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Biomedical subjects

E J Bromet

Publications and source records attributed to E J Bromet.

At least 19 recordsLinked to original sources
PubMed1998

Conduct disorder and mania: what does it mean in adults.

OBJECTIVE: Because of the relationship between childhood behavior disorders and adult substance abuse, we hypothesized that substance abusing adult bipolars were more likely to have had behavior disorders as children than nonabusing bipolar adults. METHODS: Conduct disorder (CD) symptoms in 132 bipolar adults were compared by age and presence of comorbid substance use problems using data from the Epidemiologic Catchment Area study. RESULTS: Rates of CD were higher in bipolar subjects under age 30 (32.6%) versus those over (16.3% P<0.05). Young BPs with substance use problems (SUBST) had CD rates three times those without SUBST (52% vs. 14.8%) (P < 0.01). Young subjects without mania or SUBST had CD rates of 7.75%. CONCLUSION: Substance abuse in bipolar adults may be more related to childhood conduct disorder than uncomplicated bipolar disorder.

Adolescent↗
PubMed1998

Psychiatric illness and family stigma.

Considerable research has documented the stigmatization of people with mental illnesses and its negative consequences. Recently it has been shown that stigma may also seriously affect families of psychiatric patients, but little empirical research has addressed this problem. We examine perceptions of and reactions to stigma among 156 parents and spouses of a population-based sample of first-admission psychiatric patients. While most family members did not perceive themselves as being avoided by others because of their relative's hospitalization, half reported concealing the hospitalization at least to some degree. Both the characteristics of the mental illness (the stigmatizing mark) and the social characteristics of the family were significantly related to levels of family stigma. Family members were more likely to conceal the mental illness if they did not live with their ill relative, if the relative was female, and if the relative had less severe positive symptoms. Family members with more education and whose relative had experienced an episode of illness within the past 6 months reported greater avoidance by others.

Adolescent↗
PubMed1998

Homelessness among individuals with psychotic disorders hospitalized for the first time: findings from the Suffolk County Mental Health Project.

OBJECTIVE: Although data suggest that homelessness among persons with severe mental disorders is both distressing and common, several important epidemiologic questions remain unanswered. This study reports on the occurrence of homelessness in a quasi-representative sample of persons newly hospitalized with psychotic disorders. The authors also compared rates of homelessness in different diagnostic groups and among groups with differing symptom profiles. METHOD: The study was based on data from 237 first-admission patients hospitalized at 10 of the 12 inpatient facilities in eastern Long Island, N.Y. Consensus diagnoses were derived from multiple sources of information, including the Structured Clinical Interview for DSM-III-R. Patients were followed over a 24-month period after initial interview. Homelessness histories were based on subject self-reports. RESULTS: Fifteen percent of the patients had experienced at least one episode of homelessness before or within 24 months of their first psychiatric hospitalization. In more than two-thirds of these cases, the initial homeless episode had occurred before the first hospitalization. There were no significant differences in the risk of homelessness among diagnostic groups. Among subjects diagnosed with schizophrenia and related disorders, those with high levels of negative symptoms had a significantly greater risk of prehospitalization homelessness than those with low symptom levels. CONCLUSIONS: The high rate of homelessness observed must be viewed with profound concern by clinicians, consumers, and policymakers alike. The findings support the importance of intervening early in the course of disorder, particularly for persons diagnosed with psychotic illnesses.

Adolescent↗
PubMed1997

Diagnosis, treatment, and six-month outcome status in first-admission psychosis.

Six-month outcome status was examined in 202 first-admission inpatients with DSM-III-R schizophrenia spectrum (N = 96), psychotic bipolar disorder (N = 64), and psychotic depression (N = 42) drawn from 10 facilities in Suffolk County, New York. Schizophrenics fared significantly worse on all outcome variables rehospitalization, which ranged from 17.7 to 23.4%. Bipolars had good psychosocial outcomes regardless of clinical outcome, while the two outcome domains were uncorrelated among schizophrenics and psychotic depressed. Schizophreniform patients had significantly better outcome than those with schizophrenia or schizoaffective disorder. Posthospital treatment was generally unrelated to outcome except that fewer rehospitalized schizophrenics received continuous treatment, and patients with psychotic depression with poorer psychosocial outcome received medication less frequently. These findings highlight the different treatment needs of these diagnostic groups, especially as regards the provision of more intensive rehabilitation for schizophrenic patients and the "poor-outcome" psychotic depressed.

Adolescent↗
PubMed1996

Insight in first-admission psychotic patients.

