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Biomedical subjects

R Noyes

Publications and source records attributed to R Noyes.

At least 37 records · Page 2Linked to original sources
PubMed1995

Psychiatric disorders in relatives of probands with obsessive-compulsive disorder and co-morbid major depression or generalized anxiety.

The authors report findings from a blind, controlled study of obsessive-compulsive disorder (OCD). Prevalence rates of generalized anxiety disorder (GAD) and major depressive disorder (MDD) were compared among first-degree relatives of probands with OCD and co-morbid GAD or MDD, respectively. Rates of MDD were not increased in relatives of probands with OCD and MDD; neither were rates of GAD increased in relatives of probands with OCD and GAD, although rates of GAD were increased among relatives of probands with OCD compared to relatives of healthy controls. The authors explore the implications of the findings.

Adolescent↗
PubMed1995

The association of urinary 5-hydroxyindoleacetic acid and vanillylmandelic acid in patients with generalized anxiety.

There is evidence that serotonin and norepinephrine are in some way involved in the pathophysiology of anxiety disorders. Urinary levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 46 patients with generalized anxiety disorder. There was a significant association between urinary levels of 5-HIAA and VMA: r = 0.79; p = 0.0001. Possible implications of this finding are discussed.

Anxiety Disorders↗
PubMed1995

The association of the serotonin metabolite, 5-HIAA, to the lysosomal enzyme N-acetyl-beta-glucosaminidase.

Twenty-one medication-free patients with generalized anxiety disorder (GAD) collected urine samples for 5-hydroxyindoleacetic acid (5-HIAA) and N-acetyl-beta-glucosaminidase (NAG). Nine patients with no comorbid psychiatric diagnosis showed a significant association between 5-HIAA and NAG, r = -0.683, p = 0.04. The possibility that NAG could be a marker for serotonin metabolism is discussed.

Acetylglucosaminidase↗
PubMed1994

Psychiatric comorbidity among patients with hypochondriasis.

The purpose of this study was to determine the nature and extent of comorbidity among patients with DSM-III-R hypochondriasis and to examine the relationships between this disorder and coexisting psychiatric illness. For this purpose, patients seen in a general medicine clinic were screened using measures of hypochondriacal attitudes and somatic symptoms. Those scoring above an established cutoff were given a structured diagnostic interview. In this manner, 50 patients who met DSM-III-R criteria for hypochondriasis and 50 age- and sex-matched controls were identified. The presence of other psychiatric disorders (current and past) was determined by means of the same diagnostic interview. More hypochondriacal subjects (62.0%) had lifetime comorbidity than did controls (30.0%). Major depression, the most frequent comorbid disturbance, was usually current and most often had an onset after that of hypochondriasis. Panic disorder with agoraphobia, the most frequent anxiety disorder, was also current but often began before or at the same time as hypochondriasis. Few subjects met criteria for somatization disorder but a third qualified for a subsyndromal form of this disorder. The data show that, in medical outpatients with hypochondriasis, mood and anxiety disorders frequently coexist. This comorbidity is subject to varying interpretations including overlap of symptom criteria, treatment-seeking bias, and the possibility that hypochondriasis predisposes to or causes the comorbid disorder, as seems likely in the case of depression. In some instances hypochondriasis may be an associated feature of another illness.

Adult↗
PubMed1994

Predictors of response to alprazolam and placebo in patients with panic disorder.

Date from a panic disorder treatment study with 506 patients, comparing alprazolam and placebo in a double-blind manner for 8 weeks, were analyzed to identify demographic and clinical characteristics of the patients that might predict response to treatment. The strongest predictors of response to alprazolam were age over 40, and lower baseline levels of anxiety and phobic symptoms. Predictors of response to placebo were weaker and, in addition to lower levels anxiety and panic attacks, included a lack of previous psychiatric treatment.

Adult↗
PubMed1994

The reliability of urinary 5-HIAA levels.

Examination of the serotonin metabolite, 5-hydroxyindoleacetic acid (5-HIAA), in the urine of psychiatry patients has generally not been used because the reliability of urinary 5-HIAA levels has been questioned. Thirty-seven generalized anxiety disordered patients collected two consecutive urines for measurement of 5-HIAA. The correlation of the 5-HIAA collections was r = 0.82, p = 0.0001.

Adult↗
PubMed1994

Panic disorder: treatment with valproate.

