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Biomedical subjects

H Fabrega

Publications and source records attributed to H Fabrega.

At least 109 records · Page 6Linked to original sources
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The culture and history of psychiatric stigma in early modern and modern Western societies: a review of recent literature.

This report continues a review of literature pertaining to psychiatric stigma in Western societies. It concentrates on the early modern and modern periods. The general role played by the medical profession in these two periods with respect to those suffering from psychiatric illness is emphasized. In the initial phase, its largely scientific academic perspective was prominent, and the church's influence continued but became less important. In general, it was during these two periods that the state became increasingly influential in policies involving the institutionalization of marginal populations, including the mad and insane. Many "revisionist" historians have criticized the role played by the emerging psychiatric profession in this whole process and these writings are reviewed. Overall, a complex assortment of factors are seen to contribute to an accentuation of psychiatric stigma that had its roots in the classical and medieval periods.

Attitude to Health↗
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On the homogeneity of personality disorder clusters.

This study was conducted using as subjects persons seeking psychiatric care in a public intake facility. Patients who received a diagnosis of a personality disorder (PD) on axis II constituted the study sample. The study is unique in that it attempts to analyze in a treatment population the relationships between all of the personality disorders (PD) stipulated in DSM-III with emphasis on their relationships to the associated features recorded in the remaining axes of DSM-III. The specific aim of the study was to determine the variation that exists with respect to clinical and demographic variables across the PD clusters categorized in DSM-III and across the PD types of each of the DSM-III PD clusters. In general, considerable inhomogeneity was shown within and across clusters in both demographic and clinical variables, although differences among clusters were noted as well. Cluster B differs prominently from its cohorts with respect to demographic and clinical characteristics. Some of the limitations of these results are emphasized.

Adult↗
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Psychiatric stigma in non-Western societies.

Factors bearing on social stigma in persons with a psychiatric illness are the subject of this review of the literature. The review concentrates on material pertaining to non-Western societies. This is a topic that has not received much systematic attention. The cultural meanings associated with psychiatric illness are examined. Emphasis is given to societies ordinarily studied by anthropologists and social historians of non-Western medicine. Stigma is variable in the more elementary societies. It is present in India and especially China, and studies suggest the social stigma is less prevalent in Islamic societies. It is important to distinguish between how psychiatric illness is handled in community settings as versus in the system and tradition of medicine.

Anthropology, Cultural↗
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Characterizing organic hallucinosis.

A first comprehensive description of the clinical features of patients with the rare diagnosis of organic hallucinosis (OH) is presented, based on information from 11 OH patients among 14,889 patients who presented for evaluation over a 5-year period at our institution. This characterization is of particular current relevance to diagnosticians and clinicians because of the proposed major changes in the diagnostic system for OH in the upcoming DSM-IV and because of the virtual total lack of published information concerning this syndrome. This description includes a listing of the prevalence and mean severity of each symptom. The severity of the symptoms of OH are then compared with those of its crude "functional" equivalent of schizophrenia to determine which symptoms distinguish between these categories. Associated factors are also presented concerning demographics, modes of treatment, level of functioning, and current physical problems associated with OH.

Adult↗
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Sociocultural and clinical characteristics of patients with comorbid depressions: a comparison of substance abuse and non-substance abuse diagnoses.

Patients with three varieties of major depression (MD) were compared with respect to sociocultural and clinical characteristics. The patients sought psychiatric evaluation in an intake setting during a 6-year interval. The groups that were compared included MD (sole axis I diagnosis; N = 3,913); MD with a comorbid non-substance abuse ([MD-nonSA] N = 594); and MD with a comorbid substance abuse ([MD-SA] N = 690). Prominent demographic differences were found in the three groups, with males, lower social class status, younger age, and African American ethnicity being more prominent in MD-SA. The four demographic variables, axis I status, axis II diagnosis, and axis III diagnosis constituted the independent variable in an analysis of variance (ANOVA) main-effects comparison of social function (during last year and currently in three areas) and type of depression symptoms (somatic and psychological). Of the demographic variables, age and social class proved to have significant effects on social function and psychological symptoms. Each of the three "syndromic" axes (Axis I, Axis II, and Axis III) had a significant impact on social function and psychological symptoms. Only Axis III produced differences in somatic symptoms. The social and cultural implications of these results are discussed.

Adult↗
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Characterizing organic mood syndrome, depressed type.

In this report, a first comprehensive description of the clinical features of patients with organic mood syndrome, depressed type (OMS-D), in a psychiatric hospital population is presented. This description is based on information from 130 OMS-D patients among 14,889 patients who presented for initial evaluation over a 5-year period. This description includes an enumeration of the common clinical symptoms of this syndrome. Following this, the severity of the symptoms of OMS-D are compared with those of its crude "functional" equivalent of major depressive disorder, single episode (MDD-SE). In addition, associated factors are presented concerning demographics, level of functioning, comorbidity, electroencephalographic and computed tomographic abnormalities, and current physical problems. These findings provide preliminary support for the validity of this diagnostic category, and provide relevant information concerning proposed changes in this category as listed in the DSM-IV Options Book.

