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J R Walker

Publications and source records attributed to J R Walker.

At least 55 records · Page 3Linked to original sources
PubMed1998

A direct-interview family study of generalized social phobia.

OBJECTIVE: The goal of this direct-interview family study was to replicate and extend an earlier finding of a familial liability for social phobia. The authors hypothesized that there would be higher rates of the generalized type of social phobia--but not the nongeneralized (or "discrete") type--among relatives of probands with generalized social phobia. They also hypothesized that rates of avoidant personality disorder, a frequent comorbid condition, would be higher in relatives of probands with generalized social phobia. METHOD: The authors examined rates of three social phobia subtypes defined a priori--discrete, nongeneralized, and generalized--as well as rates of avoidant personality disorder by direct interview of 106 first-degree relatives of 23 patients with generalized social phobia and 74 first-degree relatives of 24 comparison subjects without social phobia. RESULTS: Relative risks for generalized social phobia and avoidant personality disorder were markedly higher (approximately 10-fold) among first-degree relatives of probands with generalized social phobia than among first-degree relatives of comparison probands. In contrast, relative risks for discrete social phobia and nongeneralized social phobia were not significantly different between the two groups of first-degree relatives. CONCLUSIONS: These results confirm earlier findings of a higher rate of social phobia among relatives of probands with generalized social phobia and extend these findings by specifically indicating that it is only the generalized type (and its probable axis II counterpart, avoidant personality disorder) that occurs more often among the families of probands with generalized social phobia. Implications for subsequent genetic studies are discussed.

Adolescent↗
PubMed1998

Substance dependence as a compulsive behavior.

A compulsion to take a drug combined with a loss of control in limiting intake is the defining feature of substance dependence or addiction, and is the conceptual framework for the criteria of substance dependence or addiction outlined by the World Health Organization and the American Psychiatric Association. However, defining exactly what constitutes loss of control and compulsive drug taking at the level of animal models is a daunting task, and it is clear that no validated animal model exists for the whole syndrome of addiction. The present discussion redefines loss of control as a narrowing of the behavioral repertoire toward drug-seeking behavior and suggests that there are many sources of reinforcement that contribute to this behavioral focus on drug seeking. Evidence is presented demonstrating separate animal models for many of these sources of reinforcement as well as for most of the criteria for substance dependence. Evidence is also presented showing that the brain neurochemical systems involved in processing drug reward are altered by chronic drug exposure to contribute additional sources of reinforcement. Challenges for the future involve not only elucidation of the neurobiological substrates of the different behavioral components of addiction, but better animal models of these components with which to effect such studies.

Animals↗
PubMed1997

Orphan anxiety.

Explore the source record for details and available documents.

Animals↗
PubMed1997

Prolonged penile erection in the newborn.

An extensive review of the literature suggests that priapism or prolonged penile erection is extremely rare in the newborn. We present a term newborn whose clinical course of prolonged penile erection was a result of polycythemia. In the past, only 3 cases appear to have been associated with polycythemia. However, two of these cases had several other complicating factors. The remaining episodes have been described as idiopathic (7), or attributed to infection (1) or central nervous system insult (1). The recognition of this phenomenon and its historical record of clinical course is important in the newborn so inappropriate approaches to treatment may be avoided. Because of spontaneous detumescence in many instances, observation or nonsurgical management is advocated for the newborn with prolonged penile erection.

Humans↗
PubMed1997

Neuromuscular relaxation and reversal: an update.

Neuromuscular relaxants are commonly used in the provision of general anesthesia for the majority of surgical procedures. After a brief overview of the physiology of the neuromuscular junction, pharmacology of both depolarizing and nondepolarizing muscle relaxants will be discussed. Attention will be given to side effects and factors that influence neuromuscular blockade including reversal agents. This article will provide the PACU nurse with the knowledge necessary to provide safe and effective nursing care.

Humans↗
PubMed1997

Conservation of the Escherichia coli dnaX programmed ribosomal frameshift signal in Salmonella typhimurium.

Escherichia coli DNA polymerase III subunits tau and gamma are produced from one gene, dnaX, by a programmed ribosomal frameshift which generates the C terminal of gamma within the tau reading frame. To help evaluate the role of the dispensable gamma, the distribution of tau and gamma homologs in several other species and the sequence of the Salmonella typhimurium dnaX were determined. All four enterobacteria tested produce tau and gamma homologs. S. typhimurium dnaX is 83% identical to E. coli dnaX, but all four components of the frameshift signal are 100% conserved.

