Biomedical subjects

V Manicavasagar

Publications and source records attributed to V Manicavasagar.

35 records · Page 2Linked to original sources

PubMed1993

Adults who feared school: is early separation anxiety specific to the pathogenesis of panic disorder?

Although juvenile separation anxiety disorder is maintained to be a predisposing factor to adult panic disorder in DSM-III-R, past research has failed to clarify (a) whether it is separation anxiety per se or school refusal that is the pathogenic risk factor and (b) whether affected youngsters are specifically at risk of developing panic disorder rather than symptoms of general anxiety or phobias in later life. The present study of 74 adults who responded to media publicity found that a measure of early separation anxiety but not a history of school refusal was associated with risk of adult panic disorder according to DSM-III-R criteria. In contrast, separation anxiety scores were not associated with the presence or absence of general anxiety symptoms or phobic-avoidance in adulthood. Subjects with higher separation anxiety scores were more likely to have either a sibling or child with school refusal. Although the present study is limited in its method to mailed survey responses and, in part, to retrospective data, the results do provide additional support for Klein's influential separation anxiety theory of panic disorder.

Adult↗

PubMed1993

Variations in therapeutic interventions for Cambodian and Chilean refugee survivors of torture and trauma: a pilot study.

The treatment of refugee survivors of torture and trauma has attracted increasing clinical attention. The present study surveyed therapists concerning the emphasis that was placed on disclosure of previous traumatic experiences in therapy with refugees from Chile and Cambodia. Significant differences were found between the two groups with trauma story discussion being judged by therapists to be more important to treatment outcome in Chilean patients. The problem of potential therapist bias limits definitive conclusions, however we suggest that differences in cultural preparedness for psychotherapy aimed at uncovering previous traumatic experiences may be the main reason for variations in styles of therapy offered to these distinctive ethnic groups. Other possible explanations are differences in diagnostic profiles and types of previous traumatic experiences.

Acculturation↗

PubMed1993

The development of the Separation Anxiety Symptom Inventory (SASI).

Separation anxiety continues to be implicated as an early risk factor to adult emotional disorder but recent research findings are somewhat contradictory. Inconsistencies in approaches to measuring memories of early separation anxiety may have contributed to this lack of clarity. We report the development of a brief self-report instrument, the Separation Anxiety Symptom Inventory (SASI), which was designed to overcome some of these deficiencies in measurement. The SASI was shown to have a coherent factorial structure, high internal consistency (Cronbach's Alpha > .80) and test-retest reliability over an average of 24 months (Intraclass Correlation Coefficient = .89), with serial scores not being affected by changes in contemporaneous anxiety levels. Some index of the validity of the measure was achieved by (a) comparing SASI scores of index twins with descriptors of their "insecure" behaviours in early life provided by corresponding co-twins; (b) comparing SASI scores with retrospective DSM III-R diagnoses of early anxiety disorders obtained by structured interviews; and (c) examining SASI scores in subjects with histories of school refusal. The SASI provides a useful standardised measure which will aid in the further testing of the separation anxiety hypothesis of adult emotional disorder.

Adolescent↗

PubMed1993

Reported early separation anxiety symptoms in patients with panic and generalised anxiety disorders.

Attachment theory has proposed that early separation anxiety is a risk factor for adult anxiety disorder, with the recent focus being particularly on panic disorder. The results of empirical studies examining this link are, however, contradictory, possibly because of inconsistencies across studies in measuring memories of early separation anxiety. In the present study, a psychometrically sound measure, the Separation Anxiety Symptom Inventory (SASI) was used to compare memories of such early symptoms in panic disorder (including those with mild phobic-avoidance), generalised anxiety disorder and control subjects. Anxiety patients as a group returned higher SASI scores (p < 0.001) with a non-significant trend for panic disorder patients to score higher than those with generalised anxiety. These results suggest that early separation anxiety may be a harbinger of adult anxiety and that risk of panic disorder may be higher in the most severely affected youngsters. As a risk factor, early separation anxiety does not however appear to be uniquely related to adult panic disorder.

Adult↗

PubMed1993

Non-sexist Sexual Experiences Survey and Scale of Attraction to Sexual Aggression.

