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Biomedical subjects

N Breslau

Publications and source records attributed to N Breslau.

At least 109 records · Page 6Linked to original sources
PubMed1988

Validity of subtyping psychotic depression: examination of phenomenology and demographic characteristics.

The authors examine the validity of subtyping psychotic depression by comparing 111 patients with schizoaffective, unipolar, and bipolar psychotic depression on demographic characteristics and symptoms at index episode. Diagnoses were made by using Research Diagnostic Criteria (RDC). The three groups were indistinguishable in sex, race, and age at onset. Schizoaffective patients had more "schizophrenic" symptoms but were not different in depressive delusions, other psychotic symptoms, or affective symptoms. However, bipolar patients scored significantly higher than nonbipolar patients on hypomania. There is little support in these data for the schizoaffective versus nonschizoaffective distinction. Further tests are needed, including tests of response to treatment and biological markers.

Adult↗
PubMed1987

Siblings of disabled children. Effects of chronic stress in the family.

We examined the effects of chronic stress in families of severely disabled children on psychopathology in siblings. We present findings from a five-year follow-up of 192 siblings of disabled children and a geographically based probability sample of 284 children (controls), who were 6 to 18 years old at initial assessment (time 1) and 11 to 23 years old at follow-up (time 2). Data on the Psychiatric Screening Inventory were obtained from mothers at times 1 and 2. Additionally, at time 2 the Diagnostic Interview Schedule for Children was administered to the children themselves. At follow-up, the siblings' picture according to mothers' assessment appears worse than it did initially: In addition to the excess in aggressive symptoms seen at time 1, they manifested an excess in depressive affect and social isolation. The time 2 interviews with the children themselves show that the siblings scored significantly higher than controls on depressive symptoms, although the rate of DSM-III major depression was not significantly different. An excess in depressive symptoms was observed also in mothers of disabled children, who, like the siblings, were not at increased risk for major depression.

Adolescent↗
PubMed1987

Searching for evidence on the validity of generalized anxiety disorder: psychopathology in children of anxious mothers.

The diagnostic validity of generalized anxiety disorder (GAD) is tested by examining the relationship between GAD in mothers and children's overanxious disorder (OAD), separation anxiety (SA), and anxious symptoms in 331 mother-child dyads from a geographically based probability sample. Data on the relationship between mothers' major depressive disorder (MDD) and children's depression are presented for comparison. The National Institute of Mental Health (NIMH) Diagnostic Interview Schedule (DIS) was used in mothers and the NIMH Diagnostic Interview Schedule for Children (DISC), in children. Children of mothers with GAD were not at increased risk for OAD, SA, or anxious symptoms. In contrast, MDD in mothers conferred a risk for OAD in younger children and of MDD in older children. Additionally, older children of depressed mothers exhibited significantly more depressive symptoms. The presence of diffuse anxiety in children of mothers with MDD may represent a nonspecific response pattern in psychiatrically vulnerable children. Like GAD in adults, these anxiety symptoms in children may constitute a prodromal manifestation of other disorders and transient responses to life stressors.

Adolescent↗
PubMed1987

Posttraumatic stress disorder. The stressor criterion.

Posttraumatic stress disorder (PTSD) was officially introduced into psychiatric nomenclature in 1980, when it was incorporated into DSM-III. There is as yet little empirical research on the validity of the diagnosis. Literature on disasters, civilian and wartime, and on more ordinary stressful life events does not support the view that extreme stressors form a discrete class of stressors in terms of the probability of psychiatric sequelae or the distinctive nature of subsequent psychopathology. Extraordinary stressors are like more ordinary stressful events with respect to their complex differential effects upon individuals. Personal characteristics and the nature of the social environment modify the likelihood and form of the response of individuals to all types of stressors.

Humans↗
PubMed1987

Posttraumatic stress disorder: the etiologic specificity of wartime stressors.

The authors examined the effects of wartime stressors in a sample of 69 Vietnam veterans who were psychiatric inpatients in a Veterans Administration hospital. Participation in atrocities and the cumulative exposure to combat stressors, each independently of the other, conferred a significant risk for posttraumatic stress disorder. In contrast, the effect of these war experiences on the onset of panic, major depression, and mania was not significant. The results indicate that extreme stressors are uniquely linked with posttraumatic stress disorder's characteristic cluster of symptoms but challenge DSM-III's implicit assumption that the reexperienced trauma is the stressor responsible for posttraumatic stress disorder.

