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Biomedical subjects

W R Yates

Publications and source records attributed to W R Yates.

72 records · Page 4Linked to original sources
PubMed1986

The National Institute of Mental Health epidemiologic study: implications for family practice.

The National Institute of Mental Health has begun a five-site epidemiologic study of the prevalence and incidence of common psychiatric illnesses. Preliminary results reveal a high prevalence of substance abuse disorders in men and a high prevalence of affective and anxiety disorders in women. Evaluation of health care provider utilization shows that women and elderly patients with mental health problems are more likely to visit primary care providers only for mental health problems. The results have important implications for the research and curriculum of family practice.

Adult↗
PubMedDate not supplied

Cardiovascular risk factors in affective disorder.

100 patients with affective disorder (unipolar affective disorder and bipolar affective disorder) were evaluated for evidence of increased risk for the major cardiovascular risk factors including hypertension, hypercholesterolemia, obesity, and cigarette use. Unipolar affective disorder patients showed no evidence of increased cardiovascular risk compared to population controls. Bipolar affective disorder patients displayed increased systolic blood pressure, definite hypertension, and use of cigarettes. These findings are consistent with a link between affective disorders and excess cardiovascular mortality.

Adult↗
PubMedDate not supplied

Organic mood disorder: a valid psychiatry consultation diagnosis?

To determine the validity of the DSM-IIIR category organic mood disorder, we compared 50 psychiatric consultations with this diagnosis to 50 psychiatric consultations diagnosed with major depression in the medically ill. Organic mood disorder patients were more likely to be in the index affective disorder episode and have a negative family history of depression. Despite similar pharmacologic treatment between groups, the organic mood disorder group was less likely to be completely recovered at 4 years follow-up. This study suggests organic mood disorder is a valid diagnosis in the psychiatry consultation service.

Adult↗
PubMedDate not supplied

Risk factors for bulimia nervosa: a controlled study of parental psychiatric illness and divorce.

Twenty five women with normal-weight bulimia nervosa were compared with 25 age- and weight-matched women without bulimia nervosa on measures of parental psychiatric illness. Case and control probands, as well as their parents, completed the Family History Research Diagnostic Criteria (FH-RDC) interview and a battery of self-report instruments. Case probands and controls were divided into two groups based on evidence for parental psychiatric illness. The assignment of parental psychiatric illness was made by (a) a positive parental history of alcoholism or depression from the FH-RDC; or (b) evidence of parental major depression, alcoholism, or personality disorder from the self-report measures. Parental psychiatric illness occurred significantly more frequently for case probands compared to the control probands (64% vs. 24%, odds ratio = 5.6, 95% Cl = 1.7-19.2). Parental psychiatric illness was also associated with parental divorce (Fisher's exact p = .023) and a trend toward lower ratings of paternal but not maternal relationship by case probands. This study suggests parental psychiatric illness may be a risk factor for bulimia nervosa and may contribute to environmental effects through increased rates of divorce and impaired paternal relationships.

Adolescent↗
PubMedDate not supplied

An adoption study of drug abuse/dependency in females.

In a sample of 102 women who had been adopted at birth, drug abuse/dependency was found by log-linear analyses to have a major pathway of genetic etiology that started with a biologic parent with antisocial personality and led to an adoptee with conduct disorder and then through aggressivity to drug abuse/dependency, as well as from conduct disorder directly to drug abuse. This result was similar to findings from a male sample collected from the same agencies and at the same time, wherein antisocial biologic parents produced aggressive and conduct-disordered off-spring, who in turn became drug abusers/dependents as adults. Results are compatible with family studies demonstrating that female drug abusers stem from deviant families and themselves demonstrate socially deviant behavior early in life. The present study shows that one element of familial factors is genetic, and that, in addition, the family environment directly affects behavior (aggressivity) that leads to drug abuse/dependency.

Adolescent↗
PubMedDate not supplied

Increasing identification and referral of panic disorder over the past decade.

