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Biomedical subjects

J I Escobar

Publications and source records attributed to J I Escobar.

At least 55 records · Page 3Linked to original sources

The NIMH-DIS in the assessment of DSM-III schizophrenic disorder.

The National Institute of Mental Health Diagnostic Interview Schedule (NIMH-DIS) was administered by trained lay interviewers to a sample of 82 outpatients with clinical diagnoses of DSM-III schizophrenic disorder. Of these subjects, 77 percent were also diagnosed as suffering from DSM-III schizophrenic disorder according to the structured interview (NIMH-DIS) administered by a lay interviewer. The DIS interviews were scrutinized to find the reasons for their discrepancy with the clinical diagnoses. A majority of the DIS-negative schizophrenic subjects acknowledged significant psychopathology in the DIS and missed only one of the six DSM-III criteria items for schizophrenia. Test-retest results showed consistency in the subjects' reporting of lifetime schizophrenic symptoms.

Adult↗

Use of the Mini-Mental State Examination (MMSE) in a community population of mixed ethnicity. Cultural and linguistic artifacts.

The Mini-Mental State Evaluation (MMSE) was used in an epidemiological survey of a community of mixed ethnicity (Hispanic, white non-Hispanic) as part of the Los Angeles Epidemiologic Catchment Area Program. Results of the study showed that age, educational level, ethnicity, and language of the interview influenced the number of MMSE errors. Items on which the effects of ethnicity and language were most pronounced were identified, and suggestions on ways to minimize such sociocultural artifacts are provided in efforts to improve the epidemiological significance of the instrument, particularly as it concerns cross-cultural research.

Age Factors↗

Ethnicity and reporting of schizophrenic symptoms.

Eighty-one clinically diagnosed (DSM-III) Hispanic and Anglo schizophrenic subjects were evaluated with a structured diagnostic interview, the National Institute of Mental Health Diagnostic Interview Schedule (NIMH-DIS), and a battery of rating instruments (Brief Psychiatric Rating Scale, Clinical Global Impressions, Global Assessment Scale, and Hopkins Symptom Checklist 90 [SCL-90]). The authors examined: a) consistency in reporting of symptoms across different instruments administered in different formats and b) the importance of ethnic background in consistency of responses to the different instruments. A subgroup of patients (23% of total) "denied" lifetime schizophrenic symptoms in the lay interviewer-administered structured interview ("DIS negative" schizophrenic subjects). The proportion of DIS negative subjects was very similar across the two ethnic groups. However, responses by DIS negative schizophrenic subjects to a self-rating instrument (SCL-90) were significantly different for Hispanic and Anglo subjects. A subgroup of Anglo subjects denied symptoms in the DIS, but volunteered them in the self-rating instrument. Responses of Hispanic subjects were consistent regardless of format.

Acculturation↗

Comparison of injectable molindone and haloperidol followed by oral dosage forms in acutely ill schizophrenics.

The comparative efficacy of molindone and haloperidol, given by injection for the first 2-3 days of hospitalization and then continued orally for up to 4 weeks, is reported from an ongoing double-blind study. Efficacy and side effects were assessed by the Brief Psychiatric Rating Scale, Clinical Global Impressions, Treatment Emergent Symptom Scale, and Target Symptom Ratings. Analyses based on the first 35 patients who entered the study indicate that both drugs were effective and well tolerated. There were slight advantages for molindone early during the injectable phase of treatment and for haloperidol late during the oral portion of the study, but these differences were not clinically significant. No significant differences in side effects were found between the two drugs.

Acute Disease↗

Loxapine versus chlorpromazine in paranoid schizophrenia: a double-blind study.

Newly admitted paranoid schizophrenic patients (N = 68) were treated with either loxapine or chlorpromazine for up to 4 weeks. Mean maximum dosages were 84 mg/day of loxapine and 820 mg/day of chlorpromazine. Loxapine showed efficacy superior to that of chlorpromazine, confirming earlier retrospective findings. Adverse reactions were also less troublesome with loxapine.

Adult↗

Development of the Spanish-language version of the National Institute of Mental Health Diagnostic Interview Schedule.

The use of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) to elicit DSM-III-defined mental disorders among Hispanic respondents in the Los Angeles site of the Epidemiologic Catchment Area project required development of a Spanish translation of the instrument that would be understood readily by persons of Mexican, Puerto Rican, and Cuban origin. The translation was carried out using back translation, bilingual test respondents, a bilingual translation staff, an extensive committee of experienced bilingual clinicians as translation consultants, and revision following clinical evaluation. A study of its reliability and comparison with clinical diagnoses obtained with Spanish-speaking psychiatric outpatients indicated satisfactory equivalence of the Spanish DIS to the English version. Early international use of the Spanish DIS promises new data on the cross-cultural validity and prevalence rates of DSM-III-diagnosed disorders.

