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Biomedical subjects

G Andrews

Publications and source records attributed to G Andrews.

At least 55 records · Page 3Linked to original sources
PubMed1999

Recall of depressive episode 25 years previously.

BACKGROUND: Lifetime rates of depression reported in epidemiological surveys are generally only twice the 12 month rates. Either people forget the symptoms of depression or many people who have a depressive episode remain depressed for many years. Both may be true. There is a need to examine the long-term clinical validity of interviews that are used to make lifetime diagnoses. METHODS: Forty-five patients who were part of a long-term follow-up study of depression were interviewed 25 years after the index episode. The diagnoses from the original, fully structured interviews were compared with the responses people made for that period when interviewed using the CIDI 25 years later. RESULTS: Twenty-seven patients met CIDI DSM-III-R criteria for depression at index episode. At the 25 year follow-up, 19 of the 27 reported the essential symptoms of 'depression or loss of interest' being present at the index time, and in 14 of the 27 the depressive symptoms recalled met criteria for DSM-III-R major depressive episode at that time. CONCLUSIONS: Seventy per cent of people who were hospitalized for a major depressive episode can recall being depressed but only half can recall sufficient detail to satisfy the diagnostic criteria when interviewed 25 years later. As depressive episodes, especially those severe enough to warrant admission, are recalled better than many other diagnoses, one must be cautious about the lifetime rates for mental disorders reported in retrospective epidemiological surveys.

Adult↗
PubMed1999

A comparison of ICD10 and DSM-IV criteria for posttraumatic stress disorder.

The assumption that participants receiving an ICD10 diagnosis of posttraumatic stress disorder (PTSD) will also receive a DSM-IV diagnosis of PTSD was tested. Data were gathered for 1,364 participants using the Composite International Diagnostic Interview (CIDI). The 12-month prevalence of PTSD was 3% for DSM-IV and 7% for ICD10 Diagnostic Criteria for Research (ICD10-DCR). The agreement between the two systems was fair (kappa = .50). Forty eight percent of the discrepancies between the systems were accounted for by the additional criterion requiring clinically significant distress or impairment included in DSM-IV. The inclusion of symptoms of general numbing of responsiveness accounted for 18% of the discrepancies. It is concluded that ICD10-DCR PTSD cannot be assumed to be identical to DSM-IV PTSD.

Adolescent↗
PubMed1999

Efficacy, effectiveness and efficiency in mental health service delivery.

OBJECTIVE: The aim of this paper is to review the status of treatments in psychiatry. METHOD: The criteria for good treatment are defined and then treatments in psychiatry are examined for efficacy, effectiveness and efficiency. RESULTS: A large number of treatments were listed by Nathan and Gorman as having satisfied the criteria for efficacy: that is, they had been shown to be superior to placebo in randomised controlled trials. The problem of effectiveness (does the treatment still work when used by the average clinician with the average patient?) is a general one in medicine, but the evidence in psychiatry is not outstanding. The problem of efficiency (what level of resources are required to produce benefit?) is being addressed in a piecemeal fashion, and again this is no different to the situation in general medicine. CONCLUSIONS: A considerable number of treatments have been shown to satisfy the criteria for efficacy. Effectiveness requires that psychiatrists apply such proven treatments and demonstrate benefit through the use of outcome measurement. A system that separated the health budget into segments for prevention, cure and care might ensure that these three goals were pursued equitably and efficiently.

Cost-Benefit Analysis↗
PubMed1998

Induction of relational schemas: common processes in reasoning and complex learning.

Five experiments were performed to test whether participants induced a coherent representation of the structure of a task, called a relational schema, from specific instances. Properties of a relational schema include: An explicit symbol for a relation, a binding that preserves the truth of a relation, potential for higher-order relations, omnidirectional access, potential for transfer between isomorphs, and ability to predict unseen items in isomorphic problems. However relational schemas are not necessarily coded in abstract form. Predictions from relational schema theory were contrasted with predictions from configural learning and other nonstructural theories in five experiments in which participants were taught a structure comprised of a set of initial-state,operator-->end-state instances. The initial-state,operator pairs were presented and participants had to predict the correct end-state. Induction of a relational schema was achieved efficiently by adult participants as indicated by ability to predict items of a new isomorphic problem. The relational schemas induced showed the omnidirectional access property, there was efficient transfer to isomorphs, and structural coherence had a powerful effect on learning. The "learning to learn" effect traditionally associated with the learning set literature was observed, and the long-standing enigma of learning set acquisition is explained by a model composed of relational schema induction and structure mapping. Performance was better after reversal of operators than after shift to an alternate structure, even though the latter entailed more overlap with previously learned tasks in terms of the number of configural associations that were preserved. An explanation for the reversal shift phenomenon in terms of induction and mapping of a relational schema is proposed. The five experiments provided evidence supporting predictions from relational schema theory, and no evidence was found for configural or nonstructural learning theories.