BACKGROUND: The prevalence of insight was examined longitudinally in psychotic patients with schizophrenia (n = 86), bipolar disorder (n = 52), major depressive disorder (n = 35) and other psychoses (n = 16). METHOD: Before discharge and at 6-month follow-up, insight in first-admission patients from 10 facilities in Suffolk County, New York was rated as part of a modified Hamilton Depression Scale. RESULTS: Initially, 80% of depressives but approximately half with other diagnoses manifested insight. At follow-up, most patients demonstrated insight except for the schizophrenic patients. After controlling for diagnosis, significant correlates of baseline insight were being married, hospitalized in a community or academic facility, intelligence and negative symptoms. At follow-up, after controlling for diagnosis and baseline insight, prior treatment was predictive. This finding held for schizophrenic patients separately. CONCLUSION: Lack of insight is more prevalent in schizophrenia and improves over time. The components of prior treatment leading to better insight should be explored.

Adult↗
PubMed1996

Mood-congruent versus mood-incongruent psychotic symptoms in first-admission patients with affective disorder.

The distribution of mood-congruent and mood-incongruent symptoms in 49 first-admission DSM-III-R psychotic bipolar and 35 psychotic depressed patients is presented. Most patients had mood-incongruent symptoms (77.4%). 73% of mood-incongruent bipolars and 32% of incongruent depressives had a combination of mood-congruent and mood-incongruent symptoms. Demographic and clinical variables were unrelated to incongruence. The only 24-month clinical outcome predicted by mood incongruence was poorer GAF rating. 15 of the 16 patients whose diagnosis was changed at follow-up from affective to nonaffective psychosis had mood-incongruent features initially. The findings raise questions about the general prognostic utility of mood congruence.

Adult↗
PubMed1996

Diagnosis and six-month stability of negative symptoms in psychotic disorders.

Negative symptoms were examined in 150 primarily first-admission patients diagnosed with schizophrenia, schizoaffective disorder, psychotic depression, psychotic bipolar disorder, and 'other' psychoses. The analysis focused on patients who were rated on the Scale for the Assessment of Negative Symptoms (SANS) within 45 days of admission and at follow-up 6 months later. Significantly more schizophrenics had moderate to severe negative symptoms at each time point compared with other psychotic patients. The SANS scores were found to be relatively stable over time in all five diagnostic groups. Although the DSM-IV includes alogia, affective flattening, and avolition in the A criterion for schizophrenia, only alogia and affective flattening were found to be specific to this disorder. Our results point to the existence and enduring quality of negative symptoms in the early phase of psychosis and its specificity to schizophrenia even at this early stage.

Adolescent↗
PubMed1996

The Suffolk County Mental Health Project: demographic, pre-morbid and clinical correlates of 6-month outcome.

The diagnostic specificity and predictive utility of the classical prognostic indicators in schizophrenia were examined in psychotic patients enrolled in the Suffolk County Mental Health Project. First-admission psychotic patients with schizophrenia (N = 96), major depression (N = 42), and bipolar disorder (N = 64) drawn from 10 facilities in Suffolk County, New York, were assessed during their initial hospitalization and at 6-month follow-up. Longitudinal consensus diagnoses were determined after the 6-month interview. The diagnostic groups shared similar background characteristics, but schizophrenics had poorer pre-morbid adjustment, longer periods of psychosis before hospitalization and more negative symptoms initially. Except for rehospitalization, schizophrenics had the worst and bipolars the best functioning at follow-up. Among the classical prognostic indicators, the best predictor of 6-month outcome for each diagnostic group was premorbid functioning.

Adolescent↗
PubMed1995

Psychotic patients with unclear diagnoses. A descriptive analysis.

This report describes the clinical characteristics of psychotic patients who received a 6-month longitudinal research diagnosis of psychosis not otherwise specified (NOS) or for whom no consensus diagnosis was reached. The reasons why these subjects could not be classified into a specific DSM-III-R category, their classification under the proposed DSM-IV criteria, their reclassification at 24-month follow-up, and differences between these groups and patients with schizophrenia and affective disorders in demographic characteristics, initial clinical features, and short-term course are explored. Data were drawn from the first phase of the Suffolk County Mental Health Project. Longitudinal consensus procedures were used to derive 6- and 24-month DSM-III-R diagnoses based on information from a structured diagnostic interview, an interview with the patient's clinician, the medical record and discharge summary, and significant others. Thirteen subjects (4.7%) received a diagnosis of psychosis NOS, and 12 (4.3%) had no consensus diagnosis. Seven with psychosis NOS had an acute onset with rapid remission; this subgroup met DSM-IV criteria for brief psychosis without stressors. As a group, the psychosis NOS subjects were significantly older and had a lower rate of lifetime alcohol abuse/dependence than the schizophrenic and affective disorder groups. Their short-term course was significantly better than that of the schizophrenics and similar to that of patients with an affective disorder. Subjects with no consensus diagnosis were more likely to have lifetime drug abuse/dependence than the other two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Gender, premorbid characteristics and negative symptoms in schizophrenia.