Amino Acid Sequence↗
PubMed1997

Full and partial posttraumatic stress disorder: findings from a community survey.

OBJECTIVE: Full and partial posttraumatic stress disorder (PTSD) following trauma exposure were examined in a community sample in order to determine their prevalence and their relative importance and functional significance. METHOD: A standardized telephone interview with a series of trauma probes and a DSM-IV PTSD checklist was administered to a random sample of 1,002 persons in a midsized Midwestern Canadian city. The authors determined current (i.e., 1-months) prevalence rates of full PTSD, i.e., all DSM-IV criteria, and partial PTSD, i.e., fewer than the required number of DSM-IV criterion C symptoms (avoidance/numbing) or criterion D symptoms (increased arousal). Additional questions about interference with functioning were also posed. RESULTS: The estimated prevalence of full PTSD was 2.7% for women and 1.2% for men. The prevalence of partial PTSD was 3.4% for women and 0.3% for men. Interference with work or school was significantly more pronounced in persons with full PTSD than in those with only partial symptoms, although the latter were significantly more occupationally impaired than traumatized persons without PTSD. CONCLUSIONS: These findings in an epidemiologic sample underscore observations from patient and military groups that many traumatized persons suffer from a subsyndromal form of PTSD. These persons with partial PTSD, although somewhat less impaired than persons with the full syndrome, nonetheless exhibit clinically meaningful levels of functional impairment in association with their symptoms. This subthreshold form of PTSD may be especially prevalent in women. Additional study of partial PTSD is warranted.

Adolescent↗
PubMed1997

Obsessive-compulsive disorder in the community: an epidemiologic survey with clinical reappraisal.

OBJECTIVE: To examine the prevalence of obsessive-compulsive symptoms and DSM-IV obsessive-compulsive disorder (OCD), the authors conducted a telephone survey of 2,261 adults in four regions of Canada. METHOD: Trained lay interviewers administered a modified version of the OCD section of the Comprehensive International Diagnostic Interview. A subsample of respondents with probable cases and probable subclinical cases of OCD was then blindly reinterviewed by research personnel experienced in the assessment of OCD, using the Structured Clinical Interview for DSM-IV and the Yale-Brown Obsessive Compulsive Scale, to confirm the diagnosis and gauge the severity of OCD. RESULTS: The weighted 1-month prevalence of OCD in the entire sample according to the lay interviews was 3.1%. Upon clinical reappraisal, the 1-month prevalence estimate of OCD dropped to 0.6%; an additional 0.6% had subclinical OCD. The mean Yale-Brown Obsessive Compulsive Scale score of the individuals with OCD was 19.0 (SD = 4.6, median = 21); for those with subclinical OCD, the mean score was 15.4 (SD = 2.4, median = 14). Common reasons for overdiagnosis of OCD by the lay interviewers were inappropriate labeling of worries or concerns as obsessions and overestimating the degree of interference or distress attributable to obsessive-compulsive symptoms. CONCLUSIONS: OCD, while hardly a rare condition, may be somewhat less prevalent than had been believed on the basis of previous surveys. Additional studies are needed to substantiate these findings and to delineate precisely the extent of disability and reduced quality of life attributable to OCD (and OCD variants) in the community.

Adolescent↗
PubMed1997

Hypochondriacal concerns and somatization in panic disorder.

To clarify the relationship between panic disorder and the symptoms of hypochondriasis and somatization, we evaluated these symptoms and diagnoses in patients attending an Anxiety Disorders Clinic. Structured clinical interviews, self-report measures, and symptom diaries were used to assess 21 patients with panic disorder, 23 patients with social phobia, and 22 control subjects with no psychiatric disorders. Ten of the patients with panic disorder (48%) also met DSM-IV criteria for hypochondriasis, whereas only one of the patients with social phobia and none of the healthy control subjects met the criteria for this diagnosis. None of the participants met DSM-IV criteria for somatization disorder, even though both anxiety groups reported high levels of somatic symptoms. The panic disorder group reported higher levels of fear about illness and disease conviction and endorsed more somatic symptoms than did the other groups. A higher proportion of panic disorder patients reported previously diagnosed medical conditions (48%) as compared with patients with social phobia (17%) or healthy control subjects (14%). The panic disorder patients with DSM-IV hypochondriasis obtained higher scores on measures of hypochondriacal concerns, somatization, blood-injury phobia, and general anxiety and distress than did the panic disorder patients without hypochondriasis. The results suggest a strong association between panic disorder and hypochondriasis.

