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Biomedical subjects

R Mojtabai

Publications and source records attributed to R Mojtabai.

At least 19 recordsLinked to original sources
PubMed2003

Height, weight and body mass index (BMI) in psychiatrically ill US Armed Forces personnel.

BACKGROUND: In both psychiatrically ill and psychiatrically healthy adults, the connection between health and individuals' height and weight has long been examined. Specifically, research on the idea that individuals with certain body types were prone to particular psychiatric diseases has been explored sporadically for centuries. The hypothesis that psychiatrically ill individuals were shorter and weighed less than psychiatrically healthy counterparts would correspond with the neurodevelopmental model of psychiatric disease. METHOD: To evaluate possible links between psychiatric illness and physique, the height, weight and BMI of 7514 patients and 85,940 controls were compared. All subjects were part of the National Collaborative Study of Early Psychosis and Suicide (NCSEPS). Patients were US military active duty personnel hospitalized for either bipolar disorder, major depressive disorder, or schizophrenia and controls were psychiatrically-healthy US military active duty personnel matched for date of entry into the service. RESULTS: No consistent differences in height, weight or BMI were found between patients and controls, or between patient groups. Some weak ANOVA differences were found between age at the time of entering active duty and weight, as well as BMI, but not height. CONCLUSIONS: Unlike most previous studies that have looked at the links between height and psychiatric illness, this study of the NCSEPS cohort found that, at entry into the US Armed Forces, there were no consistent decreases in height for patients with bipolar disorder, major depressive disorder or schizophrenia compared with a large control group. Furthermore, there were no consistent differences for weight or BMI.

Anthropometry↗
PubMed2001

Residual symptoms and impairment in major depression in the community.

OBJECTIVE: Studies of patients with major depression in treatment settings have found significant residual symptoms and impairment after resolution of the depressive episode. However, only a small proportion of individuals with major depression seek treatment, and little is known about the residual symptoms and impairment associated with major depression in the community. This study used data from the National Comorbidity Survey, which included a nationally representative household sample of respondents in the United States, to assess the course of residual symptoms and impairment after resolution of major depressive episodes in the community. METHOD: National Comorbidity Survey respondents with lifetime major depression who were currently experiencing a major depressive episode and respondents whose last episode had ended more than 1 to 6 months, more than 6 to 12 months, or more than 12 months ago were compared with those without a history of major depression with regard to depressive symptoms and days of impairment in work functioning or other activities in the past 30 days. RESULTS: Respondents whose last episode of major depression had resolved even more than a year ago were still more symptomatic than those without a history of major depression, whereas the number of days of impairment returned to a level indistinguishable from that of respondents without a history of major depression after >6 to 12 months of resolution of the last episode. CONCLUSIONS: Major depression in the community, as in treatment settings, is associated with residual symptoms and impairment. In the community, however, residual impairment may resolve more quickly than residual symptoms.

Activities of Daily Living↗
PubMed2001

Mortality and long-term course in schizophrenia with a poor 2-year course: a study in a developing country.

BACKGROUND: The short-term course of schizophrenia is reported to be better in some developing country settings. The long-term course in such settings, however, has rarely been studied. AIMS: To examine the long-term course and mortality of schizophrenia in patients with a poor 2-year course. METHOD: The report is based on two incidence cohorts of first-contact patients in urban and rural Chandigarh, India, originally recruited for the World Health Organization Determinants of Outcome of Severe Mental Disorders study. Patients were assessed using standardised instruments at 2- and 15-year follow-ups. RESULTS: Ninety-two per cent of the patients with a poor 2-year course had a poor long-term course and 47% died - a nine times higher mortality rate than among patients with other 2-year course types. CONCLUSIONS: In this developing country setting, a poor 2-year course was strongly predictive of poor prognosis and high mortality, raising questions about the adequacy of care for such patients.

Adult↗
PubMed2000

Reliability of the life chart schedule for assessment of the long-term course of schizophrenia.

