Biomedical subjects

Frederic C Blow

Publications and source records attributed to Frederic C Blow.

At least 37 records · Page 2Linked to original sources

PubMed2005

New-onset bipolar disorder in later life.

OBJECTIVE: This analysis of a large VA database evaluated differences in clinical presentation, health service use, and psychotropic medication utilization among 16,330 patients with bipolar disorder age 60 and older. Selected differences were compared between new-onset and earlier-onset groups. METHODS: Geriatric patients with new-onset bipolar illness (NOI) were compared with geriatric patients with earlier-onset bipolar illness (EOI) on selected clinical variables and on health resource utilization. RESULTS: Among the 65,556 individuals with bipolar disorder treated in the VA in federal fiscal year 2001 (FY 01), 16,330 (24.9%) were age 60 or older. The large majority, 13,477 (82.5%), had earlier-onset bipolar illness, whereas 1,000 individuals (6.1%) had apparently new-onset bipolar disorder. A fairly consistent pattern in health resource use when comparing new- versus earlier-onset bipolar disorder was overall less resource utilization by individuals with new-onset illness. As compared with EOI individuals, NOI individuals have less outpatient care overall and fewer mental health care visits. CONCLUSIONS: Bipolar disorder among older adults is common in the VA and is an increasingly emphasized problem in older non-VA populations, as well. Health service use by older adults with bipolar disorder is high, and includes substantial utilization of inpatient non-psychiatric care. Distinctions between earlier- and new-onset bipolar disorder have important implications with respect to illness presentation and health resource utilization.

Age of Onset↗

PubMed2005

Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression.

OBJECTIVE: Depression is commonly found as a coexisting condition in dementia. An earlier retrospective study by the authors found that patients with coexisting dementia and depression (CDD) were high utilizers of inpatient and nursing home care. The current prospective study was designed to investigate specific factors that might contribute to outcomes such as nursing home placement by examining the detection and course of CDD subjects as compared with subjects with either disorder alone. METHODS: Eighty-two subjects (N=29 with CDD, N=27 with Depression Alone, and N=26 with Dementia Alone) were recruited and reassessed at 3, 6, and 12 months after baseline assessment. RESULTS: Lower rates of depression detection by treating (non-study) physicians were found in CDD subjects. Only 35% of the CDD group were correctly diagnosed and receiving adequate treatment for their depression. Although the CDD group did not differ in baseline dementia stage or cognitive functioning as compared with the dementia-only group, they had significantly higher levels of functional impairment. CDD subjects used nursing home care at significantly higher rates; nursing home placement correlated significantly with baseline severity of functional impairment and mood measures, but not with other factors, including dementia stage and medical burden. CONCLUSIONS: Undetected, untreated, or inadequately treated depression may result in higher rates of nursing home placement in patients with dementia by increasing their functional disability. Aggressive outpatient treatment of depression could improve the course of coexisting dementia and depression.

Aged↗

PubMed2005

Race, gender, and psychiatrists' diagnosis and treatment of major depression among elderly patients.

OBJECTIVE: This study examined psychiatrists' contributions to racial and gender disparities in diagnosis and treatment among elderly persons. METHODS: Psychiatrists who volunteered to participate in the study were randomly assigned to one of four video vignettes depicting an elderly patient with late-life depression. The vignettes differed only in terms of the race of the actor portraying the patient (white or African American) and gender. The study participants were 329 psychiatrists who attended the 2002 annual meeting of the American Psychiatric Association. RESULTS: Eighty-one percent of the psychiatrists assigned the elderly patient a diagnosis of major depression. Patients' race and gender was not associated with significant differences in the diagnoses of major depression, assessment of most patient characteristics, or recommendations for managing the disorder. However, psychiatrists' characteristics, particularly the location of the medical school at which the psychiatrist was trained (United States versus international), were significantly associated with a number of variables. CONCLUSIONS: Given standardized symptom pictures, psychiatrists are no less likely to diagnose or treat depression among African-American elderly patients than among other patients, which suggests that bias based simply on race is not a likely explanation for racial differences in diagnosis and treatments found in earlier clinical studies. The impact of psychiatrists' having trained at international medical schools on diagnosis, treatment, and judgment of several patient attributes may indicate the need for targeted educational initiatives for aging and cultural competency.

