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Biomedical subjects

J J Schwab

Publications and source records attributed to J J Schwab.

At least 19 recordsLinked to original sources
PubMed1998

Assessment of locus of control in patients with anxiety and depressive disorders.

We studied Levenson's Internal (I), Powerful Others (P), and Chance (C) locus of control scales in 193 patients with six DSM-III-R diagnoses: Major Depression (MD), Panic Disorder (PD), Generalized Anxiety Disorder (GAD), Social Phobia (SP), Obsessive Compulsive Disorder (OCD), and Mixed Anxiety Depressive Disorder (MAD). Compared to the comparison groups (CG), we found specific patterns for some of the diagnostic categories. There were no significant differences between the I scale scores and of those in the different anxiety and depressive disorder groups and the CG. But, patients with MD, SP, or MAD had significantly higher P scale scores than the CG. Patients with MD, PD, SP, and MAD had higher C scale scores than the CG. The OCD patients had the lowest P and C scale scores of any of the groups and not significantly different than the CG. The findings have some research and clinical implications.

Adolescent↗
PubMed1997

Explained and unexplained medical symptoms in generalized anxiety and panic disorder: relationship to the somatoform disorders.

We have examined the numbers and types of symptoms in a sample of 90 patients with generalized anxiety disorder (GAD) and 77 patients with panic disorder (PD) collected from six different sites during the conduct of a multicenter clinical trial. This information was obtained utilizing the Health Questionnaire, a 47-item self-report list of medical symptoms, patterned after the Somatization Disorder section of the Diagnostic Interview Schedule. Although the patients in this sample had a wide variety of medically explained and unexplained physical symptoms, none of them qualified for a diagnosis of somatization disorder by DSM-III-R criteria. GAD and PD patients reported remarkably similar numbers of explained and unexplained medical symptoms. The panoply of somatic symptoms presented by these patients presents a formidable diagnostic challenge for clinicians. These findings suggest that the pattern of overutilization of medical services that is well documented for PD patients may also be found for GAD patients.

Adult↗
PubMed1993

Ensuring services for persons with chronic mental illness under national health care reform.

People with chronic mental illness present complex challenges for the design of health care financing reforms. In this position statement from the committee on psychiatry and community of the Group for the Advancement of Psychiatry, the authors describe chronic and severe mental illnesses as psychiatric illnesses that require acute and ongoing psychiatric assessment and treatment, as chronic medical diseases that require ongoing rehabilitative services, and as persistent disabilities that need ongoing supportive care and social services. Any proposal for health care reform must ensure parity of chronic psychiatric illnesses with other psychiatric conditions. It must also reimburse psychiatric rehabilitation at parity with other medical rehabilitation and provide equal access to and reimbursement for broad ancillary health services that reduce costs and improve quality of life.

Chronic Disease↗
PubMed1989

Consultation-liaison psychiatry: a historical overview.

The author reviews the history of consultation-liaison psychiatry from its roots in the 1751 charter of the Pennsylvania Hospital in Philadelphia. The field has evolved through three distinct phases and has currently entered a fourth stage, called the consolidation phase, which is characterized by shrinkage of programs, marked reduction in liaison activities, and anxiety about its validity and future. While the survival of consultation-liaison psychiatry is threatened by inadequate financial resources, the author believes that the increasing demand for C-L psychiatrists will eventually mandate a greater investment in the special expertise they offer.

History, 19th Century↗
PubMed1988

Risk for depression in families over time: a pilot epidemiologic study.

A random sample of 34 families from the general population were studied over a 15-month period to determine their risk for depression over time. Adults and children in the families were interviewed three times during the 15-month period. Risk for depression was evaluated using four screening instruments, including the Diagnostic Interview Schedule. At the original interview, 40 percent of the families contained one or more members at risk for depression. The 15-month family incidence rate for risk for depression was 26 percent and of continued good mental health 74 percent. The mental health status of 35 percent of the families changed during the 15-month period, suggesting that longitudinal studies can provide a more accurate profile of family mental health than studies of families at a single point in time.

Adolescent↗
PubMed1987

Residency education in for-profit general hospitals.

In May, 1983, when the new University of Louisville teaching hospital was opened under the auspices of Humana Corporation, it became the first university hospital operated by a for-profit corporation. We describe the agreement that launched this venture and summarize the experiences of the Department of Psychiatry and Behavioral Sciences with Humana, Inc., during the past 3 years. We review our impressions of both the positive and negative effects that the for-profit managing style has had thus far on the teaching programs of the Department. Based on our experiences, there are financial and other benefits, but we think that there are also potential dangers for the future of psychiatric education inherent in the administration of a teaching hospital by a for-profit corporation. The "atmosphere of business" that pervades the climate of opinion in the United States in the 1980s and is merely epitomized by the increasing role of enterpreneurial groups in medicine can be antithetical to principles of psychiatry and has implications for psychiatric education in the future. Awareness of these developments is a task for psychiatric education and, when it is possible, comparative studies of residents and their programs in nonprofit and for-profit hospitals should be conducted.

Hospitals↗
PubMed1987

Depression and internal medicine.

Although the Fathers of Internal Medicine described melancholia and wrote extensively about the affective disorders, internists continue to have difficulties diagnosing their medical patients' depressions. Consequently, it often falls to the psychiatric consultant to make the diagnosis amongst the medical population. We present current concepts of affective disorder that should be clinically relevant to the psychiatrist who works with internists and their patients. Early, accurate diagnosis of depressed medical patients requires increased awareness of depression, observation of the patient's appearance and mood, sensitivity to his or her feelings, and specific questioning about symptoms, losses, and stressors. For depressed medical patients, we present a comprehensive treatment program which often should include: 1) supportive psychotherapy, 2) antidepressant medications; and 3) resocialization or rehabilitation. We outline certain indications for psychiatric referral, and urge psychiatrists and internists to work together closely. Increasing the sensitivity of our colleagues in internal medicine toward affective illness should lead to more prompt identification and treatment of medical patients' depressions.

Depressive Disorder↗
PubMed1984

Anxiety in depression.

Even though anxiety in depression is a common clinical condition, there is controversy about its status. Can these patients be dichotomized as having either anxiety or depression, or are there three categories--certain anxiety states, anxiety in depression, and the specific depressive disorders? A review of the findings from four major lines of research on anxiety in depression reveals contradictory results. Anxious depression may be a distinctive entity. The guidelines for diagnosis presented here emphasize the necessity to identify anxious depressed patients and to differentiate them from those with distinctive anxiety states or depressive disorders. Tricyclic medications, such as doxepin, combined with supportive psychotherapy are the treatment of choice for patients with anxiety in depression.

Adult↗
PubMed1981

Change and psychopathology: epidemiologic considerations.

The authors report data collected on 3674 subjects between 1970 and 1974 as part of an epidemiologic field survey of mental disorder in the southeastern United States, an area which was undergoing rapid sociocultural change. Rates of mental disorder, as measured by the Global Psychopathology Scale, are presented for various sociodemographic groups and are consistent with trends found in previous studies. Analysis of variance and multiple regression techniques are used to explore the relationships among awareness of social change, sociodemographic variables, and psychopathology. Low awareness of change is found to be consistently associated with low psychopathology scores across all socioeconomic groups. The authors postulate a "denial" or "filter" mechanism which may protect particularly vulnerable individuals from the psychic distress accompanying social change.

Adolescent↗