PubMed Health⌕ Search

Biomedical subjects

D B Larson

Publications and source records attributed to D B Larson.

At least 55 records · Page 3Linked to original sources
PubMed1991

Psychiatric consultations for psychoactive substance disorders in the general hospital.

A series of 511 consultations to a psychiatric consultation-liaison service was studied. Patients diagnosed with substance abuse disorders were found more likely to be younger, male, and nonwhite. Payer status was not significantly different. Psychiatric consultants' recommendations for substance abuse patients more often consisted of aftercare referral, with less utilization of nonmedical consultations, environmental manipulations, social support, and psychological testing. Further, nonsubstance abusers received more and longer follow-up visits. Overall length of stay was shorter for substance-abuse cases, and for nonabusing cases earlier consultation was associated with briefer hospital stay. The authors discuss factors that may explain these findings, and urge psychiatric consultants to rethink their approach to these patients. A thorough, thoughtful diagnostic evaluation and consideration of a variety of interventions is always indicated.

Adult↗
PubMed1991

Mandatory parental involvement prior to adolescent abortion.

The issue of parental involvement in an adolescent's decision to abort a pregnancy is complex and controversial. Consequently, the impact of legislation to mandate parental involvement is reviewed. Although the costs of such legislation are high, there are at least three important clinical benefits. First, a legal mandate will require many adolescents who would not otherwise involve their parents in this decision process to seek their counsel and emotional support. Second, parent's responsibility for the actions of their adolescent children is acknowledged within the legal system. Third, family unity may be promoted by allowing parents and adolescents an opportunity to deal more openly with the causes and implications of the pregnancy.

Abortion, Legal↗
PubMed1991

Religion and psychological distress in a community sample.

This paper examines the effect of religious attendance and affiliation on psychological distress in a longitudinal community study of 720 adults. Religious affiliation is unrelated to mental health status. In contrast, although religious attendance does not directly reduce psychological distress, it buffers the deleterious effects of stress on mental health. That is, in the face of stressful events and physical health problems, religious attendance reduces the adverse consequences of these stressors on psychological well-being.

Adult↗
PubMed1991

Expenditures for psychotropic medications in the United States in 1985.

OBJECTIVE: Psychotropic medications have seldom been included in estimates of the costs of mental health services. In the infrequent case that these costs have been assessed, they have been estimated by using national surveys of consumers of health services. The objective of this study was to estimate the costs of prescriptions for psychotropic medications in the United States in 1985 and to assess the difference with the most recent cost estimate from a health services survey (1977). METHOD: Study data were based on retail costs of psychotropic medications reported to the Pharmaceutical Data Service Alpha National Prescription and Sales Audit. The data come from a computerized survey panel of 2,250 pharmacies representative of the more than 14,000 pharmacies nationwide. The database includes all medication prescriptions filled, whether paid with cash or Medicaid or reimbursed by third-party payment. Analyses were limited to psychotropic medication prescriptions. RESULTS: In 1985, $1.45 billion was spent on outpatient psychotropic medications. Nearly $868 million (60% of the total) was spent on antianxiety and sedative-hypnotic medications, while approximately $263 million (18%) was spent on antipsychotic medications, $240 million (17%) on antidepressants, and $84 million (5%) on combination psychotropic medications. These expenditures were much higher than would have been expected given the most recent health services estimate of $513 million. CONCLUSIONS: These results demonstrate the substantial cost of psychotropic medications in 1985. The finding that the cost of psychotropic medications was so high, in contrast to the lower estimate from the 1977 survey, demonstrates the importance of obtaining more frequent cost estimates and basing future estimates on medication databases.

Costs and Cost Analysis↗
PubMed1991

Psychotropic medication prescription in U.S. ambulatory medical care.

Because of the pharmacologic power of psychotropic medications, the potential for adverse effects, and the changing popularity of particular psychotropic drugs, it is vital for pharmacoepidemiologists to monitor the prescribing patterns of these medications. Using data from the 1985 National Ambulatory Medical Care Survey (NAMCS), this article assesses psychotropic medication prescribing by U.S. ambulatory care physicians. Psychotropic medications are classified into three categories: minor tranquilizers (i.e., anxiolytics and sedative-hypnotics), antidepressants, and antipsychotics. The prescribing patterns of psychiatrists, primary care clinicians, and all other physicians are compared. Differences in psychotropic prescribing patterns by psychiatric diagnosis are examined as well. The excessive use of minor tranquilizers, the continuing use of first-generation psychotropic medications (particularly minor tranquilizers), and the lack of concordance between diagnoses and prescribed psychotropic medications are discussed.

