorders linked to obsessive-compulsive disorder. Others have questioned the validity of this conceptualization, and have debated the relationship between these disorders. Nevertheless, much has been learned about compulsive disorders, and there have been some successes with psychotherapeutic and psychopharmacologic treatments. Recent therapy-based interventions have moved from psychodynamic treatments toward cognitive-behavioral modalities. Serotonin reuptake inhibitors remain the best-studied pharmacologic treatment, but researchers have also explored other antidepressants, opioid agonists, mood stabilizers, and atypical antipsychotics.

Antidepressive Agents↗
PubMed2004

Integrating pharmacotherapy and psychotherapy in the management of anxiety disorders.

Anxiety disorders are among the most prevalent psychiatric conditions throughout the world, and they are responsible for considerable morbidity and functional impairment. Patients with these disorders make extensive use of medical resources, not only through their use of the mental health system but by frequent utilization of primary care and emergency medical services. Although it is common clinical practice to combine pharmacotherapy and psychotherapy, some researchers have argued that this has not been shown effective in practice and is an inefficient use of limited mental health resources. This article will examine the evidence supporting integrative therapy for the major Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision anxiety disorders and discuss clinical considerations surrounding the use of combined therapies for anxiety.

Adult↗
PubMed2004

Risk factors for hypochondriacal concerns in a sample of military veterans.

OBJECTIVE: The aim was to examine the influence of combat exposure and other risk factors on the development of hypochondriacal concerns among veterans of the Gulf War and to learn whether these concerns might be a source of increased symptom reporting among them. METHOD: Six hundred two veterans who were deployed to the Gulf or elsewhere during the 1991 war took part in a two-phase study of symptoms and illnesses occurring among these veterans. Hypochondriacal beliefs and attitudes were assessed by the Whiteley Index and somatic symptoms by a factor-analytically derived measure. Multiple regression models were developed for these outcomes. RESULTS: Hypochondriacal concerns were significantly associated with level of education, personal history of depression, number of prewar physical conditions, family history of functional syndromes, negative and positive temperament and disinhibition, military combat, level of military preparedness, social support, and perceived life stress. Somatic symptoms were associated with these same variables, as well as branch of service, family history of physical conditions, combat, and level of combat exposure. A regression model for hypochondriacal concerns included the number of prewar physical conditions, negative temperament, lack of social support, and perceived life stress. CONCLUSIONS: Hypochondriacal concerns were not strongly related to combat exposure. Consequently, it is not likely that such concerns account for increased symptom reporting among the veterans studied. Hypochondriacal concerns appeared to arise in response to threats posed by physical illness. Vulnerability to such threats appeared to center on the personality dimension of negative temperament. This model may serve as a guide to future investigations.

Adult↗
PubMed2004

Association among outcomes in a naturalistic statewide assessment of substance user treatment.

Substance user treatment outcome measurement is important for research and policy questions, yet little literature has addressed the relationships among outcome measures of treatment success. Ideally, treatment outcomes would correlate to at least a moderate degree. The Iowa Department of Public health requires substance user treatment programs receiving public funds to provide client information. Demographic information, "substance abuse" history, current use, arrests, and hospitalizations were ascertained at admission and a 6-month follow-up for 1374 clients (from January 1999 to December 2000). Abstinence, arrests, and hospitalizations were good outcome measures of substance user treatment success. Reduction in frequency of use was negatively associated with arrests, substance use-related hospitalizations, and increased income. Full-time employment at follow-up produced different results depending on the client's sex. However, all associations among outcomes were modest. Specificity may be reasonable in some instances; however, other situations might require a broad-spectrum approach that ideally would produce a wide range of benefits.

Adolescent↗
PubMed2004

Gulf War veterans with anxiety: prevalence, comorbidity, and risk factors.