The study's objective was to contrast the prevalence, phenomenology, and medical care utilization for panic disorder from 1980 to 1990. All psychiatric consultations from a university consultation service from the years 1980, 1985, and 1990 were located (N = 2,400). Patients meeting DSM-III-R panic disorder criteria were selected for chart review. Variations in demographics, comorbidity, prior medical evaluations, and referral patterns were analyzed. The prevalence rate for consultations meeting panic disorder criteria has increased (2.5% in 1980, 4.2% in 1985, and 5.1% in 1990; chi 2 = 7.5, P = 0.024). Referring physicians more frequently noted panic attacks in 1990 (5% in 1980, 21% in 1985, and 59% in 1990; chi 2 = 21.2, P = 0.0001). A summary measure of medical care utilization revealed no significant interval change. Panic disorder is being recognized and referred more frequently by medical physicians since the publication of DSM-III and DSM-III-R. However, delay of diagnosis and high medical care utilization remain significant problems.

Adult↗
PubMedDate not supplied

Personality disorder as a contraindication for liver transplantation in alcoholic cirrhosis.

Severe personality disorder has been proposed as a contraindication for liver transplantation. Seventy-three subjects with alcoholic-related liver disease were evaluated for personality disorder and followed for 6 months. The subjects with severe personality disorder had higher rates of divorce, higher rates of comorbid drug abuse or dependence, lower Weschler Adult Inventory Scale IQ estimates, and higher scores on indicators of emotional impairment. Personality disorder was not associated with a higher rate of return to alcohol use during the follow-up period. Three subjects with personality disorder underwent liver transplantation without behavioral or substance abuse complications. This study does not support routine exclusion of subjects based solely on a diagnosis of a severe personality disorder.

Adult↗
PubMedDate not supplied

The Academy of Psychosomatic Medicine practice guidelines for psychiatric consultation in the general medical setting. The Academy of Psychosomatic Medicine.

This practice guideline seeks to provide guidance to psychiatrists who regularly evaluate and manage patients with medical illnesses. The guideline is intended to delineate the knowledge base, professional expertise, and integrated clinical approach necessary to effectively manage this complex and diverse patient population. This guideline was drafted by a work group consisting of psychiatrists with clinical and research expertise in the field, who undertook a comprehensive review of the literature. The guideline was reviewed by the executive council of the Academy of Psychosomatic Medicine and revised prior to final approval. Some of the topics discussed include qualifications of C-L consultants, patient assessment, psychiatric interventions (e.g., psychotherapy, pharmacotherapy), medicolegal issues, and child and adolescent consultations.

Adolescent↗
PubMedDate not supplied

The evaluation of eating and weight symptoms. A comparison of medically ill and eating disorder patients.

The purpose of this study was to determine the utility of hospitalization in a medical-psychiatry unit for eating disorder patients. A retrospective chart review of 48 patients given an International Classification of Disease-9 diagnosis of an eating disorder was conducted. Presenting symptoms, functional status using the Karnofsky Index, medical and psychiatric evaluation, diagnosis, treatment, and outcome were evaluated. Patients fell into 1 of 3 groups: those with an active eating disorder and comorbid medical complications (Eating Disorder [ED] positive [POS], n = 25), those with a history of an eating disorder admitted for some other reason (ED history [HX], n = 8), and those with eating or weight symptoms ultimately found to be related to a noneating disorder or primary medical process (ED negative [NEG], n = 15). The ED POS patients were younger (28.1 vs. 49.1 years, P = 0.0001) but had a lower functional status on admission compared with the ED NEG patients (Karnofsky score 51 vs. 72, P = 0.0002). They were more likely to binge eat, restrain intake, and abuse laxatives (P = 0.0001, P = 0.024, P = 0.037, respectively) but did not differ with respect to history of vomiting (P = 0.113). The ED POS patients were more likely to be transferred to a general psychiatry or eating disorder unit. Overall length of stay was greater in this group (44.6 vs. 20.4 days, P = 0.031). Initial evaluation of patients presenting with eating or weight symptoms may be difficult given similarities between the patients with primary eating disorders and those with other underlying medical causes. The medical-psychiatry unit provides comprehensive initial evaluation and treatment of patients with eating and weight symptoms.

