Biomedical subjects
Publications and source records attributed to J Yager.
Six patients with chronic, refractory anorexia nervosa were treated with fluoxetine. Depressive symptoms diminished in all patients, and this was associated with weight gain. Subjects, despite frequent medical comorbidity, tolerated fluoxetine well, even in dosages greater than those used for depression.
Attitudes toward preventive mental health activities with high-risk children in clinical practice were surveyed in 316 pediatricians. Although generally positive attitudes were expressed regarding appropriateness and efficacy of such activities, uncertainty was expressed regarding the ethical issues and knowledge on which such activities rest. Pediatricians perceived serious barriers to preventive activities related to financial, educational, and time factors. Pediatricians whose personal health beliefs favored an internal locus of control were more positively inclined toward preventive activities. Studies relating reported attitudes and beliefs to actual practice patterns are necessary. Pediatricians also require additional training in mental health-related preventive activities.
The Personality Diagnostic Questionnaire (PDQ) was completed by 628 eating-disordered women: 300 with normal-weight bulimia, 15 with anorexia nervosa with bulimic features, and 313 with subdiagnostic eating disorders. Three-quarters (75%) of subjects with normal-weight bulimia had personality disorder diagnoses, compared with 50% of those with subdiagnostic eating disorders. The average number of separate PDQ diagnoses was 2.7 for the normal-weight bulimia group, 2.5 for the group with anorexia nervosa with bulimic traits, and 1.5 for the subdiagnostic group. The most common PDQ diagnoses were schizotypal, histrionic, and borderline disorders, but avoidant and dependent personality features also occurred. Personality disturbances may be common in patients with eating disorders.
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Help-seeking patterns and satisfaction with care were described by 641 women with eating disorders participating in a national magazine survey. Between 60.6% and 92.9% of respondents in three diagnostic groups sought professional treatment. Professional treatments most often entered were individual psychotherapy (52.9%), behavioral therapy (28.0%), group therapy (24.6%), and nutritional therapy (18.6%). Treatments were generally seen as helping "a little." Only bulimic anorexia nervosa respondents perceived any interventions to be more harmful than helpful, specifically Overeaters Anonymous and self-help groups, both nonprofessional interventions. Caregivers selected as "experts" regarding eating disorders were rated as more efficacious than others, helping "a little" to "somewhat."
This paper describes a six session multiple family group therapy program for patients and families dealing with anorexia nervosa and bulimia. The program was developed during the course of treating five such groups in our clinic and was adjunctive to other forms of therapy. The groups were highly structured and combined education, homework, psychodynamically informed group discussions and skills training. The aim of encouraging families to develop a therapeutic environment was made explicit. Responses from patients and families was extremely positive, but most felt the program was too short for their needs.
We surveyed internists, family physicians, and psychiatrists regarding their clinical experiences in assessing and treating alcohol abuse, practice characteristics, political and religious beliefs, attitudes toward substance abuse, beliefs about the efficacy of treatment, personal experiences with substance use, and sociodemographic variables. Despite the high prevalence of alcohol abuse, a third of the physicians neither regularly counseled nor referred any patients for outpatient rehabilitation, and more than half had not referred anyone for inpatient treatment. A greater breadth of experience treating alcohol problems was positively correlated with the volume of outpatients and inpatients seen, younger age, more work in primary rather than specialty patient care, less academic work, a stronger belief in the efficacy of treating alcoholism, membership in the Republican party, and a greater religiosity.
We asked 303 practicing physicians in general internal medicine, family medicine, gastroenterology, or psychiatry to indicate whether possessing or using marijuana should be considered a felony, a misdemeanor, warrant the issuance of a citation, or be legalized. The position physicians advocated was unrelated to their specialty, experience diagnosing or treating substance abuse problems, their attitudes toward the efficacy of the treatment of drug abuse, or any other work role or habit we measured. Legalization or citation as compared with harsher penalties, however, was more likely favored by physicians who were younger, less religious, politically more liberal, and those less likely to perceive a serious drug problem in society. Legalization was also more likely favored by physicians who themselves had used marijuana, cocaine, and amphetamines but was unrelated to the use of alcohol, cigarettes, or tranquilizers. Although physician opinion should be sought as society deals with the drug problem, this study suggests how physicians' characteristics may influence the opinions that are rendered.
Graduate medical education is currently in transition, with educators being asked to re-examine the extent to which hospital-based teaching models still provide adequate comprehensive training. To educate future physicians adequately, the Department of Veterans Affairs (VA) will have to change its system for delivering ambulatory care services and for teaching in ambulatory care settings. Workshop discussions focused on five major areas regarding educating residents in the ambulatory setting: educational goals and objectives, clinical experiences, curriculum development and evaluation, faculty issues, and fellowship opportunities. Recommendations include the need for residency programs to develop explicit educational goals and objectives for resident training, the identification of transdepartmental needs and coordinated planning, the support of academic clinical faculty, research and development of educational programs, and further development of fellowship training in ambulatory care. Further integration of ambulatory care activities in graduate training will require significant effort, a shift in manpower and resources and, more fundamentally, a shift in attitude and commitment at all levels of the VA and medical schools.
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In attempting to recruit mothers with anorexia nervosa and their adolescent daughters to participate in an interview study, we found that the majority of potentially suitable mothers refused to participate, fearing deleterious effects of the interviews on their relationships with their daughters. The three pairs who did participate were characterized by avoidant communication styles regarding the eating disorders, daughters focusing on what their mothers ate, mothers and daughters relating as close friends, and seemingly psychologically robust daughters. Additional research is needed to more carefully delineate the impact of maternal anorexia nervosa on the development of the children. As a matter of routine, clinicians should assess the children of patients with anorexia nervosa to institute preventive interventions, facilitate early case finding, and offer treatment where indicated.