BACKGROUND: Veterans of the first Gulf War have higher rates of medical and psychiatric symptoms than nondeployed military personnel. METHODS: To assess the prevalence of and risk factors for current anxiety disorders in Gulf War veterans, we administered a structured telephone interview to a population-based sample of 4886 military personnel from Iowa at enlistment. Participants were randomly drawn from Gulf War regular military, Gulf War National Guard/ Reserve, non-Gulf War regular military, and non-Gulf War National Guard/Reserve. Medical and psychiatric conditions were assessed through standardized interviews and questionnaires in 3695 subjects (76% participation). Risk factors were assessed using multivariate logistic regression models. RESULTS: Veterans of the first Gulf War reported a markedly higher prevalence of current anxiety disorders than nondeployed military personnel (5.9% vs. 2.8%; odds ratio = 2.1; 95% confidence interval = 1.3-3.1), and their anxiety disorders are associated with co-occurring psychiatric disorders. Posttraumatic stress disorder, panic disorder, and generalized anxiety disorder were each present at rates nearly twice expected. In our multivariate model, predeployment psychiatric treatment and predeployment diagnoses (posttraumatic stress disorder, depression, or anxiety) were independently associated with current anxiety disorder. Participation in Gulf War combat was independently associated with current posttraumatic stress disorder, panic disorder, and generalized anxiety disorder. CONCLUSIONS: Current anxiety disorders are relatively frequent in a military population and are more common among Gulf War veterans than nondeployed military personnel. Predeployment psychiatric difficulties are robustly associated with the development of anxiety. Healthcare providers and policymakers need to consider panic disorder and generalized anxiety disorder, in addition to posttraumatic stress disorder, to ensure their proper assessment, treatment, and prevention in veteran populations.

Adult↗
PubMed2004

Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention.

Suicidal behavior is frequent in patients with borderline personality disorder (BPD); at least three-quarters of these patients attempt suicide and approximately 10% eventually complete suicide. Borderline patients at greatest risk for suicidal behavior include those with prior attempts, comorbid major depressive disorder, or a substance use disorder. Comorbidity with major depression serves to increase both the number and seriousness of the suicide attempts. Hopelessness and impulsivity independently increase the risk of suicidal behavior, as does a turbulent early life and the presence of antisocial traits. In summary, because BPD is frequently complicated by suicidal behavior, clinicians must avoid the mistake of thinking that a pattern of repeated attempts indicates little desire to die. Clinicians have an important role in preventing suicide attempts and completed suicides by understanding the risk factors.

Antisocial Personality Disorder↗
PubMed2004

Use of the Mini International Neuropsychiatric Interview (MINI) as a screening tool in prisons: results of a preliminary study.

The authors describe a pilot study in which the Mini International Neuropsychiatric Interview (MINI) was used to assess a random sample of offenders newly committed to the Iowa Department of Corrections. Following sessions in which correctional personnel were trained to administer the MINI, the instrument was administered to 67 offenders. The interview took from 20 to 105 minutes (mean, 41 minutes) to administer, and all but 13 (19%) offenders were positive for a lifetime MINI disorder. Twenty-six (39%) subjects had a lifetime mood disorder, 20 (30%) a lifetime anxiety disorder, 12 (18%) a lifetime psychotic disorder, and 53 (79%) a substance use disorder. Seven (10%) subjects met criteria for a lifetime attention deficit hyperactivity disorder, while 13 (19%) had a lifetime antisocial personality disorder. Subjects had a mean of 2.8 disorders. The potential use of the MINI as a screening tool in prison settings is discussed.

Adult↗
PubMed2003

Psychiatric diagnosis and weight loss following gastric surgery for obesity.

BACKGROUND: The authors examined associations between lifetime Axis I and Axis II disorders and weight loss following gastric surgery for morbid obesity. METHODS: 44 morbidly obese subjects who had undergone vertical banded gastroplasty (VBG) were systematically interviewed with the Diagnostic Interview Schedule (DIS) and were administered the Personality Diagnostic Questionnaire (PDQ). Subjects were followed-up 6 months post-VBG to determine weight loss. RESULTS: The subjects had a mean +/- SD age of 37.7 +/- 10.6 years. Their baseline weight was 135.3 +/- 28.0 kg and their baseline body mass index (BMI) was 50.0 +/- 7.4. 34 (77%) were female. Results of linear regressions show a significant association between baseline BMI and weight loss at 6-month follow-up. After adjustment for baseline BMI, there was a non-significant trend toward increased weight loss in association with alcohol abuse/dependence. Similarly, among our analysis of 41 subjects who had received the PDQ, we found a non-significant trend toward increased weight loss in association with "any" PDQ diagnosis and with antisocial personality disorder/trait after adjusting for baseline BMI. CONCLUSION: The data suggest that Axis I and Axis II diagnoses were not predictive of weight loss following VBG during a 6-month follow-up.