The interrelationships among gender, premorbid functioning, and negative symptoms were examined in a first-admission inpatient sample with DSM-III-R schizophrenia. Fifty-two subjects were assessed with the Schedule for the Assessment of Negative Symptoms (SANS) at baseline and 6-month follow-up. Three indicators of premorbid functioning were examined: the Premorbid Adjustment Scale, the Quick Test, and the GAF for the best month in the year prior to the baseline interview. Men and women had relatively similar ratings on each of the 5 SANS global subscales at both times; they were also relatively similar on most of the indicators of premorbid functioning. The men and women were categorized into low vs moderate-high negative symptom groups at baseline, and no differences in premorbid functioning were detected. When the sample was classified into those with and without consistent negative symptoms at baseline and 6-month follow-up, the enduring negative men and women had significantly poorer premorbid functioning in several areas than the consistently non-negative patients. Our findings support the importance of assessing negative symptoms longitudinally and suggest that gender is not strongly associated with negative symptoms and premorbid functioning in patients ascertained at early stages of schizophrenia.

Adult↗
PubMed1995

Medication treatment in first-admission patients with psychotic affective disorders: preliminary findings on research-facility diagnostic agreement and rehospitalization.

The discharge medications of 101 Suffolk County subjects with facility and/or research diagnoses of affective disorder were ascertained. Rehospitalization was recorded for a 6-month follow-up period. Twenty-three of 31 patients (74.2%) with a facility diagnosis of depressive disorder were prescribed antidepressants, and 21 of 36 patients with a facility diagnosis of bipolar disorder (58.3%) were prescribed lithium. When research and facility diagnoses concurred, 84.2% of depressed patients were prescribed antidepressants, and 66.7% of bipolars were given lithium. The percentages were lower when the two diagnoses were discrepant. The results for diagnostic congruence were independent of demographic variables, length of stay, and premorbid functioning. Patients prescribed diagnosis-specific medications had a lower rate of rehospitalization (7.3%) than those not prescribed such medications (22.2%). The findings suggest that such medications are prescribed in the more unambiguous cases of affective disorders and are important (with or without antipsychotic treatment) in preventing rehospitalization.

Adolescent↗
PubMed1994

Are diagnostic criteria, time of episode and occupational impairment important determinants of the female:male ratio for major depression?

This study addresses whether the female preponderance in the 1-year prevalence of major depressive disorder is associated with differences in reporting symptoms or underreporting remote episodes, or the inclusion of work impairment in the case definition. In a sample of 1870 professionals and managers, we find (1) a more restrictive cut-off point for women does not eliminate the differential; (2) males and females equally underreport symptoms for remote episodes; and (3) adding impairment to the case definition marginally affects the F:M ratio. Thus, the large F:M prevalence ratio is not an artifact of ascertainment method, case definition, or differential recall.

Adult↗
PubMed1994

The confusion between bipolar disorder and schizophrenia in youth: where does it stand in the 1990s?

OBJECTIVE: To determine whether the bias against diagnosing bipolar disorder in youth continues, and if so, why. METHOD: Subjects are bipolar and schizophrenic patients taken from a county-wide sample of first admissions for psychosis. Patients are given structured interviews and consensus diagnoses at intake and 6 months. Age of onset of psychosis, gender, and 6-month consensus diagnosis between both groups are compared. To assess diagnostic bias, diagnostic stability and facility discharge diagnoses are examined in young (aged 15 through 20 years) versus adult (aged 30 through 40 years) patients. RESULTS: Bipolar disorder and schizophrenia are diagnosed at similar rates in younger age groups by 6-month consensus. However, bipolar disorder was underdiagnosed by Suffolk County's psychiatric hospitals in the youth. The stability of both disorders in both age groups was similar and excellent. Schizophrenia had a slightly older age at first psychosis than bipolar disorder and an equal gender representation. Bipolar disorder in males was rare after age 30. CONCLUSION: Community psychiatrists no longer call young bipolar patients schizophrenic, but they underdiagnose bipolar disorder. The more complicated nature of early-onset bipolar disorder may be a contributing factor.

