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Biomedical subjects

L K George

Publications and source records attributed to L K George.

At least 37 records · Page 2Linked to original sources
PubMed1998

Age of first onset of bipolar disorder: demographic, family history, and psychosocial correlates.

The literature suggests that bipolar elders with early and late onset of the disorder present with different demographic, family history, and psychosocial profiles, which are less well characterized than those for elderly unipolar patients. In this cross-sectional clinical survey, we assessed subjects (n = 74) from the NIMH Clinical Research Center for the Study of Depression in Later Life at Duke University who had a consensus diagnosis of bipolar depression; the primary assessment instrument was the Duke Depression Evaluation Schedule. We found that bipolar subjects with later age of onset reported less family history of psychiatric problems, more comorbid vascular disease, and more instrumental and subjective social support. Stressful life events were more frequent among bipolar subjects with earlier age of depressive symptom onset. This study suggests that early-onset disorder may be characterized by a psychosocial component, whereas organic factors may be particularly important to late-onset bipolar disorder.

Adult↗
PubMed1998

Depression and physical disability outcomes in depressed medically ill hospitalized older adults.

The authors examined depression/disability outcomes in hospitalized older medical patients during the year after hospital discharge to assess the pattern and rate of changing depression and disability, the causal relationship between these variables, and to identify patients at greatest risk for poor outcomes. A group of 119 medical patients at Duke Hospital were both depressed and disabled; they were followed for a median of 47 weeks after hospital discharge. Time-series analyses showed that depression and disability tended to track together, and most changes occurred within the first 6 months after discharge. Blacks were more likely to remit from depression despite continued disability and less likely to experience continued depression despite decreased disability. Patients with a history of depression were less likely to experience improvement in depression unless disability improved. Number of medical diagnoses and depression severity independently predicted poorer depression outcomes. Certain characteristics of patients during hospitalization predict depression/disability outcomes after discharge.

Activities of Daily Living↗
PubMed1997

Psychosocial and physical correlates of chronic depression.

This study used a case-control design to address differences in psychosocial, physical and clinical profiles between subjects who presented with a chronic index episode of major depression and those who presented with a non-chronic index episode. Subjects were adult patients participating in the Duke University Mental Health Clinical Research Center (MHCRC) for the Study of Depression in Later Life. Cases (N = 88) who reported duration of depressive symptoms lasting > or = 24 months at enrollment were compared to controls (N = 354) who reported symptoms lasting 1-12 months. The groups were compared with respect to selected demographic and clinical variables, physical function deficits, medical comorbidity, social support constructs and number of recent stressful life events. Social support and physical health were more relevant to chronicity of major depressive illness than were severity of illness or family history. Older age (> 60 years) intensified the deleterious effect of recent negative life events and reduced the deleterious effect of functional impairment on chronic major depression. These findings require special emphasis where treatment for chronic major depression is divorced from considerations of the social environment and functional capacity.

Activities of Daily Living↗
PubMed1997

The ethical challenges of a randomized controlled trial of involuntary outpatient commitment.

Involuntary outpatient commitment (OPC) is a civil justice procedure intended to enhance compliance with community mental health treatment, to improve functioning, and to reduce recurrent dangerousness and hospital recidivism. The research literature on OPC indicates that it appears to improve outcomes in rates of rehospitalization and length of stay. However, all studies to date have serious methodological limitations because of selection bias; lack of specification of target populations; unclear operationalization of OPC; unmeasured variability in type, frequency, and intensity of treatment; as well as other confounding factors. To address limitations in these studies, the authors designed a randomized controlled trial (RCT) of OPC, combined with community-based case management, which is now under way in North Carolina. This article describes ethical dilemmas in designing and implementing an RCT of a legally coercive intervention in community-based settings. These ethical dilemmas challenge the experimental validity of an RCT but can be successfully addressed with careful planning and negotiation.

Ambulatory Care↗
PubMed1997

Sexual assault history and health perceptions: seven general population studies.

This article uses data from 7 population surveys to evaluate the association of sexual assault history with health perceptions. It estimates the extent of generalizability across gender, ethnic groups, and studies; the extent to which depression accounts for or mediates the association; and whether some circumstances of assault are more strongly related to poor subjective health. Data from each of 18 subsamples of the surveys were analyzed (pooled N = 10,001; 7,550 women and 2,451 men), and results were combined by using meta-analysis. Assault was associated with poor subjective health (odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.36, 1.95) and this result was consistent regardless of gender, ethnicity, or sample. Controlling depression did not markedly change this result (OR = 1.46, 95% CI = 1.21, 1.77), indicating that depression did not account for or mediate the assault-health perceptions association. Multiple assaults and assaults by strangers or spouse were most strongly associated with poor subjective health.