Adult↗
PubMed2002

The relationship between DST results and suicidal behavior.

The authors assessed the relationship between dexamethasone suppression test (DST) results and suicidal ideations and behavior. Four-hundred-twenty-three mood disorder patients admitted to a tertiary care medical center were administered the DST from 1978 to 1981. The patients were subsequently followed up to determine death status using a record-linkage method. More than 44% had abnormal cortisol suppression (nonsuppressors) at the index admission. Suppressors and nonsuppressors did not differ significantly with respect to frequency of suicidal ideations or completed suicides. Suppressors were significantly more likely than nonsuppressors to have a history of suicide attempts or to have a suicide attempt following hospital discharge. Using logistic regression, and controlling for several important variables including diagnosis, maximum postdexamethasone cortisol was not significantly associated with suicide, suicidal ideation, or suicide attempts. We conclude that an abnormal DST is not useful as a predictor of suicidal behavior.

Adult↗
PubMedDate not supplied

STEPPS: a cognitive-behavioral systems-based group treatment for outpatients with borderline personality disorder--a preliminary report.

We describe a new cognitive-behavioral systems-based group treatment for persons with borderline personality disorder (BPD). The program is called STEPPS, an acronym for Systems Training for Emotional Predictability and Problem Solving. Briefly, the program combines cognitive-behavioral techniques and skills training with a systems component. The latter involves patients with BPD and persons in their system (e.g., family members, significant others, health care professionals). The program involves 20 two-hour weekly group meetings with two facilitators, is manual-based, and has specific goals to accomplish each week. Here, we review the background and development of the program, and present preliminary efficacy data from a subset of patients which suggest that patients experience improvement in BPD and mood-related symptoms. Survey results suggest moderate to high levels of satisfaction for the treatment from patients and therapists. A new scale, the Borderline Evaluation of Severity Over Time (BEST), developed to measure severity and change in persons with BPD, is described. We propose to conduct additional research to further validate the efficacy of STEPPS.

Adolescent↗
PubMedDate not supplied

Depression in veterans of the first Gulf War and comparable military controls.

Depression is a common mental disorder associated with poor health outcomes. The purpose of this study is to examine the prevalence of depression, mental health comorbidity, illness variables, and quality of life in a sample of military veterans serving during the first Gulf War. The Iowa Gulf War Case Validation Study involved face-to-face evaluations in 1999--2002 of 602 military personnel--either deployed ("deployed veterans") or eligible but not deployed ("non-deployed veterans") to the Gulf. Subjects were sampled by conducting a series of case-control studies nested within a population-based survey of 4,886 military personnel. All subjects were interviewed using the Structured Clinical Interview for DSM-IV (SCID-IV), and a series of semi-structured interviews and validated questionnaires. Best estimate psychiatric diagnoses were assigned based on all available data. One-hundred-ninety-two (32%) of the 602 surveyed veterans met criteria for a current or lifetime depressive disorder (major depression, dysthymia, depressive disorder--not otherwise specified). Depressed non-deployed veterans were more likely to be female and to have served in the Air Force than depressed deployed veterans. There were few significant differences between the depressed deployed veterans and the depressed non-deployed veterans. Depressed deployed veterans had significantly higher lifetime rates of comorbid cognitive dysfunction (55% vs. 35%), and anxiety disorders (59% vs. 33%)--mainly accounted for by specific phobias (12% vs. 2%) and posttraumatic stress disorder (33% vs. 10%)--than did depressed non-deployed veterans. Lifetime substance use disorders were significantly more frequent in deployed veterans than non-deployed veterans (70% vs. 52%), particularly alcohol disorders (68% vs. 52%). There were no differences in rates of personality characteristics, family psychiatric history, stressors, hypochondriasis, and level of functioning between the two study groups showed no significant differences. Depressive illness is frequent in military samples, as it is in the general population. The prevalence, pattern of comorbidity, and illness features were similar in deployed veterans and non-deployed veterans, suggesting that the depression suffered by both groups of veterans is qualitatively comparable. The main difference between study, groups was that depressed deployed veterans had higher rates than depressed non-deployed veterans of comorbid anxiety disorders, hypothesized to be part of the stress-related syndromes seen in those who experience combat.

Adult↗