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Biomedical subjects

D W Black

Publications and source records attributed to D W Black.

At least 19 recordsLinked to original sources
PubMed1997

Characteristics of 36 subjects reporting compulsive sexual behavior.

OBJECTIVE: The authors describe the sociodemographic features, phenomenology, and psychiatric comorbidity of 36 subjects reporting compulsive sexual behavior. METHOD: Twenty-eight men and eight women who responded to advertisements for "persons ... who have a problem with compulsive sexual behavior" completed structured and semistructured assessments, including the Diagnostic Interview Schedule for DSM-III-R disorders (axis I) and the Structured Interview for DSM-III-R Personality Disorders, Revised (axis II). RESULTS: The typical subject was a 27-year-old man who reported experiencing compulsive sexual behavior for nearly 9 years. Sexual behavior was described as excessive and poorly controlled and was associated with either subjective distress or impairment in interpersonal or occupational functioning or as overly time-consuming. Fourteen subjects (39%) reported a history of major depression or dysthymia, 15 (42%) a history of phobic disorder, and 23 (64%) a history of substance use disorder. Personality disorders were quite frequent, particularly the paranoid, histrionic, obsessive-compulsive, and passive-aggressive subtypes. The compulsive sexual behavior was quite varied and included both paraphilic (e.g., cross-dressing) and nonparaphilic (e.g., compulsive masturbation) types. CONCLUSIONS: Compulsive sexual behavior may be a clinically useful concept, but it describes a heterogeneous group of individuals with substantial psychiatric comorbidity and diverse behavioral problems.

Adolescent↗
PubMed1997

Fluvoxamine in the treatment of compulsive buying.

BACKGROUND: The authors report the results of an open trial of fluvoxamine in the treatment of compulsive buying. METHOD: Ten nondepressed subjects were recruited through word-of-mouth and rnet restrictive inclusion/exclusion criteria. Subjects were assessed with the Yale-Brown Obsessive-Compulsive Scale modified for compulsive buying, the Clinical Global Impression scale, and other measures. After a single-blind 1-week placebo run-in, subjects received fluvoxamine up to 300 mg daily for 9 weeks. RESULTS: Nine of 10 subjects improved and were less preoccupied with shopping, spent less time shopping, and reported spending less money. CONCLUSION: We conclude that compulsive buyers can be recruited for research and their symptoms measured and monitored and, finally, that fluvoxamine may be effective in its treatment.

Adult↗
PubMed1996

Reliability and validity of a scale to measure change in persons with compulsive buying.

A new scale to measure severity and change in persons with compulsive buying is described. Data were gathered during an open-label study in which compulsive buyers were treated with fluvoxamine, a serotonin reuptake inhibitor. The instrument showed good-to-excellent interrater reliability and high internal consistency. Its 10 separate items showed at least moderate correlations with the total score. The instrument was also sensitive to clinical change and correlated highly with other measures of illness severity. We conclude that this new instrument is both reliable and valid in measuring severity and change in persons with compulsive buying.

Adult↗
PubMed1996

Compulsive buying: a review.

Compulsive buying has a long history. Described nearly a century ago by Kraepelin, and later by Bleuler, the disorder has been of interest to psychoanalysts and to the popular media. Recent interest has been rekindled by consumer behavior research that shows it to be widespread and psychiatric research that shows it to have the earmarks of a psychiatric disorder. The author reviews the history, definition, epidemiology, family history, etiology, clinical symptoms, and treatments of compulsive buying. Preliminary data from an open-label study in which subjects received fluvoxamine are also presented.

Adult↗
PubMed1995

Exclusion of close linkage between the synaptic vesicular monoamine transporter locus and schizophrenia spectrum disorders.

The principal brain synaptic vesicular monoamine transporter (VMAT2) is responsible for the reuptake of serotonin, dopamine, norepinephrine, epinephrine, and histamine from the cytoplasm into synaptic vesicles, thus contributing to determination of the size of releasable neurotransmitter vesicular pools. Potential involvement of VMAT2 gene variants in the etiology of schizophrenia and related disorders was tested using polymorphic VMAT2 gene markers in 156 subjects from 16 multiplex pedigrees with schizophrenia, schizophreniform, schizoaffective, and schizotypal disorders and mood incongruent psychotic depression. Assuming genetic homogeneity, complete (theta = 0.0) linkage to the schizophrenia spectrum was excluded under both dominant and recessive models. Allelic variants at the VMAT2 locus do not appear to provide major genetic contributions to the etiology of schizophrenia spectrum disorders in these pedigrees.

Genetic Linkage↗
PubMed1995

Psychiatric disorders in relatives of probands with obsessive-compulsive disorder and co-morbid major depression or generalized anxiety.