Thirty-six women with normal weight bulimia for whom antidepressant medication treatment was recommended at entry into a University eating disorders clinic were followed up a minimum of one year later. Twenty-seven patients completed an adequate medication trial and 9 did not. Two-thirds had individual psychotherapy, two-thirds had group therapy, and more than a quarter had other therapies concurrently. At follow-up, three-quarters of the patients were very much improved or abstinent for bulimic symptoms. Outcome was not clearly related to completing an adequate medication trial, personality disturbance as measured by the Personality Diagnostic Questionnaire or improvement in Beck Depression Inventory scores.
In response to a 1982 magazine article 641 women completed self report instruments concerning their eating disorders. Simulated DSM-III and DSM-III-R diagnoses were generated from these responses. Rediagnosis of 397 DSM-III normal weight bulimics (NWB) yielded 93.7% with DSM-III-R bulimia nervosa (BN) and 6.3% with DSM-III-R anorexia nervosa with bulimic features (ANB). Rediagnosis of 30 DSM-III ANB, yielded 66.7% with DSM-III-R ANB, 13.3% with DSM-III-R BN and 20% with subdiagnostic eating disorders (SDED). Rediagnosis of 214 DSM-III SDEDs yielded 93.5% DSM-III-R SDEDs, and 6.5% DSM-III-R BNs a relatively small shift. No Eating Disorders Inventory Scale Score or eating disorders behavioral symptom differences were noted between DSM-III and DSM-III-R ANB, or between DSM-III NBW and DSM-III-R and BN in 1982 or 20 months later. Although DSM-III-R diagnostic criteria for eating disorders are more specific than those in DSM-III, our findings suggest they may ultimately make little difference clinically. Self report instruments may be useful in approximating clinical diagnoses in large surveys. They may be especially useful for syndromes such as eating disorders, in which measureable physical criteria and observable behaviors are prominent.
Seven hundred sixteen female UCLA students--drawn from Primary Care Clinic, Women's Health Clinic, sorority, athletic team, dance major, and undergraduate psychology class populations--completed questionnaires regarding eating disorders symptoms and attitudes compatible with the diagnostic criteria published by the American Psychiatric Association in the Diagnostic and Statistical Manual, (3rd ed., DSM-III), the Eating Disorders Inventory, and related information. The purpose of the study was to determine the prevalence of eating disorders and eating disorder-related symptoms in particular subgroups for targeting intervention and prevention programs. Although between 7.5% and 46% of subgroup populations reported the presence of individual eating disorder-related symptoms, the prevalence of active eating disorders for the group as a whole at the time of the survey was 2.1%, with the prevalence of disorders at any time during life 4.8%, using DSM-III diagnosis. The Eating Disorders Inventory scores for the group as a whole were comparable with norms reported by other researchers in the literature. Primary Care Clinic attenders and dance majors reported the highest rates of symptoms and disorders, while athletes reported the lowest rates.
1. We previously showed that chronic exposure to aspirin (100 mg kg-1 daily, by mouth) is effective in preventing the onset of hypertension in young (28-84 day old) spontaneously hypertensive rats (SHRs). This is contrary to what others have reported using older SHRs. 2. Renal prostaglandin F2 alpha was also reduced in young SHRs and Wistar-Okamoto strain rats (WKYs) exposed to aspirin. 3. In the present study we extended the period of aspirin treatment in young rats to beyond 84 days of age. We found that aspirin lost its antihypertensive effect in SHR and WKY rats at 110 +/- 7 days of age regardless of whether the exposure to aspirin had begun at age 28, 49 or 87 days. 4. We conclude that the loss of antihypertensive effect of aspirin in the SHR and in older WKY rats, is determined by some factor(s) probably not related to prostaglandin F2 alpha, which reaches full expression in the 110 +/- 7 day old rat, or is fully dissipated at this age. 5. The anti-PGF2 alpha activity of aspirin in the SHR and WKY rat was short-lived and apparently unrelated in time to the antihypertensive effect of aspirin.
The authors examined the relationship of social supports to physical and psychological well-being in 118 men and women 65 years old or older who were living independently in the community. Subjects with more symptoms of depression reported having fewer emotionally satisfying consistent supports from relatives, but those who had physical illnesses reported more supports from relatives. The authors conclude that although having fewer key supports may contribute to dysphoria, having a physical illness may mobilize meaningful support. They suggest that social supports and health outcomes be carefully defined so that possible differential relationships between them can be understood more specifically.
There are no minimum standards for the clinical training of psychiatrists with regard to the type and number of patients evaluated or treated. Interest in establishing such standards derives from a need for greater accountability, a high fail rate on the clinical portion of the American Board of Psychiatry and Neurology examinations, and an increasing demand for precise documentation of competence in specific areas by hospital privileging committees. Although considerable disagreement exists as to what the overall requirements should be, some minimum requirements can be agreed on. The authors discuss concerns about minimal standards and make suggestions for further development of standards.
In 1980, psychiatric practitioners and educators were surveyed to determine their concepts of the knowledge and skills that define a specialist in psychiatry. The authors repeated this survey, expanding the list of skill and knowledge items and asking respondents to comment on whether particular skills or knowledge were important to a psychiatric subspecialty. Less importance was ascribed in the current survey than in the earlier survey to certain long-term and social psychotherapies, and more importance was ascribed to descriptive or biological psychiatry; brief or supportive therapies; psychopharmacological agents; consultation-liaison psychiatry; evaluation of children, the aged, and alcoholics; and certain desirable personal characteristics of the psychiatrist.