Adolescent↗
PubMedDate not supplied

The evaluation of eating and weight symptoms in the general hospital consultation setting.

Eating disorders (ED) in the medically ill population have seldom been studied. The objective of this study is to review a series of medical and surgical patients referred for psychiatric evaluation for a presumed ED. Between 1982 and 1990, a series of 65 patients were referred for psychiatric consultation to evaluate for an ED. All patients records were reviewed for demographic, medical, and psychiatric information, including medical course following the consultation. Sixty-three percent of the study population were referred by internal medicine services. The most common presenting symptoms were self-induced vomiting (39.1%), binge eating (34.4%) and weight loss (31.3%). Bulimia nervosa (n = 21), anorexia nervosa (n = 19), and no psychiatric diagnosis (n = 18) were the most frequent diagnoses. Record review suggested significant challenges to accurate eating disorder diagnoses in patients presenting with primary medical complaints.

Adolescent↗
PubMedDate not supplied

The reliability of alcoholism history in patients with alcohol-related cirrhosis.

Alcoholic liver disease is considered an indication for liver transplantation when a candidate is felt to have a high likelihood of abstinence following transplantation. Historical variables such as duration of sobriety, duration and quantity of drinking, and treatment history are commonly used to estimate alcoholism prognosis, yet their reliability and validity in patients with alcoholic cirrhosis has received limited study. Fifty subjects (9 women and 41 men) with alcoholic cirrhosis underwent an alcoholism history interview. Each subject had a collateral source (usually a spouse) who was interviewed by a second interviewer blind to the subject's alcoholism history. The two histories were compared for duration of abstinence in months and estimated alcoholism relapse risk was calculated using the High-risk Alcoholism Relapse scale (HRAR). Duration of sobriety correlated highly between subject and collateral source (Spearman r= 0.96, P = 0.0001) as did HRAR total score (Spearman r = 0.72, P = 0.0001). Categorical assignments also showed high correlations with duration of sobriety (kappa = 0.97) and HRAR category (kappa = 0.63). When disagreements were present, collateral sources tended to underestimate severity of alcoholism. We conclude that patients with alcoholic liver disease provide a reliable history for alcoholism variables when compared with a collateral source, and that, when disagreements are present, subjects tend to report a more acute or severe alcohol problem. The results support the clinical use of patient history information in making decisions about medical interventions for alcoholic liver disease.

Adult↗
PubMedDate not supplied

Illicit anabolic steroid use in athletes. A case series analysis.

Because of recent anabolic steroid abuse scandals at all levels of athletic competition ranging from high school sports to the 1988 Olympics in Seoul, Korea, the investigators closely examined the anabolic steroid use histories of 20 competitive and noncompetitive weight lifters. Steroid efficacy studies only examine the anabolic effects of individual drugs. However, these 20 steroid users consistently practiced polypharmacy. During steroid use cycles lasting between 7 and 14 weeks, athletes commonly used two or three oral agents and two long-acting injectable products. Dosages of oral preparations tended to be similar to those used in efficacy studies, whereas dosages of the long-acting injectable agents were approximately three to eight times greater than those used in controlled studies. Subjects reported significant increases in body weight and strength. In addition, mental status changes were reported that included symptoms of depression, hostility, aggression, and paranoia. Based on the pattern of anabolic steroid use currently being practiced in the United States, it is apparent that past efficacy and toxicology studies are of limited value in delineating the benefits and hazards of these drugs.

Adolescent↗
PubMedDate not supplied

Advances in anxiety management.

Recent developments in neurobiology, diagnostic classification, and drug/psychotherapy trials have increased our ability to manage patients with anxiety disorders. These recent developments, along with epidemiologic surveys showing the high frequency of anxiety disorders in the general population as well as in the primary care population, have reemphasized the importance of anxiety disorders in family practice. This review presents treatment recommendations, including dosage, products, guidelines for monitoring, and discontinuation. Advances in the neurobiology of anxiety are also included.

Anxiety Disorders↗