Biomedical subjects

W Katon

Publications and source records attributed to W Katon.

At least 19 recordsLinked to original sources

PubMed1992

Chronic fatigue syndrome criteria. A critique of the requirement for multiple physical complaints.

OBJECTIVE: The purpose of this study was to test the hypothesis that the patients with chronic fatigue who have the highest number of medically unexplained physical symptoms over their lifetime would also have the highest prevalence of current and lifetime affective and anxiety disorders, lifetime affective symptoms, and the most functional disability. A further goal was to use this information to modify the current case definition to better identify a subgroup of patients with chronic fatigue syndrome who are less likely to have psychiatric illness. DESIGN: Two hundred eighty-five consecutive patients with chronic fatigue were interviewed with the National Institute of Mental Health Diagnostic Interview Schedule and completed four self-rating questionnaires measuring psychologic distress, functional disability, and the tendency to amplify symptoms. Based on previously published data, patients were divided into four groups with a progressively higher number of lifetime medically unexplained physical symptoms. The prevalence of current and lifetime psychiatric disorders, lifetime psychologic symptoms, and extent of functional impairment was then compared in these four groups of patients. MAIN RESULTS: The prevalence of current and lifetime psychiatric diagnosis and lifetime depressive symptoms increased linearly with the number of lifetime physical symptoms that the patient experienced. The extent of impairment in activities of daily living and the tendency to amplify symptoms also increased linearly with the number of medically unexplained physical symptoms. CONCLUSION: The patients with the highest numbers of medically unexplained physical symptoms had extraordinarily high rates of current and lifetime psychiatric disorders. These data suggest that the current case definition for chronic fatigue syndrome inadvertently selects for patients with the highest prevalence of lifetime psychiatric diagnoses. A recommendation based on these results is to modify the case criteria for chronic fatigue syndrome to include patients with fatigue and few physical symptoms and to identify and consider excluding patients with high numbers of physical complaints.

Anxiety Disorders↗

PubMed1992

Disability and depression among high utilizers of health care. A longitudinal analysis.

We evaluated, among depressed medical patients who are high utilizers of health care, whether improved vs unimproved depression is associated with differences in the course of functional disability. At baseline, 6 months, and 12 months, depression and disability were assessed among a sample of enrollees in health maintenance organizations (N = 145) in the top decile of users of ambulatory health care who exceeded the 70th percentile of health maintenance organization population norms for depression. Improved depression was defined as a reduction of at least one third in depressive symptoms averaged across the two follow-up times. At the 12-month follow-up, persons with severe-improved depression experienced a 36% reduction in disability days (79 days per year to 51 days per year) and a 45% reduction in disability score. Persons with moderate-improved depression experienced a 72% reduction in disability days (62 days per year to 18 days per year) and a 40% reduction in disability score. In contrast, persons with severe-unimproved depression reported 134 disability days per year at baseline, while persons with moderate-unimproved depression reported 77 disability days per year at baseline. Neither group with unimproved depression showed improvement in either disability days or disability score during the 1-year follow-up period. High utilizers of health care with severe-unimproved depression were more likely to have current major depression and to be unemployed. Improved (relative to unimproved) depression was associated with borderline differences in the severity of physical disease and in the percent married. We conclude that depression and disability showed synchrony in change over time. However, depression and disability may show synchrony in change with disability because both depression and disability are controlled by some other factor that influences the chronicity of depression (eg, chronic disease or personality disorder). The finding of synchronous change of depression and disability provides a rationale for randomized controlled trials of depression treatments among depressed and disabled medical patients to determine whether psychiatric intervention might improve functional status in such patients. Such research is needed to determine whether there is a causal relationship between depression offset and reductions in functional disability.

Activities of Daily Living↗

PubMed1992

A randomized trial of psychiatric consultation with distressed high utilizers.

This study reports the results of a randomized trial of a psychiatric consultation intervention with distressed, high utilizing patients of 18 physicians in two primary care clinics. Psychiatric consultation was associated with a significant increase in the use of antidepressants in intervention patients compared with controls in the first 6 months after intervention. Intervention patients were also significantly more likely to continue antidepressant treatment than control patients. The primary care physicians receiving psychiatric consultations increased the rate of prescribing antidepressant medications in their practice from 32 prescriptions filled per 1,000 visits before their participation in four consultations to 44 new prescriptions per 1,000 visits in the 12-month period after. There were no significant differences between intervention patients and controls at 6 and 12 months after randomization in psychiatric distress, functional disability, or utilization of health care (ambulatory visits, radiographic and laboratory testing services, admissions to inpatient medical care).

