Search PubMed⌕ Search

Biomedical subjects

W Katon

Publications and source records attributed to W Katon.

At least 109 records · Page 6Linked to original sources
PubMed1987

Chronic tinnitus: association with psychiatric diagnoses.

Twenty-one consecutive patients with severe tinnitus were interviewed using a structured psychiatric interview (the National Institute of Mental Health Diagnostic Interview Schedule) and were asked to complete the Hopkins Symptom Checklist (SCL-90) and the Chronic Illness Problem Inventory. They were compared to a control group of 14 patients attending an otolaryngological clinic with a complaint of hearing loss. The tinnitus patients had a significantly greater lifetime prevalence of major depression (62% vs 21%) than controls and a significantly higher prevalence of current major depression (48% vs 7%). The currently depressed tinnitus patients had significantly higher scores on all subscales of the SCL-90, except the phobia and paranoid subscales, compared to the non-depressed tinnitus group and on all scales compared to the controls. The number of psychosocial problems and thus the resulting disability experienced was significantly greater in the tinnitus group compared to controls and in the currently depressed tinnitus patients when compared to non-depressed tinnitus patients. In view of our results treatment should aim at not only alleviation of tinnitus, but also the frequently co-existing major depression.

Auditory Threshold↗
PubMed1987

Evaluation of psychiatric consultation-liaison in primary care settings.

This article considers eight methodologic issues in the evaluation of psychiatric consultation-liaison services in primary care settings. What should be evaluated--standardized treatment regimens administered to highly selected patient groups or individualized treatments administered to heterogeneous patient groups? How can patient groups be selected to test for generic outcomes resulting from individualized treatments? When should randomized designs be employed? Should patients or physicians be randomized? How should diagnostic classification of study subjects be accomplished? What outcomes should be measured? How can study design be accommodated to patient flow in clinical settings? What resources are required to establish a productive program of research in liaison psychiatry?

Humans↗
PubMed1987

Coping as an index of illness behavior in panic disorder.

Illness behavior in panic disorder was examined by comparing the coping strategies of female primary care patients (34 with panic disorder, 30 with simple panic, and 78 without panic.) Relationships of coping and distress were also examined within each group. The groups differed significantly on the Ways of Coping Checklist, anxiety (SCL-90 and Zung scales), depression (SCL-90 and Beck scales), and number of phobias. The panic disorder group used proportionately less problem-focused and more wishful thinking than the other groups. Within the panic disorder group, anxiety and depression were correlated negatively with problem-focused coping and positively with wishful thinking, and number of phobias was correlated negatively with the seeking of social support and positively with wishful thinking. Most importantly, when an attempt was made to statistically separate panic patients with multiple phobias from those without multiple phobias, coping was a better marker than was distress. These results emphasize the importance of cognitions in illness behavior and anxiety disorder.

Adaptation, Psychological↗
PubMed1987

An update on treatment of the anxiety disorders.

The recently discovered high prevalence of the anxiety disorders, as well as studies demonstrating their strong association with psychophysiologic symptoms, will probably increase referrals for these disorders to psychiatric clinicians. The authors review developments since 1983 in the psychopharmacologic and psychologic-behavioral treatment of the anxiety disorders. They find a growing body of empirical evidence that a variety of pharmacologic and cognitively oriented behavioral therapies are effective treatments. Less evidence is available for the utility of psychodynamic therapies, although recent studies provide some support. The authors believe that as a general rule, treatment of the more severe anxiety symptoms should always include pharmacotherapy.

Agoraphobia↗
PubMed1987

The epidemiology of depression in medical care.

