Biomedical subjects

E Frank

Publications and source records attributed to E Frank.

At least 55 records · Page 3Linked to original sources

PubMed2001

Psychotherapy for bipolar depression: a phase-specific treatment strategy?

OBJECTIVES: The depressive phase of bipolar disorder is particularly difficult to treat. Pharmacologic strategies for bipolar depression are often inadequate. We therefore review the literature on the role of psychotherapy as an adjunct to medication in the treatment of bipolar depression. METHODS: With one exception, there are no descriptions of psychotherapies employed specifically for the treatment of bipolar depression. We therefore reviewed published reports of psychotherapy for bipolar disorder in general and extracted from these reports relevant data or impressions about the specific effects of the therapies on the depressive phase of the disorder. RESULTS: Described psychosocial approaches to bipolar disorder include psychoeducation, group therapy, cognitive-behavioral therapy, couples therapy, family therapy, and interpersonal psychotherapy. Only cognitive-behavioral therapy has been tested in a pilot study for the treatment of bipolar depression specifically. Results from randomized controlled trials of family therapy and interpersonal and social rhythm therapy suggest that these treatments may be more efficacious in the treatment and prevention of depression relative to mania. CONCLUSIONS: A limited number of well-designed studies and preponderance of case reports limit definitive conclusions about the role of psychotherapy in the treatment of bipolar depression. However, converging reports suggest that cognitive-behavioral therapy, family therapy, and interpersonal and social rhythm therapy may be particularly useful for bipolar depression. We propose a novel approach to the treatment of bipolar disorder that includes the use of phase-specific sequenced psychotherapies delivered in variable patterns and linked to fluctuating mood states.

Adult↗

PubMed2001

Personal and practice-related characteristics of a subsample of US women dermatologists: data from the Women Physicians' Health Study.

BACKGROUND: The number of women dermatologists has increased dramatically over the past few decades. Despite this, there have been few studies examining the personal or professional characteristics of women dermatologists practicing in the USA. METHODS: A representative random sample of active, part-time, professionally inactive, and retired US women physicians, aged 30-70 years, was studied; this article compares data from the 95 responding dermatologists with data from 4350 other respondents. RESULTS: Women dermatologists were more likely to be US born, white, and married to a physician than were other women physicians; they were similar to other women physicians in age, marital status, children, amount of stress at home, political self-characterization, and personal health behavior. Women dermatologists were more likely to be board certified and to practice in solo or two-person practices than were other women physicians. They had fewer nights on call, were less likely to state that they worked too much, reported less stress at work, were more satisfied with their careers, and reported higher household incomes. With the decided exception of skin cancer prevention and screening, they were unlikely to have considerable training, confidence, or interest in routine prevention-related screening or counseling for patients. CONCLUSIONS: Women dermatologists are unlikely to be part of a minority group, likely to be married to another physician, and likely to have a high household income. They report reasonable work stress and high career satisfaction. Given these findings, it is not surprising that only 10% would consider changing their specialty were they to relive their lives.

Adult↗

PubMed2001

Methodologic concerns in defining lesbian for health research.

A recent report from the Institute of Medicine recommends more methodologic and substantive research on the health of lesbians. This study addresses one methodologic topic identified in the Institute of Medicine report and by a subsequent scientific workshop on lesbian health: the definition and assessment of sexual orientation among women. Data are from the Women Physicians' Health Study, a questionnaire-based U.S. probability sample survey (N = 4,501). The two items on sexual orientation (current self-identity and current sexual behavior) had a high response rate (96%), and cross-tabulation of responses indicated several combinations of identity and behavior. Three conceptually different definitions of "lesbian" are compared on the basis of (1) identity only, (2) sexual behavior only, and (3) both identity and sexual behavior. Suggestions and cautions are given to researchers who will add items on sexual orientation to new or ongoing research on women's health.

Adult↗

PubMed2001

Tolerability of combined treatment with lithium and paroxetine in patients with bipolar disorder and depression.

