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Biomedical subjects

C L Woodman

Publications and source records attributed to C L Woodman.

12 recordsLinked to original sources
PubMed2000

Association between depression and worse disease-specific functional status in outpatients with coronary artery disease.

BACKGROUND: The objective of this study was to determine if depression is associated with worse disease-specific functional status in patients with coronary artery disease. The study was designed as a cross-sectional survey and 3-month longitudinal cohort. METHODS AND RESULTS: The study took place in outpatient clinics of 3 Veterans Administration hospitals. All 7282 enrollees were surveyed and 4560 (62.6%) returned baseline questionnaires, including a screening instrument for depression. Thirty-nine percent (n = 1793) reported evidence of coronary artery disease and 1282 patients (71.5%) returned the Seattle Angina Questionnaire; 1025 patients (80%) completed a subsequent 3-month series of instruments. Main outcome measures used were the Seattle Angina Questionnaire, a valid, reliable, and responsive disease-specific functional status measure for patients with coronary disease, and the Mental Health Inventory, a mental health screening instrument from the Short Form-36. Mental Health Inventory evidence of depression was associated with significantly worse disease-specific functional status. Depressed patients had more physical limitation (mean difference in Seattle Angina Questionnaire score = 16.9, P <.001), more frequent angina (mean difference in Seattle Angina Questionnaire score = 9.5, P <.001), less satisfaction with their treatment for coronary artery disease (mean difference in Seattle Angina Questionnaire score = 9.9, P <.001), and lower perceived quality of life (mean difference in Seattle Angina Questionnaire score = 16.3, P <.001) than nondepressed patients. Frequency of depressive symptoms demonstrated an inverse relation with cardiac-specific functional status and when patients' depression status changed over time, so did their cardiac-specific health status. CONCLUSIONS: Depression is associated with significantly more physical limitation, more frequent angina, less treatment satisfaction, and lower perceived quality of life in outpatients with coronary artery disease.

Age Distribution↗
PubMed1999

A 5-year follow-up study of generalized anxiety disorder and panic disorder.

To examine the course and outcome of subjects with generalized anxiety disorder (GAD) and panic disorder, we compared 64 patients with GAD and 68 patients with panic disorder who had participated in drug treatment studies and were interviewed an average of 5 years earlier. At baseline GAD subjects were significantly older, had an earlier onset, and longer duration of illness than panic subjects. GAD subjects also had less severe symptoms. At follow-up, diagnostic stability was observed for both GAD and panic disorder. Significantly fewer GAD subjects achieved full remission at follow-up (18% vs. 45%, p < .01). Subjects with GAD were significantly less anxious at baseline than the panic disorder comparison group, but at follow-up there were few significant differences between groups on most severity of illness variables. This change was due in great part to improvement in the panic disorder group with a concomitant lack of change in the GAD group.

Adult↗
PubMed1995

Avoidant personality traits distinguish social phobic and panic disorder subjects.

The purpose of this study was to show that, as a group, patients with social phobia and panic disorder differ with respect to personality traits, further validating the distinction between these anxiety disorders. To show this, we compared the response of 46 subjects with social phobia with the response of 72 subjects with panic disorder with or without agoraphobia on the Personality Diagnostic Questionnaire. The subjects, who were recruited for treatment studies, completed this personality questionnaire after they had been off psychotropic medication for at least 1 week. Responses to the Personality Diagnostic Questionnaire showed that the social phobics had more severe personality pathology. These subjects had higher anxious and schizoid cluster scores and differed from panic subjects in having more avoidant personality traits. Panic subjects had more dependent traits. The results indicate that social phobic and panic disorder patients are distinguishable on the basis of personality characteristics. They also show that the generalized situational subtype of social phobia is closely associated with avoidant personality disorder and that these may be differing categorizations of a single disturbance.

Adult↗
PubMed1994

Psychiatric comorbidity among patients with hypochondriasis.

The purpose of this study was to determine the nature and extent of comorbidity among patients with DSM-III-R hypochondriasis and to examine the relationships between this disorder and coexisting psychiatric illness. For this purpose, patients seen in a general medicine clinic were screened using measures of hypochondriacal attitudes and somatic symptoms. Those scoring above an established cutoff were given a structured diagnostic interview. In this manner, 50 patients who met DSM-III-R criteria for hypochondriasis and 50 age- and sex-matched controls were identified. The presence of other psychiatric disorders (current and past) was determined by means of the same diagnostic interview. More hypochondriacal subjects (62.0%) had lifetime comorbidity than did controls (30.0%). Major depression, the most frequent comorbid disturbance, was usually current and most often had an onset after that of hypochondriasis. Panic disorder with agoraphobia, the most frequent anxiety disorder, was also current but often began before or at the same time as hypochondriasis. Few subjects met criteria for somatization disorder but a third qualified for a subsyndromal form of this disorder. The data show that, in medical outpatients with hypochondriasis, mood and anxiety disorders frequently coexist. This comorbidity is subject to varying interpretations including overlap of symptom criteria, treatment-seeking bias, and the possibility that hypochondriasis predisposes to or causes the comorbid disorder, as seems likely in the case of depression. In some instances hypochondriasis may be an associated feature of another illness.

