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Biomedical subjects

P R Joyce

Publications and source records attributed to P R Joyce.

At least 145 records · Page 8Linked to original sources
PubMed1980

A family with abdominal pain.

We present the case history of a middle-aged woman with a "battle scarred" abdomen who has had abdominal pain for over 20 years and more than 36 hospital admissions in this time. Her children have also had 25 hospital admissions for abdominal pain and three normal appendices removed. This complaint of recurrent abdominal pain not due to a physical disorder is conceptualised in terms of abnormal illness behaviour rather than in traditional terms such as hysteria and hypochondriasis.

Abdomen↗
PubMed1980

The medical model-why psychiatry is a branch of medicine.

With a perspective from evolutionary biology and a view of the philosophy of science as described by Popper, various models of psychiatry are discussed. It is concluded that any satisfactory model must be a synthesis of the biological, psychological and social. It is argued that the concept of diagnosis is the core of the medical model, and that psychiatry is a branch of medicine, and not a social science, because the biological aspect is very important.

Autistic Disorder↗
PubMed1975

Alpha-1-antitrypsin variants in New Zealand.

Twelve percent of a sample of New Zealand Europeans were found to have variant forms of alpha-1-antitrypsin. The distribution of different variants was similar to that found in other Northern European populations. Four percent were heterozygotes for the deficiency state (Z allele) which predisposes to both emphysema and cirrhosis. An initial survey of New Zealand Maoris suggests that although they have a lower overall incidence of variants, there is an increased frequency of the deficiency Z allele. This may be a contributory factor to the susceptibility of the Maori to respiratory and liver disease.

Adult↗
PubMedDate not supplied

The epidemiology of panic symptomatology and agoraphobic avoidance.

In a random community survey of 1,498 urban adults age 18 to 64 years who were interviewed using the Diagnostic Interview Schedule (DIS), the lifetime prevalence of panic disorder was 2.2% +/- 0.4%. This was higher in women (3.4% +/- 0.7%) than in men (0.9% +/- 0.6%), and in those under the age of 45 years. Lifetime prevalence for panic attacks was 7.8% +/- 0.7%. Panic attacks and panic disorder had a similar distribution by age and sex, with higher rates in women than men, and also in the under 45 age groups. The panic symptomatology reported by those subjects with panic attacks was similar to that described by subjects meeting full criteria for panic disorder. The lifetime prevalence of phobic disorders was 10.7% +/- 0.9% and was more common in women (14.6% +/- 1.3%) than in men (6.8% +/- 1.3%). The lifetime prevalence of agoraphobia was 3.8% +/- 0.5%. The occurrence of panic attacks and phobic disorders were frequently related, and in agoraphobic subjects those with more severe agoraphobic avoidance reported more panic symptoms. Indeed, among agoraphobic subjects with at least moderate agoraphobic avoidance, nearly all had either panic attacks or major depression. Subjects with panic attacks and moderate agoraphobic avoidance compared with patients with panic attacks alone, especially when panic symptoms appear before the age of 15, are more likely to have grown up in a family where there was parental conflict, are more likely to have left school at a younger age and without school exams, and are likely to have had more symptoms of a childhood conduct disorder.

Adolescent↗
PubMedDate not supplied

Temperament and early environment influence comorbidity and personality disorders in major depression.

Measures of temperament and early environment were obtained from 108 patients with major depression using the Tridimensional Personality Questionnaire (TPQ) and Parental Bonding Instrument (PBI). TPQ and PBI measures distinguished between depressed patients and controls. Depressed patients with comorbid axis I disorders appear to be temperamentally different from those who do not have these disorders. Those with alcoholism have higher novelty seeking (NS) scores; those with panic disorder have higher harm avoidance (HA) scores; and those with simple phobia have higher persistence (P) scores. More than half the patients had an axis II disorder. Those with a comorbid personality disorder recall worse parental care and have lower reward dependence (RD) scores. Individual personality disorders and DSM-III-R personality disorder clusters reflect to a significant degree underlying temperament as measured by the TPQ. These results suggest that it is possible to better understand the patterns of comorbidity between major depression, other axis I disorders, and personality disorders by studying the underlying temperament dimensions in these patients.

Adolescent↗
PubMedDate not supplied

A relationship between prolactin levels and dexamethasone suppression test results in major depressive disorder.

Fifteen patients with a major depressive disorder and 20 control subjects have completed a 1 mg Dexamethasone Suppression Test (DST) and on a separate day have had their prolactin and cortisol levels measured at 16.00 h. Among the depressed patients there was a significant positive correlation between the DST cortisol and the prolactin level, with abnormally elevated prolactin levels occurring in those depressed patients with very high DST cortisol (greater than 400 nmol/l) levels.

Adult↗
PubMedDate not supplied

Individual differences in plasma cortisol changes during mania and depression.

