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Biomedical subjects

R A Sansone

Publications and source records attributed to R A Sansone.

At least 37 records · Page 2Linked to original sources
PubMed1999

Managing somatic preoccupation.

Somatically preoccupied patients are a heterogeneous group of persons who have no genuine physical disorder but manifest psychologic conflicts in a somatic fashion; who have a notable psychologic overlay that accompanies or complicates a genuine physical disorder; or who have psychophysiologic symptoms in which psychologic factors play a major role in physiologic symptoms. In the primary care setting, somatic preoccupation is far more prevalent among patients than are the psychiatric disorders collectively referred to as somatoform disorders (e.g., somatization disorder, hypochondriasis). Diagnostic clues include normal results from physical examination and diagnostic tests, multiple unexplained symptoms, high health care utilization patterns and specific factors in the family and the social history. Treatment may include a physician behavior management strategy, antidepressants, psychiatric consultation and cognitive-behavior therapy.

Cognitive Behavioral Therapy↗
PubMed1998

Using DSM-IV primary care version: a guide to psychiatric diagnosis in primary care.

The prevalence of patients with psychiatric disorders in primary care settings indicates that family physicians have a need for a diagnostic manual suited to the realities of their practice. This article reviews the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., primary care version (DSM-IV-PC) and highlights the ways it accommodates the clinical needs of family physicians. DSM-IV-PC emphasizes the use of nine diagnostic algorithms for the most prevalent psychiatric disorders in primary care. The authors review the conceptual similarities between DSM-IV and DSM-IV-PC and the diagnostic features that are unique to DSM-IV-PC, and offer an illustrative case that incorporates a DSM-IV-PC approach to diagnosis. The authors also outline clinical and technical issues that remain unresolved in DSM-IV-PC.

Adult↗
PubMed1998

The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder.

Intentional self-harm behavior is an important clinical phenomenon that appears highly related to borderline personality disorder (BPD). Self-harm behavior in the context of borderline personality probably exists along a continuum from graphic, self-harm behavior to milder forms of self-sabotaging behavior that might be viewed as self-defeating Relatively little attention has been paid to developing a self-report measure of intentional self-harm, particularly as a screening device for detecting BPD. In Study 1, an initial list of self-harm behaviors encountered in clinical practice was narrowed to those behaviors related to BPD in a sample comprised of adults from both a mental health and non-mental health setting. All participants (N = 221) underwent a semistructured diagnostic interview for BPD. Using a cut-off score of 5 on the resulting 22-item Self-Harm Inventory (SHI), 83.7% of research participants were correctly classified as having BPD or not. In Study 2, women (N = 285) sampled from an outpatient medical setting completed the SHI and a widely used self-report measure of BPD. The SHI cut-off score resulted in correct classification of 87.9% of the individuals. In Study 3, using a sample of adults involuntarily hospitalized for psychiatric reasons (N = 32), the SHI performed at least as well as another self-report measure of BPD in diagnosing participants (the final diagnosis was based on a semistructured interview). The results are discussed with regard to potential advantages and utility of the SHI and need for further validation.

Adolescent↗
PubMed1998

The relationship between obesity and medical utilization among women in a primary care setting.

OBJECTIVE: This project was designed to explore the utilization of specific health care resources by obese compared with nonobese women in a primary care setting. METHOD: Eighty-three obese women, consecutively identified during nonemergent appointments in a primary care health maintenance organization (HMO) setting, were compared with 111 nonobese women with regard to several parameters of health care utilization. All participants' medical records were reviewed for the preceding 12 months for the number of diagnoses, combined telephone and physician contacts with the facility, different physicians seen, and prescriptions. RESULTS: Increasing body mass index (BMI) was predictive of a greater number of diagnoses, contacts with the facility, total number of prescriptions, and number of different physicians seen. After controlling for the number of diagnoses, BMI remained predictive of the number of different physicians seen. DISCUSSION: Our findings indicate that increasing BMI is associated with greater health care utilization, primarily through greater morbidity. Additionally, there may also be particular psychosocial and illness factors which contribute to obese women's patterns of physician contact.

Adolescent↗
PubMed1998

Panic disorder: the ultimate anxiety.

Panic disorder, an intense exacerbation of anxiety accompanied by a variety of physical symptoms, is twice as common among women as among men. Onset is bimodal (teens/20 s and mid-30 s/40 s), 50% of cases are accompanied by agoraphobia, and the etiology is probably multifactorial. Treatment in the primary care setting includes pharmacologic (selective serotonin reuptake inhibitors) and cognitive-behavioral intervention. Medication is initiated at low doses, and the drug-evaluation trial is of 6 weeks duration. Psychiatric referral is helpful in nonresponders and in those with comorbid psychiatric conditions. Outcome varies, with most patients experiencing relief with treatment. For some people, however, the disorder is chronic, with ongoing exacerbations and remissions.

Antidepressive Agents↗
PubMed1998

Borderline personality symptomatology, experience of multiple types of trauma, and health care utilization among women in a primary care setting.