Adult↗
PubMed1994

Predictors of response to alprazolam and placebo in patients with panic disorder.

Date from a panic disorder treatment study with 506 patients, comparing alprazolam and placebo in a double-blind manner for 8 weeks, were analyzed to identify demographic and clinical characteristics of the patients that might predict response to treatment. The strongest predictors of response to alprazolam were age over 40, and lower baseline levels of anxiety and phobic symptoms. Predictors of response to placebo were weaker and, in addition to lower levels anxiety and panic attacks, included a lack of previous psychiatric treatment.

Adult↗
PubMed1994

Panic disorder: treatment with valproate.

BACKGROUND: To determine the efficacy of divalproex sodium in the treatment of panic disorder, divalproex sodium was administered in a 6-week open clinical trial to 12 patients who had a primary DSM-III-R diagnosis of panic disorder. METHOD: Treatment was begun at 500 mg of divalproex sodium daily and was increased according to clinical response and side effects. Clinicians completed a Clinical Global Impressions Scale weekly and a Hamilton Rating Scale for Anxiety every other week. Patients completed a panic-attack diary and a Brief Symptom Inventory weekly. RESULTS: All 12 patients completed the study, and all were moderately to markedly improved. Measures of panic attacks and anxiety improved more quickly and robustly than measures of phobic avoidance. Eleven of the 12 patients elected to remain in treatment and at 6-month follow-up had sustained improvement. CONCLUSION: These findings suggest that valproic acid may be effective for the treatment of panic disorder. Double-blind studies will be required to further verify these findings.

Adult↗
PubMedDate not supplied

One-year follow-up of medical outpatients with hypochondriasis.

To examine the diagnostic stability and outcome of hypochondriasis, the authors followed 50 patients with this disorder and 50 age- and sex-matched control subjects after 1 year. After 1 year, two-thirds of the subjects continued to meet criteria for hypochondriasis, and the remaining third had persisting hypochondriacal symptoms. The hypochondriacal subjects were improved on most measures but still differed from the control subjects with regard to attitudes, perceptions, and behaviors that had distinguished them initially. More severe symptoms, longer duration of illness, and coexisting psychiatric illness were predictive of a worse outcome. The data indicate that the diagnosis of hypochondriasis is stable over time, and that, although symptoms wax and wane, characteristic features persist. The findings underscore the importance of diagnosing and treating hypochondriasis in medical outpatients.

Adult↗
PubMedDate not supplied

The relationship between irritable bowel syndrome and psychiatric illness. A family study.

Although irritable bowel syndrome (IBS) is a common disorder among gastrointestinal clinic outpatients, it continues to be a diagnosis of exclusion. In treatment-seeking populations, IBS has been frequently associated with psychiatric illness, and this co-occurrence has added to controversy about the validity of the IBS diagnosis. This study is a preliminary effort to examine the nature of this relationship by using the family study design. The probands consisted of 20 patients with IBS and 20 patients who had undergone laproscopic cholecystectomy. Their first-degree relatives were interviewed to obtain lifetime diagnoses of functional gastrointestinal and psychiatric syndromes. Significantly more IBS probands had lifetime psychiatric illness than the cholecystectomy probands. The lifetime prevalence of IBS as well as other functional gastrointestinal syndromes was not significantly different between the groups of relatives. However, significantly more relatives of the IBS probands had lifetime psychiatric illness than the relatives of the cholecystectomy probands. Among the relatives with functional gastrointestinal disorders, significantly more had psychiatric illness. This preliminary study provides support for a relationship between IBS and psychiatric illness by the finding of an increased prevalence of psychiatric disorders among the relatives of patients who have IBS.

Adult↗
PubMedDate not supplied

Psychiatric disorders and survival after lung transplantation.

The 30 patients who underwent lung transplantation between 1990 and 1996 were included in this study, and data were analyzed to find predictors of 1-year survival posttransplantation. All patients were followed throughout the posttransplantation period. Fifteen patients had a pretransplantation diagnosis of an anxiety and/or depressive disorders. Of the 30 patients transplanted, 19 survived 12 months or more, and 11 died less than 12 months posttransplantation. The > 12-month survival group had a mean age of 45.2 years at transplantation, compared with a mean age of 43.0 years in the < 12-month group (NS). The mean Psychosocial Assessment of Candidates for Transplant score and premorbid history of smoking did not differ between the groups. The > 12-month survival group had more psychiatric illness pretransplantation than the < 12-month survival group (56% vs. 27%, P < 0.05). The recipients with a psychiatric history (N = 15) were more likely to survive 1 year posttransplantation than the recipients without a psychiatric history (80% vs. 47%, P < 0.05) and were not significantly different from the recipients without a psychiatric history in terms of episodes of rejection, bronchiolitis obliterans, or noncompliance with treatment. Depression and anxiety are treatable disorders that occur frequently in patients with end-stage lung disease, and a premorbid history of either did not predict a worse outcome posttransplantation in this study of lung transplantation recipients.

Adult↗