Adult↗
PubMed1998

The psychometric properties of the Composite International Diagnostic Interview.

The Composite International Diagnostic Interview, or CIDI, is a fully structured interview that maps the symptoms elicited during the interview onto DSM-IV and ICD-10 diagnostic criteria and reports whether the diagnostic criteria are satisfied--nothing more, nothing less. The inter-rater reliability has been demonstrated to be excellent, the test-retest reliability good, and the validity has been demonstrated to be good, given the methodological constraints. The CIDI is available in lifetime and 12-month versions, and in both paper-and-pencil and computer-administered forms. The latter version is suitable for self-administration in cooperative subjects. The CIDI is available in many languages. It is supported by ten centres around the world, which conduct regular training programmes for interviewers. The training programmes are standardised and the training materials are comprehensive. The data from the CIDI is entered into standard data entry and scoring programmes that give as output the diagnostic criteria satisfied. The interviews, the training materials, and the scoring programmes are copyright by the World Health Organization (WHO) and are supervised by an advisory committee on behalf of WHO. That committee and the training centres welcome enquiries from researchers and clinicians who are interested in using the CIDI.

Humans↗
PubMed1998

The Center for Epidemiological Studies Depression Scale in older community samples in Indonesia, North Korea, Myanmar, Sri Lanka, and Thailand.

Cultural differences in the reporting of depressive symptoms among older people were examined using the Center for Epidemiological Studies Depression (CES-D) scale in five Southeast Asian countries: Indonesia, Korea, Myanmar, Sri Lanka, and Thailand. Previous work in Asian samples--principally North American immigrants--suggested differential functioning of the CES-D. The four-factor solution established in the original studies of the CES-D was replicated for all countries using a confirmatory factor analytic approach. It was, however, demonstrated that little information was lost in considering full-scale scores rather than the four subscales separately. The behavior of the CES-D in older Asian populations was found to be comparable to results obtained in North American and European cultures. Significant somatization of depression in these Asian samples was not found. There appears to be a general factor measuring depressed mood across older populations. The results support the validity of comparing responses on the CES-D across cultures.

Affect↗
PubMed1998

Evidence of a genetic contribution to functional bowel disorder.

OBJECTIVE: Anecdotally, functional bowel disorders (FBD) such as the irritable bowel syndrome appears to cluster in some families, but no studies have investigated the heritability of FBD. We aimed to investigate the influence of heritable factors in FBD. METHODS: Same sex twin pairs enrolled in the Australian Twin Registry completed a structured interview that included questions related to symptoms consistent with FBD: abdominal pain, diarrhea, constipation, excessive gas or bloating, and nausea. Reasons for the occurrence of each symptom, including their physicians' diagnoses, were recorded. Lisrel 7.16 software was used to fit genetic models following standard procedures. RESULTS: Of the 686 individual twins from same-sex pairs, 33 (4.8%) had one or more symptoms diagnosed by a medical practitioner as functional bowel disorder. Complete data on this symptom scale was available for 186 monozygotic and 157 same sex dizygotic twin pairs. A model in which 56.9% (95% CI: 40.6-75.9%) of the variance was attributed to additive genetic variance, with the remaining 43.1% attributed to the individual's unique environment, closely fitted the data (chi2=0.01, df=4, p=1.0). CONCLUSION: Our results suggest that a substantial proportion of the liability for FBD may be under genetic control. Whether this liability is related to the disorder itself or to other potential predisposing factors requires clarification.

Adolescent↗
PubMed1998

Burden of disease. Methods of calculating disability from mental disorder.

BACKGROUND: The Global Burden of Disease studies are important because they encompass morbidity as well as mortality. Burden due to morbidity is calculated from incidence, duration and disability. There is a dearth of epidemiological measurements of disability. METHOD: Data from a quasi-community sample (n = 1364) were analysed. Diagnoses of mental and physical disorders, and reports of disability, were based on established methods. RESULTS: The disabilities reported in mental and physical disorders were comparable. Disability was correlated with comorbidity. The disability in mental disorders was examined by three methods: pure disorders, main problem and regression. It appears that major depression and substance disorder weights were overestimated, and anxiety disorder weights were underestimated in the Global Burden of Disease studies. CONCLUSIONS: A method for disentangling the effects of concurrent comorbidity is presented. The size of burden attributed to mental disorders is of potential benefit for funding mental health services, It is important that we get the estimates right.

Adult↗
PubMed1997

Controlled trial of exposure and response prevention in obsessive-compulsive disorder.