Cross-Cultural Comparison↗

The Spanish Diagnostic Interview Schedule. Reliability and comparison with clinical diagnoses.

The National Institute of Mental Health Diagnostic Interview Schedule (DIS) was translated into Spanish. The reliability of the Spanish instrument, its equivalence to the English version, and its agreement with clinical diagnoses were examined in a study of 90 bilingual (English-and Spanish-speaking) and 61 monolingual (Spanish-speaking only) patients from a community mental health center. The study design involved two independent DIS administrations and one independent clinical evaluation of each subject.

Adolescent↗

Post-traumatic stress disorder in Hispanic Vietnam veterans. Clinical phenomenology and sociocultural characteristics.

The complex symptomatology of Hispanic Vietnam veterans receiving treatment for post-traumatic stress disorders (PTSD) was explored with the National Institute of Mental Health Diagnostic Interview Schedule, a structured diagnostic interview that yields current and lifetime operational diagnoses (e.g., DSM-III). Social networks and level of acculturation of these veterans were also examined and compared to those of a "control" group and a sample of veterans with DSM-III schizophrenic disorder (both samples included only Hispanic veterans from the Vietnam and post-Vietnam eras). All subjects reported heavy combat stress and met DSM-III criteria for PTSD. Most were very symptomatic and had significant social impairment. PTSD was rarely seen as a discrete entity but appeared instead mixed with symptom clusters cutting across various DSM-III diagnoses. Social networks of PTSD veterans were intermediate in size, frequency of contact with network members, and network density to those of the comparison groups. A distinctive feature of the PTSD group was the high proportion of negative relationships with close family members, especially spouses. "Highly" symptomatic PTSD veterans reported significantly smaller networks, fewer contacts outside the close family circle, and more negative emotionality directed toward family members than "minimally" symptomatic veterans. While all Hispanic groups studied were not significantly different in level of acculturation, PTSD veterans appeared more alienated from their cultural heritage than the other groups. The severe and polymorphous psychopathology found among these veterans suggests that "rap" groups alone may not constitute an adequate therapeutic approach and that more formal psychiatric therapies should be additionally considered in the management of Vietnam-linked PTSD.

Acculturation↗

Depressive phenomenology in North and South American patients.

The authors assessed patients newly admitted to two North American health centers and one South American (Colombian) center according to a standardized protocol, with a structured interview, a symptom checklist, and a depression scale. The patients were suffering from major depressive disorders with endogenous features. There was an impressive similarity in symptoms of depression across cultures, supporting the idea of a universal core depressive syndrome. However, somatization indexes, psychomotor components of depression, and levels of psychopathology differed between U.S. and Colombian samples. The authors offer a general discussion of potential determinants of these cross-cultural differences.

Adult↗

Residency in mental-health pharmacy with a research component.

A 12-month postdoctoral specialized residency program in mental-health pharmacy practice with a psychopharmacology research component is described. The resident spent approximately four hours a day in clinical practice and in research activities in the inpatient setting; 10 hours per week in clinical research activities in an ambulatory patient setting; and 10 hours per week in teaching and scholarly activities. The resident was a member of a psychopharmacology research team that also included a research psychiatrist, a nurse, and two psychiatric medical residents at an adult acute-care site. The resident prepared a review of the preclinical evaluations of each investigational drug and participated in the initial screening of study patients. The resident was responsible for patient consent procedures, coordinating clinical evaluations, and scheduling necessary laboratory tests. As a member of the clinical team, she was also responsible for obtaining medication histories, monitoring and reporting adverse drug reactions, maintaining accurate dosage records, and completing the appropriate rating scales in the clinical evaluation of patients. In the ambulatory setting, the resident participated in the outpatient management of study patients. The resident learned to assess patient's clinical progress, maintain progress notes, write medication orders and administer medications in acute situations, maintain individual treatment plans, follow approved drug research protocols, and provide a program of education for patients and families when necessary. In addition, the resident was involved in educational programs for pharmacy students. This training program enables the pharmacist to gain experience in drug research studies, clinical practice, and pharmaceutical education, while contributing to psychopharmacology research.

Ambulatory Care↗