Biomedical subjects

C S North

Publications and source records attributed to C S North.

At least 37 records · Page 2Linked to original sources

PubMed1998

Content and curriculum in psychoeducation groups for families of persons with severe mental illness.

OBJECTIVE: The study compared problems identified by participants in a workshop for families with a relative who had severe mental illness with topics addressed in published descriptions of multifamily psychoeducational interventions to determine whether the problems and needs of family members differed from those covered in professionally prepared psychoeducational materials. METHODS: Participants in a one-day psychoeducational workshop were asked to identify and rank in order of importance the problems they faced in managing mental illness. Most workshop participants were family members who did not have a severe mental illness, but family members with a severe mental illness and mental health service providers also attended. Lists of problems generated by 86 participants containing a total of 355 items were analyzed for content, and 11 problem categories were identified and ranked. These categories were then compared with the content of multifamily psychoeducation programs described in the literature. RESULTS: Although the methodology limited generalizability of findings, the results suggest important distinctions between content developed by professionals and the needs identified by family members, particularly in families' greater emphasis on negative symptoms and on family relationships. CONCLUSIONS: The findings suggest that input from the family, the ill family member, and mental health providers is necessary for developing psychoeducation curricula that will meet families' needs. Professionals who design multifamily psychoeducation curricula are encouraged to incorporate enough flexibility to accommodate the specific needs of members of particular groups and to provide general information that is useful for all groups.

Adaptation, Psychological↗

PubMed1997

A diagnostic comparison of homeless and nonhomeless patients in an urban mental health clinic.

This study compared demographic and diagnostic characteristics of a sample of homeless outpatient mental health clinic attenders with a domiciled comparison group from the same clinic. Data on demographic variables and DSM-III-R psychiatric diagnoses were collected over a two-year period on a consecutive sample of 166 homeless and 117 nonhomeless clinic attenders. Data on demographics and psychiatric diagnoses of the homeless clinic attenders were further compared with data collected systematically from 900 homeless individuals in the same city. In the clinic, homeless subjects were more often members of ethnic minorities, and homeless women were significantly younger and better educated than their nonhomeless counterparts. Rates of schizophrenia, bipolar disorder, and somatization disorder were not significantly different between homeless and nonhomeless groups. Major depression was about four times as prevalent in nonhomeless men as in homeless men. Homeless men were significantly more likely than nonhomeless men to qualify for a diagnosis of alcohol use disorder, and homeless women were more likely than other women to qualify for a diagnosis of drug use disorder. Both homeless men and women were significantly more likely than their domiciled counterparts to meet criteria for antisocial personality disorder. Personality disorder other than antisocial was more prevalent in nonhomeless men than in homeless men. Combined rates of personality disorder were significantly higher among homeless than nonhomeless women, but not men. Homeless clinic attenders were demographically and diagnostically very similar to a general homeless population in the same city. The only diagnosis that was more prevalent in the homeless clinic than in the homeless community was antisocial personality disorder. We concluded that because of difference in diagnostic prevalence, homeless and nonhomeless individuals in mental health clinics need to be considered independently. Clinicians treating homeless outpatients may benefit from having special facility in diagnosis and management of antisocial personality disorder and substance abuse, along with expertise in other psychiatric disorders in this population.

Adult↗

PubMed1997

A comparison of clinical and structured interview diagnoses in a homeless mental health clinic.