The authors report findings from a blind, controlled study of obsessive-compulsive disorder (OCD). Prevalence rates of generalized anxiety disorder (GAD) and major depressive disorder (MDD) were compared among first-degree relatives of probands with OCD and co-morbid GAD or MDD, respectively. Rates of MDD were not increased in relatives of probands with OCD and MDD; neither were rates of GAD increased in relatives of probands with OCD and GAD, although rates of GAD were increased among relatives of probands with OCD compared to relatives of healthy controls. The authors explore the implications of the findings.

Adolescent↗
PubMed1995

Exclusion of close linkage of the dopamine transporter gene with schizophrenia spectrum disorders.

OBJECTIVE: Involvement of genetic factors in the pathogenesis of schizophrenia spectrum disorders has been indicated in twin, adoption, and familial aggregation studies; the pivotal role played by the dopamine transporter in dopaminergic neurotransmission makes it a candidate gene for these disorders. Detection of close linkage between a dopamine transporter marker and schizophrenia spectrum disorders would strongly support the existence of causal relationships between genetic mutations at the dopamine transporter locus and the disease phenotype. METHOD: The authors assessed the linkage between this gene and schizophrenia spectrum disorders by using polymorphic dopamine transporter gene markers in 156 subjects from 16 multiplex pedigrees with schizophrenia as well as schizophreniform, schizoaffective, and schizotypal disorders and mood-incongruent psychotic depression. RESULTS: Complete (theta = 0.0) linkage to the schizophrenia spectrum was excluded under both dominant and recessive models. CONCLUSIONS: These results indicate that allelic variants at the dopamine transporter locus do not provide major genetic contributions to the etiology of schizophrenia and related disorders in these pedigrees.

Alleles↗
PubMed1995

Acute treatment response in outpatients with panic disorder: high versus low depressive symptoms.

The authors studied 75 outpatients with DSM-III-R panic disorder who had participated in a clinical trial and had been randomly assigned to receive fluvoxamine, cognitive therapy, or placebo for an 8-week period. They compared a group with high levels of depressive symptoms and a group with low levels of depressive symptoms. At baseline, patients with high levels of depressive symptoms were more likely to have severe phobic avoidance and to have higher scores on measures of anxiety, hyochondriasis, and disability. An important finding was that depressive symptoms improved at a rate which paralleled improvement in panic and anxiety. Likewise, the presence of depressive symptoms did not interfere with treatment response in panic disorder. Clinical implications of the findings are discussed.

Adult↗
PubMed1995

The long-term outcome of antisocial personality disorder compared with depression, schizophrenia, and surgical conditions.

The objective of this study was to assess the long-term outcome of antisocial personality disorder (APD) compared with depression, schizophrenia, and surgical conditions. Seventy-one men meeting DSM-III criteria for APD and hospitalized at the University of Iowa Department of Psychiatry between 1945 and 1970 were followed up between 1986 and 1990, an average of 29 years after discharge. Comparison groups, collected during the Iowa 500 study, included depressed subjects (n = 225), schizophrenic subjects (n = 200), and surgical control subjects (n = 160). Patients were rated as having good, fair, or poor adjustment for marital, residential, occupational, and psychiatric status. The Global Assessment Scale was also used to rate subjects. At follow-up, antisocial subjects were doing significantly better than schizophrenic subjects for marital and residential, but not occupational or psychiatric, adjustment. Both depressed subjects and surgical controls had significantly better adjustment than antisocial subjects in all areas except residential status. Although these data apply to antisocial men who had been psychiatrically hospitalized, we conclude that APD causes significant long-term impairment in important domains of life.

Adolescent↗
PubMed1994

Compulsive buying. Demography, phenomenology, and comorbidity in 46 subjects.

Compulsive buying has been generally ignored in the psychiatric literature, although it is apparently frequent, underrecognized, and can lead to severe financial and legal consequences for its sufferers. The current investigation was designed to assess the overall life-style and problems of subjects identified as compulsive shoppers. Forty-six compulsive buyers were assessed for comorbid psychiatric disorders with the Diagnostic Interview Schedule, the Structured Interview for DSM-III-R Personality Disorders, and a semistructured interview to assess buying behavior. The typical shopper was a 31-year-old female who had developed compulsive buying at age 18 years. Subjects spent their money on clothing, shoes, and records/compact discs. The average debt load accrued was $5,422 out of an average yearly income of $23,443. More than two-thirds met lifetime criteria for a major (Axis I) mental disorder, most commonly anxiety, substance abuse, and mood disorders. Nearly 60% were found to meet criteria for a DSM-III-R personality disorder, most commonly the obsessive-compulsive, borderline, and avoidant types. The authors conclude that compulsive buying is a definable clinical syndrome which can cause its sufferers significant distress and is associated with significant psychiatric comorbidity.