BACKGROUND: To determine the efficacy of divalproex sodium in the treatment of panic disorder, divalproex sodium was administered in a 6-week open clinical trial to 12 patients who had a primary DSM-III-R diagnosis of panic disorder. METHOD: Treatment was begun at 500 mg of divalproex sodium daily and was increased according to clinical response and side effects. Clinicians completed a Clinical Global Impressions Scale weekly and a Hamilton Rating Scale for Anxiety every other week. Patients completed a panic-attack diary and a Brief Symptom Inventory weekly. RESULTS: All 12 patients completed the study, and all were moderately to markedly improved. Measures of panic attacks and anxiety improved more quickly and robustly than measures of phobic avoidance. Eleven of the 12 patients elected to remain in treatment and at 6-month follow-up had sustained improvement. CONCLUSION: These findings suggest that valproic acid may be effective for the treatment of panic disorder. Double-blind studies will be required to further verify these findings.

Adult↗
PubMed1993

The validity of DSM-III-R hypochondriasis.

BACKGROUND: Because of the uncertainty about the status of hypochondriasis, the disorder is rarely diagnosed. To address this problem we examined the validity of DSM-III-R hypochondriasis as identified by structured interview. METHODS: Patients in a general medicine clinic were screened for hypochondriacal attitudes and symptoms. Those patients who scored above an established cutoff had a structured diagnostic interview, and 50 patients who met DSM-III-R criteria for hypochondriasis and 50 age- and sex-matched controls were thus identified. Information was obtained from both groups on health perceptions, health care utilization, and level of functioning using self-report and physician-rated measures. Additional information on diagnoses and treatment recommendations was obtained from record audits. RESULTS: Clinic physicians rated hypochondriacal subjects as having more unrealistic fear of illness (hypochondriasis) and diagnosed psychiatric and functional somatic syndromes more frequently in hypochondriacal than in control subjects. Hypochondriacal subjects viewed their health as worse, had more health worries, and had more severe psychiatric symptoms than control subjects. They also reported poorer physical functioning and work performance, greater health care utilization, poorer response to medical treatment, and less satisfaction with the care received than controls. CONCLUSIONS: Results show that, although the diagnosis of hypochondriasis is rarely made, physician recognition is high. They also show that several indicators of internal and external validity of this diagnostic category exist. Findings suggest that if physicians are to reduce the functional impairment and nonproductive health care utilization of these patients, they will need to make the diagnosis of hypochondriasis and intervene appropriately. However, for this to occur, research demonstrating predictive validity and treatment responsiveness of the disorder will be required.

Adult↗
PubMed1993

Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale.

Nine hundred and thirty inpatients and outpatients with cancer were approached to complete the Hospital Anxiety and Depression Scale (HADS). Eight hundred and nine (86.9%) of those approached participated in this screening. Using the suggested cutoff score of 8 for the anxiety and depression subscales, we found that 47.6% of this population would warrant further psychiatric evaluation. Twenty-three percent (23.1%) had scores 11 or greater and would be the most likely to have had anxiety (17.7%) or depressive (9.9%) disorders based on DSM-III-R criteria. Patients with active malignant disease and inpatient status were more likely to have higher depression scores. The HADS was an easily administered tool that identified a large proportion of cancer patients as having high levels of anxiety or depression. However, clinical psychiatric interviews were not performed, so it is not possible to determine what proportion of patients would benefit from treatment.

Adult↗
PubMed1993

Environmental factors related to the outcome of panic disorder. A seven-year follow-up study.

The purpose of this study was to examine factors related to the outcome of naturalistically treated panic disorder. In order to achieve this we followed up 69 patients 7 years after they had presented at a psychiatric clinic. At follow-up, the patients were generally doing well despite persisting symptoms. Patients who were more severely ill at the time of initial assessment had a worse outcome. These patients had more severe panic and agoraphobic symptoms, had illnesses of longer duration, and more often had histories of major depression. Among the developmental variables examined, separation from a parent by death or divorce was strongly related to poor outcome. Other factors associated with poor outcome included high interpersonal sensitivity, low social class, and unmarried marital status. The findings show that, for this chronic illness, measures of severity and chronicity predict more severe and persisting symptoms. They also indicate that outcome is importantly related to the social environment in which the illness develops and with which it interacts.

Adult↗
PubMed1993

Personality disorder in obsessive-compulsive volunteers, well comparison subjects, and their first-degree relatives.

