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Biomedical subjects

L J Cohen

Publications and source records attributed to L J Cohen.

At least 37 records · Page 2Linked to original sources
PubMed1995

Trichotillomania and obsessive-compulsive disorder.

Trichotillomania, a disorder characterized by repetitive hair pulling, has been only recently systemically investigated. Such research was encouraged by data that showed obsessive-compulsive disorder, which is also characterized by ritual behaviors, responds selectively to serotonin reuptake inhibitors. In this review, we consider similarities and contrasts in the diagnosis, demographics, phenomenology, neurochemistry, neuropsychiatry, and treatment of trichotillomania and obsessive-compulsive disorder. We argue that a view of trichotillomania as an obsessive-compulsive spectrum disorder that may involve disturbances in grooming behaviors comprises a useful clinical and research heuristic. Nevertheless, there may also be important differences between the two disorders; in particular, trichotillomania has a number of characteristics in common with impulsive disorders. Further empirical investigation is necessary to determine the nature of these complex disorders and their relationship to one another.

Adolescent↗
PubMed1995

Pharmacoeconomic issues in the treatment of depression.

The goal of pharmacoeconomics is to define the cost and value of different treatment strategies. The cost-effectiveness analysis, one model used in the study of pharmacoeconomics, considers not only the cost of the drug itself, but also the labor costs associated with physician and pharmacy visits, and expenses for laboratory testing. Drugs that require more intensive medical surveillance, either for dose adjustments or overall management of treatment-related side effects, can escalate costs. In the case of antidepressant drugs, various cost-effectiveness analyses have shown that the total cost of disease management is similar for generic tricyclics and the more expensive selective serotonin reuptake inhibitors. This outcome is due to the higher labor costs associated with tricyclics that offset their acquisition cost advantage. The application of cost-effectiveness studies in formulary decision-making and clinical practice guidelines, will maximize the use of health care resources.

Algorithms↗
PubMed1995

Clinical profile, comorbidity, and treatment history in 123 hair pullers: a survey study.

BACKGROUND: Trichotillomania, characterized by an irresistible urge to pull one's hair, may be more prevalent than previously believed. Despite increasing attention devoted to this topic in the recent literature, there are few studies based on large samples that are potentially generalizable to a community population. METHOD: Surveys addressing clinical profile, comorbidity, and treatment history were mailed to all responders to a nationally distributed magazine article on trichotillomania. Out of 772 surveys sent, 123 completed surveys were returned. RESULTS: While there was a predominance of females in the whole sample, female-to-male prevalence was lower in children than adults. Onset was predominantly in childhood (mean age = 11 years), most frequently in middle childhood and least frequently before age 6. Subjects pulled hair from a variety of sites, including scalp, eyelashes, eyebrows, pubic region, face, and body, but the highest incidence and severity involved scalp hair. Children under 6 were more likely than other age groups to pull scalp hair and possibly less likely to pull other hair. In adults, symptom profile was not associated with age at onset. While subjects reported high rates of comorbid conditions in both self and family, trichotillomania was reportedly formally diagnosed in only 40% of the subjects. Although subjects reported a range of treatments, the majority (58%) reported no treatment history. Finally, only minimal improvement was reported for all modalities, with no significant difference in response to psychotherapy, behavior therapy, clomipramine, or fluoxetine. CONCLUSION: Trichotillomania is a chronic illness that may be difficult to treat. Controlled studies on comorbidity, epidemiology, treatment-seeking patterns, and long-term treatment response are needed.

Adolescent↗
PubMed1994

Psychiatric hospitalization as an experience of trauma.

The experience of being a client in a locked, inpatient psychiatric unit can be considered trauma-producing. This article examines that phenomenon, offers suggestions for reform, and recommends dialogue for further change.

Adaptation, Psychological↗
PubMed1994

Letters from Carol.

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Anorexia Nervosa↗
PubMed1994

The experience of therapeutic reading.

This article describes a qualitative study of therapeutic reading intended to provide understanding of bibliotherapy. Using the Colaizzi method, interviews with eight participants were analyzed and the structure of the experience of therapeutic reading identified. The structure of the experience of therapeutic reading was recognition of self evolving into ways of feeling and ways of knowing. A discussion of the implications of results is presented.

Adult↗
PubMed1994

The assessment and treatment of refractory anxiety.

Most patients with anxiety disorders can be effectively treated with the use of specific pharmacologic and psychological approaches. Nevertheless, some anxiety patients remain refractory to standard treatments. For these patients, reappraisal and a systematic approach can be helpful. A common problem in patients with "treatment-resistant" anxiety is the use of inadequate doses or inadequate duration of medication treatment. Alternatively, the diagnosis may need to be reconsidered, and comorbid diagnoses carefully assessed. Comorbid psychiatric, medical, and neurologic conditions may complicate the treatment of anxiety or require additional specific treatments. Finally, alternative pharmacologic approaches for specific types of anxiety can yield successful outcomes.

Anti-Anxiety Agents↗
PubMed1993

Timing of neuroendocrine responses and effect of m-CPP and fenfluramine plasma levels in OCD.

The present study assesses the timing of and relationship between neuroendocrine response and metabolite blood levels following the partial serotonin (5-HT) agonist m-CPP and the 5-HT releaser/reuptake blocker fenfluramine. Cortisol levels peaked significantly earlier than did prolactin, m-CPP, fenfluramine, or norfenfluramine blood levels by time-to-peak analysis. This earlier cortisol response to both 5-HT agents raises the possibility that peripheral mechanisms may play a role in cortisol release. Since peak m-CPP level correlated even more closely to peak prolactin rise than did peak fenfluramine, this suggests that prolactin response to oral m-CPP challenge is useful in assessing 5-HT function.

Adult↗
PubMed1992

Cheryl's scarf.

Explore the source record for details and available documents.

Child↗
PubMed1991

The decontextualization of mental illness: the portrayal of work in psychiatric drug advertisements.

This paper explores the decontextualization of mental illness in psychiatric drug advertisements. Taking the portrayal of work in several drug advertisements which appeared in the American Journal of Psychiatry* as the object of our analysis, we show how these ads tend to individualize mental illness and its treatment by failing to consider the social realities that contribute to or, in some way, affect mental illness. We conclude with a discussion of how such ads distort debate over treatment options and legitimize existing social relations and attitudes.

Advertising↗
PubMed1990

Work and mental health. Personal, social, and economic contexts.

This paper offers a critique of the prevailing view of the relationship between work and mental health. The critique is based on an examination of the personal, social, and economic contexts of work, especially in regard to people with serious mental illnesses. The paper concludes with a discussion of the implications of these contexts for necessary changes in social structures, attitudes, and vocational rehabilitation efforts.

Adaptation, Psychological↗