Major depression may be the most common medical or psychiatric disorder seen in primary medical care clinics, occurring in approximately 6 to 10 percent of the clinic populations. Despite this high prevalence rate, patients with depression often go undiagnosed or are misdiagnosed. The evidence suggests a multifactorial etiology for this problem. Many patients with depression selectively focus on the somatic components of their depressive syndrome and minimize or even deny affective and cognitive symptoms. Depression and medical disorders also often occur concomitantly with depression causing amplification of somatic complaints. Due to the unidimensional focus on the biomedical model many physicians only evaluate and treat the physical illness and do not diagnose the depression. This often leads to aggressive medical testing and treatment that carries the risk of iatrogenic injury (polysurgery, multiple tests and procedures, prescription of opiates and benzodiazepines). Several interventions are suggested to improve the diagnostic acumen of primary care physicians.

Depressive Disorder↗
PubMed1987

Atypical or nonanginal chest pain. Panic disorder or coronary artery disease?

Of 195 patients with atypical or nonanginal chest pain presenting in a cardiology clinic, 104 consented to be evaluated for anxiety disorders using a structured psychiatric interview. Thirty patients had histories of coronary artery disease (CAD). Fifty-nine patients in the sample (16 of those with CAD and 43 of those without CAD) fit diagnostic criteria for panic disorder (PD). Those without CAD and with PD were primarily women (mean age, 43 years) with predominantly nonanginal chest pain. Those patients with both CAD and PD were primarily men (mean age, 54 years) with predominantly atypical angina. Since PD has been shown to be readily responsive to pharmacologic intervention, this diagnosis should be considered in patients with atypical or nonanginal chest pain.

Adolescent↗
PubMed1987

Panic disorder. Spectrum of severity and somatization.

One hundred++ ninety-five primary care patients were screened for panic disorder utilizing the National Institute of Mental Health Diagnostic Interview Schedule (DIS) as well as four additional questions that screened for core autonomic symptoms of panic disorder. A spectrum of severity of panic disorder was found. A subgroup of patients, labeled in the study as having simple panic, was found to have anxiety attacks associated with four or more autonomic symptoms, but they did not meet DSM-III recurrence criteria (three anxiety attacks within a 3-week period). Compared to primary care patients without panic attacks, patients with both simple panic and panic disorder exhibited multiple phobias, avoidance behavior, a high lifetime risk of major depression, and elevated scores on self-rating scales of anxiety and depression. The four autonomic screening questions that the authors added to the DIS interview increased the sensitivity of the DIS in identifying patients with panic disorder. Patients with panic disorder who selectively focus on their frightening autonomic symptoms may not be identified by screen questions that only focus on the cognitive awareness of anxiety.

Adolescent↗
PubMed1986

Panic disorder: epidemiology, diagnosis, and treatment in primary care.

Anxiety is the fifth most common clinical diagnosis in the primary care setting. Panic disorder, a severe episodic form of anxiety, has been found to occur in approximately 6% of primary care patients. These patients often selectively focus on one of the frightening autonomic symptoms and are frequently misdiagnosed. The three most common presentations of panic disorder in the medical setting are cardiac symptoms (chest pain, tachycardia), neurologic symptoms (headache, dizziness/vertigo, syncope), and gastrointestinal symptoms, especially epigastric distress. The presentation of cardiac symptoms by patients with panic disorder is especially likely to lead to expensive and potentially iatrogenic medical testing. Hypertension and peptic ulcer are the most commonly associated medical diagnoses in patients with panic disorder. Major depression, alcohol abuse, simple phobias, and posttraumatic stress disorder are the most frequently associated psychiatric diagnoses. Psychopharmacologic treatment of panic disorder has been demonstrated to be highly effective in double-blind, placebo-controlled studies. Effective psychopharmacologic agents include the tricyclic antidepressants (notably imipramine and desipramine), the monoamine oxidase inhibitors (phenelzine), and the high-potency benzodiazepines (alprazolam).

Adolescent↗
PubMed1986

Depression--medical utilization and somatization.

We screened 147 primary care patients for depression using depression rating scales and a psychiatric interview. In the one year after screening, the patients with depression visited and phoned their physicians more frequently and had more medical evaluations than the nondepressed control group. The patients with depression were more likely to have nonspecific or vague complaints and psychophysiologic or depressive symptoms than the control group; their family physicians during this same period were more likely to diagnose a psychophysiologic problem.