Adult↗
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Characterizing organic mood syndrome, manic type.

The purpose of this study is to provide the first empirically based description of the clinical features of organic mood syndrome, manic type (OMS-M). During a recent 5-year period, 14,889 new patients presented for initial evaluation and care at our institute. Of these patients, a total of 12 cases of OMS-M were diagnosed. Evaluations were conducted using the Initial Evaluation Form, which was developed to be compatible with the DSM-III. The symptom profile of OMS-M was compared with that of "functional" manics (bipolar disorder, manic type [BD-M]). A variety of associated clinical factors were also assessed. The OMS-M patient demonstrated somewhat less severe acute symptomatology but more longstanding functional impairment than in BD-M. OMS-M patients also displayed a lower age at onset of illness and a higher level of perinatal problems and developmental delays compared with BD-M patients. The OMS-M group displayed a low family burden of mania. The most striking distinguishing feature of OMS-M was the prevalence of neurological disorders, with a surprisingly high prevalence of seizure disorders. Seizure disorders were more prevalent in OMS-M than in other organic brain syndromes (OBS).

Adult↗
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Nonparametric mixture logistic regression models for clinical disposition.

Psychiatric hospitalization is one of the most important decisions in the care of patients. This is attributed to the complexity and intensity of treatment and isolation of patients from the family and community into a typically highly controlled and supervised setting. Logistic regression models are fitted to assess the relationship between DSM-III axes and psychiatric hospitalization decisions. Since the apparent error rate tends to underestimate the true error rate, the estimate for the downward bias of the apparent error was computed. A generalization of the logistic regression model is fitted where the intercept is assumed to be a random parameter.

Adolescent↗
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Cultural challenges to the psychiatric enterprise.

Two challenges to psychiatry emanating from the study of cultural differences in mental illness are reviewed. The first challenge, conducted under the banner of cultural relativism, appeared to undermine the validity of psychiatric disorders. The misconceptions of this challenge, as embodied in the excesses of the labeling theory of sociology, were associated with the writings of antipsychiatrists and rejection of the community mental health movement. The result of all this was a devaluation of insights inherent in the cultural perspective. The second challenge draws emphasis to the pervasive role played by cultural differences in every facet of the psychiatric enterprise. Its relevance and contributions are briefly summarized. The study of the cultural sciences as they pertain to psychiatry offers a necessary corrective to the increasing impersonality and reductionism that is coming to characterize the neurobiologic approach.

Cross-Cultural Comparison↗
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Gender effects on the clinical presentation of alcoholics at a psychiatric hospital.

Despite the clinical importance of gender effects on symptom patterns and comorbidity patterns in alcoholics, little is known about such effects in treatment facilities other than alcoholism treatment centers. This study evaluated the effect of gender on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatric hospital. It demonstrated that major depression and accompanying depressive and anxiety-related symptoms are more prominent in female alcoholics than in male alcoholics, whereas antisocial personality disorder and antisocial symptoms are more prominent in male alcoholics presenting to a psychiatric hospital. The study also demonstrated that reversed neurovegetative symptoms are more severe in female than in male alcoholics.

Adult↗
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Racial effects on the clinical presentation of alcoholics at a psychiatric hospital.

Despite the clinical importance of race effects on comorbidity and symptom patterns in recent community studies, little is known about such effects in various treatment facilities. This study evaluated the effect of race on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatric hospital. The factor that most strongly distinguished the racial groups was socioeconomic status (SES). After controlling for SES and other factors, no significant difference was noted between ethnic groups in the prevalence of major depressive disorder (MDD) or antisocial personality disorder. However, after controlling for SES and other factors, alcohol and drug use were more severe in African-American alcoholics, along with four symptoms associated with alcohol and drug use. In contrast, reversed neurovegetative symptoms, anxiety-related symptoms, and some personality-related symptoms were more severe in white alcoholics.

Adult↗
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Age effects on the clinical presentation of alcoholics at a psychiatric hospital.

Little is known about the effects of age on the clinical presentation of alcoholism in various treatment settings, despite the clinical importance of this factor. This study evaluates the effects of age on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatric hospital. Young alcoholics displayed the most prominent substance use, antisocial behavior, depressive symptoms (including suicidality), and impulsivity. Early middle-aged alcoholics displayed the highest levels of drinking. Elderly alcoholics displayed the highest levels of cognitive dysfunction, although some level of cognitive dysfunction was present among even the youngest alcoholics. These findings confirm and clarify the effects of age on the clinical profile of alcoholics presenting for initial evaluation at a psychiatric hospital.

Adult↗