OBJECTIVE: This study compared psychiatric diagnoses ascertained by independent clinicians with structured research interviews of homeless psychiatric patients assessed in a mental health clinic and in the community. Problems of both overdiagnosis and underdiagnosis in structured research interviews compared to clinician assessment were predicted. METHOD: Over a period of a year, 97 patients referred to a mental health clinic for homeless people were assessed with the Diagnostic Interview Schedule (DIS) administered by a clinical social worker who then completed a full clinical psychiatric social work assessment. These same patients received a thorough and systematic clinical psychiatric evaluation by a psychiatrist or psychologist, both experienced with this population. These clinicians gathered data from multiple sources, often with extended observation over time. The DIS and clinician diagnoses were made blind to one another and then compared; the clinician was often made aware of some of the symptoms that the social worker had elicited, but not whether the elicited material was from the DIS or from the clinical assessment. Diagnoses of 33 clinic patients previously assessed by trained nonclinician DIS interviews in an epidemiologic study of the homeless population in the community were also compared to clinician diagnoses, and no information from these patients' survey DIS interviews was made available to the clinicians. RESULTS: Compared to clinician assessment, structured interviews underdiagnosed antisocial personality disorder (ASPD) and overdiagnosed major depression. Alcohol use disorder and schizophrenia showed only small discrepancies by assessment method. Drug use disorder revealed no bias according to method of ascertainment, but showed very discrepant kappa levels comparing DIS to clinician assessment in the two different comparison contexts. CONCLUSIONS: If structured research methods assessing the homeless population actually overestimate depression, underestimate ASPD, and misclassify drug abuse, then policies stemming from structured interview research recommendations may call for levels and types of services not optimally suited to the reality of this population's needs. Because mental illness and substance abuse are thought to be critical factors in the generation and perpetuation of homelessness, the issue of accurate diagnosis is tantamount to understanding and providing workable solutions to the problem of homelessness. Further research is needed to untangle potential confounders of the homeless situation to psychiatric diagnosis.

Community Mental Health Centers↗

PubMed1997

Psychiatric disorders among the homeless: a comparison of older and younger groups.

The purpose of this study is to identify differences between older and younger homeless subgroups. Nine hundred homeless persons were interviewed using the National Institute of Mental Health Diagnostic Interview Schedule, and DSM-III-R diagnoses were made. Results showed that 79 (13%) of the 600 men and 10 (3%) of the 300 women were in the older (age > or = 50 years) group. Compared with their younger counterparts, older subjects were more likely to be male and white, to report lower incomes and poorer health, and to meet criteria for lifetime alcohol-use disorder. Fewer older than younger subjects met criteria for lifetime drug use disorder and post-traumatic stress disorder. These findings suggest that older and younger individuals have different vulnerabilities to homelessness.

Adult↗

PubMed1997

One-year follow-up of survivors of a mass shooting.

OBJECTIVE: This report describes a 1-year follow-up study of survivors of a mass shooting incident. Acute-phase data from this incident were previously reported in this journal. METHOD: The Diagnostic Interview Schedule/Disaster Supplement was used to assess 136 survivors at 1-2 months and again a year later, with a 91% reinterview rate. RESULTS: In the acute postdisaster period, 28% of subjects met criteria for posttraumatic stress disorder (PTSD), and 18% of subjects qualified for another active psychiatric diagnosis. At follow-up, 24% of subjects reported a history of postdisaster PTSD (17% were currently symptomatic), and 12% another current psychiatric disorder. Half (54%) of all 46 individuals identified as having had PTSD at either interview were recovered at follow-up, and no index predictors of recovery were identified. There were no cases of delayed-onset PTSD (beyond 6 months). Considerable discrepancy in identified PTSD cases was apparent between index and follow-up. Inconsistency in reporting, rather than report of true delayed-onset, was responsible for all PTSD cases newly identified at 1 year. The majority of subjects with PTSD at index who were recovered at follow-up reported no history of postdisaster PTSD at follow-up, suggesting considerable influence of fading memory. CONCLUSIONS: This study's findings suggest that disaster research that conducts single interviews at index or a year later may overlook a significant portion of PTSD. The considerable diagnostic comorbidity found in this study was the one robust predictor of PTSD at any time after the disaster. Disaster survivors with a psychiatric history, especially depression, may be most vulnerable to developing PTSD and therefore may deserve special attention from disaster mental health workers.

Adult↗

PubMed1997

Predictors of achieving stable housing in a mentally ill homeless population.

Relationships among demographic characteristics, diagnostic groups, presenting problems, and service use were examined in two groups of mentally ill persons: a group of 60 formerly homeless persons who had been housed for at least 24 months and a group of 60 persons who remained homeless. Use of eight types of services over a 26-month period was examined. Women were significantly more likely to be housed than men. Individuals whose primary presenting problem was subsistence needs were more likely to be housed than those whose primary problem was mental, illness or substance abuse. Those with a diagnosis of personality disorder used fewer services. Housed individuals were more likely to use services than those who were homeless.

Adult↗

PubMed1997

Psychiatric illness in female physicians. Are high rates of depression an occupational hazard?