BACKGROUND: This project was designed to explore the relationship between recollected trauma history, borderline personality symptomatology, and health care utilization among women in a primary care setting. METHOD: Women (N = 116) consecutively recruited during routine gynecological appointments were given a set of questionnaires that explored 5 types of trauma (i.e., sexual, physical, and emotional abuse; physical neglect; witnessing violence) as well as borderline personality symptomatology. The preceding 12 months of participants' medical records were blindly reviewed to determine several measures of health care utilization (i.e., number of telephone contacts to the facility, physician visits, ongoing and acute prescriptions, specialist referral). RESULTS: Multiple forms of trauma were related to increased telephone contacts, physician visits, acute prescriptions, and ongoing prescriptions. Borderline personality symptomatology was related to physician visits and ongoing prescriptions. Neither was related to the number of specialist referrals. Total number of types of trauma and borderline personality symptomatology scores were moderately related to each other (r = .36, p < .01). CONCLUSION: With the exception of specialist referrals, the experience of multiple types of trauma and borderline personality symptomatology contribute to higher health care utilization among women in a primary care setting, but not to a substantial degree. The experience of trauma and borderline personality symptomatology appear partially related to each other. This relationship has several implications.

Borderline Personality Disorder↗
PubMed1998

An investigation of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors.

OBJECTIVE: To determine the psychiatric characteristics of a sample of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors (SSRIs) as well as to assess the appropriateness of extended treatment. STUDY DESIGN: A prospective case series of patients (convenience sample) assessed with survey, psychological testing, interview, and medical record review. METHODS: Participants (n = 39) were patients in a health maintenance organization primary care setting receiving treatment with SSRI-type antidepressants for 12 months or longer, with no psychiatric evaluation or treatment immediately before commencement of antidepressant therapy. Each participant completed measures of self-destructive behavior and personality disturbance, underwent a clinical psychiatric interview, and had their medical record reviewed to determine psychiatric diagnoses by the primary care physician at the initiation of antidepressant treatment. RESULTS: On psychiatric interview, 64.1% of participants were diagnosed with major depression, the majority recurrent (46.2% of the entire sample); 46.2% with dysthymia; and 38.5% with panic disorder. Psychiatric morbidity in this sample was reflected by recurrent depressive episodes, long-standing depression, comorbid psychiatric diagnoses on interview (average of 1.8 diagnoses per participant), self-harm behaviors, and personality pathology. Seventy-seven percent of primary care diagnoses gleaned from medical records reflected depressive diagnoses. The approximate "match" rate for a depression-spectrum diagnosis between psychiatric interviewer and primary care physicians was 90%; however, on psychiatric interview, 16.7% of participants had bipolar disorder and 38.5% had panic disorder, which were not noted in the primary care medical record. CONCLUSIONS: Patients in primary care settings receiving extended treatment with SSRIs may have complex psychopathology for which long-term antidepressant treatment appears appropriate.

Antidepressive Agents↗
PubMed1998

History of trauma and attempted suicide among women in a primary care setting.

The results of past research have demonstrated apparent links between suicidality and a history of sexual abuse or physical abuse. However, the relative predictive power of such abuse histories in explaining sucidality remains unknown, as does the potential relationship between sucidality and emotional abuse, physical neglect, and witnessing violence. In the current study, 151 women who presented for nonemergent medical care indicated whether they had experienced each of five types of abuse and whether they had ever attempted suicide. Similar to past research, increased rates of having attempted suicide were evident among women who had been sexually or physically abused. Rates of past suicide attempts were also higher among those who had experienced emotional abuse or had witnessed violence. However, many women indicated having experienced multiple forms of trauma. In a multivariate analysis, only sexual abuse and physical abuse were uniquely predictive of having attempted suicide. Results are discussed with regard to the potential importance of bodily intrusiveness during abuse as most predictive of subsequent suicidality.

Adolescent↗
PubMed1997

The comorbidity, relationship and treatment implications of borderline personality and obesity.

Studies indicate that a significant minority of obese individuals in clinical studies meet criteria for borderline personality. Although the relationship between obesity and borderline personality remains unexplained, the following article discusses the implications of treating obesity among individuals with this personality disorder. Longitudinal intervention, normalizing or regulating eating patterns, and reframing weight plateaus are emphasized.

Borderline Personality Disorder↗
PubMed1997

Increased health care utilization as a function of participation in trauma research.

OBJECTIVE: This study was designed to compare, in a primary care setting, the health care utilization of women who participated in a trauma research study with the health care utilization of women who did not. METHOD: Health care utilization in the 12 months before and the 12 months after participation in trauma research was determined for both participants (N = 116) and a group of control subjects (N = 100) matched for day of service. RESULTS: Pairwise t test results indicated that for the women who participated in the research, all measures of health care utilization significantly increased in the 12 months after the trauma study; for the control subjects, only the number of ongoing prescriptions significantly increased. Sign tests confirmed that a significantly greater number of research participants demonstrated a positive difference (increase in utilization) for all health care variables, whereas only ongoing prescriptions demonstrated a significant systematic increase among control subjects. CONCLUSIONS: The findings suggest that participation in trauma research may increase subsequent health care utilization.