Adolescent↗
PubMed1994

Predictors of short-term treatment response in 66 patients with panic disorder.

Short-term treatment response in panic disorder was studies in 66 subjects who had completed 3 weeks of treatment with fluvoxamine (n = 23), cognitive therapy (n = 20), or placebo (n = 23). Clinical and self-rated assessments were gathered at baseline, during, and after treatment. Using multiple logistic regression, treatment with fluvoxamine, a low panic attack severity score, and absence of a comorbid personality disorder were identified as significant predictors of recovery. Personality disorder was an important negative predictor to outcome with cognitive therapy. The results support the efficacy of fluvoxamine, and show that patients with low symptom severity and a normal personality respond well to treatment.

Adolescent↗
PubMed1994

The demography, phenomenology, and family history of 22 persons with compulsive hair pulling.

This study reports on the demographics, phenomenology, and family history of 22 compulsive hair pullers. Subjects were recruited through a psychiatric outpatient clinic as well as newspaper advertisements. Subjects completed a semistructured interview focused on hair-pulling behavior and demographics, the Diagnostic Interview Schedule to assess major (Axis I) mental disorders, and the Structured Interview for DSM-III-R Personality Disorders to assess Axis II disorders. The typical subject was a 33-year-old woman who had completed 1 or more years of college and had been pulling her hair for 19 years. Nearly two-thirds met the criteria for a major mental disorder (particularly anxiety and mood disorders), and more than one-half met the criteria for a personality disorder. Nearly three-quarters of first-degree relatives were reported to have a psychiatric disorder, and about 5% were reported to be hair pullers.

Adolescent↗
PubMed1994

Risperidone: review of its pharmacology and therapeutic use in schizophrenia.

The discovery of antipsychotic medications has revolutionized the treatment of schizophrenia and other psychotic disorders. However, side effects such as extrapyramidal symptoms (EPS) and tardive dyskinesia have been limiting factors in treatment. The introduction of atypical drugs such as clozapine and risperidone has ushered in a new era. This article provides an overview of the pharmacology, efficacy, and techniques for the clinical use of risperidone, which has recently become available.

Antipsychotic Agents↗
PubMed1994

Multiple chemical sensitivity syndrome: a clinical perspective. I. Case definition, theories of pathogenesis, and research needs.

Multiple chemical sensitivity syndrome (MCS) does not appear to fit established principles of toxicology. Yet social, political, and economic forces are demanding that MCS be defined medically, even though to date scientific studies have not identified pathogenic mechanisms for the condition or any objective diagnostic criteria. Consequently, a working definition of MCS can rely only on an individual's subjective symptoms of distress and attribution to environmental exposures rather than currently measurable objective evidence of disease. Nevertheless, patients labeled with MCS are clearly distressed and many are functionally disabled. In this review, four theories of causation are explored: (1) MCS is a purely biologic/physical or psychophysiologic reaction to low-level chemical exposures. (2) MCS symptoms may be elicited by low-level environmental chemical exposures, but the sensitivity is initiated by psychologic stress. (3) MCS is a misdiagnosis and chemical exposure is not the cause. The symptoms may be due to misdiagnosed physical or psychologic illness. (4) MCS is an illness belief system manifest by culturally shaped illness behavior. Areas for further research regarding the etiologies of MCS are suggested. Recognizing that the cause of the syndrome may be multifactorial, strategies are proposed for clinical evaluation and management in Part II of this manuscript using a biopsychosocial model of illness.

Humans↗
PubMed1994

Multiple chemical sensitivity syndrome: a clinical perspective. II. Evaluation, diagnostic testing, treatment, and social considerations.

Multiple chemical sensitivity syndrome (MCS) does not appear to fit established principles of toxicology. Social, political, and economic forces are demanding that MCS be defined medically, even though scientific studies have failed as yet to identify pathogenic mechanisms for the condition or any objective diagnostic criteria. Consequently, a working definition of MCS can only rely on a person's subjective symptoms of distress and attribution to environmental exposures rather than currently measurable objective evidence of disease. Nevertheless, patients labeled with MCS are clearly distressed and many are functionally disabled. Without reconciling the different theories of etiology of MCS discussed in Part I of this report, and recognizing that the cause of the syndrome may be multifactorial, strategies are proposed for clinical evaluation and management of patients with MCS using a biopsychosocial model of illness. The social implications of this illness are also discussed.

Health Policy↗