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Biomedical subjects

J E Helzer

Publications and source records attributed to J E Helzer.

At least 55 records · Page 3Linked to original sources
PubMed1984

A study of the association between Crohn's disease and psychiatric illness.

This study is an examination of the association between Crohn's disease and psychiatric illness using careful gastrointestinal evaluation, a structured psychiatric interview of known reliability and validity, and explicit diagnostic criteria for psychiatric illness. A proband sample of 50 subjects with Crohn's disease was obtained from a university clinic and a private clinic. Fifty control subjects with chronic medical illnesses obtained from the same two clinic sources were also examined. Compared with controls, a significantly greater number of the patients with Crohn's disease met criteria for some psychiatric disorder at some time in their lives, and a significantly greater number had a diagnosis of depression. A greater number of the probands reported obsessional or phobic symptoms, and the mean number of obsessional symptoms was higher in probands than in controls. We found no evidence of an interaction between psychiatric disorder and Crohn's disease. The significance of the discovered association for the treatment and natural history of Crohn's disease is discussed.

Adult↗
PubMed1983

Contribution of the six-month criterion to the predictive validity of the DSM-III definition of schizophrenia.

To test the contribution of the criterion of six months of illness to the predictive usefulness of the DSM-III diagnosis of schizophrenia, we compared, from a sample of 121 patients with functional psychosis, those who had been ill for six months or more at index but did not meet the nontemporal DSM-III criteria and those who met the full criteria. We found that while the six-month criterion is an important component, it is not the sole reason for the predictive power of these criteria. Many who met only this criterion had relatively good outcomes, and, as a group, their outcomes were only slightly worse than for the entire series of psychotic patients. Those who met the full criteria had a significantly poorer outcome in terms of both continued psychopathology and social functioning.

Humans↗
PubMed1983

Diagnostic interactions. Alcoholism and antisocial personality.

The association of alcoholism with other psychiatric disorders is important from both a research and a therapeutic point of view. In a medically hospitalized inpatient sample, we found a strong relationship between alcoholism and antisocial personality. Controlling for the overlap of diagnostic symptomatology, antisocial subjects still had a significantly higher prevalence of alcoholism than nonantisocial. The antisocial individual was more likely to be exposed to problem drinking, and once exposed, he tended to be more susceptible to developing the full alcoholism syndrome. Gender and a family history of problem drinking also predicted alcoholism. Characterological and neurophysiological correlates of antisocial personality and their relationship to problem drinking are discussed.

Adult↗
PubMed1983

Definitions of mania: concordance and prediction of outcome.

The authors compare several definitions of mania in three series of patients. All the definitions were successful in selecting patients with a favorable outcome, but there were large differences in the number of patients diagnosed, ranging from 17 to 55. The Research Diagnostic Criteria (RDC) distinction between mania and schizoaffective mania proved useful in that the schizoaffective patients continued to show schizophrenic and paranoid symptoms, had more manic episodes, and had a poorer social outcome. The DSM-III tripartite division into nonpsychotic mania and two subgroups of psychotic mania did not appear to have a clear advantage over the RDC dichotomy in the prediction of outcome.

Adolescent↗
PubMed1983

Standardized interviews in psychiatry.

Although they have a long history of use, standardized or structured interviews for the gathering of clinical data in psychiatry have become increasingly popular in the last 10 years. Some definitions of structured interviews and a brief historical review of their use are presented. In addition to enhancing the reliability of symptoms and diagnoses in research, there is evidence that structured interviews improve the comprehensiveness of the data base, and reduce examiner bias. Even in the routine clinical setting, completeness of data collection and accuracy of diagnosis would appear to outweigh potential disadvantages. The scope and limitations of instruments currently in common use (PSE and SADS), and the DIS, developed for epidemiological use by non-clinician interviewers in an extensive NIMH study, are reviewed. The importance of future developments in structured interview design derives from widespread recognition of the significance of precisely defined diagnostic criteria in research and practice.

Humans↗
PubMed1982

A controlled study of the association between ulcerative colitis and psychiatric diagnoses.

Fifty consecutive patients with ulcerative colitis were personally examined to determine the lifetime prevalence of specific psychiatric diagnoses. A personality assessment and a tabulation of recently occurring stressful events were done. A matched control sample with chronic nongastrointestinal medical illnesses was evaluated in the same way. The two groups were compared so as to quantify the relative association and impact of psychiatric disorder in ulcerative colitis. We found no greater frequency of diagnosable psychiatric disorder in ulcerative colitis patients than in the control population. Those with ulcerative colitis and a psychiatric illness did not appear to have more serious gastrointestinal involvement, nor did severity of the ulcerative colitis predict more frequent or more serious psychiatric disorder. Personality profiles were similar in probands and controls, and there was no correlation between the frequency of potentially stressful life events within the six months prior to interview and severity of ulcerative colitis at the time of interview. We did find slightly higher levels of obsessional symptomatology in ulcerative colitis cases, but this association appeared to be weak and unrelated to the severity of the gastrointestinal disorder. Despite the fact that more than a quarter of the ulcerative colitis patients had some diagnosable psychiatric illness, the occurrence of psychiatric disorder was rarely documented in the medical charts.

Adult↗
PubMed1982

Definitions of depression: concordance and prediction of outcome.