Sixty-six male and 51 female second year medical students anonymously completed the Sexual Experiences Survey (SES) and the Attraction to Sexual Aggression (ASA) Scale, both modified so that women could report behaviours in which they were aggressors, and men, behaviours in which they were victims. Men's aggression scores on the two scales were significantly correlated. As expected, more men than women reported both the likelihood and the experience of being sexual aggressors, although 6% of women reported being so aroused they couldn't stop when their partner didn't want intercourse and 13% of men reported having intercourse against their will. In men sexually coercive behaviours correlated positively with the masculinity scale of the Bem Sex Role Inventory. Fewer female medical students reported experiencing sexually aggressive behaviours compared to US or New Zealand university students; however, the percentage of male students who reported using or threatening to use physical force was in the same range as that of US students. Significant attention to the issue of sexual coercion would appear necessary in the education of medical students.

Adult↗

PubMed1991

Parental representations of patients with panic disorder and generalised anxiety disorder.

Previous studies using the Parental Bonding Instrument have shown a general trend for neurotic subjects to score their parents as less caring and more protective. Such a finding was broadly replicated in a study of 80 clinically anxious subjects and age- and sex-matched controls. Although direct comparisons of PBI scores failed to reveal clear-cut differences between generalised anxiety (GA) and panic disorder (PD) subgroups, logistic regression analyses revealed higher odds ratios for parental assignment to aberrant categories in the GA group, with PD patients reporting a more limited pattern of overprotective parenting only. Our findings suggest that adverse parental behaviour may be relevant to the pathogenesis of GA, while parental 'affectionate constraint' may be a parental response to early manifestations of PD.

Adult↗

PubMed1990

Perceptions of general and specific therapist behaviors.

In the process of developing a two-part therapist rating scale, we obtained questionnaire responses from a large sample of subjects who had undergone one of a variety of psychotherapies. Our data support the importance of perceived therapist care as a strong correlate of patient satisfaction, and patients seemed able to discriminate clearly between psychodynamic and cognitive-behavioral therapies. In the first (nonspecific) questionnaire, we derived five dimensions (Care-Concern, Directive-Control, Critical-Confronting, Understanding, and Charisma) from principal-components analyses, with the first two dimensions being relatively independent of each other. A multiple-regression analysis revealed that combined scale scores accounted for 50% of the variance of patient satisfaction ratings, with the Care dimension accounting for most of this effect. In the second questionnaire, data were analyzed from respondents who had undergone therapy with known cognitive-behavioral or psychodynamic therapists; but, in a minority of subjects who were recruited through the media, we depended on detailed descriptive vignettes to allocate them to one or another of these "specific" types of psychotherapy. Six scales emerged, three characterizing cognitive-behavioral therapies (Behavioral Task Orientation, Organization, and Cognitive Focus) and three representing psychodynamic therapies (Transference, Inner Conflict, and Relationship). Subjects' ratings on all scales strongly discriminated between the two broad modalities of therapy, suggesting that patient reports may provide valid measures of therapist styles. We conclude that questionnaires such as the one we are developing may provide economical measures for assessing therapist consistency when comparing different modalities of psychotherapy.

Adult↗

PubMed1988

Neurotic depression: delineation of symptom profiles and their relation to outcome.

Ninety-one subjects diagnosed clinically as having a 'neurotic depression' were interviewed and then re-assessed at 6 weeks and 20 weeks. Four symptom profiles of clinical features were derived: 'negative cognition', 'lack of drive', 'anxiety', and 'arousal', the last being independent of the other three dimensions and of the severity of depression. Symptom profile scores were then examined against antecedent risk variables and outcome. Links between profile scores and personality variables suggest that personality may colour the clinical presentation of neurotic/reactive depressions, and challenge the assumption that a typology of these depressive disorders based on clinical features is achievable. The break-up of an intimate relationship in the preceding 12 months was a strong predictor of a good outcome. Further analyses suggested, firstly, that there was a distinct subgroup delineated by this life event, with features weighted to the 'arousal' symptom profile, including many symptoms often associated with diagnosis of 'endogenous depression'; and, secondly, that this life event and a good outcome were directly linked, being uninfluenced by personality or other mediating variables.

Anxiety↗

PubMed1986

Childhood bereavement circumstances associated with adult depression.