Ambulatory Care↗
PubMed1991

Effects of age on reporting of adverse clinical events: results from two postmarketing surveillance methods.

Two postmarketing surveillance methods were employed to determine the possible effects of age on reports by outpatients of adverse clinical events (ACEs) occurring shortly after treatment with targeted oral antibiotics or tricyclic antidepressants. One approach involved staff-initiated interviews of patients by telephone and the other involved patient-initiated telephone calls to report possible adverse drug reactions. Regardless of the method, the interviews obtained ACE reports both spontaneously and by review of organ systems. Both postmarketing methods confirmed monotonic relationships for age with treatment duration on the target drugs and with the number of concurrent medications. However, the expected positive correlation between age and spontaneously reported ACEs was evident only in the self-monitoring patients who initiated reports. Negative correlations between age and the number of reported valid ACEs were seen in six independent samples, whereas only two demonstrated a positive relationship. This disparity may elucidate a critical methodologic problem: careful attention must be paid to the means of eliciting information about possible adverse clinical events before attempting to study adverse drug reactions, which are necessarily a subset of ACEs.

Administration, Oral↗
PubMed1991

Tricyclic antidepressant prescribing for nonpsychiatric disorders. An analysis based on data from the 1985 National Ambulatory Medical Care Survey.

BACKGROUND: Primary care physicians often do not document a psychiatric diagnosis when prescribing psychotropic medications. Recent literature suggests the potential benefit of tricyclic antidepressants (TCAs) in a number of nonpsychiatric conditions (low back pain, peptic disease, fibrositis, headache, peripheral neuropathy, rheumatoid disease, and irritable colon). METHODS: Data from the 1985 National Ambulatory Medical Care Survey (NAMCS) were used to categorize the primary diagnoses given during office visits in which tricyclic antidepressants were prescribed. Comparisons were made across specialties. RESULTS: Primary care physicians prescribed tricyclic antidepressants in 1% of all visits (an estimated 2,892,000 visits per year). Whereas 50% of these visits at which TCAs were prescribed were for documented psychiatric illnesses or conditions, 15% were for nonpsychiatric TCA-responsive conditions. The majority of visits by patients with these disorders were to primary care physicians. The pattern of TCA prescribing for these disorders by primary care physicians parallels that of other medical specialties except that primary care physicians prescribed TCAs for nonpsychiatric TCA-responsive disorders less frequently than did other medical specialists. CONCLUSIONS: When nonpsychiatric TCA-responsive disorders are included, primary care physicians document with appropriate diagnoses 15% more of their TCA prescriptions than previous studies have indicated. An understanding of the 35% of TCA prescriptions that do not show proper documentation will require further study and information not available from the NAMCS:

Adolescent↗
PubMed1990

Methodology in consultation-liaison research: a classification of biases.

Methodology is receiving overdue attention in psychiatric research. This article focuses on biases encountered in studies in consultation-liaison psychiatry. A classification of biases derived from epidemiology is presented, and the expected impact of each bias is discussed. Methods to minimize bias in the design and implementation of consultation-liaison research are suggested.

Bias↗
PubMed1990

Supplier-induced demand for pastoral care services in the general hospital: a natural experiment.

Assesses the effects the elimination of a pastoral care training program and a reduction in staff had on referral rates for pastoral care. Results showed a decrease in referrals initiated by pastoral care staff but an increase in pastoral care referrals initiated by medical staff and patients. Notes that when pastoral care staff were less available, the demand for their services became more apparent.

Chaplaincy Service, Hospital↗
PubMed1990

High-repetitive submaximal treadmill exercise training: effect on normal and dystrophic mice.

