Biomedical subjects
Publications and source records attributed to J I Escobar.
Type, distribution, and comorbidity of functional somatic symptoms were examined in four community samples, three Hispanic and one non-Hispanic white. Important intergroup and intragroup differences between Hispanic and non-Hispanic white groups were identified. Of the four groups, Puerto Rican respondents reported the highest level of somatic symptoms; this finding was apparently independent of sociodemographic factors.
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The authors prospectively examined the prevalence of somatization symptoms among community respondents after a natural disaster in Puerto Rico. Exposure to the disaster was related to a higher prevalence of medically unexplained physical symptoms, particularly gastrointestinal ones (abdominal pain, vomiting, nausea, excessive gas) and pseudoneurological ones (amnesia, paralysis, fainting, unusual spells/double vision).
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Prevalences of Diagnostic Interview Schedule/DSM-III psychiatric disorders for male veterans and nonveterans from four war eras were estimated using data from over 7500 male community respondents interviewed by the Epidemiologic Catchment Area program at five geographic areas across the country. Veterans serving after Vietnam (Post-Vietnam era) had greater lifetime and 6-month prevalences of psychiatric disorder than their nonveteran counterparts, whereas the reverse tended to be the case for the Vietnam, Korean, and World War II war eras. Comparisons across war eras revealed a trend for more psychiatric disorder, especially substance abuse, in younger veterans and nonveterans than in older respondents.
The current definition of Somatization Disorder requires the assessment of each of 35 symptoms, 13 of which have to be scored as meeting special criteria (e.g., not due to medical reasons) in order to make the diagnosis. The detailed questioning and probing about each symptom can be quite elaborate--hence the interest in developing briefer screening indexes. This study evaluated two sets of screening indexes for Somatization Disorder (those of Othmer and DeSouza and Swartz and colleagues) that had been previously developed in psychiatric and community samples. One hundred medical outpatients with chronic fatigue constituted the study sample. The patients underwent thorough medical evaluations and were administered the Diagnostic Interview Schedule (DIS) to make the psychiatric diagnoses. Of the two screening sets, the one developed in a psychiatric outpatient sample (Othmer and DeSouza's) had the best sensitivity. Although a screening index derived from the DIS interviews of this group of patients also had excellent sensitivity, we support the use of Othmer and DeSouza's index in medical outpatients with a chief complaint of chronic fatigue.
An abridged somatization construct (the Somatic Symptom Index) derived from the Diagnostic Interview Schedule's somatization disorder items was tested on community epidemiological samples to examine its prevalence, risk factors, and predictive value. The construct had a high prevalence (range, 4.4% to 20% compared with .03% to 0.7% for the full DSM-III somatization disorder diagnosis), was related to low socioeconomic status, female gender, older chronological age, and Hispanic ethnic background. The presence of this construct determined preferential use of medical services and predicted high indices of disability. The Somatic Symptom Index may have practical utility for clinical and community studies of somatoform phenomena.
This report from the Los Angeles site of the NIMH Epidemiologic Catchment Area study reveals significant ethnic and national origin differences in lifetime prevalence rates for three out of six specific, DSM-III-defined anxiety disorders. In the case of simple phobia, United States-born Mexican Americans report higher rates than native non-Hispanic whites or immigrant Mexican Americans, the latter two groups having similar rates. Mexican Americans born in the United States had higher rates of agoraphobia than immigrant Mexican Americans, and non-Hispanic whites reported higher lifetime rates of generalized anxiety disorder compared with both immigrant and native Mexican Americans. Neither ethnic nor national origin differences in lifetime prevalence rates were found for panic disorder, social phobia, and obsessive-compulsive disorder. Selective migration is postulated as a potential factor influencing prevalence differences between native and immigrant Mexican Americans.
This paper reviews recent research that used the Diagnostic Interview Schedule (DIS) to characterize medically unexplained symptoms and their clustering in clinical and community populations. While the type of symptom(s) differed little across samples, the distribution of a less restrictive construct of somatization ('abridged' somatization) showed interesting differences across the various groups. The authors propose that in view of its relatively high prevalence, abundant psychiatric comorbidity and the simple and unintrusive nature of the assessment, use of the abridged construct may have practical value particularly when exploring psychopathology among medical and community populations.
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This paper reviews the evolution of psychiatric nosologies in North America and the major epidemiological surveys of Mental Disorders culminating with the recently completed National Institute of Mental Health Epidemiologic Catchment Area project (NIMH-ECA). The NIMH-ECA examined the prevalence of diagnosable (DSM III) Mental disorders in 5 U.S. communities utilizing a highly structured diagnostic interview, the Diagnostic Interview Schedule (DIS). Data from the Los Angeles ECA, one of five study sites are presented with particular emphasis on cross-cultural comparison (Mexican Americans versus Non Hispanic Whites). Overall, there were only a few cross-cultural differences in prevalence of specific diagnoses. Mexico-born Mexican Americans showed a lower prevalence for most disorders examined than their U.S. born counterparts, and a subgroup of Mexican-American women (those over the age of 40) showed higher rates of phobic and dysthymic disorders as well as a greater number of functional somatic symptoms than other groups.
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An abnormal chromosome No2 was found in the case of a child with an imperforate anus, a recto-vaginal fistula, unilateral atresia of the inner canal ,and deformity of the external ear. G-banding studies revealed an insertion of a segment of the short arm into the long arm in one of the chromosomes No. 2 of the proband, the apparent result of a de novo phenomenon of chromosome rearrangement.
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Blood pressure changes during treatment with an intravenous tricyclic (chlorimipramine) were systematically assessed on twenty depressed patients diagnosed as primary or secondary affective disorders according to research diagnostic criteria. Patients with primary affective disorder showed a significantly greater decline in systolic blood pressure during this treatment than patients with secondary affective disorder. The decline in the blood pressure paralleled clinical improvement. Differential changes in blood pressure appear to be one more instance of constitutional differences for depressive subtypes, and may prove to be practical and reliable predictors of treatment response to tricyclic antidepressants.
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An open clinical trial with intravenous chlorimipramine was carried out on twenty depressed inpatients, diagnosed as primary or secondary affective disorders following a classificatory scheme for use in psychiatric research. Eleven of twelve patients with primary affective disorders had a significant decrease in symptoms of depression at the end of two weeks. In contrast, eight patients with secondary affective disorders did not show such significant improvement. Changes in physiological parameters (systolic blood pressure) were significantly greater in the primary affective disorders than in the secondary ones. It is inferred from the results of this trial, that intravenous administration of chlorimipramine is a safe and feasible procedure, which may compare to electroconvulsive therapy in the treatment of severe unipolar and bipolar depressions.