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Biomedical subjects

K H Blacker

Publications and source records attributed to K H Blacker.

At least 19 recordsLinked to original sources
PubMed1993

Relationship of past depressive episodes to symptom severity and treatment response in panic disorder with agoraphobia.

BACKGROUND: Many investigators have reported that panic disorder (PD) patients with comorbid major depression (MD) have more severe symptoms and a poorer response to treatment than patients with PD alone. It is not known if this is due to a distinct and more serious underlying disorder in these patients or simply a result of the simultaneous presence of the two disorders. METHOD: Nondepressed patients presenting for treatment of panic disorder with agoraphobia (PDA) were studied before treatment (N = 180) and after 4 weeks of treatment with adinazolam sustained release (N = 89) or placebo (N = 91). Twenty-nine percent (N = 53) of the patients had a past history of MD. Symptom severity and treatment outcome were compared in patients with primary, secondary, single, recurrent, or no past MD. RESULTS: There were no consistent differences in symptom severity or treatment outcome in patients with a past history of primary, secondary, or single episode MD compared with patients with no history of MD. However, a small number of patients with history of recurrent MD exhibited consistently greater symptom severity and poorer response to treatment than patients with no history of MD. CONCLUSION: The greater severity and worse outcome of comorbid PD and MD observed in earlier studies are more likely due to the simultaneous presence of the two disorders than to a more serious and enduring underlying disorder. However, our results suggest that recurrent MD may indicate a more serious condition in patients with PDA. This possibility warrants further study.

Adult↗
PubMed1991

Response to treatment in panic disorder with associated depression.

Thirty outpatients with panic disorder (PD) were treated at an anxiety clinic using a symptom-focused approach. Thirteen (43%) had no history of major depressive disorder (MDD), 12 (40%) had a history of secondary MDD, and 5 (17%) had history of primary MDD. The outcome was equally good in patients with no history of MDD (77% had good or excellent outcomes) and patients with a history of secondary MDD (83% had good or excellent outcomes). Patients with a history of primary MDD had the worst outcomes. These findings agree with earlier studies showing that secondary MDD does not adversely affect prognosis of patients presenting for treatment of PD.

Adult↗
PubMed1989

Improving the preparation of preclinical students for taking sexual histories.

The authors evaluated human sexuality training programs at two California medical schools. In one program, students had no experience taking a sexual history. In the other, students were randomly assigned either to conduct or to observe a brief sexual history interview with a community volunteer. The students who conducted an interview showed more significant improvements in knowledge of human sexuality, perceived appropriateness of taking a sexual history and perceived personal skill in taking a sexual history than did the students who neither observed nor took a sexual history and also developed more critical views of practicing physicians' skills in taking such histories. The students who observed an interview improved more in knowledge and perceived personal skill than did the students who had no interview experience.

Education, Medical, Undergraduate↗
PubMed1977

Frightened men: a wish for intimacy and a fear of closeness.

Men who failed to achieve an adequate separation from their mothers are particularly prone to experience serious distress with their marriages during their middle years, when the wish for intimacy, coupled with a fear of closeness never resolved during infancy, is retriggered. An onslaught of biological, social, and psychological stresses force acknowledgement of previously denied needs for succor, plunging them into battle with their wife-surrogate mother. The resulting counterphobic, hypersexual, ofter self-destructive behaviors are usually falsely interpreted as oedipal. Clinical material in this report strongly suggests this distress is not primarily related to genital sexual issues or fears of castration, but more often concerns issues of autonomy and independence which typically involve the mother and which arose in the toddler or anal phase. Supportive evidence for this thesis from cross-cultural observations, child developmental studies, and primatology is presented, and the usefulness of this view in facilitating clinical work with such men is described.

Adaptation, Psychological↗
PubMed1975

Tracing a memory.

Comparisons of the nests of associations within which a single memory reappeared during the course of an analysis deemed successful by analysis and patient revealed changes in content and structure of these matrices. Judges, given a sample of associations surrounding a reappearance, were able to relate a particular appearance to its sequential location in the development and flow of an analysis. In the study samples, the patient became increasingly active and insightful as the analysis progressed. Resistance decreased, and the memory, initially given as a narrative report, became a powerful metaphor for the examination of conflicts concerning aggression and its defense, passivity. The results of the judges' analyses and of the thematic analysis suggest that a close examination of associations surrounding a repeated stimulus, a single memory, can be used as an index of analytic progress.

Adult↗
PubMed1975

Clinical recognition of early schizophrenic decompensation.

The early signs and symptoms of schizophrenic decompensation are subtle and variegated. Today's community patient often presents with vague complaints of brief duration making it imperative that today's diagnostician be able to recognize and appropriately treat early psychopathology. This paper collates a number of observations of developing psychotic phenomena -- self reports, clinical studies and controlled experiments -- and provides a useful format for organizing these complex and changing behaviors. Data are presented and discussed using our clinical schema for detailing the natural progression of developing psychotic phenomena into four distinct stages. Efficacy of early recognition and treatment in aborting or diminishing a major psychotic episode is discussed. The advantages of recognizing the early signs of psychotic decompensation are apparent. First, with adequate intervention and treatment, the overt psychotic state may be attenuated. Although the feasibility of reducing the incidence of schizophrenia through intervention in "high risk" groups, or those experiencing insidious symptoms remain speculative (further investigation in this area is urgently needed), nonetheless, early diagnosis and comprehensive rehabilitative care significantly improves social and occupational adjustment. A second advantage accrues from early diagnosis. It enables patient and family to better cope with the illness. We have previously outlined a schema detailing the natural progression of developing psychotic phenomena into four distinct stages. The phenomena, when identified, can be seen as a continuum. However, many clinicians fail to recognize the earlier phases and typically the diagnosis of psychosis is made relatively late at what we call stage three of the four stages we described.

Affective Symptoms↗