We report on the inter-rater reliability of the Life Chart Schedule (LCS). The LCS is designed to assess the long-term course of schizophrenia in four key domains (symptoms, treatment, residence, and work) over two time periods (past two years, entire period of illness). The subjects were 27 consecutive admissions to a schizophrenia research unit. The LCS was filled out by pairs of raters, blinded to each others' ratings, using the same data (interview with subject and chart). Reliability was examined for 45 LCS ratings selected from all four domains and both time periods. Selected ratings pertained to the duration of specified experiences, the quality of these experiences, and the long-term time trend. The kappa statistic and the intra-class correlation coefficient (ICC) were used to determine inter-rater reliability for continuous and categorical ratings, respectively. LCS ratings proved reliable in all four key domains and both time periods. The reliability was fair to excellent for ratings of duration of experience (ICC ranged from 0.53 to 0.99), quality of experience (kappa ranged from 0.46 to 0. 92) and long-term time trends (kappa ranged from 0.66 to 0.94). The LCS can be used to obtain reliable ratings of the long-term course of schizophrenia in multiple domains.

Adolescent↗
PubMed2000

Heterogeneity of cycloid psychoses: a latent class analysis.

BACKGROUND: Three hypotheses have been proposed in regard to the origin of cycloid psychoses: (1) they are an independent nosological entity; (2) they are atypical cases of affective disorders; and (3) they are a heterogeneous group of disorders. This study examined the heterogeneity hypothesis by attempting to delineate distinct affective and non-affective subgroups. METHODS: In 60 cases drawn from a classic study of cycloid psychoses by Perris (1974), latent class analysis was used to delineate subgroups. RESULTS: Two classes were identified in the analysis: one characterized by the convergence of affective symptoms and family history of affective disorders and the other by the relative paucity of such features. CONCLUSIONS: Cycloid psychoses are composed of at least two subgroups, distinguishable on the basis of symptoms and family history.

Acute Disease↗
PubMed2000

Neuropsychological differences between first-admission schizophrenia and psychotic affective disorders.

OBJECTIVE: The study compared the neuropsychological functioning of patients with first-admission schizophrenia with that of patients with first-admission psychotic affective disorders. METHOD: Data came from the Suffolk County Mental Health Project, an epidemiological study of first-admission psychotic disorders. Subjects with a diagnosis of schizophrenia (N=102) and psychotic affective disorders, including bipolar disorder with psychotic features (N=72) and major depressive disorder with psychotic features (N=49), were compared on a battery of neuropsychological tests administered 2 years after the index admission. RESULTS: Subjects with schizophrenia performed worse than those with the psychotic affective disorders, even after adjusting the results for differences in demographic characteristics and general intellectual functioning. The most consistent differences were on tests of attention, concentration, and mental tracking. The two psychotic affective disorder groups were indistinguishable in performance on the neuropsychological tests. CONCLUSIONS: Even early in its course, schizophrenia is distinguishable from psychotic affective disorders by global and specific neuropsychological deficits. These deficits might contribute to the disability and poor outcome associated with schizophrenia in the mid- and long-term course.

Adolescent↗
PubMed2000

Delusion as error: the history of a metaphor.

Error has been the major metaphor for understanding delusions through the past three centuries. Modern definition of delusion as erroneous opinion or belief is evidence of the continuing role of this metaphor to this day. However, through long habituation the metaphorical nature of the association between delusion and error is no longer recognized. In other words, the metaphor has become literal and all but invisible. This paper seeks to shed light on this metaphor by tracing its development from inception in the seventeenth century to the present time. Also, the impact of the metaphor on modern research and therapeutic approaches is briefly discussed. Finally, to put the metaphor of error in perspective, some other metaphors applied to delusion over the years are reviewed.

Delusions↗
PubMed2000

Duration of remitting psychoses with acute onset. Implications for ICD-10.