Ambulatory Care↗

PubMed1992

Epidemiology of depression in primary care.

Major depressive disorder has been recently found to be associated with high medical utilization and more functional impairment than most chronic medical illnesses. Major depression is a common illness among persons in the community, in ambulatory medical clinics, and in inpatient medical care. Studies have estimated that major depression occurs in 2%-4% of persons in the community, in 5%-10% of primary care patients, and 10%-14% of medical inpatients. In each setting there are two to three times as many persons with depressive symptoms that fall short of major depression criteria. Recent studies have found that in one-third to one-half of patients with major depression, the symptoms persist over a 6-month to one-year period. The majority of longitudinal studies have determined that severity of initial depressive symptoms and the presence of a comorbid medical illness were predictors of persistence of depression.

Cross-Sectional Studies↗

PubMed1992

Adequacy and duration of antidepressant treatment in primary care.

Among a sample of 119 distressed high-utilizers of primary care, 45% of patients evaluated by a psychiatrist as needing antidepressant treatment had been treated in the year before the examination. However, only 11% of the patients needing antidepressants had received adequate dosage and duration of pharmacotherapy. In the year following the intervention, study patients whose physicians were advised regarding treatment during a psychiatric consultation were more likely to receive antidepressant medications (52.7%) relative to a randomized control group (36.1%). However, the intervention did not significantly increase the provision of adequate antidepressant therapy (37.1% vs 27.9%). Among study patients using antidepressants, patient characteristics did not differentiate patients who received adequate dosage and duration of antidepressant medications from those who did not. Analysis of data on the duration of antidepressant therapy for all health maintenance organization enrollees initiating use of antidepressants showed that only 20% of patients who had been given prescriptions for first-generation antidepressants (amitriptyline, imipramine, or doxepin) filled four or more prescriptions in the following six months, compared to 34% of patients who had prescriptions for newer antidepressants (nortriptyline, desipramine, trazodone and fluoxetine). Experimental research evaluating whether these newer medications (with more favorable side effect profiles) improve adherence, and thereby patient outcome, is needed.

Adult↗

PubMed1991

Mixed anxiety and depression.

We review evidence from community, primary care, and psychiatric samples to determine whether there are a group of patients who have mixed symptoms of anxiety and depression that are below diagnostic thresholds for either group of disorders. A review of the data strongly suggests that such a group of patients exists and that, despite lacking sufficient symptoms to meet diagnostic thresholds from the revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987), they often have significant impairment in social and vocational functioning. Because many of these patients also suffer from medically unexplained somatic symptoms, they may be more likely to frequently use nonpsychiatric medical care. Longitudinal studies suggest that persons with mixed anxiety-depression symptoms may represent a population who are at increased risk for more severe mood and anxiety disorders.

Anxiety Disorders↗

PubMed1991

Somatization: a spectrum of severity.

OBJECTIVE: The DSM-III-R diagnosis of somatization disorder requires that a patient have a specific number of medically unexplained somatic symptoms. This number of symptoms was developed by committee consensus, and it is not clear whether patients with this specific number of symptoms can be differentiated from patients with lower but still substantial numbers of somatic symptoms. METHOD: Fifty-one percent of 767 high utilizers of two primary care clinics were identified as distressed by an elevated SCL anxiety, depression, or somatization scale score or by their primary care physician. The Diagnostic Interview Schedule (DIS) was completed on 119 distressed high utilizers who were randomly assigned to an intervention group in a controlled trial of psychiatric consultation. The 119 distressed high utilizers were separated into four categories according to the number of unexplained somatic symptoms found on the DIS and were compared on demographic, psychiatric distress, disability, medical, and health utilization variables. RESULTS: The data suggest that many clinical and behavioral features of somatization are significantly more common in patients with four to 12 medically unexplained somatic symptoms rather than changing dramatically at the diagnostic threshold for somatization disorder. The data also showed that patients who meet the DSM-III-R criteria for somatization disorder are severely ill and have a high burden of psychiatric illness and disability. CONCLUSIONS: The results suggest that the DSM-IV somatoform disorders section should include somatization disorder, an abridged definition of somatization disorder often associated with anxiety and depression, as well as a type of somatization associated with an adjustment disorder.

