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Biomedical subjects

H Fabrega

Publications and source records attributed to H Fabrega.

At least 55 records · Page 3Linked to original sources
PubMed1989

Cultural relativism and psychiatric illness.

Psychiatry has had a long-standing association with sociology and, especially, cultural anthropology. These social sciences have been influential in developing the concept of cultural relativism and applying it to psychiatry, sometimes in a challenging way and with much detriment. The concept has been used by some antipsychiatrists in attempts to discredit psychiatric practice. Contemporary psychiatrists endorsing a form of biological determinism have tended to either disregard the concept or judge it as trivial if not nonsensical. This study describes the concept of cultural relativism, reviews its applications to illness, and analyzes its implications from a historical and theoretical point of view. Its varied aspects, power, and limitations are discussed.

Cross-Cultural Comparison↗
PubMed1989

DSM-III disorders in a large sample of psychiatric patients: frequency and specificity of diagnoses.

This study examined certain nosological features of DSM-III axis I diagnostic categories and subcategories as applied to 11,292 general psychiatric patients presenting for care, using a semistructured assessment procedure. The most frequently used major categories were affective, substance use, childhood-onset, and adjustment disorders. Secondary diagnoses were given to 26% of the patients. Male patients predominated in the categories of impulse-control, psychosexual, and substance use disorders, and female patients predominated in the categories of anxiety, affective, and somatoform disorders. Of the 329 five-digit subcategories available in DSM-III, 296 (90%) were actually used. Sixteen percent of the patients were given unspecific primary diagnoses.

Adolescent↗
PubMed1989

An ethnomedical perspective of Anglo-American psychiatry.

Although psychiatry is part of Western biomedicine and its roots in neurobiology are widely appreciated, Anglo-American psychiatry addresses social behavior that is deviant and potentially stigmatizing and is said to uniquely engage in social control. Moreover, its concerns overlap and compete with those of other regulatory institutions of the state. For these reasons, the manner in which psychiatry operates is subject to challenge, criticism, and controversy. The author proposes that a look at psychiatry from the vantage point of ethnomedicine--the comparative study of medical systems--can enhance an appreciation of the current controversies in psychiatry and psychiatry's role as a medical institution.

Cross-Cultural Comparison↗
PubMed1988

Somatoform disorder in a psychiatric setting. Systematic comparisons with depression and anxiety disorders.

Somatoform disorder (SD) is recognized as an important clinical entity in general medicine although its psychiatric nature is insufficiently appreciated. Its prevalence and descriptive validity among psychiatric patients have not been investigated. These two aspects of SD are examined by comparing it with depressive and anxiety disorders, both of which include somatic symptoms and often are confounded with it. A semistructured evaluation procedure applied in a naturalistic clinical setting yielded a diagnosis and ratings of a large array of symptoms. The relative rarity of SD stands out, as well as the unique way in which it tends to be used in diagnostic formulations of psychiatric patients seeking evaluation and care. These results may reflect these patients' reluctance to seek psychiatric care and to define their problems as mental, as well as the bias of clinicians working in psychiatric settings geared to looking for traditional psychopathology. The distinguishing symptoms of SD vis-à-vis depressive and anxiety syndromes are outlined. These symptoms suggest that SD patients resemble depressives, but harbor traits that reflect personality and interpersonal difficulties. However, rater bias may have influenced these results as well.

Adult↗
PubMed1987

Adjustment disorder as a marginal or transitional illness category in DSM-III.

This study examines the resources of DSM-III for dealing with conditions that fall outside the domain of illnesses with specific, recognized, and clearly delineated symptom profiles. In discussing some of the theoretical and problematic aspects of the categories "Adjustment Disorder" (AD) and "not ill" (NI), AD is viewed as an example of a marginal or transitional illness category. Clinical psychopathologic features of subjects in the AD and NI categories are compared with those in the logical complementary category composed of all other specific diagnosis categories of DSM-III. The results support the descriptive validity of AD and NI in DSM-III.

Adjustment Disorders↗
PubMed1987

Multiaxial characterization of depressive patients.

A review of the literature on the comprehensive description of depressive patients revealed prominent concern with syndromic subtypes, course of illness, and personality factors, followed by severity, concomitant physical disorders, psychosocial stressors, and adaptive functioning. The descriptive value of multiaxial approaches for depression was illustrated through the application of an extended DSM-III formulation to all 3455 depressive (bipolar depression, major depression, dysthymic disorder, and atypical depression) and 7837 nondepressive patients of all ages and sexes presenting for evaluation and care at the Psychiatric Institute of the University of Pittsburgh during a period of 53 months. Twenty-six percent of the depressive patients received an additional diagnosis in axis I, the most frequent of which were substance use disorder, anxiety disorder, and condition not attributable to a mental disorder. In axis II, depressive patients presented a differentially higher frequency of dependent personality disorder and the "anxious/fearful" cluster of personality disorders. In axis III, 47% of the depressive vs. 40% of the nondepressive patients had a positive diagnosis of physical illness, with a significantly higher frequency among depressive patients attained by acquired hypothyroidism, migraine, essential hypertension, unspecified abdominal hernia, and unspecified arthropathies. Specific stressors differentially more frequent among depressive patients were those of conjugal, parenting, and occupational types and those reflecting the impact of physical illness. Overall stressor severity was at severe, extreme, or catastrophic levels for 42% of the depressive and 31% of the nondepressive patients. The highest level of adaptive functioning in the past year was good, very good, or superior for 44% of the depressive and 29% of the nondepressive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Psychiatric diagnosis. A cultural perspective.