More than half of female physicians may experience a psychiatric illness during their lifetime. Depression is by far the most common such disorder, and the suicide rate is alarmingly high. However, female physicians appear to be at lower risk for substance abuse than male physicians. The medical profession could benefit from increased awareness of depression among female physicians and removal of barriers to treatment, such as stigma and discrimination against those with psychiatric illness.

Depression↗

PubMed1996

Gastrointestinal symptoms and psychiatric disorders in the general population. Findings from NIMH Epidemiologic Catchment Area Project.

High rates of psychiatric disorder have been documented in patients with functional bowel syndromes sampled from physicians' offices. Lifetime psychiatric disorder and/or current psychiatric symptoms are thought to be much more highly associated with current gastrointestinal bowel symptoms in clinical settings than in the community. The relationship of lifetime functional gastrointestinal symptoms to lifetime psychiatric disorders has not been examined systematically in randomly selected samples of general community populations. The current study reports findings from existing data on a large, randomly selected population sample that may help to clarify these associations. Epidemiologic Catchment Area (ECA) project data were analyzed to examine relationships of functional gastrointestinal symptoms and psychiatric diagnoses in the community. Individuals with two or more medically unexplained gastrointestinal symptoms had high rates of psychiatric disorders. This was also true for the subgroup in which abdominal pain was one of the two symptoms. The overwhelming majority of subjects reporting medically unexplained gastrointestinal symptoms said they had consulted physicians for those symptoms. General population ECA data indicate that women in the community report more functional gastrointestinal complaints than men, that individuals with lifetime gastrointestinal complaints have high rates of lifetime psychiatric disorders (not necessarily currently symptomatic), and most have contacted a physician regarding their gastrointestinal symptoms. These data complement studies showing that patients with current gastrointestinal symptoms often do not consult a physician, or when they do, such behavior is associated with active psychiatric symptoms. These present data are consistent with the hypothesis that patients with recurrent symptoms are those who routinely seek medical help and who have high rates of psychiatric disorders, whereas those with symptoms that resolve or are improved by a medical intervention do not maintain treatment-seeking behavior.

Catchment Area, Health↗

PubMed1996

Are the mentally ill homeless a distinct homeless subgroup?

The question has been raised whether it is useful or meaningful to dichotomize the homeless population by mental illness - i.e., to consider the mentally ill homeless as distinct from other homeless people. The current article presents evidence from a single data set to address this question empirically. Data from a randomly sampled population of 900 homeless men and women systemically interviewed using the Diagnostic Interview Schedule were examined to determine associations of mental illness with the problems of homelessness, controlling for the presence of substance abuse in the analyses. Although a few clinically meaningful associations with mental illness were found that might suggest directions for appropriate interventions, mental illness did not differentiate individuals in many important demographic and biographic respects. Individual diagnoses did not perform much better in differentiating the homeless by mental illness. Schizophrenia and bipolar mania showed a few significant associations not identified by the "major mental illness" construct. Major depression, constituting the majority of nonsubstance Axis I disorder in the homeless, provided no association beyond that obtained with the "major mental illness" category. The data provide little support for conceptualizing homeless subgroups or homelessness in general on the basis of mental illness alone. To do so also risks neglecting the emotional distress of the majority without major mental illness and the other problems that homeless persons share regardless of psychiatric illness. While serious mental illness is overrepresented among the homeless, it represents just one of many important vulnerability factors for homelessness. Substance abuse is far more prevalent than other Axis I disorders. Media images equating homelessness with major mental illness unnecessarily stigmatize homeless people and encourage oversimplified and narrowly conceived psychiatric interventions. While continuing attention is needed on improving identification and management of serious mental illness among the homeless, this must be accomplished within the broader context of social and economic aspects of homelessness.

Adult↗

PubMed1996

Alcoholism in women. More common--and serious--than you might think.

Rising rates of alcohol use disorders and disproportionate medical complications in alcoholic women, plus the dire consequences to their fetuses and children, suggest the need for increased attention to this problem in medical practice. Direct, systematic inquiry about drinking patterns is the most practical and efficient way to detect cases of alcoholism. The potential dangers of prescribing abusable psychoactive drugs for alcoholic women, because of their greater demand or apparent need for these agents, should dictate attention to alcohol use in all medical practice settings.