Patients with bipolar disorder are often prescribed lithium in combination with a selective serotonin reuptake inhibitor. Doubts still remain, however, about the safety of the combination, particularly with regard to the risk of developing a serotonin syndrome. The authors retrospectively evaluated the safety of the combination of lithium and paroxetine when the two medications were sequentially prescribed in patients with bipolar disorder. The authors examined a sample of 17 patients with bipolar disorder who were treated with lithium during a depressive episode and who required paroxetine as an adjunctive antidepressant to ongoing lithium treatment. Averaging across all subjects, no statistically significant increase was found for any of the somatic symptoms that were assessed before and after paroxetine was added to ongoing lithium therapy. Examining the clinical records of each patient in detail; however, four patients who developed significant adverse events, possibly related to an emerging serotonin syndrome were identified. Clinicians should be aware of the possible development of a serotonin syndrome among patients in whom paroxetine is added to ongoing lithium treatment.

Adult↗

PubMed2001

Differential effects of age on brain gray matter in bipolar patients and healthy individuals.

This study examined possible differences in total gray and white matter brain content in bipolar patients and healthy individuals, and their relationship with age. 22 DSM-IV bipolar patients and 22 healthy controls underwent a 1.5-tesla Spoiled Gradient Recalled Acquisition (SPGR) MRI. Evaluators blind to patients' identities measured total brain, gray and white matter volumes using a semi-automated software. No differences were found for total brain volume, gray matter or white matter volumes between bipolar patients and healthy controls (MANCOVA, age as covariate, p > 0.05). Age was inversely correlated with total gray matter volume in patients (r = -0.576, p = 0.005), but not in controls (r = -0.193, p = 0.388). Our findings suggest that any existing gray matter deficits in bipolar disorder are likely to be localized to specific brain regions, rather than generalized. The inverse correlation between age and brain gray matter volumes in bipolar patients, not present in healthy controls, in this sample of mostly middle-aged adults, could possibly indicate more pronounced age-related gray matter decline in bipolar patients, and may be of potential relevance for the pathophysiology of the disorder.

Adolescent↗

PubMed2001

Characteristics of female psychiatrists.

OBJECTIVE: This study assessed within-gender differences between psychiatrists and other physicians by using data taken from a large national sample of U.S. female physicians. METHOD: The authors used data from the Women Physicians' Health Study, a large, national questionnaire-based survey conducted in 1993-1994, to compare characteristics of female psychiatrists (N=570) with those of other female physicians (N=3,875). RESULTS: Psychiatrists were older, in poorer health, less likely to be married, more likely to be current or ex-smokers, and more likely to be politically liberal than were the other female physicians. Psychiatrists were somewhat (although not necessarily significantly) more likely than the other female physicians to report having had personal or family histories of various psychiatric disorders. Psychiatrists were more likely to have a solo practice and less likely to be in a group practice. They worked fewer hours than the other female physicians but reported comparable hourly incomes. Psychiatrists did not differ from the other female physicians in perceived work amount, work stress, work control, or career satisfaction. Their satisfaction with their specialty was, however, greater than that of the other female physicians. For nearly all of the 14 preventive health care counseling practices examined, the amount of preventive counseling psychiatrists reported performing, the clinical relevance they ascribed to those practices, their self-confidence in performing the practices, and the amount of training they reported receiving in preventive counseling practices was significantly lower than that of primary care practitioners and lower than or comparable to that of other specialists. CONCLUSIONS: Female psychiatrists significantly differ from other female physicians with regard to a number of personal and professional dimensions.

Adult↗

PubMed2001

Traumatic grief treatment: a pilot study.

OBJECTIVE: The effects of a treatment program targeting debilitating grief symptoms were tested in a pilot study. METHOD: Twenty-one individuals experiencing traumatic grief were recruited for participation, and 13 completed the full 4-month protocol. The treatment protocol used imaginal re-living of the death, in vivo exposure to avoided activities and situations, and interpersonal therapy. RESULTS: Significant improvement in grief symptoms and associated anxiety and depression was observed for both completer and intent-to-treat groups. CONCLUSIONS: The traumatic grief treatment protocol appears to be a promising intervention for debilitating grief.

Adult↗

PubMed2001

Characteristics of women pediatricians.

