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Biomedical subjects

Larry Culpepper

Publications and source records attributed to Larry Culpepper.

33 records · Page 2Linked to original sources
PubMed2002

Nonpsychiatric illness among primary care patients with trauma histories and posttraumatic stress disorder.

OBJECTIVE: The authors examined the relationship between posttraumatic stress disorder (PTSD), trauma, and self-reported nonpsychiatric medical conditions in a sample of 502 primary care patients with one or more anxiety disorders. METHODS: Primary care patients with one or more DSM-IV anxiety disorders were assessed for comorbid psychiatric and substance use problems and for a history of trauma. These individuals also completed a self-report measure of current and lifetime medical conditions, lifetime tobacco use, and current regular exercise. RESULTS: Of 502 participants with at least one anxiety disorder, 84 (17 percent) reported no history of trauma, 233 (46 percent) had a history of trauma but no PTSD, and 185 (37 percent) met DSM-IV criteria for PTSD. Patients with PTSD reported a significantly greater number of current and lifetime medical conditions than did participants with other anxiety disorders but without PTSD. Primary care patients with PTSD were more likely to have had a number of specific medical problems, including anemia, arthritis, asthma, back pain, diabetes, eczema, kidney disease, lung disease, and ulcer. Possible explanations for the greater rates of medical conditions among participants with PTSD were examined as predictors in multiple regression. PTSD was found to be a stronger predictor of reported number of medical problems than trauma history, physical injury, lifestyle factors, or comorbid depression. CONCLUSIONS: These findings suggest that PTSD is associated with a higher rate of general medical complaints.

Adult↗
PubMed2002

Escitalopram: A New SSRI for the Treatment of Depression in Primary Care.

Escitalopram is the S-enantiomer of the racemic compound citalopram, a selective serotonin reuptake inhibitor (SSRI) widely used for the treatment of depression. This review describes the current body of pharmacologic and clinical evidence supporting the use of escitalopram for the treatment of depression and anxiety. Preclinical studies have confirmed that it is primarily this molecule that provides the inhibition of serotonin reuptake responsible for the antidepressant effect of citalopram, with minimal-to-nonexistent affinity for other receptor sites. Clinical trials of escitalopram in depressed patients indicate that escitalopram, 10 mg/day, is as effective as 40 mg/day of its parent compound, citalopram, with an excellent safety and tolerability profile. Because of its increased selectivity, escitalopram represents a refinement in SSRI therapy for symptoms of depression and anxiety. This article also explores the implications of a more selective SSRI on the management of depressed patients in the primary care clinical practice.

Journal Article↗
PubMed2002

Generalized anxiety disorder in primary care: emerging issues in management and treatment.

Generalized anxiety disorder (GAD) is highly prevalent in primary care patients and is a source of major morbidity. The low rate of recognition and diagnosis of GAD is often the result of insufficient knowledge on the part of primary care physicians, time pressures, and competing demands during patients' visits. Patient attribution of symptoms and the stigma related to mental illness also contribute to underrecognition. Other contributing factors include the natural history of GAD, the bimodal age of presentation, a chronic but waxing and waning course, frequent comorbidity with other anxiety and depressive disorders, and the controversy regarding the best diagnostic criteria. However, proper diagnosis is critical to appropriate management. Primary care management of GAD and associated comorbidities includes education about the nature of GAD as a medical disorder that is amenable to treatment and counseling about treatment alternatives and coping strategies. Most patients with GAD suffer from insomnia, and treating insomnia can be of great benefit to them. While cognitive-behavioral therapy and relaxation therapy are effective in treating GAD, most patients in primary care settings are likely to require pharmacologic treatment. Although commonly used, benzodiazepines and their short-term benefits are overshadowed by their decreased long-term effectiveness, their minimal treatment of psychic symptoms, and their degradation of patient performance. The selective serotonin reuptake inhibitor (SSRI) paroxetine is indicated for the short-term treatment of GAD, although adequate data supporting the use of most SSRIs for GAD are not yet available. The serotonin-norepinephrine reuptake inhibitor venlafaxine provides a treatment option resulting in both short- and long-term improvement of symptoms, attaining not only a response but also remission from GAD and prevention of relapse.

Adaptation, Psychological↗
PubMed2001

Trauma and Posttraumatic Stress Disorder in Primary Care Patients.

BACKGROUND: This article examines the nature of psychological trauma and posttraumatic stress disorder (PTSD) in 504 patients recruited from primary care settings. METHOD: Patients were screened for anxiety in waiting rooms at 14 general medical settings, and those with a sufficient number and severity of anxiety symptoms were administered a standardized diagnostic clinical interview. Those who met DSM-IV criteria for an anxiety disorder and who were willing to participate were included in this study. Of the 504 patients, 185 met DSM-IV criteria for PTSD. RESULTS: Results indicated that 418 (83%) of primary care patients in our sample reported at least 1 traumatic event in their lifetime. The most prevalent traumas experienced by the entire sample of participants were witnessing others being seriously injured or killed, serious accidents, and rape. Of those participants with PTSD, rape was the strongest predictor of a PTSD diagnosis. Analyses examining gender differences indicated that, for women, a history of other unwanted sexual contact or witnessing a sexual assault, being attacked with a weapon or with intent to kill, or witnessing someone being injured were found to be risk factors for a PTSD diagnosis. Examination of clinical characteristics indicated a high rate of comorbidity of psychiatric disorders among patients with PTSD, including high rates of alcohol/substance abuse, depression, and suicide attempts. CONCLUSION: These findings emphasize the continued need to assess patients presenting at general medical facilities about trauma history.