OBJECTIVE: The authors sought to determine the frequency of DSM-III personality disorders in subjects with obsessive-compulsive disorder, well comparison subjects, and their first-degree relatives. METHOD: Thirty-two subjects with obsessive-compulsive disorder and 33 age-(within 5 years) and gender-matched well comparison subjects were assessed with the Structured Interview for DSM-III Personality Disorder and several self-report instruments. Their first-degree relatives were assessed in a blind manner with the same instruments. RESULTS: Subjects with obsessive-compulsive disorder were more likely than well comparison subjects to have a personality disorder, but compulsive personality was not the most frequent. No significant differences were found in the prevalence of personality disorders among first-degree relatives, including compulsive personality, or in obsessional, hysterical, or oral character traits. CONCLUSIONS: Personality disorders are highly prevalent among patients with obsessive-compulsive disorder, but the data do not support a relationship between obsessive-compulsive disorder and compulsive personality.

Adult↗
PubMed1992

A family study of obsessive-compulsive disorder.

First-degree relatives of probands with obsessive-compulsive disorder (OCD) (n = 32) and psychiatrically normal controls (n = 33) were blindly interviewed with the use of the Diagnostic Interview Schedule. The morbidity risk for anxiety disorders was increased among the relatives of obsessional subjects compared with that for the relatives of controls, but the risk for OCD was not. Risk for a more broadly defined OCD (including relatives with obsessions and compulsions not meeting criteria for OCD) was increased among the parents of obsessional subjects but not among the parents of controls (16% vs 3%). The findings suggest that an anxiety disorder diathesis is transmitted in families with OCD, but that its expression within these families is variable. The findings also support the current practice of classifying OCD as an anxiety disorder.

Adolescent↗
PubMed1992

A comparison of patients with illness phobia and panic disorder.

Fourteen subjects with illness phobia, a subtype of hypochondriasis, were compared with an equal number of subjects with panic disorder who had been matched for age and sex. The illness phobic subjects differed from panic subjects in not having spontaneous panic attacks or agoraphobic symptoms, the characteristic features of panic disorder. The onset of illness phobia was related to experience with illness in half the subjects. Half of the illness phobic subjects also had family histories of anxiety disorders. The results suggest that illness phobia is distinct from panic disorder and that it is a disorder in which environmental and genetic factors are etiologically important.

Adult↗
PubMed1992

Generalized anxiety disorder vs. panic disorder. Distinguishing characteristics and patterns of comorbidity.

In order to examine the validity of the distinction between generalized anxiety disorder (GAD) and panic disorder (PD) we compared 41 subjects with GAD and 71 subjects with PD. The GAD subjects had never had panic attacks. In contrast to the symptom profile in PD subjects suggestive of autonomic hyperactivity, GAD subjects had a symptom pattern indicative of central nervous system hyperarousal. Also, subjects with GAD had an earlier, more gradual onset of illness. In terms of coexisting syndromes, GAD subjects more often had simple phobias, whereas PD subjects more commonly reported depersonalization and agoraphobia. GAD subjects more frequently had first-degree relatives with GAD, whereas PD subjects more frequently had relatives with PD. A variety of measures indicated that our GAD subjects had a milder illness than those with PD. Also, fewer GAD subjects gave histories of major depression than did PD subjects. Among GAD subjects, coexisting major depression was associated with simple phobia and thyroid disorders and among PD subjects, comorbid depression was associated with social phobia and hypertension. Our findings indicate that the separation of GAD from PD is a valid one. They also indicate that, within disorders, unique patterns of comorbidity may exist that are important both clinically and theoretically.

Adult↗
PubMed1992

Adrenergic receptor genes as candidate genes for panic disorder: a linkage study.

OBJECTIVE: Several lines of investigation suggest that the noradrenergic neurotransmitter system may be involved in the pathogenesis of panic disorder. Since a mutation in a gene coding for one of the adrenergic receptors could account for both the familial nature and autonomic dysfunction of panic disorder, the authors performed analyses of the linkage between panic disorder and five adrenergic receptor loci. METHOD: The subjects were 14 multiplex pedigrees with DSM-III panic disorder or agoraphobia with panic attacks. The loci tested were the alpha 1/beta 2 pair on chromosome 5q32-q34, the alpha 2/beta 1 pair on chromosome 10q24-q26, and a second alpha 2 locus on chromosome 4. Flanking loci were included in the analysis on chromosomes 5 and 10 to increase the informativeness of the adrenergic receptor loci. RESULTS: Lod scores less than -2.0 were found at all five receptor loci. CONCLUSIONS: These findings provide strong evidence against the possibility that genetic mutation at any of these loci is responsible for panic disorder in these pedigrees.

Adolescent↗