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Biomedical subjects

W Katon

Publications and source records attributed to W Katon.

At least 127 records · Page 7Linked to original sources
PubMed1982

Depression and somatization: a review. Part II.

In Part I, the authors described the relationship between somatization and depression and the extent and rate of misdiagnosis of the problem of depression in primary care. A conceptual model was developed to explain the patient's selective perception and focus on the somatic manifestation of depression and the resulting misdiagnosis. In the first section, the sociocultural and childhood experience were reviewed as two major factors influencing the ability of the patient to perceive affective changes. In this second part, the authors review the influence of the developmental stage of the patient's cognitive mechanisms and the effect of the environmental systems in which the patient dwells, i.e., medical care, family and social network, work/disability and the sociopolitical institutions, on the recognition of affective, cognitive and somatic symptoms.

Adolescent↗
PubMed1982

Somatization in family practice: a biopsychosocial approach.

The family physician sees many patients who present physical symptoms that have primarily an emotional or psychosocial basis. This paper defines the concept of somatization, reviews its prevalence and consequences, and develops a conceptual model of somatization that includes cultural, childhood, psychological, and environmental factors. Physicians and the medical care system play a significant role in reinforcing somatization by patients. A biopsychosocial approach to the clinical assessment, diagnosis, and management of these patients is presented along with case examples that exemplify the utility of this approach.

Adolescent↗
PubMed1981

A prospective study of 60 consecutive psychiatric consultations in a family medicine clinic.

This paper describes a prospective study collating demographic, medical, psychiatric, and illness behavior characteristics of 60 consecutive patients referred for consultation to a psychiatric liaison physician attending in a family medical clinic. The data were accumulated to add to the developing body of information about the characteristic psychosocial problems family physicians treat. Results showed that the most frequent psychiatric diagnosis in these patients was primary affective disorder depression. The presence of somatic complaints often obscured the recognition and management of psychiatric syndromes such as depression, anxiety neurosis, personality disorder, family and marital discord, psychosis, and alcoholism. The importance of training in psychopharmacology and time limited psychotherapy was underscored by the frequent consultant recommendations for the use of these treatment modalities by the family physician. Patients averaged 2.4 illness problems (psychosocial problems and reactions that arise from a perceived illness), pointing to the need to systematically evaluate and treat them concomitantly with traditional disease problems.

Academic Medical Centers↗
PubMed1981

Beliefs that foster physician avoidance of psychosocial aspects of health care.

Although training in family medicine emphasizes a biopsychosocial approach to patients, many residents experience difficulties in carrying out the appropriate psychosocial part of their diagnosis and treatment. Through teaching family medicine residents in a year-long Balint and Difficult Patient seminar, there has emerged a consistent set of core tacit beliefs which inhibit physicians from thinking psychosocially about their patients. These beliefs appear to be rigidly held but not examined or challenged. This paper presents the major of these beliefs and for each a more realistic therapeutic reply. They are grouped into three categories: (1) beliefs concerning physician's role (eg, I must rule out organic disease; only then can I focus on psychosocial problems), (2) beliefs concerning what the patient supposedly wants or does not want (eg, my patients want me to rule out organic problems), and (3) physicians" fears about approaching patients as people (eg, if the patient has the same problem I do, how can I help if I have not helped myself). By making overt these tacit assumptions, this paper attempts to highlight core barriers to the implementation of biopsychosocial care, increase understanding of effective alternatives, and challenge physicians to examine their hidden beliefs about patient care and their approach to patients.

Attitude of Health Personnel↗
PubMed1981

Chronic anorexia nervosa: medical mimic.

While anorexia nervosa is typically construed as an acute, dramatic disorder of younger women, long-term follow-up studies indicate that morbidity is chronic or relapsing in 30 percent to 50 percent of cases and sometimes leads to death. In older patients or those with atypical clinical features or obscure complications, chronic starvation may mimic other diseases, and rigid adherence to current diagnostic criteria may impede recognition and appropriate treatment. Anorexia nervosa should be viewed as a spectrum of disorders, with varying courses and presentations, in order that clinicians in nonpsychiatric settings may be equipped to provide adequate care of patients with this complex psychosomatic disease.

Adult↗
PubMed1980

Treatment of depression in the medically ill elderly with methylphenidate.

Three depressed geriatric patients had a marked therapeutic response to the psychostimulant drug methylphenidate. These patients either had been unable to tolerate tricyclic antidepressants or had a medical illness that contraindicated tricyclic therapy. The lack of adverse effects in our elderly patients and methylphenidate's effectiveness as an antidepressant were consistent with the findings of other investigators. These results suggest that psychostimulants deserve further evaluation as antidepressant agents in the geriatric population.