Adult↗
PubMed1986

The cost implications of academic group practice. A randomized controlled trial.

We evaluated the reorganization of a general medical clinic into several group practices, using equivalent groups of patients and physicians in a randomized controlled trial. The group practice, unlike the traditional clinic, provided decentralized registration, clinic coverage five days a week, and telephone coverage at night and on weekends. Residents worked in small groups with an attending physician, nurse practitioner, and receptionist. All financial activity involving a sample of 2299 patients was followed during the 11-month intervention. The total hospital charges per patient were 26 percent lower for the patients seen in the group practice than for those seen in the traditional clinic (P = 0.003). This difference was primarily attributable to inpatient charges, which were 27 percent lower per patient hospitalized (P = 0.004). The mean length of stay was 8.3 days among group-practice patients and 10.5 days among traditional-clinic patients (P = 0.011). We conclude that organizational changes to improve outpatient access and to integrate inpatient and outpatient services can decrease medical charges.

Academic Medical Centers↗
PubMed1986

Chronic stress and major depression.

Six-month and lifetime rates of DSM-III major depressive disorder (MDD) and characteristics of the disorder were compared in mothers of children with disabilities (chronic stress sample, n = 310) and in a geographically based probability sample (controls, n = 357). The presence of DSM-III MDD was ascertained by the National Institute of Mental Health Diagnostic Interview Schedule. Although mothers in the chronic stress sample had significantly more depressive symptoms, rates of MDD were not significantly different in the two samples. The women with MDD in the chronic stress sample reported a lower age of onset and more episodes in lifetime than diagnostically comparable controls, but the two samples did not differ in symptomatology of worst episode. The data do not support an etiologic role for chronic stress in MDD, nor do they support the hypothesis that chronic stress is associated with a unique symptom profile or more severe episodes. They suggest a role for chronic stress in precipitating episodes, although the evidence on this point must be interpreted with caution.

Adult↗
PubMed1986

Selective resistance to parathyroid hormone in cultured skin fibroblasts from patients with pseudohypoparathyroidism type Ib.

We measured cAMP production in response to agonists in cultured skin fibroblasts from subjects with pseudohypoparathyroidism type Ib (PHP Ib; normal phenotype, resistance to PTH only, normal guanine nucleotide stimulatory coupling protein activity) and skin fibroblasts from normal subjects. There were no significant differences in basal or prostaglandin E1- and forskolin-stimulated cAMP production in PHP Ib vs. normal fibroblasts. Fibroblasts from 7 of 10 subjects with PHP Ib had significantly reduced peak cAMP responses to PTH [3.95 +/- 0.88 vs. 15.9 +/- 4.2 pmol/100 micrograms protein (mean +/- SD); n = 7 for both groups; P less than 0.001]. PTH-stimulated cAMP production was significantly reduced in the 7 subjects with PHP Ib at all concentrations of PTH tested [3-1000 ng/ml human PTH-(1-34)]. In the other 3 subjects with PHP Ib, the cAMP response to PTH was either normal (2 subjects) or above the normal range (1 subject). Thus, skin fibroblasts from many, but not all, subjects with PHP Ib have selective resistance to PTH in terms of cAMP response. Since the defect is hormone specific and persists in culture, we suggest that an intrinsic defect in the PTH receptor may cause PTH resistance in certain subjects with PHP Ib. The cause of PTH resistance in the subjects with a normal cAMP response to PTH is not known, but the data suggest heterogeneity even within the PHP Ib subgroup.

Adolescent↗
PubMed1986

Very low birth weight infants: effects of brain growth during infancy on intelligence quotient at 3 years of age.

To evaluate the role of postnatal growth on IQ at 3 years of age, 139 appropriate for gestational age, very low birth weight infants (less than 1.5 kg) born in 1977 and 1978 were studied at 40 weeks (term), and at 8, 20, and 33 months (corrected) of age. Weight, height, and head circumference were measured at each age, neurologic status was measured at 20 months, and Stanford Binet IQ at 33 months. Multiple regression analysis revealed that head circumference at 8 months of age is the best growth predictor of IQ at 3 years of age. Path analysis was performed to measure the effects of biologic and social factors measured earlier in life on IQ at 3 years. These factors explained 43% of the variance in IQ at 3 years of age. Head circumference at 8 months had a direct effect on IQ at 3 years, controlling for all other variables in the model. Neonatal risk had an indirect effect via head circumference. Neurologic impairment had direct and indirect (via head circumference) effects; race and socioeconomic status had direct effects on IQ but no effects on growth at 8 months of age. Thus, brain growth at 8 months significantly influenced 3 year IQ at 3 years of age among very low birth weight infants, even when medical and sociodemographic variables were controlled.

