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Biomedical subjects

J H Greist

Publications and source records attributed to J H Greist.

At least 19 recordsLinked to original sources
PubMed1992

A comparison of two computer-administered versions of the NIMH Diagnostic Interview Schedule.

This study compared three versions of the NIMH Diagnostic Interview Schedule (DIS): "traditional" interviewer-administered DIS; computer-administered DIS (subject interacting alone with computer); computer-prompted DIS (interviewer using computer program as a guide). Kappas for 20 diagnoses ranged from .15 to .94, and averages for the three method pairs ranged from .57 to .64, which are comparable to other DIS reliability studies. Agreement between pairs of methods were comparable. Subjects' attitudes toward the computer interview were positive. While they felt they could better describe their feelings and ideas to a human, they found the computer contact less embarrassing. Overall, subjects had no preference for one method over another. Measures of social desirability and deviant response biases were correlated with diagnostic results. Reading ability did not affect subject's ability to respond to the DIS, although subjects with lower reading levels preferred the computer interview more.

Adult↗
PubMed1992

Clomipramine hydrochloride in childhood and adolescent obsessive-compulsive disorder--a multicenter trial.

Children and adolescents with obsessive compulsive disorder were studied in an 8-week, multicenter, double-blind, parallel groups trial of clomipramine hydrochloride (CMI) versus placebo. Efficacy assessments included the child version of the Yale-Brown Obsessive Compulsive Scale and the National Institute of Mental Health Global rating scale. At the end of 8 weeks, CMI-treated patients showed a mean reduction in Yale-Brown Obsessive Compulsive Scale score of 37% compared to 8% in the placebo group. Side effects were typical of tricyclic antidepressants. In a 1-year open label treatment, CMI continued to be effective and well tolerated.

Adolescent↗
PubMed1992

The effect of enalapril on serum lithium levels in healthy men.

BACKGROUND: Several authors have recently described the development of lithium toxicity after the addition of angiotensin-converting enzyme inhibitors to a stable lithium regimen. This pilot study was designed to systematically investigate the effects of enalapril, an angiotensin-converting enzyme inhibitor, on the serum level of lithium. METHOD: In a 26-day outpatient study, nine healthy men took lithium for 10 days, lithium and enalapril for 10 days, and lithium alone again for 6 days. Serum lithium levels were measured while patients were taking lithium alone and while they were taking the lithium/enalapril combination. RESULTS: There were no statistically significant differences between mean serum lithium level during treatment with lithium alone and during treatment with the lithium/enalapril combination. However, one subject showed a 31% increase in serum lithium level after enalapril was added. CONCLUSION: Although no statistically significant differences between mean serum lithium level during treatment either with lithium alone or with lithium/enalapril were found, it is possible that the low dose of enalapril and low serum lithium levels employed for subject safety may have resulted in a type II statistical error. If enalapril doses or initial serum lithium levels were similar to those described in case reports, a significant difference in mean serum lithium levels may have been observed. While a predictable interaction between lithium and enalapril probably does not occur in all patients, factors such as enalapril dose, serum lithium level before addition of enalapril, or the presence of heart disease may make such an interaction more likely. At the levels of lithium and enalapril used in this study, elevated serum lithium concentration does not appear to be a universal event, but physicians must exercise appropriate caution.

Adolescent↗
PubMed1992

Behavior therapy for obsessive compulsive disorder.

Behavior therapy for OCD with exposure and response prevention is effective in reducing obsessions and rituals in at least half of those suffering this disabling disorder. Office-based sessions in which patients participate actively in designing exposure and response prevention homework are usually sufficient. Therapist assistance is sometimes needed for those who fail to perform these assignments on their own. Poor compliance, severe comorbid conditions, and CNS-depressing drugs can interfere with behavior therapy. Techniques to manage these difficulties, including modifications of behavior treatment and the use of serotonin reuptake inhibiting drugs, can increase substantially the number of patients responsive to behavior therapy.

Adaptation, Psychological↗
PubMed1992

An integrated approach to treatment of obsessive compulsive disorder.

Except for rarely performed psychosurgery, obsessive compulsive disorder seldom improved with reversible treatments before 1966. In that year, Victor Meyer reported successful treatment of OCD with behavior therapy, and clomipramine was first released. For the past 25 years, controlled research has demonstrated specific efficacy of exposure for obsessional anxiety and ritual or response prevention for reducing ritual time, interference, and associated distress. Over the same time span, clomipramine has been conclusively shown to be an effective treatment for obsessive compulsive disorder in double-blind controlled trials against placebo and other nonpotent serotonin uptake inhibitor antidepressants. Fluvoxamine, fluoxetine, and sertraline, all potent serotonin uptake inhibitors, have also demonstrated efficacy in obsessive compulsive disorder; fluvoxamine is the best studied of these three compounds. The combination of behavior therapy and a potent serotonin uptake inhibitor is currently the best treatment for most patients. Psychosurgery still has a part to play in the treatment of a small proportion of severely disabled and distressed obsessive compulsive patients unresponsive to other effective treatments.

Behavior Therapy↗
PubMed1991

Performance of two forms of a computer psychiatric screening interview: version I of the DISSI.

This study reports on the performance of two forms of version I of the Diagnostic Interview Schedule (DIS) computer screening interview, using the traditional interviewer-administered DIS (T-DIS) as the standard. The screening interview was either self-administered (called the S-DISSI) with the subject keying in responses, or interviewer-administered (I-DISSI), with the interviewer keying in the subject's responses. Sensitivity and specificity for both forms were ample (excluding antisocial personality), ranging from 60% to 100% for sensitivity and 54% to 95% for specificity. Concordances with the T-DIS were similar for both forms of the screening interview, ranging from .10 to .87 and compared favorably to those reported by other investigators. The I-DISSI took on average 30 min less than either the T-DIS and S-DISSI. Since the performances of both versions were equivalent, the decision to use either may be based on available resources and characteristics of the study population.