To contrast women pediatricians (n = 807) with other U.S. women physicians, we used data from the Women Physicians' Health Study, a national, randomly sampled questionnaire survey (total n = 4,501). Compared with other women physicians, women pediatricians worked less and reported lower incomes but also reported less work stress and less career dissatisfaction. Pediatricians were less likely to counsel/perform screening regarding cholesterol, HIV, smoking, and alcohol but more likely regarding skin cancer or sunscreen use, nutrition, and weight. Given current emphases on trying to improve U.S. children's health practices, these findings are of concern.

Female↗

PubMed2001

Smoking cessation counseling by primary care women physicians: Women Physicians' Health Study.

OBJECTIVES: The Women Physicians' Health Study (WPHS) offers a unique opportunity to examine the counseling and screening practices of women physicians. The objectives of this study were to: describe the prevalence of self-reported smoking cessation counseling among primary care women physicians and determine the association between physician demographic, professional, and personal characteristics and smoking cessation counseling. METHODS: Conducted in 1993-1994, WPHS is a nationally representative cross-sectional mailed survey of U.S. women physicians and included 4,501 respondents representing all major specialties. Primary care physicians included 5 specialty areas and were grouped into 3 categories: (1) general primary care; (2) obstetrics/gynecology (ob/gyn); and (3) pediatrics. Frequent counseling was defined as having counseled patients who were known smokers at every visit or at least once a year. RESULTS: Women physicians in general primary care (84%) and ob/gyn (83%) were more likely to frequently counsel their patients about cessation than were pediatricians (41%). Perceived relevance of counseling to a physician's practice was significantly associated with frequent counseling. Personal characteristics (current smoking status, personal or family history of a smoking-related disease, or living with a smoker as an adult or child) were not significantly correlated with counseling. CONCLUSION: The majority (71%) of physicians reported frequently counseling their patients. However, there was significant variation by physician specialty. In addition, perceived relevance of counseling was strongly associated with counseling behavior. Physician counseling on cessation can reduce tobacco-related morbidity and mortality. Increasing perceived relevance, implementing system changes, and creating accountability can facilitate cessation counseling by physicians.

Adult↗

PubMed2001

Non-primary care physicians and smoking cessation counseling: Women Physicians' Health Study.

OBJECTIVES: The Women Physicians' Health Study (WPHS) offers a unique opportunity to examine the counseling and screening practices of women physicians in various specialties. In this study we describe the prevalence of self-reported counseling on smoking cessation among non-primary care women physicians and examine the association between their demographic, professional, and personal characteristics and such counseling on smoking cessation. METHODS: Conducted in 1993-1994, WPHS is a nationally representative cross-sectional mailed survey of U.S. women physicians with 4,501 respondents representing all major specialties. Physicians in 9 specialty areas were grouped in 6 categories: (1) anesthesiology; (2) general surgery and surgical subspecialties; (3) emergency medicine; (4) medical subspecialties; (5) psychiatry; and (6) other. Frequent counseling was defined as having counseled patients who were known smokers at every visit or at least once a year. RESULTS: Overall, 45% of the physicians frequently counseled smokers to quit. Medical subspecialists (80%) were most likely and psychiatrists (29%) least likely to counsel frequently. Specialty, perceived relevance of counseling to the physician's practice, and self-confidence in counseling about smoking cessation were associated with frequent counseling. CONCLUSION: Cessation counseling by non-primary care physicians can reduce tobacco-related morbidity and mortality. Increasing perceived relevance and self-confidence among this group of physicians, combined with implementation of system changes and the creation of physician accountability can facilitate the provision of such counseling.

Adult↗

PubMed2001

Aging and the market in the United States.

Current Social Security reform proposals in the United States presume that, as long as the cash income of future retirees is secure, private businesses will take care of producing just the goods and services an aging population requires. However, the performance of private nursing homes, assisted-living complexes, pharmaceuticals, health, insurance, and transportation services for the elderly raises serious questions about the ability of markets to cater to the needs of a vulnerable population. Industries that specialize in goods and services for the old face repeated accusations of fraud, overcharging, poor service, and deceptive practices. The article reports on research on the performance of a number of industries that serve the aged. A careful look at these markets should caution us against relying too heavily on private markets to serve an aging population. The surplus funds flowing into Social Security might be better employed financing the kinds of public services for the elderly that private markets have so far failed to deliver.