Body Height↗
PubMed1985

Psychological disturbance in children with physical disabilities: continuity and change in a 5-year follow-up.

This study measures continuity in behavioral disturbance over a 5-year period among 255 children with physical disabilities who were 6 to 18 years old at first assessment. The pattern of the results differed from that reported previously for a sample of the general population of children. Disabled children showed little stability in aggression, an area in which stability over time had been consistently reported for the general child population. Furthermore, important differences were observed between children with cystic fibrosis and children with cerebral palsy, myelodysplasia, or multiple physical handicaps, all conditions involving brain abnormality. Children with cystic fibrosis followed the trend toward better adjustment seen among the general population of children. In contrast, among children with conditions involving the brain, the majority of those who had been classified as psychologically severely impaired remained at this level of impairment 5 years later. In two behavioral domains, Mentation Problems and Isolation, children with conditions involving the brain maintained, on the average, the same markedly high score they had initially. Among children with physical conditions involving the brain, Mentation Problems and Isolation signify persistent problems that do not subside as the children mature.

Adolescent↗
PubMed1985

Refining DSM-III criteria in Major Depression. An assessment of the descriptive validity of criterion symptoms.

In this study we estimate the power of DSM-III Major Depression (MDD) symptoms to discriminate MDD from (1) Generalized Anxiety Disorder (GAD) and (2) no disorder. The NIMH-DIS was administered to 319 women exposed to chronic stress (all were mothers of disabled children). Two methods were used: (1) conditional probabilities, and (2) multiple regression analysis. Symptoms had greater utility in discriminating MDD from no disorder than from GAD. 'Gained weight' and 'thinking about death' had the least efficacy in either discrimination. 'Hypersomnia' and 'insomnia' contributed to the discrimination from no disorder, whereas 'fatigue' and 'sex disinterest' discriminated MDD from GAD. 'Guilt', 'trouble concentrating', 'lost appetite' and 'wanted to die' were important in both comparisons. Despite recent emphasis on observable behaviors and physiologic measures, guilt, a subjectively experienced inner state, was the most important symptom in MDD.

Anxiety Disorders↗
PubMed1985

Depressive symptoms, major depression, and generalized anxiety: a comparison of self-reports on CES-D and results from diagnostic interviews.

This study evaluates the validity of the Center for Epidemiologic Studies Depression Scale (CES-D) by comparing it to DSM-III diagnoses of major depression and generalized anxiety, using the National Institute of Mental Health Diagnostic Interview Schedule (DIS). Data were gathered on a sample of 310 mothers of children with chronic disabilities. The utility of the CES-D for detecting major depression was approximately equal to its utility for detecting generalized anxiety. Multivariate analysis revealed that the unique association of CES-D with current depression was equal to its association with current generalized anxiety and that the two disorders had additive effects on CES-D. The analysis did not identify any individual CES-D symptom as specific to either disorder. The findings, therefore, do not support the notion that the CES-D measures depression specifically.

Adaptation, Psychological↗
PubMed1985

DSM-III generalized anxiety disorder: an empirical investigation of more stringent criteria.

The diagnoses of generalized anxiety disorder (GAD) according to DSM-III and according to revised criteria (requiring 6 months' duration and 6 symptoms) were determined by the use of the National Institute of Mental Health Diagnostic Interview Schedule in a probability sample of 357 women. The DSM-III GAD lifetime rate of 45% was reduced by a factor of five when the revised definition was applied. The reduction was due chiefly to the longer duration criterion. Requiring a higher number of symptoms did not raise the threshold for the diagnosis, since 74% of persons with a period of 1 month or more of generalized anxiety reported six symptoms. Although chronicity was associated with more pervasive symptomatology, the excess in symptoms appears to be due to the very high prevalence of major depression (73%) among the newly defined (i.e., chronic) GAD positives.

Adult↗