Seventy-nine women whose mothers had died during the subjects' childhood and whose fathers had remarried were studied to determine how bereavement might dispose to depression in adulthood. Lower social class appeared the most consistent predictor. The sudden death of the mother, the older age of the child, the perception of family support as being deficient in the immediate post-bereavement phase, a longer delay between the mother's death and the stepmother's assuming a maternal role, and the judgement of any replacement mother-figure as being inadequate were associated with adult depression. An important negative finding was that depression in the bereavement phase was neither predictive of a subsequent episode of depression nor of higher levels of state and trait depression in adulthood.

Adult↗

PubMed1984

Depression in general practice.

The nature and course of depressive disorders in a group of general practice patients were assessed by screening 564 subjects who attended representative practices in Sydney by means of a self-report depression inventory. Of these, 25% of women and 17% of men reported significant depressive symptoms. An interview was sought with these "potential depressives" to determine, in particular, the extent to which they might be considered to have a psychiatric disorder, using the PSE case-finding procedure. Of those interviewed, 83% scored as psychiatric "cases", while the mean duration of their depression was nine months. A longitudinal component to the study suggested that the mental condition of the sample had improved minimally at six weeks' and at 20 weeks' follow-up assessments.

Adult↗

PubMed1984

Publishing in the parish.

A consecutive series of 500 papers submitted to the 'Australian and New Zealand Journal of Psychiatry' is evaluated to provide information on Journal publication procedures, to assess the Journal peer review process and to examine factors associated with the outcome of submissions. While the majority of submissions was by psychiatrists and psychologists, the highest acceptance rates were for papers presented by psychiatric registrars and by psychiatrists. Of the submissions for which a final decision had been made, 50% were accepted for publication and very few papers were accepted without revision. Regional differences in submission rates were noted and, more importantly, regional differences in acceptance rates were quantified. A subsidiary analysis suggested that the latter differences reflected a general pattern and were not peculiar to, or a reflection of, Journal policy.

Australia↗

PubMedDate not supplied

Depression in general practice attenders. "Caseness", natural history and predictors of outcome.

Assessment of 564 routine attenders of 12 Sydney general practices established that 25% of the women and 17% of the men scored as "potential depressives". Thirty-five agreed to an interview and review over 6 months, with 83% of this group initially rating as a "psychiatric case" on the Present State Examination. The sample could be characterized as being chronically depressed (mean duration of 9 months), as predominantly (86%) female, in having relatively stable but dysfunctional relationships, and by having experienced chronic and acute-on-chronic stressors. The degree of which subjects improved in the following 20 weeks could be predicted by their degree of improvement in the first few weeks and as early as the 6th day after assessment. While overall improvement was minimal, several baseline predictors of a better outcome were suggested: a history of having episodic or recurrent episodes, a more severe depression, lower social class, break-up of an intimate relationship as a precipitant, a neutralizing life event and family support. Married subjects and those with young children had a poor outcome.

Adjustment Disorders↗

PubMedDate not supplied

Is early separation anxiety a risk factor for adult panic disorder?: a critical review.

Heightened levels of early separation anxiety (SA) have long been linked to the risk of adult panic disorder (PD), suggesting that the two types of anxiety arise from a common diathesis--a proposition that has considerably influenced the classification of the anxiety disorders. However, the SA-PD link remains contentious, with some recent studies failing to confirm that putative association. All published research studies investigating the relationship of early SA to PD and/or other anxiety disorders were reviewed. Taken as a whole, the evidence provides support for the SA-PD hypothesis, although the specificity of that relationship needs further clarification. Problems of sample selection, retrospective measurement of early SA and comorbid diagnoses limit the certainty with which inferences can be drawn from existing data. Nevertheless, a recent community-based study provides additional support for the SA-PD hypothesis. Possible developmental pathways linking SA to PD are considered. One possibility that has not received adequate research attention is that early SA disorder (SAD) may persist into adulthood, rendering the sufferer vulnerable to panic and other anxiety symptoms when confronted with salient life stressors. We conclude that it is premature to reject the SA hypothesis of PD. Only well-designed longitudinal studies can map the complex developmental pathways linking early and later manifestations of morbid anxiety.

Adolescent↗

PubMedDate not supplied

Separation anxiety in adulthood: a phenomenological investigation.