Depressive Disorder↗
PubMed1986

Panic disorder: epidemiology in primary care.

One hundred ninety-five patients in a primary care practice were screened with the National Institute of Mental Health Diagnostic Interview Schedule, a structured psychiatric interview, so that the epidemiology of panic disorder could be studied. Thirteen percent of the patients met criteria described in the Diagnostic and Statistical Manual of Mental Disorders, ed 3 (DSM-III) for panic disorder (6.7 percent if the DSM-III exclusionary criteria are used). An additional 8.7 percent of patients, labeled in the study as having simple panic, had four or more autonomic symptoms of panic disorder but did not meet DSM-III criteria (three panic attacks in a three-week period). Compared with controls, patients with panic disorder or simple panic had a significantly higher lifetime risk of major depression, multiple phobias, and avoidance behavior and higher scores on their psychological distress scales. Patients with panic disorder and simple panic often misinterpreted their symptoms as being due to a physical illness and had significantly higher scores on the somatization scale of the SCL-90 and on a medical review of symptoms than did the controls with no panic disorder. It is important to diagnose panic disorder accurately because double-blind placebo-controlled studies have demonstrated the efficacy of psychopharmacologic treatments, including tricyclic antidepressants (notably imipramine and desipramine), the high-potency benzodiazepine (alprazolam) and monoamine oxidase inhibitors (phenelzine). Primary care physicians, by screening patients with complaints of tension and anxiety, as well as multiple unexplained somatic complaints for panic disorder, may be able to reduce somatic preoccupation and disease phobia by instituting effective therapy.

Adolescent↗
PubMed1985

Chronic pain: lifetime psychiatric diagnoses and family history.

Thirty-seven patients with chronic pain admitted to a 3-week inpatient pain program were interviewed using the NIMH Diagnostic Interview Schedule and the family history method. The most frequent psychiatric diagnoses were major depressive disorder (current episode = 32.4%, past episode = 43.2%) and alcohol abuse (40.5%). More than half of the patients had a history of one or more episodes of major depression and/or alcohol abuse before the onset of their chronic pain. Family history revealed that 59.5% of the patients had at least one first-degree family member with chronic pain, 29.7% had a family member with affective illness, and 37.8% had a family member with alcohol abuse.

Adult↗
PubMed1984

Panic disorder and somatization. Review of 55 cases.

A retrospective study of 55 patients with panic disorder referred for psychiatric consultation by primary care physicians is presented. Eighty-nine percent of the patients initially presented with one or two somatic complaints, and misdiagnosis often continued for months or years. The three most common presentations were cardiac symptoms (chest pain, tachycardia, irregular heart beat), gastrointestinal symptoms (especially epigastric distress), and neurologic symptoms (headache, dizziness/vertigo, syncope, or paresthesias). Eighty-one percent of patients had a presenting pain complaint. Hypertension and peptic ulcer were the most common medical diagnoses, and depression and alcoholism the most frequently associated psychiatric diagnoses.

Adult↗
PubMed1984

Tricyclic antidepressant therapy for peptic ulcer disease.

The role of tricyclic antidepressants (TCAs) as agents for treatment of peptic ulcer disease is of growing interest. In both placebo-controlled clinical trials and comparative studies with cimetidine, TCAs have proved effective and safe as ulcer-healing agents. The mechanism of action by which TCAs produce healing has not been fully elucidated. In vivo studies in man have generally shown that TCAs decrease gastric acid secretion. In addition to their well-known anticholinergic properties, in vitro studies have indicated potent H1- and H2-receptor blocking activities for these agents. Separate from these effects on acid output, the antipain/depression effect of TCAs may be of benefit in certain patients with ulcers. Other advantages of these agents include their long half-lives, low cost, and readily available serum monitoring. Further clinical studies with detailed physiologic and psychologic observations and serum monitoring using TCAs in patients with peptic ulcer disease are needed.