Daytime plasma cortisol levels in four rapid cycling bipolar affective disorder patients were measured longitudinally over multiple affective episodes, and changes in levels with mood state assessed for each individual patient. While three of the four patients had, as expected, increased cortisol levels during depression, higher cortisol levels were also found in the days immediately preceding depressive episodes. Daytime cortisol levels in mania were more variable but were lower in mania for two of the patients. It is hypothesized that in the early stages of mania decreased cortisol levels reflect early neurochemical changes, but that, as manic episodes become dysphoric and/or severe, elevated cortisol levels occur.

Adult↗
PubMedDate not supplied

The unipolar-bipolar depressive dichotomy and the relationship between afternoon prolactin and cortisol levels.

Afternoon prolactin and cortisol levels were measured in 29 patients suffering from a current major depressive episode. Among the 15 unipolar depressed patients the afternoon prolactin and cortisol levels were positively correlated, but 14 bipolar depressed patients did not show a similar relationship, and had prolactin levels lower than the unipolar patients. This finding adds to the growing list of ways in which the neurobiology of bipolar and unipolar depression may differ.

Adult↗
PubMedDate not supplied

Sex differences in rates of depression: cross-national perspectives.

Rates of depression are compared by sex in epidemiologic surveys conducted in the United States, Canada, Germany and New Zealand. These surveys used similar sampling and diagnostic techniques and the data were standardized to the age and sex distribution of the USA to facilitate comparisons. Data show that the rates of major depression and dysthymia are higher in females than in males and are approximately equal for bipolar disorder across all four countries. The mean age of onset of major depression did not differ by sex across the four countries. The rates of major depression for males seem to be rising and for females stabilizing for birth cohorts born after 1945 (World War II). New data from the National Comorbidity Survey which has younger birth cohorts can directly examine this issue.

Adult↗
PubMedDate not supplied

Identifying personality disorders: towards the development of a clinical screening instrument.

The study objective was to identify a set of personality disorder (PD) criteria from the DSM PD diagnostic sets that can be used to detect subjects with an increased likelihood of having a PD diagnosis. In a series of outpatients evaluated systematically in two waves for every criteria item for 12 DSM-III-R PDs, stepwise logistic regression identified 45 criteria as discriminative for their specific PDs, which are selected for further analysis to assess their ability to discriminate for any PD. Receiver operating characteristic (ROC) analysis is used to evaluate their discriminative power in an independent conjoined sample (N = 1,342) from six centers that assessed every PD criteria item by structured instrument (Structured Clinical Interview for DSM-III-R PDs [SCID-II, Personality Disorder Examination [PDE], and Structured Interview for DSM-III-R PDs [SIDP-R]). The cutoff that maximizes information gain is used to determine the diagnostic threshold (DT). Initially, 15 of 45 criteria are identified. At the 0.43 PD prevalence, a DT of 2 or more of the 15 PD criteria across samples is optimal. The maximum information gain (MIG) is .42 bits, and the AUR is 0.94+/-.007. Other performance indices at this cutoff are .90 sensitivity, .84 specificity, .81 positive predictive power (PPP), .91 negative predictive power (NPP), and .86 hit rate (HR). Taken collectively, the 15 PD criteria selected by the data reduction techniques suggest a narrowed set to be assessed in screening for the presence or absence of any PD with comparable or better psychometric properties than other tests routinely used for diagnosing medical and psychiatric disorders. If specific PD categorization is needed, a second-step comprehensive assessment should follow.

Algorithms↗
PubMedDate not supplied

Lifetime anxiety disorders in women with bulimia nervosa.

We examined the prevalence and ages at onset of additional childhood and adult psychiatric disorders in women with bulimia nervosa and evaluated the differential impact of a mood or anxiety disorder on the presentation of bulimia nervosa. One hundred fourteen women participating in a clinical trial of cognitive-behavioral therapy for bulimia nervosa were assessed at pretreatment with structured diagnostic methodology. Although mood disorders were the most frequently occurring additional psychiatric disorder (75%), 64% experienced an additional anxiety disorder. Age at onset of the anxiety disorders was markedly earlier than age at onset of bulimia nervosa or other comorbid conditions. Stratification of the sample on the presence of a mood or anxiety disorder revealed no differences in the core bulimic symptoms across groups. The presence of a mood disorder was associated with greater body dissatisfaction, lower Global Assessment of Functioning Scales (GAFS) score, more externalizing disorders of childhood, and, as expected, higher Hamilton Depression Rating Scale (HDRS) scores. The presence of an anxiety disorder was related to a history of anorexia nervosa and earlier age at onset of drug or alcohol dependence. Early-onset anxiety disorders are prevalent and may represent one potential pathway to bulimia nervosa.

Adolescent↗
PubMedDate not supplied

Predictors of 1-year treatment outcome in bulimia nervosa.