Adolescent↗
PubMed1997

Use of antidepressants by nonpsychiatrists in the treatment of medically ill hospitalized depressed elderly patients.

OBJECTIVE: The purpose of this study was to examine antidepressant use by nonpsychiatrists in the treatment of depressed elderly medical inpatients. METHOD: Patients aged 60 or older who were admitted to medical services at Duke Hospital were evaluated by a geropsychiatrist who used a structured psychiatric interview to identify major or minor depressive disorder. Medical records of depressed patients were reviewed for use of antidepressants and benzodiazepines before admission, during hospitalization, and on discharge. After discharge, depressed patients were contacted four times by telephone at 12-week intervals to inquire about medication use (median follow-up time = 45 weeks). RESULTS: Of 153 depressed patients, 40.5% received antidepressants at some time during their hospital stay or follow-up period, 25.5% received only benzodiazepines, and 34.0% received neither. The most commonly prescribed antidepressant was amitriptyline (45.2% of treated patients), administered at an average maximum dose of 49 mg/day. Only 15 of 114 untreated depressed patients started antidepressant therapy during hospitalization (nine with amitriptyline). Of 91 depressed patients who did not receive antidepressants either before admission or during hospitalization, only 11% received any antidepressant therapy during the median 11-month follow-up; again, half were treated with amitriptyline at doses of 10-30 mg/day. Intensity of antidepressant therapy was predicted by severity of depressive symptoms, history of psychiatric problems, and higher income. CONCLUSIONS: A relatively low proportion of depressed older medical inpatients receive treatment with antidepressants. Patients treated with antidepressants often receive potentially dangerous tertiary tricyclics at inadequate doses. Unless depression is identified and treated during medical hospitalization, it is unlikely to be treated adequately after discharge.

Age Factors↗
PubMed1997

Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes.

OBJECTIVE: The purpose of this study was to examine and compare rates of depression, correlates, and course of symptoms in medically ill hospitalized elders through use of six diagnostic schemes (inclusive, etiologic, exclusive-inclusive, exclusive-etiologic, substitutive-inclusive, and substitutive-etiologic). METHOD: A consecutive series of 460 cognitively unimpaired patients aged 60 or over who were admitted to the medical inpatient services of Duke Hospital underwent a structured psychiatric evaluation administered by a psychiatrist. Patients with depression were contacted by telephone at 12-week intervals after discharge to assess weekly change in depressive symptoms (median follow-up time = 47 weeks). RESULTS: The prevalence of major depression varied from 10% to 21% depending on diagnostic scheme; similarly, minor depression varied from 14% to 25%. Diagnostic strategy made little difference in known psychological and health characteristics of patients with depression (predictive validity) or severity of depressive symptoms (convergent validity). The diagnostic strategy that best distinguished a severe and persistent major depression was the exclusive-etiologic approach; however, this strategy missed 49% of patients with major depression identified by the inclusive approach, almost 60% of whom continued to experience persistent symptoms of depression many weeks after discharge. CONCLUSIONS: Diagnostic strategy affects rates of major and minor depression, with about a twofold difference between the extremes. There is little reason, however, to choose one diagnostic scheme over another in all cases. Diagnostic strategy should be chosen on the basis of the specific goals and purposes of the examiner. While the exclusive-etiologic approach identifies the most severe and persistent depressions, the inclusive approach is the most sensitive and reliable approach and is an intermediate predictor of persistent depression.

Adult↗
PubMed1997

Attendance at religious services, interleukin-6, and other biological parameters of immune function in older adults.

OBJECTIVE: First, to examine and explain the relationship between religious service attendance and plasma Interleukin-6 (IL-6) levels, and second, to examine the relationship between religious attendance and other immune-system regulators and inflammatory substances. METHODS: During the third in-person interview (1992) of the Establishment of Populations for Epidemiologic Studies of the Elderly (EPESE) project, Duke site, 1718 subjects age sixty-five or over had blood drawn for analysis of immune regulators and inflammatory factors, including IL-6 measurements. IL-6 was examined both as a continuous variable and at a cutoff of 5 pg/ml. Information on attendance at religious services was available from the 1992 interview and two prior interviews (1986 and 1989). RESULTS: Religious attendance was inversely related to high IL-6 levels (> 5 pg/ml), but not to IL-6 measured as a continuous variable. Bivariate analyses revealed that high religious attendance in 1989 predicted a lower proportion of subjects with high IL-6 in 1992 (beta-.10, p = .01) High religious attendance in 1992 also predicted a lower proportion of subjects with high IL-6 levels in 1992 (beta-.14, p = .0005). When age, sex, race, education, chronic illnesses, and physical functioning were controlled, 1989 religious attendance weakened as a predictor of high IL-6 (beta-.07, p = .10), but 1992 religious attendance retained its effect (beta-.10, p = .02). When religious attenders were compared to non- attenders, they were only about one-half as likely to have IL-6 levels greater than 5 ng/ml (OR 0.58, 95% CI 0.40-0.84, p < .005). Religious attendance was also related to lower levels of the immune-inflammatory markers alpha-2 globulin, fibrin d-dimers, polymorphonuclear leukocytes, and lymphocytes. While controlling for covariates weakened most of these relationships, adjusting analyses for depression and negative life events had little effect. CONCLUSIONS: There is a weak relationship between religious attendance and high IL-6 levels that could not be explained by other covariates, depression, or negative life events. This finding provides some support for the hypothesis that older adults who frequently attend religious services have healthier immune systems, although mechanism of effect remains unknown.

