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Biomedical subjects

K A Phillips

Publications and source records attributed to K A Phillips.

At least 55 records · Page 3Linked to original sources
PubMed1999

Body dysmorphic disorder and depression: theoretical considerations and treatment strategies.

Body dysmorphic disorder (BDD), also known as dysmorphophobia, consists of a distressing and impairing preoccupation with an imagined or slight defect in appearance. BDD is an underrecognized and relatively common disorder that is associated with high rates of occupational and social impairment, hospitalization, and suicide attempts. BDD is unlikely to simply be a symptom of depression, although it often coexists with depression and may be related to depression. It is important to recognize BDD in depressed patients, because missing the diagnosis can result in refractory BDD and depressive symptoms. Available data indicate that BDD may not respond to all treatments for depression and may instead respond preferentially to serotonin-reuptake inhibitors. In addition, lengthier treatment trials than those required for depression may be needed to successfully treat BDD and comorbid depression. It can be difficult and challenging to diagnose BDD in depressed patients because the symptoms are often concealed due to embarrassment and shame. This paper discusses the relationship between BDD and depression and discusses practical strategies for recognizing and treating BDD and depressive symptoms in patients with depression.

Body Image↗
PubMed1999

Thirty-three cases of body dysmorphic disorder in children and adolescents.

OBJECTIVE: Body dysmorphic disorder (BDD), a preoccupation with a nonexistent or slight defect in appearance, usually begins during adolescence. Because there have been no studies of the clinical features of BDD in children and adolescents, the authors assessed these features in the largest series to date. METHOD: Thirty-three children and adolescents with DSM-IV BDD were assessed for demographic characteristics, phenomenology, associated psychopathology, and treatment history and response. RESULTS: Bodily preoccupations most often focused on the skin (61%) and hair (55%). All subjects had associated compulsive behaviors, most often camouflaging (e.g., with clothing) in 94%, comparing with others (87%), and mirror checking (85%). Ninety-four percent reported impairment in social functioning and 85% in academic or job functioning due to BDD. Thirty-nine percent had had psychiatric hospitalizations, and 21% had made a suicide attempt. Ten (53%) of 19 subjects treated with a serotonin reuptake inhibitor had much or very much improvement in BDD symptoms; in contrast, 0 of 8 trials with other psychotropic medications, 0 of 1 trial of cognitive-behavioral therapy, and 1 of 20 psychotherapy trials resulted in improvement. Twelve (36%) subjects received surgical, dermatological, or dental treatment, with a poor outcome in all cases. CONCLUSIONS: BDD can cause significant morbidity in children and adolescents. These preliminary data suggest that serotonin reuptake inhibitors may be an effective treatment in this age group.

Adolescent↗
PubMed1999

Breast carcinomas arising in carriers of mutations in BRCA1 or BRCA2: are they prognostically different?

PURPOSE: To review the preclinical and clinical studies relevant to the prognosis and prognostic associations of BRCA1- and BRCA2-associated breast carcinomas, with an emphasis on research methodology. METHODS: Reports of relevant studies obtained from a MEDLINE search, and references from these articles, were critically reviewed. RESULTS: Consistent associations with both favorable (medullary or atypical medullary carcinoma) and unfavorable (high tumor grade, hormone receptor negativity, somatic p53 mutation) prognostic characteristics have been found for BRCA1-associated breast carcinomas. Inconsistent results have been demonstrated for prognostic associations of BRCA2-associated breast tumors. Clinical studies that have directly assessed the prognosis of these tumors have not shown a clear effect of BRCA1 or BRCA2 mutation, but no study has used optimal methodology. In vitro and animal model data suggest a possible influence of these mutations on response to agents that cause double-strand DNA breaks, but clinical data are limited. CONCLUSION: The elucidation of an identifiable subgroup of breast carcinomas that result from germline mutations in BRCA1 or BRCA2 may be an important step toward genotype-based understanding of prognosis and choice of therapy in this disease. However, currently there are inadequate data to support use of BRCA1 or BRCA2 status to counsel individuals regarding their prognosis or to select treatment. Well-designed studies of population-based inception cohorts of breast cancer patients, which have adequate sample size and complete follow-up, and which use objective outcome criteria and blinding of outcome assessment, are required to optimally address this question.

Animals↗
PubMed1998

Applying GPS to the study of primate ecology: a useful tool?