Adolescent↗
PubMed1994

Eliciting psychotic symptoms using a semi-structured diagnostic interview. The importance of collateral sources of information in a first-admission sample.

This study addressed the importance of medical record information in determining the presence of psychotic symptoms in first-admission patients. A sample of 232 first-admission inpatients screened for psychotic symptoms by facility personnel was administered the Structured Clinical Interview for DSM-III-R (SCID) followed by a medical record review and interview with a significant other. Medical records were unavailable for sixteen patients. These patients were more often female, married, and more suspicious than patients whose records were reviewed. Of those having interviews and record reviews, 49 showed no clear evidence of psychosis. The remainder were divided into three groups: 97 subjects who revealed all of their psychotic symptoms during the interview (SCID-ALL); 61 who revealed only some of their delusions or hallucinations during the interview (SCID-PART); and 25 who revealed none of this information during the interview but whose records clearly described psychosis (SCID-NONE). The three groups were reasonably similar demographically and with respect to clinical history. Clinically, at the time of interview, SCID-NONE subjects were less often still psychotic, were rated on the Brief Psychiatric Rating Scale as less depressed, more withdrawn, less cooperative and less severely ill, and had poorer insight ratings on the Hamilton Depression Scale.

Adult↗
PubMed1994

Comparison of facility and research diagnoses in first-admission psychotic patients.

OBJECTIVE: The present study investigated the concordance of clinical and research-based DSM-III-R diagnoses in community, public, and university hospital first-admission patients. In addition to demographic characteristics, information and criterion variance were assessed as explanations for the diagnostic disagreements. METHOD: As part of the Suffolk County (New York) Mental Health Project, 223 first-admission subjects with a psychotic disorder were interviewed with the Structured Clinical Interview for DSM-III-R, and consensus diagnosis was made by two project psychiatrists. Clinical diagnoses were abstracted from discharge summaries obtained subsequent to the research diagnoses, and reasons for disagreement between the two diagnoses were determined. RESULTS: Moderate overall agreement between facility and research diagnoses was found, with highest agreement with the university facility, lowest with the public facilities, and intermediate agreement with the community facilities. Demographic variables were not significantly associated with diagnostic discordance. Apparent reasons for diagnostic disagreement included evidence of variability in information available to clinicians and research psychiatrists (N = 39 or 48% of cases with disagreement), as well as in clinical judgment in the application of DSM-III-R criteria (N = 42 or 52% of cases with disagreement). CONCLUSIONS: Considerable differences between facility and research diagnoses remain, especially in the public and community sectors; these differences can be attributed to information and criterion variance. Longitudinal follow-up is necessary to establish the predictive validity of the initial clinical and research diagnoses. Future research should also address other possible reasons for these discrepancies.

Adult↗
PubMed1993

Predictors of temporal patterns of psychiatric distress during 10 years following the nuclear accident at Three Mile Island.

The present study examines psychiatric symptom levels during a 10-year period in a community sample of mothers of young children. All were identified in the early aftermath of the 1979 Three Mile Island nuclear accident, and followed through the accident's 1989 anniversary. Cluster analysis was used to identify long-term distress profiles during the study period; women's temporal profiles were found to be either (a) stable and at low, clinically nonsignificant levels of distress across all measurement points or (b) at consistently elevated, clinically significant levels that varied with the timing of postaccident events such as the restart of the undamaged reactor and the 10th anniversary. Subsequent multivariate analyses indicated that preaccident characteristics, as well as parameters reflecting respondents' initial involvement with, and reactions to the accident, were important for distinguishing between women within the two temporal profile groups. Implications of the results for both policy formulation and continued research on significant environmental stressors is discussed.

Accidents↗
PubMed1993

Seasonal variations of current symptoms in a healthy population.

Among a large workplace population interviewed over a year, current symptoms were assessed using the Hopkins Symptom Checklist (HSCL). Variation in symptoms by date of assessment was observed among the 314 women but not the 1556 men. Among women, symptoms were greatest during late autumn and winter, and significant inverse correlations were found between available daylight at the time of assessment and standard symptom dimensions of anxiety and somatisation, as well as an expanded mood scale more inclusive of depressive symptoms within the check-list. The amplitude of the seasonal effect was such that the prevalence of female 'cases', as defined by HSCL criteria, was twice as high during winter than during the rest of the year. The data are consistent with a role for light-dark exposure in eliciting or synchronizing annual mood rhythms. The sex-by-season interactions may contribute to the sex differences in overall prevalence of depression.

Adult↗