Adaptation, Psychological↗
PubMed1997

Modeling the cross-sectional relationships between religion, physical health, social support, and depressive symptoms.

The authors examined models of the relationships between religious activities, physical health, social support, and depressive symptoms in a sample of 4,000 persons age 65 and over. Religious activity was examined first as a single composite construct and then split into three component variables that were examined individually. Religious activity as a single construct was correlated with both social support and good physical health but was unrelated to depression. Split into the three components, model fit was significantly increased. Frequency of church attendance was positively related to physical health and negatively related to depression, but was surprisingly unrelated to social support. Frequent churchgoers were about half as likely to be depressed. Private prayer/Bible reading was negatively correlated with physical health and positively correlated with social support, but unrelated to depression. Religious TV/radio listening was unrelated to social support, negatively related to good physical health, and, unexpectedly, positively associated with depression.

Activities of Daily Living↗
PubMed1997

Interpreting the effectiveness of involuntary outpatient commitment: a conceptual model.

Many experimental trials of community mental health interventions fail to develop testable conceptual models of the specific mechanisms and pathways by which relevant outcomes may occur, thus falling short of usefully interpreting what happens inside the experimental "black box." This paper describes a conceptual model of involuntary outpatient commitment (OPC) for persons with severe and persistent mental disorders. The model represents an attempt to "unpack" the effects of OPC by incorporating several interacting variables at various stages. According to this model, court-mandated outpatient treatment may improve long-term outcomes both directly and indirectly in several ways: by stimulating case management efforts, mobilizing supportive resources, improving individual compliance with treatment in the community, reducing clients' psychiatric symptoms and dangerous behavior, improving clients' social functioning, and finally by reducing the chance of illness relapse and rehospitalization. A randomized clinical trial of OPC is underway in North Carolina that will test the direct and indirect effects suggested by this model, using longitudinal data from the multiple perspectives of mental health clients, family members, and case managers.

Ambulatory Care↗
PubMed1996

Sociodemographic and clinical correlates of number of previous depressive episodes in the depressed elderly.

Age of onset has been used as a correlate of depressive symptomatology in the elderly. Examining frequency of episodes may improve our ability to make such correlations. The authors studied variations in an index presentation of depression in late life based on the number of previous depressive episodes. Having more than two previous episodes (as compared to two or less) was related to younger age, early age of onset, dysthymia, feelings of worthlessness, difficulty concentrating, slowed thoughts, suicidal ideation, generalized anxiety, and decreased perceptions of social support. In a logistic regression model, significant predictors of more than two previous episodes were young age, early age of onset, dysthymia, suicidality, and lower perceived social support. Patients with many episodes may be at higher risk for more severe illness and may require more aggressive treatment.

Aged↗
PubMed1996

The association of sexual assault and attempted suicide within the community.

BACKGROUND: Lifetime community rates of attempted suicide were compared between those who reported a history of sexual assault and a control group without such a history. METHODS: The 2918 respondents in the Duke University Epidemiological Catchment Area Study were placed into groups with reported sexual assault (n = 67) and those with no known history of such (n = 2851). Multivariate and bivariate procedures were used to examine the relation between sexual assault and attempted suicide. RESULTS: Subjects reporting a history of sexual assault were more likely to be female, younger, and to report higher rates of lifetime suicide attempt and post-traumatic stress symptoms; no differences were found in the number of chronic medical disorders, major depression, substance abuse or substance dependence, or panic attacks. Nine (14.9%) of the 67 index group subjects reported a suicide attempt, 4 of whom reported their first sexual assault as occurring before age 16 years. A sexual assault history was associated with increased prevalence of lifetime suicide attempt after controlling for sex, age, education, posttraumatic stress symptoms, and psychiatric disorder. Findings were similar in the female-only subsample (n = 1778). For women, the odds of attempting suicide was 3 to 4 times greater when the first reported sexual assault occurred prior to age 16 years compared with age 16 years or older. CONCLUSIONS: Sexual assault is associated with an increased lifetime rate of attempted suicide. In women, a history of sexual trauma before age 16 years is a particularly strong correlate of attempted suicide.