Adult↗
PubMed1990

Clomipramine versus fluoxetine in obsessive-compulsive disorder: a retrospective comparison of side effects and efficacy.

Since it will be some time until data will be available comparing clomipramine and fluoxetine for the treatment of patients with obsessive-compulsive disorder (OCD), a meta-analysis of previous studies was performed in an attempt to gain some information about comparable efficacy and side effects of these two commonly used agents. In 31 OCD patients receiving clomipramine in a controlled trial and 72 OCD patients receiving fluoxetine openly, both drugs appeared effective, with clomipramine having a somewhat larger effect than fluoxetine. Different side effect profiles may have a bearing on patient selection.

Clomipramine↗
PubMed1990

Computer-administered cognitive-behavioral therapy for depression.

The authors evaluated a six-session interactive computer cognitive-behavioral treatment program given to volunteer patients who met Research Diagnostic Criteria (RDC) for major or minor depressive disorder. Patients were randomly assigned to computer-administered cognitive-behavioral treatment, to therapist-administered cognitive-behavioral treatment, or to a waiting-list control condition. After treatment and at 2-month follow-up, both treatment groups had improved significantly more than control subjects in their scores on the Beck Depression Inventory, SCL-90-R depression and global scales, Hamilton Rating Scale for Depression, and Automatic Thoughts Questionnaire. The treatment groups did not differ from each other at either time.

Adult↗
PubMed1990

A double-blind, placebo-controlled trial of fluvoxamine versus imipramine in outpatients with major depression.

The authors employed a double-blind, placebo-controlled design to investigate the effectiveness of fluvoxamine versus imipramine in 54 outpatients with moderate major depression. Fluvoxamine proved superior to placebo but not to imipramine on the Hamilton Rating Scale for Depression and the Montgomery and Asberg Depression Rating Scale. Nausea and hyperarousal were the most common side effects in the fluvoxamine-treated patients.

Adolescent↗
PubMed1990

Treatment of obsessive compulsive disorder: psychotherapies, drugs, and other somatic treatment.

Ninety percent of obsessive compulsive patients can be helped by treatment with behavior therapy and drug treatment, used sequentially or concurrently. The effectiveness of these treatments has been demonstrated in controlled clinical trials and is superior to electroconvulsive therapy and dynamic or cognitive psychotherapies for this disorder. Potent serotonin uptake inhibiting drugs, from the class of heterocyclic antidepressants, are the most effective antiobsessional medications currently available. Although these drugs usually do not induce complete remission, they can reduce obsessive compulsive symptoms by 30% to 42%. Behavior therapy combines exposure and response prevention, which the patient first learns with the therapist and then practices independently. With behavior therapy, patients confront the triggers for their anxiety and then delay, diminish, or discontinue their rituals. Reduction in symptoms with behavior therapy averages 50% or greater. Behavior therapy is usually not effective in patients who are substantially depressed, are delusional, fail to comply, or undermine therapy with covert rituals or avoidance techniques. The rare patient with very severe obsessive compulsive disorder who does not respond to behavior or drug therapy may be a candidate for psychosurgery. Modern psychosurgical procedures are quite safe and can improve symptoms in the majority of otherwise unresponsive patients.

Antidepressive Agents↗
PubMed1990

Treating the anxiety: therapeutic options in obsessive compulsive disorder.

Obsessive compulsive disorder (OCD) is far more prevalent and frequently more severe than recognized previously. Behavior therapy with exposure and response-prevention has proven effective treatment, as have potent serotonin uptake inhibitors, especially clomipramine, despite a high relapse rate after drug discontinuation. These therapies are complementary and a combination of the two approaches shows great promise in the treatment of OCD.

Anxiety Disorders↗
PubMed1990

Clomipramine and obsessive compulsive disorder: a placebo-controlled double-blind study of 32 patients.

Thirty-two nondepressed patients with obsessive compulsive disorder were randomly assigned to treatment with clomipramine (N = 16) or placebo (N = 16) in a 10-week double-blind study. Of the 15 patients who received at least 3 weeks of clomipramine treatment, 11 (73%) improved, 5 (33%) improved by more than 50%, and none worsened. Only 2 (12.5%) of the 16 placebo-treated patients improved, 1 (6%) by more than 50%; two (13%) worsened. Clomipramine treatment was associated with statistically significant improvement on several measures of obsessive compulsive symptoms. Side effects were more frequent and severe with clomipramine than with placebo. Although most patients tolerated clomipramine well, 3 discontinued treatment because of side effects.

Adult↗
PubMed1989

Obsessive-compulsive disorder.

Patients with obsessive-compulsive disorder complain of anxiety-producing intrusive thoughts and/or perform repetitive, anxiety-reducing rituals. A combination of behavior therapy and drug therapy is generally beneficial in this relatively common disorder. Behavior therapy consists of exposing patients to anxiety-provoking situations and helping them avoid ritualistic responses. Drug therapy appears to work by blocking serotonin reuptake in the brain.

Adult↗
PubMed1989

Serotonin and treatment in obsessive-compulsive disorder.

Recognized since the Middle Ages, and clearly described for more than 100 years, obsessive-compulsive disorder (OCD) continues to intrigue and challenge mental health professionals. Recent evidence has implicated dysfunctional serotonergic neurotransmission in OCD. This review summarizes the evidence favoring a serotonergic hypothesis for OCD followed by a more detailed discussion of the implications the hypothesis holds for treatment.

Behavior Therapy↗