BACKGROUND: The acute and transient psychotic disorders (ATPD) in ICD-10 advanced the nosology of remitting psychoses with acute onset. But the proposed criteria for ATPD--especially in regard to duration--are tentative and need to be validated. AIMS: To evaluate: (a) the duration of remitting psychoses with acute onset; (b) the applicability of the ATPD criteria for these cases; and (c) differences in duration and ATPD diagnoses across sociocultural settings. METHOD: Data from the World Health Organization Determinants of Outcome study were used. RESULTS: The 98 cases of remitting psychoses with acute onset had a modal duration of 2-4 months, with 43% falling in this range. Mainly because of this, few met the ATPD criteria. Duration and diagnostic findings were similar across settings. CONCLUSIONS: ATPD criteria need refinement, especially in regard to duration. Further studies aimed at early detection and assessment of onset and duration of these disorders are needed.

Acute Disease↗
PubMed1999

Duration of illness and structure of symptoms in schizophrenia.

BACKGROUND: Previous research has mainly focused on the cross-sectional structure of symptoms in schizophrenia. This meta-analysis examined the association of duration of illness with the structure of symptoms. METHODS: Using explicit criteria, 22 studies reporting on the correlations of symptoms in 2665 schizophrenic patients were selected. From each study, symptom-pair correlations for negative symptoms as rated by Scale for the Assessment of Negative Symptoms (SANS) and positive symptoms as rated by the Scale for the Assessment of Positive Symptoms (SAPS) were extracted. Variability among symptom-pair correlations across studies was assessed using tests of homogeneity. For symptom-pair correlations which were not found to be homogeneous, the association of average duration of illness with the symptom-pair correlations were examined. RESULTS: There was considerable variability in symptom-pair correlations across studies. Part of this variability was explainable by variations in average duration of illness. Longer duration of illness was associated with lower negative-negative symptom-pair correlations and higher negative-positive symptom-pair correlations. CONCLUSIONS: The findings suggest that the structure of symptoms in schizophrenia evolves over time, following a consistent pattern. In the early stages of illness, negative and positive symptoms form cohesive dimensions. With time, these dimensions become less cohesive and the boundaries between them, less clear.

Adult↗
PubMed1999

Fever and acute brief psychosis in urban and rural settings in north India.

BACKGROUND: This case-control study used data from Chandigarh, North India to investigate the association between antecedent fever and acute brief psychosis. AIMS: To assess whether antecedent fever may be a biological correlate of acute brief psychosis, and contribute to the nosology of acute brief psychosis. METHOD: The study was based in an incidence cohort from two catchment areas, an urban and a rural site, that were part of the World Health Organization Determinants of Outcome study. The cases (n = 17) met criteria for acute brief psychosis; controls (n = 40) were patients with other acute and subacute psychoses. The Life Events Schedule was used to determine the presence of antecedent fever. RESULTS: The crude odds ratio for fever as a risk factor for acute brief psychosis was 6.2 (P = 0.004). The odds ratio in a logistic regression analysis--adjusted for site, gender and CATEGO classification--was 11.2 (P = 0.003). CONCLUSIONS: Antecedent fever may be a biological correlate of acute brief psychosis. This finding supports the validity of this entity, and has implications for its aetiology and diagnosis.

Acute Disease↗
PubMed1998

Role of psychosocial treatments in management of schizophrenia: a meta-analytic review of controlled outcome studies.

This meta-analytic review sought to answer questions concerning the role of psychosocial treatments in the comprehensive management of patients with schizophrenia. The review focused on the effects of combining psychosocial treatment with somatic treatment. Findings demonstrated the additive and supplementary effects of psychosocial treatments and the durability of these effects. Patients with more chronic illness appeared to be more responsive to psychosocial treatments, as were patients in studies conducted in non-Western countries. Among the Western countries, studies from Scandinavian countries reported the least effectiveness for psychosocial treatments. There was some evidence for differential effect of psychosocial treatments on different dimensions of illness as the measures of disorganized behavior and employment showed little difference in treated and control groups. There was also some evidence for differences between different modalities of treatment as group treatments produced smaller effects. Implications for practice and future research are discussed.

Antipsychotic Agents↗
PubMed1998

Identifying misidentifications: a phenomenological study.