Data on the spatiotemporal distribution of resources can be collected and plotted using GPS (global positioning system) and GIS (geographical information system) technologies. By combining such data with information on foraging and ranging behavior of nonhuman primates, one can analyze the influence of resource distribution on social organization and group cohesion. We investigated the abilities of a three-channel GPS receiver to collect location data under varying canopy densities in both temperate and tropical forests. Eighty randomly selected points were sampled in a beech-maple forest in northeast Ohio, USA; 65 points also were sampled at several tropical forests in Costa Rica and Trinidad. At each point we attempted to obtain a GPS position fix; we also determined the speed of satellite acquisition and measured canopy density using a spherical densiometer. The ability to obtain a reading differed greatly between the two forest types (chi(2) = 53.79, P < 0.001). Ninety-seven percent of all attempts were successful in the temperate forest, whereas only a 34% acquisition rate was obtained in the tropical forests. Logistic regression showed that the probability of obtaining a reading in Neotropical forests was 75% but only when canopy cover was less than 20%. Thus, these minimal-channel GPS units may be of limited utility for behavioral ecologists working in closed-canopy Neotropical forests.

Animals↗
PubMed1998

Tool use in wild capuchin monkeys (Cebus albifrons trinitatis).

White-fronted capuchins were observed to use leaves as cups to retrieve water from tree cavities. On multiple occasions several individuals performed this behavior. Thus, these capuchins engage in habitual tool use, as defined by McGrew's classificatory scheme of tool using behavior.

Animals↗
PubMed1998

The costs and outcomes of restricting public access to poison control centers. Results from a natural experiment.

OBJECTIVES: The authors examined the costs and outcomes resulting from a natural experiment during which direct public access to poison control centers was restricted and then restored. METHODS: Both societal and health care purchaser perspectives were used. Probability data were obtained from a natural experiment during which public callers from a large county in California were electronically blocked from directly accessing the poison control center. Callers were referred to 911, which had direct access to the poison control center, if they thought they had a poisoning emergency. We conducted telephone interviews of: (a) persons who attempted to call the poison control center for a child's poisoning exposure but who did not have direct access (n = 270) and (b) persons who called the poison control center after direct access was restored (n = 279). Cost data were obtained from primary data collection and from other sources. The outcome measure was the appropriateness of the treatment location (at home or at a health care facility). Caller-reported outcomes were also examined. RESULTS: The average additional cost per blocked call was $10.89 from a societal perspective, or $33.14 from a health care purchaser perspective. Fourteen percent of callers with restricted access were treated at an inappropriate location, compared with only 2% of callers with direct poison control center access. Also, 14% did not obtain any professional advice after they attempted to call the poison control center, although 66% of these cases involved potentially toxic substances. Results were robust across a range of sensitivity analyses. CONCLUSION: Restricting direct public access to poison control centers created additional costs to society, the health care sector, and callers.

California↗
PubMed1998

The Brown Assessment of Beliefs Scale: reliability and validity.

OBJECTIVE: The authors developed and evaluated the reliability and validity of the Brown Assessment of Beliefs Scale, a clinician-administered seven-item scale designed to assess delusions across a wide range of psychiatric disorders. METHOD: The authors developed the scale after reviewing the literature on the assessment of delusions. Four raters administered the scale to 20 patients with obsessive-compulsive disorder (OCD), 20 patients with body dysmorphic disorder, and 10 patients with mood disorder with psychotic features. Audiotaped interviews of scale administration conducted by one rater were independently scored by the other raters to evaluate interrater reliability. The scale was administered to 27 patients twice to determine test-retest reliability. Other insight instruments as well as scales that assess symptom severity were administered to assess convergent and discriminant validity. Sensitivity to change was assessed in a multicenter treatment study of sertraline for OCD. RESULTS: Interrater and test-retest reliability for the total score and individual item scores was excellent, with a high degree of internal consistency. One factor was obtained that accounted for 56% of the variance. Scores on the Brown Assessment of Beliefs Scale were not correlated with symptom severity but were correlated with other measures of insight. The scale was sensitive to change in insight in OCD but was not identical to improvement in severity. CONCLUSIONS: The Brown Assessment of Beliefs Scale is a reliable and valid instrument for assessing delusionality in a number of psychiatric disorders. This scale may help clarify whether delusional and nondelusional variants of disorders constitute the same disorder as well as whether delusionality affects treatment outcome and prognosis.

1-Naphthylamine↗
PubMed1998

Reliability and validity of depressive personality disorder.