Activities of Daily Living↗

PubMed1990

Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs.

Among a sample of 767 high utilizers of health care, 51% were identified as distressed by an elevated score on the SCL anxiety and depression scales, the SCL somatization scale, or by their primary-care physician. These distressed high utilizers were found to have a high prevalence of chronic medical problems and significant limitation of activities caused by illness. In the prior year, they made an average of 15 medical visits and 15 telephone calls to the clinic. The Diagnostic Interview Schedule was completed on 119 distressed high utilizers randomly assigned to an intervention group in a controlled trial of psychiatric consultation. The following DSM-III-R disorders were most common: major depression 23.5%, dysthymic disorder 16.8%, generalized anxiety disorder 21.8%, and somatization disorder 20.2%. Two thirds had a lifetime history of major depression. The examination resulted in an improved diagnostic assessment for 40% of intervention patients and a revised treatment plan for 67%.

Adolescent↗

PubMed1990

Appraised changeability of a stressor as a modifier of the relationship between coping and depression: a test of the hypothesis of fit.

The goodness of fit among the appraised changeability of a stressor, coping, and depression in people with psychiatric, physical health, work, and family problems was examined (N = 746). It was expected that problem-focused coping (as opposed to emotion-focused coping) would be used more and be more adaptive in situations appraised as changeable as compared with situations appraised as not changeable. Although few relationships existed between appraisal and coping, tests of fit between coping and depressed mood (maladaption) were much stronger. In people with nonpsychiatric conditions, problem-focused coping and depressed mood were negatively related when a stressor was appraised as changeable but were unrelated when a stressor was appraised as not changeable. Emotion-focused coping was positively related to depression when a stressor was appraised as changeable. No general relations were observed in the people with psychiatric conditions.

Adaptation, Psychological↗

PubMed1990

Coping profiles associated with psychiatric, physical health, work, and family problems.

Compares the coping profiles of 11 samples (total N = 1,298) of individuals experiencing psychiatric, physical health, work, or family problems. Comparisons are made in individuals with and without anxiety and depression to control for the effects of distress. Coping was similar for samples in similar problem categories but different for samples in different categories. Psychiatric patients made more use of avoidance and less use of social supports than individuals in the other categories. Samples with physical health problems were among the most frequent users of social supports. Individuals with a family problem were among the most frequent users of problem-focused coping and the least frequent users of self-blame. Groups with work stress were the most frequent users of self-blame. These results suggest that coping profiles may be useful in describing and differentiating groups of stressed individuals.

Adaptation, Psychological↗

PubMed1990

Anxiety and depression in a village in Lesotho, Africa: a comparison with the United States.

Adults in a village in Lesotho, Africa, were interviewed to determine the community prevalence of major depression, panic disorder, and generalised anxiety disorder. The prevalence data were compared with data from a large epidemiological study in the United States utilising the same research instrument. There was a significantly higher prevalence of all three diagnoses in Lesotho as compared with the United States. As in the United States, women were at an increased risk for these disorders, although statistical significance was not demonstrated for depression. The majority of people (77%) who had experienced panic attacks said they had sought help for their symptoms, with the majority attending Western-trained doctors. The relationship between explanatory models and help-seeking behaviour was explored in people who had had panic attacks. Less than 40% of those with generalised anxiety disorder said they sought help.

Adult↗

PubMed1990

Depression and chronic medical illness.

Major depression is the most common clinical problem primary care physicians are called upon to diagnose and treat. Depression is associated with high medical care utilization, amplification of somatic symptoms and disability, poor self-care and adherence to medical regimens, and increased morbidity and mortality from medical illness. Despite the high prevalence and the maladaptive effects of major depression on patients' lives, this affective illness is often not accurately diagnosed or effectively treated. Double-blind, placebo-controlled studies have increasingly demonstrated efficacy of the antidepressant agents in primary care patients, patients with chronic pain, and patients with comorbidity--chronic medical illness and major depression.

Antidepressive Agents↗

PubMed1989

Coping in chest pain patients with and without psychiatric disorders.