Aged↗

PubMed2001

The development of study exit criteria for evaluating antimanic compounds.

BACKGROUND: There is increasing interest on the part of investigators and the public at large in finding ways to study and improve treatments for the seriously mentally ill without exposing such individuals to unnecessary risks. One group of particular interest in this regard are patients suffering from acute mania. We set out to define "exit" criteria or novel clinical endpoints that might help to assess the efficacy of antimanic compounds. We sought a method that would be safer, more economical, and less sensitive to nonspecific factors in the clinical environment while still allowing unambiguous assessment of efficacy. METHOD: From a pool of subjects being screened for or already participating in intervention studies, we retrospectively identified 76 admissions of patients with a manic or mixed episode according to DSM-IV. We fit a mixed-effects regression model to all available data obtained using the Bech-Rafaelsen Mania Scale from admission to day 28 of treatment. Using the estimated model coefficients, we obtained empirical Bayes (EB) estimates of each subject's trend coefficients based on (1) all available data and (2) data through day 11 of treatment for mania. RESULTS: We found a high correlation (r = .67) between EB estimates of final response at day 28 and actual day 28 scores on the Bech-Rafaelsen scale based on scores through day 11. When subjects were categorized as full, partial, or nonresponders according to their final Bech-Rafaelsen score, we were able to show that only 2 of the 23 predicted nonresponders became full responders, 27 of the 31 predicted full responders became full responders, and 16 of the 22 predicted partial responders became partial or full responders. CONCLUSION: We conclude on the basis of this chart review study that it should be possible to define exit criteria for trials assessing the efficacy of antimanic compounds on the basis of relatively short duration exposure to experimental treatment.

Acute Disease↗

PubMed2001

Comorbidity of axis I disorders in patients with traumatic grief.

BACKGROUND: Traumatic grief has been found to be a distinct disorder from both depression and anxiety; however, there is no information in the literature regarding comorbidity of traumatic grief with other psychiatric disorders. METHOD: Twenty-three bereaved subjects who presented for treatment of traumatic grief symptomatology were included in this study. The Inventory of Complicated Grief (ICG) was used to confirm the presence of traumatic grief and assess its severity. In addition, the Structured Clinical Interview for DSM-IV was performed. RESULTS: Most subjects met criteria for a current or lifetime Axis I diagnosis. Fifty-two percent (N = 12) met criteria for current major depressive disorder, and 30% (N = 7), for current posttraumatic stress disorder (PTSD). ICG scores and functional impairment were higher among patients with more than one concurrent Axis I diagnosis. CONCLUSION: Comorbid major depressive disorder and PTSD may be prevalent in patients presenting for treatment of traumatic grief.

Adult↗

PubMed2001

Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years.

OBJECTIVE: The researchers evaluated the effectiveness of paroxetine and Problem-Solving Treatment for Primary Care (PST-PC) for patients with minor depression or dysthymia. STUDY DESIGN: This was an 11-week randomized placebo-controlled trial conducted in primary care practices in 2 communities (Lebanon, NH, and Seattle, Wash). Paroxetine (n=80) or placebo (n=81) therapy was started at 10 mg per day and increased to a maximum 40 mg per day, or PST-PC was provided (n=80). There were 6 scheduled visits for all treatment conditions. POPULATION: A total of 241 primary care patients with minor depression (n=114) or dysthymia (n=127) were included. Of these, 191 patients (79.3%) completed all treatment visits. OUTCOMES: Depressive symptoms were measured using the 20-item Hopkins Depression Scale (HSCL-D-20). Remission was scored on the Hamilton Depression Rating Scale (HDRS) as less than or equal to 6 at 11 weeks. Functional status was measured with the physical health component (PHC) and mental health component (MHC) of the 36-item Medical Outcomes Study Short Form. RESULTS: All treatment conditions showed a significant decline in depressive symptoms over the 11-week period. There were no significant differences between the interventions or by diagnosis. For dysthymia the remission rate for paroxetine (80%) and PST-PC (57%) was significantly higher than for placebo (44%, P=.008). The remission rate was high for minor depression (64%) and similar for each treatment group. For the MHC there were significant outcome differences related to baseline level for paroxetine compared with placebo. For the PHC there were no significant differences between the treatment groups. CONCLUSIONS: For dysthymia, paroxetine and PST-PC improved remission compared with placebo plus nonspecific clinical management. Results varied for the other outcomes measured. For minor depression, the 3 interventions were equally effective; general clinical management (watchful waiting) is an appropriate treatment option.