Adjustment Disorders↗
PubMed1980

A biopsychosocial approach to surgical evaluation and outcome.

There is increasing necessity for including an evaluation of psychosocial as well as biomedical factors when assessing the need for surgical intervention and its possible outcomes. Potential problems between patient and surgeon can arise when these factors are not taken into account. Recent behavioral science literature supports the use of a conceptual framework and concise clinical method for evaluating psychosocial factors and negotiating treatment with a patient. Such a method may be useful in reducing patient-surgeon conflicts and the negative outcomes (such as patient noncompliance, dissatisfaction, medical-legal suits and poor patient care) that can result when such an assessment is not mutually discussed.

Adult↗
PubMedDate not supplied

Can depression treatment in primary care reduce disability? A stepped care approach.

OBJECTIVE: To assess effects of stepped collaborative care depression intervention on disability. DESIGN: Randomized controlled trial. SETTING: Four primary care clinics of a large health maintenance organization. PATIENTS: Two hundred twenty-eight patients with either 4 or more persistent major depressive symptoms or a score of 1.5 or greater on the Hopkins Symptom Checklist. Depression items were randomized to stepped care intervention or usual care 6 to 8 weeks after initiating antidepressant medication. INTERVENTION: Augmented treatment of persistently depressed patients by an on-site psychiatrist collaborating with primary care physicians. Treatment included patient education, adjustment of pharmacotherapy, and proactive monitoring of outcomes. MAIN OUTCOME MEASURES: Baseline, 1-, 3-, and 6-month assessments of the Sheehan Disability Scale and the social function and role limitation subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). RESULTS: Patients who received the depression intervention experienced less interference in their family, work, and social activities than patients receiving usual primary care (Sheehan Disability Scale, z = 2.23; P =.025). Patients receiving intervention also reported a trend toward more improvement in SF-36-defined social functioning than patients receiving usual care (z = 1.63, P =.10), but there was no significant difference in role performance (z = 0.07, P =.94). CONCLUSIONS: Significant disability accompanied depression in this persistently depressed group. The stepped care intervention resulted in small to moderate functional improvements for these primary care patients. Arch Fam Med. 2000;9:1052-1058

Data Collection↗
PubMedDate not supplied

Frustrating patients: physician and patient perspectives among distressed high users of medical services.

OBJECTIVE: To identify differences between patients viewed as frustrating by their physicians and those considered typical and satisfying. DESIGN: This cross-sectional observational study focused on psychologically distressed high users of medical services. Frustrating patients were compared with typical and satisfying patients, using data from patient questionnaires, physician assessments, structured psychiatric interviews, and computerized utilization records. SETTING: Group Health Cooperative of Puget Sound, a large health maintenance organization. PATIENTS/PARTICIPANTS: Study patients were in the top decile for ambulatory visits, and bad elevated scores for anxiety, depression, and somatization. Among the 339 patients invited to participate in the study, 251 agreed, and 228 were rated by their physicians. MAIN RESULTS: A substantial proportion (37%) of the high users were viewed as frustrating by their physicians. Physicians' ratings of physical disease severity did not differ among the groups, but frustrating patients rated their own health status less favorably and reported more somatic symptoms and disabilities. The frustrating group utilized more medical services than did other distressed high utilizers. All three groups had a high prevalence of mental disorders. However, frustrating patients had higher rates of somatization and generalized anxiety disorder. CONCLUSIONS: Physicians and their frustrating patients had contrasting views of the patients' illnesses. The best predictors of physician frustration were somatization and increased medical service utilization. There is need for further research and clinical attention concerning optimal clinical management for patients with somatization.

Adult↗
PubMedDate not supplied

Infrequent panic attacks: psychiatric comorbidity, personality characteristics and functional disability.

Primary care patients with infrequent panic attacks were found to have similar levels of disability in their social, family and vocational functioning to patients who met DSM-III-R criteria for panic disorder. Both panic subgroups had significantly more functional disability than controls. Patients with panic and infrequent panic had significantly more Axis I psychiatric comorbidity than primary care controls but similar levels of medical comorbidity. Patients with panic disorder had a significantly higher prevalence of one or more other lifetime psychiatric diagnoses, current major depression, and current DSM-III-R depressive symptoms compared to patients with infrequent panic. Patients with infrequent panic scored as high on the NEO personality measure of neuroticism as patients with panic disorder, and both panic subgroups had significantly higher neuroticism levels than controls.

Adult↗