Journal Article↗
PubMedDate not supplied

Frequency and patterns of psychiatric comorbidity in a sample of primary care patients with anxiety disorders.

The current report examines the rates of psychiatric comorbidity in a sample of 539 primary care patients diagnosed with anxiety disorders using the Structured Clinical Interview for DSM-IV (SCID-IV). Though not a typical psychiatric sample, rates of comorbidity were found to be as high or higher than those reported in studies conducted in traditional mental health settings. Multiple anxiety disorders were diagnosed in over 60% of participants and over 70% of participants had more than one current axis I diagnosis. Rates of current and lifetime comorbid major depression were also very high. Patterns of diagnostic comorbidity were also examined, with significantly elevated risks for the co-occurrence of several specific pairings of disorders being found. The study results are discussed in context of a recently published, large-scale study of anxiety disorder comorbidity in psychiatric patients (Brown et al., 2001). Implications of these results for both the mental health and primary care fields are also discussed.

Adult↗
PubMedDate not supplied

Predictive genetics in primary care: expectations for the motivational impact of genetic testing affects the importance family physicians place on screening for familial cancer risk.

PURPOSE: To investigate whether the importance family physicians place on familial cancer-risk screening is influenced by expectations for the motivational impact of a high-risk genetic test result. METHODS: Mailed survey of the Massachusetts Academy of Family Physicians. RESULTS: Respondents expected patients would increase pursuit of screening for cancer (99.6%) and other diseases (89.9%), quit smoking (93.6%), and improve diet/exercise (92.5%). The degree of motivational effect was significantly related to the importance they place on screening. CONCLUSIONS: Family physicians believe that a high-risk cancer genetic-test result would motivate their patients to pursue risk-reduction behavior, and this belief is related to the importance they place on screening their patients for an inherited risk of cancer.

Attitude of Health Personnel↗
PubMedDate not supplied

Opportunities, challenges, and lessons of international research in practice-based research networks: the case of an international study of acute otitis media.

The requirements of research become more complex and demanding in international collaborations. The opportunity to study naturally occurring variation in treatment prompted networking primary care research networks in the United Kingdom, The Netherlands, and North America to study acute otitis media. Additional challenges faced and addressed in this study included (1) differing national requirements for protecting human subjects; (2) variation in data collection processes in primary care practices; (3) data transmission among participants; (4) duties and tariffs on necessary instruments; (5) fluctuation in currency exchange rates; (6) incapacitation of coinvestigators; (7) complex administration of funds; (8) financing the additional, legitimate costs of collaboration; (9) sustaining strong personal relationships among coinvestigators; and (10) accepting longer time frames than would otherwise be expected. Overall, international practice-based research can be productive, affect millions of people, and be extremely rewarding to investigators. It is not, however, for the faint-hearted.

Adolescent↗
PubMedDate not supplied

Family physician self-efficacy with screening for inherited cancer risk.

BACKGROUND: Recent evidence has shown low and inconsistent rates of family history screening among generalist physicians. Little has been done to investigate the physician factors likely to mediate this behavior. We investigated family physicians' beliefs about screening their patients for inherited cancer risk, measuring their perceptions of self-efficacy and the importance of screening. METHODS: We mailed a cross-sectional, 1-page questionnaire to all active members (691) of the Massachusetts Academy of Family Physicians, measuring their attitudes about predictive genetic cancer screening. RESULTS: We received responses from 300 of the 691 members (43%). Although 87% believed screening to be important, less than two thirds believed they were effective in screening. CONCLUSIONS: Many family physicians lack confidence in their ability to screen patients for a family history of cancer despite recognizing its importance to their practice.

Adult↗
PubMedDate not supplied

Clarifying EBM resources.

Explore the source record for details and available documents.

Education, Nursing, Continuing↗
PubMedDate not supplied

Prevalence and patterns of adult yoga use in the United States: results of a national survey.

BACKGROUND: Although yoga appears to be popular in the United States, there are no published studies on yoga's prevalence or patterns of use. METHODS: In 1998 we surveyed by telephone a nationally representative sample of 2055 English-speaking U.S. adults (60% weighted response rate) regarding yoga use. RESULTS: Of the respondents, 7.5% used yoga at least once in their lifetime and 3.8% used yoga in the previous 12 months. Respondents who used yoga at least once were more likely than non-users to be female (68% vs. 51%), college educated (68% vs. 45%), and urban dwellers (93% vs. 74%). Factors independently associated with yoga use at least once included female gender (OR 2.5 [95% CI 1.7-3.8]), baby boomer age group (ages 34-53) compared to pre-baby boomers (> or = 54 (2.3 [1.4-4.0]), education beyond high school (2.2 [1.4-3.5]), residing in large and small metropolitan areas compared to non-metropolitan areas (3.8 [1.8-7.8] and 2.7 [1.3-5.8], respectively), and use of other CAM therapies (5.3 [2.7-10.5]). Of respondents using yoga in the previous 12 months, 64% reported using yoga for wellness, 48% for health conditions, and 21% specifically for back or neck pain. Ninety percent felt yoga was very or somewhat helpful and 76% did not report spending money related to their yoga. CONCLUSIONS: In 1998 an estimated 15.0 million American adults had used yoga at least once in their lifetime and 7.4 million during the previous year. Yoga was used for both wellness and specific health conditions often with perceived helpfulness and without expenditure.

Adult↗