Cimetidine↗
PubMed1984

Depression: relationship to somatization and chronic medical illness.

Although depression has been found to be the most common medical or psychiatric diagnosis among patients seen in primary care settings, the disorder is often missed and/or treated inappropriately. Problems in differential diagnosis, particularly among patients presenting primarily with somatic complaints, are reviewed. A study is described in which patients referred to a psychiatric consultation-liaison service were categorized as somatizing or nonsomatizing and given DSM-III diagnoses. Somatoform disorders occurred in only 33% of somatizing patients; the predominant diagnosis in this group was major depression. Implications of these findings for the recognition and treatment of depression, especially that associated with physical symptoms or disease, are discussed.

Adult↗
PubMed1983

Schizophrenia.

The diagnostic criteria for schizophrenia have been extensively changed by the third edition of the Diagnostic and Statistical Manual of Mental Disorders, recently adopted by the American Psychiatric Association (DSM III). To receive this diagnosis, the patient must have onset of illness before age 45 years, have had a chronic course, manifest the presence of characteristic symptoms, such as delusions, hallucinations, or loose associations during a phase of the illness, and have experienced a downhill social and vocational course; affective disorders and organic brain syndrome must be carefully excluded. The utilization of this "narrow" definition has caused a major shift toward increasing the diagnosis of affective disorders and decreasing the diagnosis of schizophrenia in the United States. The etiology of schizophrenia is still uncertain, but recent research has elucidated one subgroup of schizophrenic patients who have subtle indices of neurological damage and a clinical course similar to that found in dementia. Dopamine excess in the mesolimbic system is the predominant inferred cause for the majority of schizophrenia cases, and antipsychotic medications all rely on dopamine receptor blockade for their efficacy. Antipsychotic medications are effective in schizophrenia but are less potent against such negative symptoms as apathy, neglect of personal hygiene, and social withdrawal.

Adult↗
PubMed1983

Panic disorder.

Panic disorder is a subtype of anxiety manifested by discrete periods of apprehension or fear and at least four of the following somatic symptoms: dyspnea, palpitations, chest pain, choking, dizziness, depersonalization or derealization experience, paresthesias, hot and cold flashes, sweating, faintness, trembling, and fear of dying, going crazy, or doing something uncontrolled during an attack. Because the patient with panic disorder often selectively focuses on one of these somatic symptoms and may minimize or deny psychosocial distress, panic disorder is frequently misdiagnosed. As a result of the frightening nature of the symptoms, a pattern of overutilization of medical care systems frequently ensues. Panic disorder is usually precipitated by stressful life events, most commonly separation or loss, in a patient with a genetic or acquired vulnerability. As with other psychophysiologic illness (depression, duodenal ulcer) resolution of the acute stressful life event may not lead to resolutions of the physiologic changes. Two specific tricyclic antidepressants, imipramine and desipramine, have been shown to be effective therapeutic agents in treating panic disorder.

Adolescent↗
PubMed1982

Depression and somatization: a review. Part I.

The authors describe the relationship between the major depressive disorder and somatization. A literature review documenting the incidence and prevalence of depression in primary care and the rate of misdiagnosis is presented. Evidence is collated that points to several factors in misdiagnosis. The patient often selectively complains about the somatic manifestations of depression, minimizes the affective and cognitive components and is treated symptomatically. This is due to the physician's lack of recognition that the patient may have major depressive disorder and yet not recognize and report the mood component. The authors develop a conceptual; model that elucidates the mechanism behind the selective perception and focus by the patient on the somatic manifestations of depression. In this first part, the influence of sociocultural and childhood experience on the ability of the patients to recognize and report mood changes is delineated. Understanding this model is crucial in preventing misdiagnosis and potential iatrogenic harm to the patient.

Age Factors↗