Biomedical subjects
Publications and source records attributed to S R Dager.
Intravenous sodium lactate was given to seven patients with primary depression and secondary panic attacks and 26 patients with panic disorder or agoraphobia with panic attacks. The two groups had similar rates of panic response. These results challenge the diagnostic specificity of lactate-induced panic.
Fifty consecutive panic patients had M-mode echocardiographs read independently by two cardiologists with expertise in echocardiography. In this prospective study, there was poor interrater reliability (22 of 50; K = 0.11) for diagnosis of mitral valve prolapse (MVP). On repeat evaluation 10 months later there was also unacceptable intrarater reliability for each reader: 22 of 35 (K = 0.41) and 22 of 35 (K = 0.45). We conclude that M-mode echocardiography is clinically unreliable for establishing the diagnosis of mitral valve prolapse. These findings suggest that the variable reporting of M-mode-determined mitral valve prolapse in psychiatric populations may reflect differences among echocardiologists rather than differences in cardiac pathology. The clinical implications of these findings are discussed.
This study examined the relationship between the chronic disorders, generalized anxiety disorder (GAD) and dysthymic disorder (DD), and the more acute disorders, panic disorder (PD) and major depressive disorder (MDD) in 110 psychiatric outpatients with diagnoses of either PD, MDD, GAD, or DD. Pure, mixed, and early-/late-onset forms of the chronic disorders were compared with each other and then with PD and MDD on clinical measures and psychiatric history. Minimal differences were found between pure GAD and mixed GAD or between pure DD and mixed DD. The chronic disorders, DD and GAD, had distinct clinical symptom profiles when compared with each other and appeared more closely related to their parent disorders than to each other. However, despite these similarities, there were significant differences between DD and MDD in contrast to the minimal differences between GAD and PD, providing less support for GAD as a valid diagnostic category separate from PD. Comparisons of early-/late-onset DD and GAD showed more severe symptoms in late-onset DD, in contrast to more severe symptoms in early-onset GAD. These varying patterns of symptom severity may warrant study for further syndromal delineation.
"Psychological injury" in the workplace constitutes the fastest-growing sector of workers' compensation disability claims in several states. Most such claims pertain to effects of "occupational stress," including interpersonal conflicts with supervisors or co-workers, adaptation to changing work practices, and job insecurity. Of equal interest are the psychological consequences of chemical insults on the job. In the case of occupational respiratory exposures, psychological co-morbidity may occur along with a variety of acute, chronic, and latent illness states. Both predictable responses (such as adjustment reactions to disabling physical conditions) and idiopathic patterns (such as the development of odor-conditioned panic attacks or panic disorder) have been described. Physicians who evaluate and treat such patients need to be alert to the potential interaction of physiological and psychological stressors. Effective prevention and treatment requires not only an appreciation of the patient's view of the disease process, but also a recognition of the role of prognostic uncertainty in the subsequent development of anxiety symptoms. In some cases, exclusive attention to physical signs and symptoms may actually lead to a worsening of impairment and disability.