OBJECTIVE: Depressive personality disorder was introduced into DSM-IV's appendix amid controversy. While that disorder appears to be a reliable and valid one, the authors offer new data about its relationship to major depression, dysthymic disorder, and other personality disorders. METHOD: The authors assessed 54 subjects with early-onset, long-standing mild depressive features for depressive personality disorder, axis I and axis II disorders, family history, and treatment history; they conducted follow-up interviews 1 year after the baseline assessment. Subjects with (N=30) and without (N=24) depressive personality disorder were characterized and compared in terms of those variables. RESULTS: Although depressive personality disorder and dysthymia co-occurred in some subjects, 63% of subjects with depressive personality disorder did not have dysthymia, and 60% did not have current major depression. Although subjects with depressive personality disorder were more likely than the mood disorder comparison group to have another personality disorder, 40% had no such disorder. Contrary to study hypotheses, mood disorder was not more common in first-degree relatives of subjects with depressive personality disorder than in relatives of the comparison group. Subjects with and without depressive personality disorder had similar rates of past treatment with medication and psychotherapy; however, the duration of psychotherapy was significantly longer for subjects with than for those without depressive personality. The depressive personality diagnosis was relatively stable over the 1-year follow-up period. CONCLUSIONS: Depressive personality disorder appears to be a relatively stable condition with incomplete overlap with axis I mood disorders and personality disorders. Further studies are needed to better characterize its treatment response and relationship to axis I mood disorders.

Adult↗
PubMed1998

Design and interpretation of clinical trials that evaluate agents that may offer protection from the toxic effects of cancer chemotherapy.

PURPOSE: To review the features of randomized clinical trials (RCTs) used in the development of agents that may protect against chemotherapy-induced toxicities, including trials of the cardioprotective agent dexrazoxane, hematologic growth factors, and amifostine; to suggest recommendations based on information gained from such trials and improvements in the design of ongoing and future trials. METHODS: Critical review of reports of RCTs obtained from a Medline search, references from these articles, and review of trials listed in the physician data query (PDQ) clinical trials data base. RESULTS: Several of the phase III trials did not use a format of comparing widely accepted strategies of chemotherapy with and without a protective agent. Instead, patients in the control arms of some of the trials have been exposed to more prolonged use or increased dosage of toxic chemotherapy that placed them at greater risk of the toxicity the protective agent was designed to prevent (eg, cardiotoxicity in trials of dexrazoxane, myelosuppression or thrombocytopenia in trials of growth factors). CONCLUSION: RCTs have shown clear evidence of biologic activity for the protective agents, but this does not imply therapeutic benefit as compared with alternative strategies such as avoidance of prolonged use of cardiotoxic agents or use of standard doses of chemotherapy. Ongoing and future trials of protective agents should be modified to avoid undue risk to patients.

Amifostine↗
PubMed1998

Personality dimensions associated with depressive personality disorder.

Depressive personality disorder (DPD) is a historically important construct that requires empirical attention. This study compares 26 subjects with this disorder to 20 non-DPD subjects who have similar histories of longstanding early-onset depression on three personality measures, the Tridimensional Personality Questionnaire (TPQ), NEO-Five Factor Inventory, and Defense Style Questionnaire (DSQ). The samples were demographically similar and had similar rates of comorbid depression and dysthymia. They differed in that DPD subjects scored significantly higher on Harm Avoidance and Neuroticism, and significantly lower on Novelty Seeking, Extroversion, and Adaptive defense mechanisms. Implications for clinical care and nosology are discussed.

Adaptation, Psychological↗
PubMed1998

Efficacy and safety of fluvoxamine in body dysmorphic disorder.

BACKGROUND: Body dysmorphic disorder (BDD), a preoccupation with an imagined or slight defect in appearance, has been noted in case reports, retrospective studies, and clinical series to respond to serotonin reuptake inhibitors (SRIs). These data further suggest that the delusional variant of BDD (delusional disorder, somatic type) may also respond to SRIs. However, systematic pharmacologic treatment studies of BDD and its delusional variant are needed. METHOD: Thirty subjects with BDD or its delusional variant (DSM-IV) were prospectively treated in an open-label fashion with fluvoxamine for 16 weeks. Subjects were assessed at regular intervals with the Yale-Brown Obsessive Compulsive Scale Modified for BDD (BDD-YBOCS), the Clinical Global Impressions (CGI) scale, the Hamilton Rating Scale for Depression, the Brown Assessment of Beliefs Scale, and other measures. RESULTS: BDD-YBOCS scores (mean +/- SD) decreased from 31.1 +/- 5.4 at baseline to 16.9 +/- 11.8 at termination (p < .001). Nineteen (63.3%) subjects were rated as responders on the BDD-YBOCS and the CGI (10 [33.3%] were much improved, and 9 [30.0%] were very much improved). Delusional subjects were as likely to respond to fluvoxamine as nondelusional subjects, and delusionality significantly improved. All 5 responders who were delusional at baseline were no longer delusional at study endpoint. The mean dose of fluvoxamine was 238.3 +/- 85.8 mg/day, and mean time to response was 6.1 +/- 3.7 weeks. Fluvoxamine was generally well tolerated. CONCLUSION: These results suggest that fluvoxamine is a safe and effective treatment for BDD, including its delusional disorder variant. Controlled treatment trials are needed to confirm these findings.

Adult↗