Separation anxiety disorder is well recognized as a juvenile psychiatric disorder, but it appears to be rarely diagnosed in adulthood. Drawing on our clinical impressions and a review of the relevant literature, we sought to investigate whether separation anxiety symptoms could be identified in adulthood. Forty-four subjects recruited by a media campaign were administered a semistructured interview and a self-report checklist for adult separation anxiety (ASA) symptoms, as well as the Separation Anxiety Symptom Inventory (SASI), a retrospective measure of early separation anxiety symptoms. Diagnoses of major depressive disorder (MDD), panic disorder (PD), agoraphobia (Ag), and dependent personality disorder were made using the SCID-P and SCID-II. Thirty-six subjects met criteria for a putative diagnosis of ASA based on a global clinical rating and/or endorsement of DSM-IV-derived criteria. Although most subjects dated the separation anxiety symptoms to their juvenile years, it was notable that one third reported the first onset of separation anxiety symptoms in adulthood. Although comorbid lifetime anxiety or depressive disorders were common, the majority of subjects reported that the separation anxiety symptoms predated other axis I disorders. Only six subjects (17%) were diagnosed with dependent personality disorder. Although limited by the method of sampling, this preliminary study suggests the need to examine more systematically whether a form of separation anxiety disorder may occur in adulthood.

Adult↗

PubMedDate not supplied

Continuities of separation anxiety from early life into adulthood.

The study investigates whether a putative diagnosis of separation anxiety disorder can be identified in adulthood and whether there are continuities between juvenile and adult forms of the disorder. Seventy patients with conventional adult diagnoses of panic disorder and generalized anxiety disorder attending an anxiety clinic were administered an interview and checklist to assess separation anxiety (SA) symptoms in adulthood. Memories of early SA were assessed using the Separation Anxiety Symptom Inventory (SASI). A subsample (n = 31) was used to calibrate the checklist against assignment to a category of adult separation anxiety disorder (ASAD) based on the structured interview. In an expanded sample (n = 70), patients assigned to the ASAD category returned statistically higher scores on the SASI, with the severity of juvenile SA symptoms accounting for 33% of the variance of adult SA scores (p < .001). Assignment of subjects to the putative ASAD category was not associated with any conventional adult anxiety diagnosis and symptoms of SA appeared to predate the onset of the other anxiety disorders. One possible explanation for the data is that, in some individuals, early onset separation anxiety disorder may persist into adulthood, but the symptoms may either be overlooked or, alternatively, obscured by secondary features such as panic.

Adolescent↗

PubMedDate not supplied

Is there a false memory syndrome? A review of three cases.

The controversy over recovered memories of childhood sexual abuse (CSA) is whether such experiences can be forgotten for long periods and retrieved later in therapy or in response to cues or triggers from the environment. False memory syndrome (FMS) is caused by memories of a traumatic experience--most frequently CSA--which are objectively false, but in which the person strongly believes. Personality factors often play a role in the development of FMS. Because CSA is such a devastating experience, false accusations of sexual abuse have enormous, if not shattering, consequences for families. We present three case reports to illustrate features of the FMS. FMS should be listed for further study to establish valid criteria for making the diagnosis under the category of "factitious disorders," and a subcategory of "false memories/beliefs of abuse," with a further subdivision of "induced by therapy." The FMS controversy occurred in the context of a general moral panic about sexual abuse in the early 1980s. Psychiatrists should have a high degree of scepticism to moral panics.

Adult↗

PubMedDate not supplied

A self-report questionnaire for measuring separation anxiety in adulthood.

Little attention has been given to measuring symptoms of separation anxiety (SA) in adulthood. The development of an Adult Separation Anxiety Questionnaire (ASA-27) is described and compared to a previously derived Adult Separation Anxiety Semistructured Interview (ASA-SI). Principal components analysis revealed a coherent construct of SA with high internal consistency (Cronbach's alpha =.95) and sound test-retest reliability (r =.86; P <.001). A receiver operation characteristic (ROC) analysis against the semistructured interview yielded a high area under the curve index (AUC = 0.9) suggesting that the questionnaire is an adequate alternative measure of SA. Results of this study support previous research suggesting that a construct of SA may be readily measured in adults.

Adult↗