BACKGROUND: Exposure and response prevention is considered a treatment of choice for obsessive-compulsive disorder (OCD). Yet there have been very few randomised controlled trials employing credible placebo conditions. This study compares exposure and response prevention with a general anxiety management intervention. METHOD: Eighteen patients meeting DSM-IV criteria for OCD were randomly assigned to either exposure and response prevention or anxiety management. Both treatments involved approximately 15 hours of therapy over a three-week period. RESULTS: There was a significant reduction in obsessive-compulsive symptoms following treatment with exposure and response prevention, while no change occurred in the control group. This was found to be statistically significant using a composite measure of OCD symptom severity, patient ratings of interference and therapist ratings of symptom severity. CONCLUSIONS: These findings suggest that the symptom reductions associated with behaviour therapy for OCD are a result of the specific techniques of exposure and response prevention, rather than non-specific aspects of the therapy process. General anxiety management techniques are not effective in the treatment of OCD.

Adult↗
PubMed1997

Disability, outcome and case-mix in acute psychiatric in-patient units.

BACKGROUND: Eighteen acute in-patient psychiatric units in Australia funded a syndicate to measure case-mix, disability and outcome of treatment. This syndicate included eight units in public general hospitals, five in stand-alone public psychiatric hospitals and five in private psychiatric hospitals. METHOD: Up to 100 in-patients admitted consecutively to each hospital (1359 in all) were assigned to a Diagnosis-Related Group (DRG), rated on the Health of the Nation Outcome Scales (HoNOS) and asked to complete the Medical Outcomes Trust Short Form 36 (SF36). These scales were administered again at discharge. Demographic information and length of stay were also recorded. Disability was measured by scores on the HoNOS and SF36 at admission, and outcome was assessed by the change in scores between admission and discharge. RESULTS: The public hospitals treated significantly more patients with schizophrenia and fewer with affective disorders, and their case load on admission was more disabled, on the whole, than that of the private hospitals. They achieved the same outcome or health gain as the private hospitals, but needed a shorter length of stay to do so. The addition of disability scores to DRG moderately increased the ability to predict length of stay. CONCLUSIONS: Routine outcome assessment using reliable and valid instruments is practical, and could lead to improvements in the quality of care for psychiatric patients.

Adolescent↗
PubMed1997

Intimate saboteurs.

BACKGROUND: The bariatric patient exists in dynamic relationship with family members and friends who have considerable influence upon the patient and his or her surgical outcome. When family members and friends behave as intimate saboteurs, they attempt to hamper, hurt, or subvert the bariatric patient's goal of achieving and maintaining a healthy body weight. Successful or not, intimate saboteurs provide significant treatment challenges for the patient and the treatment team. METHODS AND PATIENTS: Patient profiles provide examples of intimate sabotage. The psychological construct of Family Systems Theory is used as a plausible explanation for the sabotage of friends and family. CONCLUSIONS: Multidisciplinary professionals treating the bariatric patient must be aware of the critical influence of intimate saboteurs and the tactics they use to sabotage. Treatment guidelines recommended by Family Systems Theory are presented as strategies to mitigate the influence of intimate saboteurs.

Agonistic Behavior↗
PubMed1997

Referred adolescents as young adults: the relationship between psychosocial functioning and personality disorder.

OBJECTIVE: To examine the functioning of young adults who had been referred for psychiatric treatment during adolescence. METHOD: A group of 145 adolescents referred at a mean age of 14 years were interviewed at a mean age of 20 years to ascertain their functioning and whether they suffered from a personality disorder. RESULTS: Having a personality disorder was associated with poor functioning at follow-up independently of adolescent diagnosis. Antisocial personalities were typified by problems with the law, a poor work record and early cohabitation, while other personality disorders were characterised by social isolation and problems in interpersonal relationships. Poor quality of the family environment and having received treatment during the follow-up period were the only developmental variables associated with poor functioning. CONCLUSIONS: Developing a personality disorder and having a poor family environment, rather than having an adolescent disorder, appear to be the factors that result in poor functioning in young adults.

Adolescent↗
PubMed1997

Community surveys: the benefits and sacrifices.

Community-based research is becoming more important, especially with the introduction of the RDP and the changing role of NGOs. Community surveys are a part of this new research approach. This paper enters the debate around the role and importance of surveys. A case study of a community survey done in Mfuleni by the Western Cape Community Partnership Project will be used to illustrate the points made. Key considerations are raised in terms of the potential for the community survey to be useful. These include the role of the survey in providing information and assisting in the process of the development of the project as a whole. In addition the cost effectiveness plus the ethical and political dimensions are considered. In the course of the survey important lessons were learned that could benefit others also doing research of this type. Issues raised include the importance of the presence of specific research skills being part of the team throughout the project, the importance of full negotiation of access, being clear in terms of objectives and the questions to be asked, sampling issues, problems of questions demanding memory recall, community participation and spreading of skills, and the dissemination of results.

Community Health Services↗