Adolescent↗
PubMed1996

Effects of gender and ethnic group on blood pressure control in the elderly.

In order to determine the adequacy of blood pressure treatment in black and white elderly men and women, the authors performed a cross-sectional population survey in Central North Carolina in 1986-1987. Participants included a random sample of noninstitutionalized individuals age 65 years or older. Blacks were oversampled. A health questionnaire was administered, and blood pressure was measured. Of 5,223 eligible persons, 4,162 (80%) participated. Fifty-four percent of subjects were black and 65% were women. Sixteen percent of the study subjects were white men, 30% white women, 19% black men, and 35% black women. The mean age was 73 years. Fifty-three percent had hypertension. Among hypertensives, 80.8% were taking blood pressure medication. Among treated hypertensives, blood pressure was adequately controlled, (measured diastolic blood pressure of 90 mm Hg or lower) in 85.6%. Women were 52% more likely than men and blacks were 40% less likely than whites to exhibit adequate blood pressure control. Older age and smoking were also associated with better blood pressure control. The authors conclude that hypertension is more likely to be controlled in elderly women than men and less likely to be well-controlled in elderly blacks than whites. The choice of antihypertensive agent may also be important. Further investigation is needed into the mechanisms accounting for the observed sex and race differences.

Adrenergic beta-Antagonists↗
PubMed1996

Missing links: the case for a social psychology of the life course.

The major purpose of this discussion is to demonstrate that the knowledge base has suffered as a result of insufficient cross-fertilization of social-psychological and life course/aging perspectives. The central focus of the article is identification of research issues of interest to life course and aging scholars that would be enriched by increased attention to social-psychological principles and, conversely, identification of social-psychological research topics that would be advanced by increased attention to life course and aging issues.

Aged↗
PubMed1995

Racial differences in the occurrence of herpes zoster.

The purpose of this study was to determine if there are racial differences in the occurrence of herpes zoster (shingles). The study population was the Duke Established Populations for Epidemiologic Studies of the Elderly, a probability sample of community-dwelling persons > 64 years old in North Carolina. Interviewers administered a comprehensive health survey to the participants that included questions about lifetime occurrence of shingles. Of the 3206 subjects, 316 (9.9%) had had zoster: 81 (4.5%) of 1754 blacks and 235 (16.1%) of 1452 whites had had shingles (P < .0001). After controlling for age, cancer, and demographic factors, blacks remained one-fourth as likely as whites (adjusted odds ratio 0.25, 95% confidence interval 0.18-0.35; P = .0001) to have experienced zoster. In summary, blacks had a significantly lower risk of developing herpes zoster than whites, a new finding in herpes zoster epidemiology.

Age Factors↗
PubMed1995

Clinical and phenomenological comparisons of late-onset and early-onset depression.

OBJECTIVE: The authors examined the relationship between age at onset of first depressive episode and clinical features in elderly depressed patients. METHOD: They used data on age at onset and clinical features in 246 elderly depressed patients treated at the National Institute of Mental Health Clinical Research Center for the Study of Depression in Later Life, located at Duke University. RESULTS: Two variables--loss of interest and number of depressive episodes--were related to age at onset in all analyses. CONCLUSIONS: This study confirms the hypothesis that apathy is more prominent in late-onset than in early-onset depression.

Activities of Daily Living↗
PubMed1995

New directions in research on involuntary outpatient commitment.

OBJECTIVE: Involuntary outpatient commitment has been used as a method of improving tenure in community programs for individuals with severe and persistent mental illness. This paper reviews literature on research about involuntary outpatient commitment and suggests questions and methods for future research. METHODS: Literature describing research studies of involuntary outpatient commitment, located by searching MEDLINE and following up references cited in relevant articles, was reviewed with attention to patient characteristics and diagnostic, treatment, and outcomes measures. RESULTS: Involuntary outpatient commitment appears to provide limited but improved outcomes in rates of rehospitalization and lengths of hospital stay. Variability in community treatment makes interpretation of other types of outcome difficult. Few studies specifically identify results among patients with severe and persistent mental illness. CONCLUSIONS: No studies have examined the extent to which outpatient commitment affects compliance and treatment when essential community services such as case management are consistently and aggressively provided, nor have studies controlled for potentially confounding factors such as treatment and nontreatment effects, including informal coercion. A randomized trial of involuntary outpatient commitment should be useful in evaluating the effectiveness of this type of intervention.

Ambulatory Care↗