This report contains a theoretical discussion of psychiatric diagnosis and reflects a broad cross-cultural perspective. The current theory that appears to underlie psychiatric diagnosis in biomedicine is outlined and examined from the standpoint of its similarities and differences to diagnostic systems in other, more elementary, systems of medicine. Problems posed by the nature of psychiatric illness, as these relate more broadly to the theory and enterprise of diagnosis and classification, are reviewed. The report addresses the nature of category structure models in psychiatry, the differences between the classification of illness and natural objects, the influence of symbolic/cultural/historical factors in psychiatric illness ascertainment, different parameters of a measurement approach to psychiatric diagnosis, and the problem of co-occurrence of psychiatric illness. Whenever possible, the rationale and system of DSM-III is used for purposes of discussion and illustration. The aim of the report is to outline and review these and related factors to conceptualize the enterprise of psychiatric illness diagnosis in a broad comparative social medical frame of reference.

Cross-Cultural Comparison↗
PubMed1987

Adjustment disorder and psychiatric practice: cultural and historical aspects.

A universal concern of healers and health practitioners of all social groups is that of caring for individuals reacting to social and interpersonal hardships. One could view individuals experiencing such hardships as prototypical patients of a society's health profession, however this may be defined. In contemporary psychiatry, such individuals are diagnosed as showing an "adjustment disorder." In view of the time-honored legitimacy of caring for individuals meeting criteria for an adjustment disorder, it is ironic that the status of this "disorder" in the discipline's contemporary nosology is controversial and anomalous. In this paper, these and related issues are discussed. Emphasis is given to some of the cultural, historical and clinical-epidemiologic factors that render disturbances that can be diagnosed as adjustment disorder important in psychiatry and, indeed, worthy of inclusion in DSM-III. Theoretical and empirical problems that would render this entity a more legitimate one in contemporary biomedical psychiatry are reviewed.

Adjustment Disorders↗
PubMed1986

Descriptive validity of DSM-III depressions.

There are five categories of psychiatric disorders in DSM-III that embrace depressive moods: adjustment disorder with depressed mood (group 1), bipolar depression (group 2), major depression (group 3), dysthymic disorder (group 4), and atypical depression (group 5). A large sample of patients seen in a metropolitan university psychiatric referral center, with these categories as primary diagnoses in axis I, constitute the subjects studied (N = 2988). The study includes a comparison of the cross-sectional clinical properties of these patients, including an inventory of psychopathological symptoms, entries in axes II to V (i.e., as described in DSM-III, plus a sixth axis measuring current adjustment) and immediate dispositions rendered by clinicians. This study addresses the descriptive validity of DSM-III diagnostic categories of depression. A clustering of depressions based on a continuum of severity is uncovered as well as unique features of certain subtypes that point to categorical aspects of DSM-III mood disorders. The nature and implication of these findings are discussed.

Adjustment Disorders↗
PubMed1985

International experience with DSM-III.

The authors investigated various aspects of the international use of and experience with DSM-III through a consultation by mail sponsored by the World Psychiatric Association. The respondents were 175 expert diagnosticians nominated as such by the national psychiatric associations of 52 countries spanning all continents. The United States diagnostic system was used by 72% of the participants, only slightly less than the internationally official International Classification of Diseases, Injuries, and Causes of Death, ninth revision (ICD-9) (77%). Furthermore, DSM-III was perceived to be considerably more useful than the current international classification manual. The leading difficulties encountered with DSM-III involved problematic boundaries or definitions of diagnostic categories and the lack of suitable categories in some cases. The most frequent recommendations offered for the advancement of diagnostic systems included the improvement of patient evaluation procedures, the greater use and refinement of multiaxial diagnosis, and the empirical validation of diagnostic systems.

Cross-Cultural Comparison↗
PubMed1983

Electrocardiographic effects of social stress on coronary-prone (type A) individuals.

Subjects selected for possession of either the Type A (coronary-prone) or Type B (coronary-resistant) behavior pattern interacted with a computer, while appearing to interact with a partner, in a formal competitive game of social strategy. Type A subjects exhibited greater impatience than Type B subjects. Computer analysis of the electrocardiogram revealed that social stimulation elicited larger ventricular electrophysiological responses (ST segment depression, and reduction of T wave and R wave amplitudes) in Type A than in Type B subjects. Such changes are consistent with the assumption of greater cardiac sympathetic activity during the social interactions in the Type A subjects.

Arousal↗
PubMed1979

Elementary systems of medicine.

The beliefs about causes of disease, orientations to medical problems, and the treatment practices of relatively small and elementary societies are reviewed and analyzed. Selected published reports of this problem area of ethnomedicine serve as source material. An attempt is made to induce generalizations which will serve as a possible baseline for studies dealing with related material pertaining to more advanced societies.

Alaska↗
PubMed1979

Neurobiology, culture, and behavior disturbances. An integrative review.

The study of the influence of culture on behavior disturbances has a long history in psychiatry. Attention has principally focused on etiological questions and on how psychiatric illness is handled socially, although there is a tradition which deals with the manifestations of so-called functional psychiatric illnesses. In all of these instances, the methods and rationale of the social sciences have been employed and underlying neurobiological factors neglected. However, since a people's culture is learned, it is obviously internalized in some way in the individual. A basic question is how cultural influences may possibly affect the organization and functioning of the nervous system and, by extension, behavior and its disturbances. The relevance of this topic for psychiatry and the social sciences is illustrated by analysis of four prototypical organic psychiatric illnesses.

Alcohol Amnestic Disorder↗