We first examined relations between psychiatric disorder and coronary heart disease (CHD) in 77 patients presenting with chest pain. The coping profiles of chest pain patients with and without psychiatric disorder and CHD were then compared. Psychiatric patients with no medical illness (n = 129) were also studied. On the basis of previous research we hypothesized specific coping differences across the groups. As expected, chest pain patients without psychiatric disorder scored significantly higher on a problem-focused coping scale than chest pain patients with psychiatric disorder, who in scored higher on this scale than psychiatric patients with no medical illness. The opposite pattern occurred for a measure of wishful thinking. Scores of chest pain patients with psychiatric disorder were higher on a measure of avoidance and lower on a measure of seeking of social supports than those without psychiatric disorder. Scores on a self-blame measure were not different across the groups. The results are discussed in the context of illness behavior and somatization.

Adaptation, Psychological↗

PubMed1989

Relationship between endometriosis and affective disorder.

Comparing 14 women with and 55 women without endometriosis, the authors found no significant differences in the prevalence of affective disorder. They discuss the discrepancy between their finding and Lewis et al.'s finding of an association between affective disorder and endometriosis.

Adult↗

PubMed1989

Somatic symptoms and depression.

Patients with psychiatric illness frequently visit their medical physicians with somatic complaints or amplification of complaints about chronic medical illness, yet few of these patients meet Diagnostic and Statistical Manual of Mental Disorders-Third Edition (DSM-III) criteria for a somatoform disorder. In a sample of 197 medical patients interviewed with the Diagnostic Interview Schedule, only 7.1% met DSM-III criteria for somatization disorder, but nearly one third of these patients met criteria for an abridged notion of somatization. Patients with current and lifetime major depression had significantly higher mean totals of positive somatic symptoms compared with controls who had no psychiatric disorder. Nearly one half of these patients with one or more depressive episodes in the course of their lifetime met the abridged criteria for somatization. This association of major depression with somatization is quite similar to findings from the Epidemiologic Catchment Area study suggesting that major depression, not the somatoform disorders, may be associated with most of the somatization seen in medical clinics.

Adult↗

PubMed1989

Panic disorder in the medically ill.

The authors describe five patients with concurrent panic disorder and medical illness. Panic disorder either caused worsening of the medical illness or was associated with continued physiologic symptoms that mimicked the symptoms of the medical illness after the illness had improved. In both cases, panic disorder was associated with high rates of medical utilization, increased patient suffering, and often costly medical tests. Accurate diagnosis and treatment decreased physiologic and psychiatric symptoms as well as medical utilization.

Adult↗

PubMed1988

Chest pain: relationship of psychiatric illness to coronary arteriographic results.

Seventy-four patients with chest pain and no prior history of organic heart disease were interviewed with a structured psychiatric interview immediately after coronary arteriography. The majority of patients with both negative and positive coronary angiographies had undergone previous exercise tolerance tests, but the patients with angiographic coronary artery disease were significantly more likely to have had positive results on a treadmill test. Patients with chest pain and negative coronary arteriograms were significantly younger; more likely to be female; more apt to have a higher number of autonomic symptoms (tachycardia, dyspnea, dizziness, and paresthesias) associated with chest pain, and more likely to describe atypical chest pain. Patients with chest pain and normal coronary arteriographic results also had significantly higher psychologic scores on indices of anxiety and depression and were significantly more likely to meet criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, for panic disorder (43 percent versus 6.5 percent), major depression (36 percent versus 4 percent), and two or more phobias (36 percent versus 15 percent) than were patients with chest pain and a coronary arteriography study demonstrating coronary artery stenosis.

Age Factors↗

PubMed1988

Disabling tinnitus. Association with affective disorder.

Forty consecutive patients with disabling tinnitus were interviewed using a structured psychiatric interview and were asked to complete the Hopkins Symptom Checklist (SCL-90), the Chronic Illness Problem Inventory, and the Revised Ways of Coping Checklist. They were compared to a control group of 14 patients attending the same otolaryngologic clinic with a complaint of hearing loss. The tinnitus patients had a significantly greater lifetime prevalence of major depression (78% vs 21%) than controls and a significantly higher prevalence of current major depression (60% vs 7%). The currently depressed tinnitus patients had significantly higher scores on all subscales of the SCL-90 compared to the nondepressed tinnitus group and to the controls. The number of psychological problems as measured by the Chronic Illness Problem Inventory was significantly greater in the tinnitus group than in controls. This difference in psychosocial disability was due to the high psychologic and social impairment in the depressed tinnitus group, as there were no significant differences in psychosocial problems between the nondepressed tinnitus group and the controls. These results demonstrate that tinnitus disability is strongly associated with major depression and suggest that treatment of the concurrent affective illness may reduce disability due to tinnitus.

Depressive Disorder↗