Adolescent↗
PubMed1997

Healthcare utilization among women with eating disordered behavior.

This study was designed to explore relationship between self-reported eating disordered behavior (without formally established eating disorder diagnoses) and healthcare utilization among women in a primary care setting. Through a self-report questionnaire, 150 participants between the ages of 17 and 49 were asked if they had ever vomited, starved themselves, or abused laxatives in a manner that was intentional and self-harming (i.e., eating disordered behavior identified as pathologic by the participant). Participants who reported a history of disordered eating (n = 17) exhibited higher scores on two of five measures of healthcare utilization (mean number of telephone contacts and mean number of specialist referrals) compared with participants without eating disorders (n = 133). These data suggest that eating disordered behavior may be a predictor of increased healthcare utilization among women in primary care settings.

Adolescent↗
PubMed1997

Health care utilization and history of trauma among women in a primary care setting.

Participants were 150 women seen consecutively by a female family physician in an HMO setting for nonemergent medical care. Each participant completed a questionnaire that explored three areas of trauma. Twelve months after the administration of the questionnaire, medical records of each participant were reviewed for several measures of health care utilization (i.e., number of telephone contacts, physician visits, ongoing prescriptions, acute prescriptions, specialist referrals). Age, education, and current marital status were unrelated to medical utilization. Participants' acknowledged history of physical and emotional abuse significantly correlated with most measures of health care utilization, whereas sexual abuse generally did not. The implications of these findings are discussed.

Adolescent↗
PubMed1996

Prevalence of borderline personality symptoms in two groups of obese subjects.

OBJECTIVE: The purpose of this study was to compare the prevalence of borderline personality symptoms and self-harm behavior in two distinct groups of obese subjects. METHOD: Obese women, 17 from an eating disorders program and 60 from a primary care setting, were administered the borderline personality scale of the Personality Diagnostic Questionnaire--Revised, the Diagnostic Interview for Borderline Patients, and the Self-Harm Inventory. RESULTS: There was a significant between-group difference on all study measures, with subjects in the eating disorders program displaying more psychopathology. CONCLUSIONS: Study group membership appears to have a significant effect on the prevalence of psychopathology in obese women.

Adolescent↗
PubMed1996

Dysthymic disorder: the chronic depression.

Dysthymic disorder is defined as chronic depression of a mild to moderate degree for at least two years' duration. The disorder tends to be underdiagnosed despite a prevalence of 5 to 15 percent in primary care settings. Both the diagnosis and treatment of dysthymic disorder may be complicated by a variety of comorbid psychiatric and medical conditions as well as chronic stressors. Treatment may be determined by the accompanying comorbid condition. Antidepressant drugs are moderately efficacious in the treatment of dysthymia, with selective serotonin reuptake inhibitors preferred over tricyclic antidepressants. However, patients may report oversensitivity to antidepressants, experience only partial remission with treatment and suffer relapses. Adjunctive support or psychodynamic psychotherapy should also be considered.

Chronic Disease↗
PubMed1996

Dysthymic disorder: the depression that never quits.

Dysthymic disorder, an insidious and chronic depressive mood disorder that waxes and wanes in intensity over several years, is fairly prevalent in healthcare settings. Although the explicit etiology is unknown, serotonergic dysfunction may be involved. Dysthymia appears to have a high rate of comorbidity, including both psychiatric and medical disorders. The primary care physician should maintain an awareness of this mood disorder, be able to screen efficiently for signs and symptoms, and be able to differentiate major depression from dysthymia. The foundation of treatment is pharmacotherapy, in particular with serotonergic antidepressants, although response is moderate at best. Antidepressants are initiated at low doses and drug trials are conducted for 3-month periods if not precluded by side effects. When reasonably effective, antidepressants should be continued for 2 to 3 years or more. Adjunctive interventions in the treatment of dysthymia are based on comorbid psychiatric or medical conditions. Although dysthymia is an insidious, difficult-to-treat disorder, intervention is worthwhile. Further research may elucidate more effective interventions for this challenging disorder.

Antidepressive Agents↗
PubMed1996

The experience of psychiatric residents with disaster support: a descriptive report.

This study was designed to explore the experiences and reactions of psychiatric residents who provided support to victims at the Oklahoma City bombing site. Participants were seven residents who were surveyed eight months following the disaster. Results describe respondents' perceptions of stress and support factors at the time of participation as well as post-disaster symptoms. In the aftermath, only one respondent reported stress symptoms suggestive of a psychiatric diagnosis. Respondents reported a decrease in symptoms one month after the disaster. The majority acknowledged that they would participate in disaster relief in the future. These data confirm the importance of proper preparation, support, and debriefing for medical personnel attending a disaster as well as the probability that symptomatic reactions will be time-limited for most individuals.

Adult↗