We examined predictors of outcome 1 year after completion of a randomized clinical trial assessing the additive efficacy of two forms of exposure with response prevention to a core of cognitive-behavioral therapy (CBT) for bulimia nervosa (BN). One hundred one women who met DSM-III-R criteria for BN, and who completed the clinical trial, were available for follow-up at 1 year. Predictor variables were assessed prospectively and partitioned temporally to reflect lifetime history (including personality), pretreatment clinical status, and posttreatment clinical status. Outcome was based on the frequency of binging and purging in the 3 months before assessment based on carefully constructed lifechart interviews. A series of stepwise logistic regressions were performed to determine independent predictors of 1-year outcome while controlling for treatment received. Demographic variables were unrelated to treatment outcome. A history of obesity was predictive of poor outcome, whereas a history of alcohol dependence decreased the odds of poor outcome. High self-directedness on the Temperament and Character Inventory (TCI) predicted favorable outcome at 1 year, whereas personality disorder symptoms were not predictive. Pretreatment global functioning, bulimia scores on the Eating Disorders Inventory (EDI), and the presence of major depression predicted poor outcome. Posttreatment binging, food restriction, and urges to binge on a cue reactivity assessment predicted poor outcome at 1 year. The character trait of self-directedness is a strong predictor of good outcome for CBT, and methods to enhance this trait may be worthy of investigation. Low global functioning and the presence of major depression at presentation may require additional treatment than focused CBT for BN. Our results argue for treatment goals that include abstinence from binging and restricting and decreases in urges to binge in response to high-risk cues.

Adolescent↗
PubMedDate not supplied

Lifetime comorbidity of alcohol dependence in women with bulimia nervosa.

To determine how women with comorbid bulimia nervosa and alcohol dependence differed from those with bulimia nervosa alone, 114 women with DSM-III-R bulimia nervosa were assessed at intake for a randomized clinical trial with structure diagnostic interviews and psychometric instruments. The sample was divided on the basis of the presence (47%) or absence (53%) of lifetime alcohol dependence. Axis I and Axis II disorders, clinical features of bulimia, and personality and temperament characteristics were then compared. Women with comorbid alcohol dependence and bulimia nervosa reported a higher prevalence of suicide attempts, anxiety disorders, other substance dependence, conduct disorder and personality disorders (especially borderline and histrionic), and higher scores on novelty seeking, impulsivity, and immature defenses. There were few differences in the severity of bulimic symptoms. Findings revealed that women with comorbid bulimia nervosa and alcohol dependence bear a greater burden of Axis I and Axis II psychopathology and display greater symptoms of impulsivity and novelty seeking.

Adolescent↗
PubMedDate not supplied

Psychopathology and personality of young women who experience food cravings.

The objective of the present study was to investigate the psychopathology and personality characteristics of women who experience food cravings. A total of 101 young women selected at random from the community completed the Diagnostic Interview for Genetic Studies with a trained interviewer. The interview included a section about food-craving experiences and associated factors. Subjects also completed a self-report questionnaire booklet containing the Temperament and Character Inventory (TCI) and the Eating Disorder Inventory (EDI). Compared to noncravers, women who reported food cravings were significantly more likely to report a history of alcohol abuse/dependence (p = .003), significant weight changes (p = .003), and to have undertaken dieting (p = .02), bingeing (p = .05), vomiting (p = .02), exercise (p = .04), diet pill (p = .03), and laxative use (p = .01) to control weight. There was a trend for the cravers to have higher novelty-seeking scores on the TCI (p = .06). Our findings suggest that women who experience food cravings are more likely to have met criteria for alcohol abuse/dependence and tend to have temperament characterized by higher levels of novelty seeking. In addition the high rates of eating-disorder symptomatology implies overconcern with body weight and shape in the women who experienced food cravings.

Adult↗
PubMedDate not supplied

The effects of meal composition on subsequent craving and binge eating.

This study investigated the effects of meals differing in macronutrient composition on subsequent food craving, bingeing, nutrient intake, and mood. Nine women who had prospectively demonstrated episodes of craving received one each of a high-protein, high-carbohydrate, and mixed meal on three separate days. Appetite and mood ratings were taken before and at four intervals up to 150 min after meal consumption. Subsequent ad libitum food intake was recorded in diaries. Premeal hunger, appetite and mood ratings were similar across meal type. After the protein-rich meal, craving for sweet, carbohydrate-rich foods was significantly higher than after the carbohydrate and mixed meals. Elevated negative mood state after the protein-rich meal and reduced vigor after the carbohydrate meal were not statistically significant. The first ad libitum eating episodes after the protein meal contained significantly higher absolute and proportional amounts of total carbohydrate and sucrose and were more likely to be categorized as a binge than were those after the carbohydrate and mixed meals. Those ad libitum eating episodes classified as a craving/binge were characterized by a higher energy and absolute carbohydrate, fat, and sucrose content. Evidence of macronutrient compensation after a protein-rich meal suggests that carbohydrate intake regulation may exist in certain individuals. Possibly via the effects of sensory-specific satiety, serotonergic function, or cognitive factors, a protein-rich meal may induce craving for sweet-tasting, palatable foods in susceptible individuals.

Adult↗