Using patient samples in London hospitals, the authors compared three methods of diagnosing and subdividing depressive illness in terms of their ability to predict outcome. The Catego class D+ selected patients who continued to suffer from episodes of psychotic depression. The Research Diagnostic Criteria selected patients with schizoaffective depressions whose outcome a completely different from that of major depressive disorder. DSM-III had advantages over the other systems, since it divides depression into three subtypes that differ from each other and from schizophrenia. Patients with a DSM-III diagnosis of mood-incongruent psychotic depression had persistent schizophrenic psychopathology, but their outcome differed from that of both schizophrenic and manic-depressive patients.

Bipolar Disorder↗
PubMed1981

National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity.

A new interview schedule allows lay interviewers or clinicians to make psychiatric diagnoses according to DSM-III criteria, Feighner criteria, and Research Diagnostic Criteria. It is being used in a set of epidemiological studies sponsored by the National Institute of Mental Health Center for Epidemiological Studies. Its accuracy has been evaluated in a test-retest design comparing independent administrations by psychiatrists and lay interviewers to 216 subjects (inpatients, outpatients, ex-patients, and nonpatients).

Humans↗
PubMed1981

Renard diagnostic interview. Its reliability and procedural validity with physicians and lay interviewers.

A psychiatric diagnostic interview that can be reliably and validly administered by nonpsychiatric physicians and lay interviewers has both research and clinical applications. We examined the interrater reliability and procedural validity of the Renard Diagnostic Interview (RDI), an instrument designed for these purposes. Randomly selected psychiatric inpatients were interviewed once by a psychiatrist using our standard departmental research interview and were then given RDIs by two psychiatrists, two lay interviewers, or one of each. The reliability of the RDI is estimated by examining diagnostic concordance for the two RDI interviews. Procedural validity is estimated by examining diagnostic concordance between the RDI and the traditional departmental interview. Both reliability and procedural validity were found to be high, and the study demonstrates that lay interviewers using the RDI after a brief period of training can obtain accurate diagnostic information.

Humans↗
PubMed1981

Predictive validity of DSM-III and Feighner definitions of schizophrenia. A comparison with research diagnosis criteria and CATEGO.

The new DSM-III and the Feighner criteria give definitions of schizophrenia that are restrictive in that they require six months of illness before the diagnosis can be made. The definitions are compared with definitions of schizophrenia in the Research Diagnosis Criteria and CATEGO in terms of predictive validity using a cohort of 125 psychotic patients from the United States-United Kingdom Diagnostic Project. The results showed that while the DSM-III and Feighner definitions were more restrictive, they also had a higher degree of predictive specificity than the other two definitions. No patient diagnosed by DSM-III or Feighner criteria showed a change in diagnosis over time, and these patients were more likely to have persistent schizophrenic symptoms and to have social handicap. The appropriateness of the requirement of six months of illness and the practicality of using outcome as a validity measure are discussed.

Bipolar Disorder↗
PubMed1981

A longitudinal record study of renal function in patients treated with lithium.

We reviewed hospital charts of 62 patients receiving long-term lithium therapy in an attempt to see if renal function deteriorated in association with lithium treatment. We found no association between duration of lithium treatment of up to four years and change in BUN or creatinine or the development of proteinuria. There was a nonsignificant tendency for cases showing a rise in BUN from index to follow-up to have had a chart record of lithium intoxication, but these same cases tended to have a lower follow-up creatinine. There was a tendency for older patients to have higher BUN and creatinine at follow-up than at index, but there was no association between this and duration of lithium treatment.

Adult↗
PubMed1981

The use of a structured diagnostic interview for routine psychiatric evaluations.

The author reports the use of a structured psychiatric interview for the routine initial evaluation of all referrals to an inpatient psychiatric consultation service during a 1-year period. Acceptance of this procedure by physician examiners and by patients was high. There was evidence that the structured interview was a useful diagnostic tool and did not interfere with patient rapport. The advantages of structured interviews for routine clinical evaluations are discussed.

Attitude of Health Personnel↗
PubMed1981

Diagnostic concordance between DSM-III, Feighner, and RDC.

The NIMH Diagnostic Interview Schedule was administered by psychiatrists to 216 individuals. The DSM-III, Feighner, and RDC diagnoses derived from the computerized interview results were then compared for eight psychiatric disorders. Rates of diagnostic concordance among the systems are given, and the causes of diagnostic discrepancies are discussed. Diagnostic concordance was highest for mania and alcoholism and lowest for schizophrenia and antisocial personality disorder. Implications of these findings and future research directions are discussed.

Alcoholism↗
PubMed1979

Depression in Viet Nam veterans and civilian controls.

In order to investigate the long-term psychological consequences of Viet Nam combat, the authors located and personally interviewed a group of 571 randomly selected Viet Nam veterans and 284 matched civilian controls 3 years after the veterans returned to the United States. In the veterans they found a weak association between combat and subsequent depressive symptoms, but the association did not persist after controlling for preservice factors. The incidence of depressive symptoms and syndromes was similar when veterans were compared with nonveterans. Results are contrasted with a 12-month follow-up study of the same veterans in which a stronger association between combat and later depression was found.

Antisocial Personality Disorder↗