Exercise as a treatment for muscular dystrophy is controversial. Whereas vigorous high-resistive exercise increases skeletal muscle degeneration in animals with neuromuscular disorders, the effect of low-intensity, high-repetitive exercise has been conflicting. The purpose of this study was to determine if low-intensity, high-repetitive exercise has a beneficial effect on dystrophic mice. Dystrophy mice and unaffected littermates were exercised daily starting at age three weeks on a treadmill (4 m/min, 18 degrees incline, 100 meters, three weeks' duration). Exercise increased the dystrophic soleus twitch tension, the rate of twitch tension development, and the rate of twitch tension relaxation by 55%, 58%, and 48%, respectively (p less than .05). The twitch:tetanus ratio increased by 57% (p less than .05). Both the soleus and the extensor digitorum longus from the exercised dystrophic mice had significantly less degeneration (as shown by reduced internal nuclei, necrosis, fiber splitting, and moth-eaten fibers) than the nonexercised dystrophic mice (p less than .05). This study suggests that exercise training programs can be beneficial or at least not result in further muscle fiber degeneration if (1) the exercise program is started early in the course of the disease; (2) submaximal high-repetitive or even high-resistive exercise is used; and (3) the histopathologic degeneration is slowly progressive or in an arrested state.

Animals↗
PubMed1989

Prescription of psychotropics to children in office-based practice.

Multiple authors have stressed the need for close follow-up and simultaneous psychotherapy in most children treated with psychotropic drugs. However, little is known about the actual prescription of psychotropic medications in pediatric settings. Using the 1985 National Ambulatory Medical Care Survey, we investigated the frequency of follow-up arrangements and concurrent psychotherapy among US children in visits to office-based practices. We then explored determinants of psychotropic drug prescriptions. Mental health indicators, sociodemographic characteristics, provider type, and provider familiarity with the patient were important predictors of psychotropic prescriptions. Few providers report referral or concurrent psychotherapy for their patients receiving psychotropics, and follow-up plans were no different for children with or without psychotropics after controlling for other variables. This means that many children in outpatient care who are taking psychotropic medications may not be receiving optimal management for behavioral or emotional problems.

Adolescent↗
PubMed1989

Effect of hind-limb suspension on young and adult skeletal muscle. I. Normal mice.

The purpose of this study was to determine the effect of hind-limb suspension (HS) on morphometric, histologic, and contractile characteristics of fast extensor digitorum longus (EDL) and slow soleus (SOL) twitch muscles in adult and immature mice. Hind-limb suspension for 2 weeks was used to produce atrophy in two groups of mice, ages 4 and 12 weeks, with nonsuspended animals serving as controls. Young HS mice exhibited marked decreases in SOL weight, length, cross-sectional area (CSA), twitch and tetanic tensions, and rates of tension development and relaxation, with increases in fatigue resistance. HS reduced the diameter of both type I and IIA fibers, increased the percentage of type I fibers, and decreased the percentage of type IIA fibers in both young and adult SOL. Muscle weight, length, CSA, IIA and IIB fiber areas, and maximum rate of tetanic tension development were decreased in EDL of young HS mice; fatigue resistance and EDL half-relaxation times were increased. For most parameters evaluated, slow twitch muscle was more affected than fast twitch. HS affected contractile characteristics less than morphometric or histologic parameters. Rates of tension development and relaxation were the contractile parameters most affected by HS, and the time parameters of contraction were least affected. For all measurements young mice were more affected than adult mice.

Aging↗
PubMed1989

Effect of hind-limb suspension on young and adult skeletal muscle. II. Dystrophic mice.

Disuse atrophy induced by limb immobilization reportedly protects dystrophic mouse muscle from histopathological changes. This study was conducted to determine whether disuse atrophy induced by hind-limb suspension (HS) limits the histopathology and contractile abnormalities typically observed in the dystrophic mouse. Two weeks of hind-limb suspension were applied to dystrophic mice (line 129B6F1) at two ages, 4 weeks (6 mice) and 12 weeks (8 mice). Thirty-one untreated dystrophics served as controls. In general, HS exaggerated the dystrophic signs, especially in the younger mice; it reduced animal weight, muscle weight, maximum tetanic and twitch tensions, and rates of tetanic and twitch tension development. HS further slowed the contractile properties of soleus (SOL) and extensor digitorum longus (EDL) muscles, and increased their fatigue resistance. HS reduced the size of type I and IIA fibers in the 6-week SOL and EDL, but not in the 14-week muscles. HS produced a preferential atrophy of SOL type I fibers, with a parallel increase in type IIA fibers. However, it did not alleviate the fiber size variability, degree of necrosis, central nucleation, inflammation, or muscle fibrosis in dystrophic muscles. These data demonstrate that disuse by hind-limb suspension does not prevent the histopathological deterioration or loss of muscle function in 6- and 14-week dystrophic mice.

Aging↗