Adult↗
PubMed1996

Public-speaking fears in a community sample. Prevalence, impact on functioning, and diagnostic classification.

BACKGROUND: Recent epidemiologic studies have revealed that social phobia is more prevalent than has been previously believed. An unresolved issue is the extent to which public-speaking fears constitute a recognizable form of social phobia in a community sample and, moreover, to what extent these fears are associated with functional morbidity. METHODS: To examine the prevalence and impact of public-speaking fears and their relationship to social phobia in a community sample, we conducted a randomized telephone survey of 499 residents of Winnipeg, Manitoba, a medium-sized midwestern metropolitan area. RESULTS: One third of the respondents reported that they had excessive anxiety when they spoke to a large audience. The onset of fears was early (ie, 50%, 75%, and 90% by the ages of 13, 17, and 20 years, respectively). Anxious cognitions about public speaking included the following fears: doing or saying something embarrassing (64%), one's mind going blank (74%), being unable to continue talking (63%), saying foolish things or not making sense (59%), and trembling, shaking, or showing other signs of anxiety (80%). In total, 10% (n = 49) of the respondents reported that public-speaking anxiety had resulted in a marked interference with their work (2%), social life (1%), or education (4%), or had caused them marked distress (8%). Twenty-three persons (5%) had public-speaking anxiety in isolation (ie, without evidence of additional kinds of social fears). CONCLUSIONS: These data support the inclusion of severe forms of public-speaking fears within the social phobia construct and, furthermore, suggest that public-speaking anxiety may have a detrimental impact on the lives of many individuals in the community.

Adolescent↗
PubMed1996

Anxiety sensitivity and treatment outcome in panic disorder.

The purpose of this study was to examine the relationship between change in anxiety sensitivity, as measured by the Anxiety Sensitivity Index (ASI), and treatment outcome in a sample of 106 subjects with a DSM-III-R diagnosis of panic disorder (with or without agoraphobia) who were participants in an evaluation study of cognitive-behavioral treatment. Results revealed that subjects who received active treatment had significantly lower anxiety sensitivity scores at post-treatment than the wait-list control group. We also examined change in anxiety sensitivity from pre- to post-treatment in reference to Clinical Global Improvement (CGI) ratings and with the effect size statistic. Subjects who showed improvement based on CGI ratings also demonstrated a reduction in anxiety sensitivity. Furthermore, the effect sizes obtained with the ASI were greater in magnitude than those obtained with other widely used anxiety self-report measures. Taken together, the finds supported the use of the Anxiety Sensitivity Index as a treatment outcome measure in panic disorder research.

Adult↗
PubMed1996

Panic disorder or social phobia: which is worse?

Twenty-eight patients with panic disorder (PD) and 30 with social phobia (SP) were compared on demographic and psychopathology measures. The demographic comparisons showed that, although people with SP were better educated, they were more likely to be single, living alone, and unemployed. The comparisons of psychopathology showed that the proportion of people with PD and SP with a life time major affective disorder did not differ, nor did the two groups differ on the proportion of Ss reporting past suicide attempts. However, a greater proportion of patients with SP had Brief Michigan Alcohol Screening Test scores above 5, indicating alcohol abuse problems. The implications of these findings are discussed.

Activities of Daily Living↗
PubMed1996

Drugs affecting hemostasis.

Most patients admitted to the PACU are closely observed for postoperative bleeding. Although some bleeding is to be expected, some patients may have alterations in the hemostatic process leading to excess blood loss. Hemostasis can be intentionally altered by drugs given preoperatively and/or intraoperatively. The effects of these drugs may contribute to the postoperative blood loss. This article reviews the normal hemostatic process as a foundation for discussing the commonly used drugs affecting hemostasis.

Anticoagulants↗
PubMed1996

What is new with inhaled anesthetics: Part 1.

Inhaled anesthetic agents are widely used in the maintenance of general anesthesia. The newer agents, desflurane and sevoflurane, possess pharmacokinetic profiles that are distinctly different from the older inhaled anesthetics. These differences significantly impact the PACU nursing care. This article will focus on the uptake, distribution, and elimination of inhaled anesthetic agents with emphasis being placed on the postanesthesia care of surgical patients receiving these newer agents.

Anesthetics, Inhalation↗