Alcohol Drinking↗

PubMed1995

Eighteen-month follow-up data on a treatment program for homeless substance abusing mothers.

In response to the dearth of data on substance abuse treatment among homeless mothers, this study breaks new ground in presenting 18-month follow-up data on 149 homeless mothers with young children enlisted in a substance abuse treatment program. The effects of residential compared to nonresidential services were evaluated over the follow-up period. Although dropout rates were high, predictors of dropout were identified, and the residential had a lower dropout rate compared to the nonresidential comparison group. Members of both residential and nonresidential groups evidenced improvement in alcohol and drug problems and in housing stability, regardless of the amount of time they spent in the program. This project demonstrated that homeless mothers can be more successfully engaged in substance abuse programs with provisions of residential placement in addition to participation in a therapeutic community. Future interventions can take advantage of this knowledge in designing more effective programs.

Adult↗

PubMed1995

Complaints of constipation in obsessive-compulsive disorder.

Psychoanalytic observation has launched a long tradition in medical literature that links constipation with obsessive-compulsive traits. This association, however, has never been tested empirically. The current investigation sought to test this hypothesized association empirically using a large, randomly sampled population database. Data from the Epidemiologic Catchment Area project collected with the Diagnostic Interview Schedule were analyzed to determine the association, if any, of complaint of medically unexplained constipation (ascertained from the somatization disorder section of the interview) with a DIS diagnosis of obsessive compulsive disorder (OCD). Reported history of constipation was significantly associated with a lifetime diagnosis of OCD in women (not men), even when controlling for symptom-reporting biases using number of other positive somatoform symptoms. This association was specific to constipation and OCD and did not apply to other functional bowel symptoms including diarrhea, bloating (gas), and abdominal pain. Other psychiatric disorders commonly implicated with functional bowel complaints--major depression and panic disorder--were not significantly associated with constipation controlling for effects of other somatoform symptoms. The lack of association of constipation with OCD in men in a general population sample fails to support psychoanalytic concepts that historically have linked these two phenomena, but a special relationship of OCD with constipation was present in women.

Constipation↗

PubMed1994

Violence and the homeless: an epidemiologic study of victimization and aggression.

The present study is a random, systematic study of 900 homeless subjects in St. Louis that describes violence in their lives, both in terms of victimization, by specific violent traumatic events, and victimizing with recognized aggressive behaviors. Many subjects had experienced a traumatic event, and post-traumatic stress disorder was very common. Substance abuse and other Axis I disorders were associated with a history of a traumatic event. The majority of men and a substantial proportion of women also had a history of physically aggressive behaviors, often beginning in childhood. Aggressive adult behavior was associated with substance abuse and major depression. The aggressive behaviors usually predated homelessness, and about half continued after the individual had become homeless. Therefore, it is seen that violence is very much a part of the lives of the homeless, and it seems to be part of a broader picture of problems associated with risk for and experience of homelessness.

Adolescent↗

PubMed1994

Not all homeless women are alike: effects of motherhood and the presence of children.

Previous work suggests that the population of homeless women is a heterogeneous group, and that motherhood and the presence or absence of children define sub-groups that may be distinct. The current study is a systematic study of 300 homeless women (90% of whom were mothers) according to these suggested sub-groupings. Mothers whose children were with them, compared to other women, were younger and often unemployed and welfare dependent. Mothers without their children had higher rates of nonsubstance Axis I disorders (48%) and alcoholism (33%), and 72% had a lifetime psychiatric diagnosis. Homeless mothers whose children are not with them represent a deviant subgroup with more personal (and fewer social) vulnerabilities to homelessness and may represent a target population for focus of psychiatric treatment efforts. Mothers with their children may benefit more from increased attention to social services.

Adolescent↗

PubMed1994

Posttraumatic stress disorder in survivors of a mass shooting.

