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Biomedical subjects

W Katon

Publications and source records attributed to W Katon.

At least 91 records · Page 5Linked to original sources
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↗
PubMed1988

Chest pain with negative cardiac diagnostic studies. Relationship to psychiatric illness.

A total of 98 patients with chest pain and no prior history of organic heart disease underwent a structured psychiatric interview at the time of cardiac diagnostic testing, either coronary arteriography or exercise treadmill. Patients with negative cardiac test results were significantly younger and more likely to be female, endorsed a greater number of autonomic symptoms with their chest pain, and were more likely to report atypical chest pain. These patients had significantly higher scores on measures of anxiety and negative life events and significantly greater prevalences of DSM-III panic disorder (47% vs. 6%), major depression (39% vs. 8%), and two or more simple phobias (43% vs. 12%) than did patients with cardiac test results demonstrating coronary artery disease. Using logistic regression, a model was developed to estimate the probability of negative cardiac test results from patient characteristics and psychiatric diagnoses.

Adult↗
PubMed1988

Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse.

Structured psychiatric and sexual abuse interviews were administered to 25 women with chronic pelvic pain and a comparison group of 30 women with specific gynecological conditions. All 55 patients underwent diagnostic laparoscopy, and the results of the fiberoptic pelvic examination were objectively classified by the study gynecologist, who was blind to the psychiatric diagnoses. The patients with chronic pelvic pain showed a significantly higher prevalence of major depression, substance abuse, adult sexual dysfunction, somatization, and history of childhood and adult sexual abuse than the comparison group. There were no significant differences between the groups in severity or type of pelvic pathology.

Adolescent↗
PubMed1988

The association between chronic pelvic pain, psychiatric diagnoses, and childhood sexual abuse.

Twenty-five women with chronic pelvic pain who had undergone diagnostic laparoscopy and 30 women who had laparoscopic examinations for tubal sterilization or infertility investigation were compared psychologically using structured psychiatric and sexual abuse interviews. Results of the fiberoptic pelvic examination were rated independently using the American Fertility Society classification of endometriosis. Compared with controls, the patients with chronic pelvic pain showed significantly greater prevalence of lifetime major depression, current major depression, lifetime substance abuse, adult sexual dysfunction, and somatization. They were also significantly more likely than controls to have been a victim of childhood and adult sexual abuse. There were no significant differences in either the degree or type of pelvic disease between patients with pelvic pain and controls.

Child↗
PubMed1988

Antidepressants in the medically ill: diagnosis and treatment in primary care.

Major depression is one of the most common clinical problems seen by primary-care physicians. The prevalence is 5% to 10% in primary-care outpatients and 15% in medically ill inpatients. Despite this high prevalence rate, depression is frequently not accurately diagnosed. Evidence suggests that misdiagnosis often occurs because patients with depression frequently focus preferentially on somatic complaints or amplify complaints of chronic medical illness. The tricyclic antidepressants are more effective than placebo, both in treating medically ill patients with depression and primary-care patients with major depression. Common side effects of the tricyclic antidepressants such as the anticholinergic, cardiac, and blood-pressure problems are reviewed, with emphasis on the use of specific tricyclics in medically ill populations.

Antidepressive Agents, Tricyclic↗