Adolescent↗

PubMed2001

Treatment recommendations versus treatment realities: recognizing the rift and understanding the consequences.

Depression is a treatable disorder, although it often requires long-term therapy. To aid physicians in the effective long-term management of depression, treatment guidelines have been established by a number of organizations with minimum treatment duration recommendations. Unfortunately, numerous studies document a significant disparity between these recommendations and clinical practice realities. In particular, studies have shown that fewer than half of treated patients receive the recommended duration of 6 months of continuation therapy. Other clinical practice studies have reported that early discontinuation from therapy is associated with a substantial increase in the risk of relapse or recurrence. Long-term treatment of depression in clinical practice settings may benefit from a closer approximation to the conditions found in clinical trial settings.

Antidepressive Agents↗

PubMed2001

Interpersonal psychotherapy for late-life depression: past, present, and future.

Interpersonal psychotherapy (IPT) has demonstrated efficacy in protecting against a recurrence of major depression in elderly subjects when used alone on a monthly basis and when combined with antidepressant medication. The authors summarize their experience using IPT over the past 10 years and discuss a variety of treatment correlates. In addition, preliminary results using IPT combined with paroxetine in depressed elders reveals no difference in remission rates between cognitively intact and cognitively impaired depressed elders.

Age of Onset↗

PubMed2001

[Synthesis of estrone derivatives containing different halogens and/or heterocyclic moieties].

New compounds derived from the 3-methyl and 3-benzyl ethers of a D-secoestrone aldehyde were synthesized. In the presence of different Lewis acids D-homosteroids could form. These reactions which can be explained by an intramolecular Prinstype mechanism follow high stereoselectivity and reactivity and lead to compounds containing 16 beta-oriented halogens in the sterane skeleton. The formation and reaction of the imines derived from the aldehyde and aniline as well as substituted anilines provide a highly efficient access to steroid derivatives. The steroid alkaloids are of pharmacological interest.

Estrone↗

PubMed2000

Paper vs. electrons. Epidemiologic publishing in a changing world.

PURPOSE: To present the parallel histories of epidemiologic and electronic publishing and consider positive and negative factors that might affect their amalgam.METHODS: We performed a quantitative assessment of the arc of epidemiologic publication from 1966-1999, using major self-designated epidemiologic journals as a sample, and of scholarly electronic publication from 1991-1997, based on current literature review. We use an online, paperless journal as a case study, and review selected information-technology opinion in the area.RESULTS: By traditional standards, growth in epidemiologic publication has been considerable, with the addition of six new journals since 1966. In contrast, scholarly electronic publication for the period 1991-1997 grew from 27 to 2459 journals (not all exclusively online). Positive features of electronic publishing include flexibility, shortened time to publication, freedom from fixed publication date, diversity in presentation, and instant linkage to relevant material. A case study of a new online journal illustrates the substantive power of the medium. Negative factors include restriction (or unrestricted expansion) of the audience, the potential for hasty peer review, pitfalls in establishing credibility, an emphasis on style over content, technologic dependence, and additions to the information explosion. Relative cost and archiving are still debated. In assessing the pros and cons, it is important to distinguish electronic mechanisms that facilitate publication from electronic publishing, and to appreciate the difference between moving an existing journal to the electronic medium, and creating a new online journal.CONCLUSIONS: The movement from print to internet is probably inexorable, but a headlong rush may be ill-advised. Several models for dual publishing now exist, with the expectation that many, including the journals that serve epidemiology, will do so. The ultimate configuration is difficult to predict, but likely to be shaped in large measure by market forces, technologic advances and to a lesser extent, by habit and aesthetics.

Journal Article↗