OBJECTIVE: Posttraumatic stress disorder (PTSD) has been best studied among combat veterans. Less is known about PTSD among civilian populations exposed to traumatic events. A recent mass murder spree by a gunman in a cafeteria in Killeen, Tex., has provided a unique opportunity to study acute-phase civilian responses to a combat type of experience. METHOD: Approximately 1 month after the disaster, 136 survivors were interviewed with the Diagnostic Interview Schedule/Disaster Supplement. RESULTS: In the acute postdisaster period, 20% of the men and 36% of the women met criteria for PTSD, which was the most prevalent psychiatric disorder. Most subjects who developed PTSD had no history of psychiatric illness. Rates of preexisting PTSD were relatively high and did not predict the presence of PTSD after the disaster. A history of other predisaster psychiatric disorders predicted postdisaster PTSD in women but not in men. One-half of the women and one-fourth of the men with postdisaster PTSD also met criteria for another postdisaster psychiatric diagnosis, especially major depression. Psychopathology was infrequent in subjects without PTSD. CONCLUSIONS: Disaster intervention workers may be able to most effectively use limited mental health provider resources in the acute postdisaster period by focusing on screening for acute PTSD, which will identify the majority of cases with psychiatric disorders following this kind of disaster. Survivors who have no history of psychiatric disorder should be screened along with those who do because in the present study, they represented the majority of the PTSD cases. Subjects with a history of major depression and women with preexisting psychopathology may be especially vulnerable to posttraumatic syndromes. Individuals with PTSD should be further examined for additional psychiatric diagnoses that may complicate recovery, especially major depression. PTSD among survivors of civilian combat-like experiences does not appear to present in the same way that it has been described in Vietnam veterans.

Adult↗

PubMed1994

A review of studies of psychiatric factors in Crohn's disease: etiologic implications.

Researchers have recently challenged long-held concepts of psychological origins to inflammatory bowel disease, in particular with ulcerative colitis. The purpose of this paper is to review published studies on psychiatric factors in Crohn's disease to determine whether available evidence points to the absence or presence of a significant relationship between Crohn's disease and stressful life events or psychiatric symptoms or disorders. Twelve articles with > or = 10 subjects on which statistical data were reported from standardized instruments of measure were found. Most reported a significant association between Crohn's disease and psychiatric factors. Many of the investigative groups reporting such an association in Crohn's disease had also studied ulcerative colitis and failed to find a similar association in that disease. Published data indicate that Crohn's disease, unlike ulcerative colitis, may be statistically associated with lifetime psychiatric disorders. This association appears to be more modest than in irritable bowel syndrome, in which far higher rates of psychiatric disorders are reported than in Crohn's disease.

Anxiety Disorders↗

PubMed1994

Comparison of white and nonwhite homeless men and women.

The majority of the homeless population are people of color. There has been little study of racial differences among the homeless population, and racial findings have not been reported separately for homeless men and women. This study investigated differences between white and nonwhite homeless people in a randomly selected sample of 600 homeless men and 300 homeless women in St. Louis. The 900 homeless people were interviewed using the Diagnostic Interview Schedule and Homeless Supplement. About three-fourths of the sample were African Americans. The homelessness of the white people was more often internally related, for example, substance abuse in men and non-substance abuse psychiatric illness in women. The homelessness of nonwhite people was more often externally related, for example, socioeconomic problems caused by lower incomes for men and reliance on a failing welfare system by women and their dependent families. These differences point to potentially divergent emphases for intervention with these subpopulations. Because of the diversity within racial subgroups, however, all need a variety of interventions for both external and internal problems.

Adult↗

PubMed1993

A comparison of homeless men and women: different populations, different needs.

Homeless women are very different from homeless men, but few studies have reported data separately on them or compared them directly with men. This report on a study of 600 homeless men and 300 homeless women in St. Louis presents comparison data on these populations. The pivotal difference between homeless men and women was that unlike men, most women had young children in their custody. The women were also younger than men, more likely to be members of a minority group, and more often dependent on welfare. They had been homeless for a shorter period and spent less time in unsheltered locations. Compared to men, they had less frequent histories of substance abuse, incarceration, and felony conviction. Solitary women (without children with them), compared to women with children in their custody, were more likely to be white, had been homeless longer, and more often had a history of alcoholism or schizophrenia. On most variables, values for solitary women lay somewhere between those for men and for women with children. The population of homeless women is therefore heterogeneous, with at least two subgroups. These groups are likely to benefit from intervention programs that are designed to address their specific problems and needs, which are not necessarily the same as those of homeless men.

Adolescent↗