This study assessed how well the current classification system of the delusional misidentification syndromes (DMSs) represents the full range of misidentification phenomena encountered in self-descriptions of psychotic patients. To this end, a sample of 58 self-descriptions of ex-patients who had suffered from an episode of psychosis were reviewed. Misidentifications fitting the definition of one of the DMSs were identified in only 3 cases, whereas those fitting a general and broad definition were identified in 16 cases. It is argued that the restrictive nature of the currently dominant DMSs classification may have led to the neglect of a wide range of misidentification phenomena which do not fit the descriptions of any one of the classic DMSs. Proper identification, description and classification of these non-DMS misidentification phenomena is needed.

Autobiographies as Topic↗
PubMed1998

Limitations of the symptom-oriented approach to psychiatric research.

BACKGROUND: We critically reviewed the arguments of the symptom-oriented researchers who propose to replace syndromes and diagnostic categories with symptoms as units of analysis in psychiatric research. METHOD: Three central arguments were examined: (a) current diagnostic categories lack reliability and validity; (b) using diagnostic categories leads to misclassification and confounding; and (c) symptom-oriented theories are clearer, easier to test, and more likely to lead to an explanation of psychopathology. These arguments are based on three assumptions respectively: (a) symptoms have higher reliability and validity; (b) underlying pathological processes are symptom-specific; and (c) elucidation of the process of symptom development will lead to (and must precede) the discovery of the causes of syndromes. RESULTS: We found little evidence supporting these assumptions and arguments based on them. CONCLUSION: There are no clear advantages in replacing syndromes with symptoms as units of analysis for psychiatric research.

Decision Making↗
PubMed1998

Long-term course of acute brief psychosis in a developing country setting.

BACKGROUND: This study in North India compared acute brief psychosis--defined by acute onset, brief duration and no early relapse--with other remitting psychoses, over a 12-year course and outcome. METHOD: In a cohort of incident psychoses, we identified 20 cases of acute brief psychosis and a comparison group of 43 other remitting psychoses based on two-year follow-up. Seventeen people (85%) in the acute brief psychosis group and 36 (84%) in the comparison group were reassessed at five, seven and 12 years after onset, and were rediagnosed using ICD-10 criteria. RESULTS: At 12-year follow-up, the proportion with remaining signs of illness was 6% (n = 1) for acute brief psychosis versus 50% (n = 18) for the comparison group (P = 0.002). Using ICD-10 criteria, the majority in both groups were diagnosed as having schizophrenia. CONCLUSIONS: Acute brief psychosis has a distinctive and benign long-term course when compared with other remitting psychoses. This finding supports the ICD-10 concept of a separable group of acute and transient psychotic disorders. To effectively separate this group, however, the ICD-10 criteria need modification.

Acute Disease↗
PubMed1997

Factors affecting relapse in patients discharged from a public hospital: results from survival analysis.

This study examined the effects of demographics, personal resources, and psychiatric characteristics on relapse risk in patients discharged from two state facilities. Data on 2,002 first admissions to an Oklahoma state hospital and an associated CMHC during a single year, and information on readmissions of these patients to any of the seven state facilities providing inpatient treatment for an additional two years were collected. Data were analyzed by survival analysis with the Cox regression model. Out of the different demographic, social and psychiatric variables, the patients' diagnosis, length of index hospitalization and level of functioning at discharge as well as interaction of employment status and living status and interaction of age and living status were significantly related to relapse rate. These findings are discussed in the context of previous research.

Adult↗
PubMed1995

Interrater reliability of ratings of delusions and bizarre delusions.

OBJECTIVE: The authors evaluated the interrater reliability of ratings of bizarre delusions, addressing limitations of previous studies. METHOD: Fifty randomly selected psychiatrists rated bizarre delusions in 30 case vignettes adapted from a previous study by Spitzer and associates. Estimates of reliability were obtained for definitions of bizarre delusions in the DSM-III, DSM-III-R, and draft DSM-IV criteria for schizophrenia and for the clinicians grouped according to their current and previous experience with psychotic patients. RESULTS: The kappas for ratings of bizarre delusions according to the different definitions and among clinicians with different levels of experience were in the moderate to fair range. CONCLUSIONS: The reliability of ratings of bizarre delusions appears to be less than satisfactory for clinical practice, and the increased weight given to this symptom in modern diagnostic systems does not seem justifiable.

Delusions↗