Adult↗

PubMed2005

Menopause-related quality of life in chronically mentally ill women.

OBJECTIVE: Menopause is an important life event that has not yet been well characterized among women with severe mental illness. Our goal was to evaluate menopause-related quality of life among severely mentally ill women. METHOD: We conducted a cross-sectional assessment of perimenopausal and postmenopausal women, ages 45-55, diagnosed with schizophrenia/schizoaffective disorder, bipolar disorder, or major depression, who were receiving inpatient or outpatient psychiatric care. Women were compared regarding menopausal symptoms and quality of life using the Menopause Specific Quality of Life Scale (MENQOL). RESULTS: Women with severe mental illnesses who were peri- and post-menopausal experienced considerable vasomotor, physical, sexual, and psychosocial symptoms related to menopause. On seven of 29 MENQOL items, women with major depression reported problems significantly more often than women with other serious mental illnesses. CONCLUSIONS: This preliminary study indicates that psychiatrists and other physicians should consider the frequency and overlap of menopausal and psychiatric symptoms among women with serious mental illness in this age group.

Bipolar Disorder↗

PubMed2004

Ethnicity and diagnostic patterns in veterans with psychoses.

BACKGROUND: Differential diagnosis of schizophrenia and bipolar disorder is a challenging but important task. These conditions often exhibit overlapping clinical symptomatology, but have different prognoses and pharmacological management strategies. Factors other than clinical presentation may influence diagnosis. Past studies suggest that ethnicity is one such factor, with variations observed in diagnostic rates of serious mental illness (SMI). With increasing attention paid to provider cultural competency, we investigate current diagnostic practices within a veteran population. METHOD: Controlling for patient need characteristics and illness severity, we examine whether ethnic differences in diagnosis continue to exist. If so, race may adversely enter the evaluation process. A national database of all SMI veterans explores the relationship between ethnicity and diagnosis. The role of symptomatology is also examined. Given minimal variation in veteran socioeconomic status, the Department of Veterans Affairs (VA) provides a natural setting to address this confounding factor. The 1999 National Psychosis Registry provides a sample of 134,523 veterans diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. Multinomial logistic regression yielded odds ratios (OR) for being diagnosed with schizophrenia versus bipolar disorder; the schizoaffective versus bipolar risk was likewise assessed, exploring theoretical aspects of a psychosis-affective 'continuum'. RESULTS: Small effects were observed for being male, single or rural resident. However, the demographic characteristic most strongly associated with a schizophrenia diagnosis was race. The OR for African Americans was 4.05, and 3.15 for Hispanics. Similar though less dramatic results were revealed for schizoaffective disorder. CONCLUSIONS: This study confirms continued ethnic disparities in diagnostic patterns, and highlights the importance of recognizing ethnic differences in symptom presentation while emphasizing greater cultural competency.

Black or African American↗

PubMed2004

Psychological distress and return to substance use two years following treatment.

This study examined client background characteristics, substance use severity, and psychological distress in relation to return to alcohol and drug use among men and women 2 years following substance user treatment. Participants (n = 180) completed a baseline interview within their first month of substance user treatment (conducted in 1995/1996) and follow-up interview 2 years following the baseline interview (conducted in 1997/1998). Structural equation modeling analyses were used to examine the relationship among client background characteristics and problem severity indicators, measured during treatment, in relation to alcohol and illicit drug use 2 years posttreatment. Psychological distress directly predicted alcohol and illicit drug use during follow-up and appeared to mediate the relationship between client background characteristics (such as gender, race, and marital status) and substance use consequences on posttreatment substance use. Income directly predicted alcohol use and age directly predicted illicit drug use, regardless of problem severity (including psychological distress and substance use consequences). Results support long-term clinical monitoring of psychological distress as a marker for return to drug or alcohol use.

Adolescent↗

PubMed2004

Poor antipsychotic adherence among patients with schizophrenia: medication and patient factors.

Many patients with schizophrenia are poorly adherent with antipsychotic medications. The newer, atypical antipsychotics may be more acceptable to patients and result in increased adherence. We used national Department of Veterans Affairs (VA) pharmacy data to examine whether patients receiving atypical agents are more adherent with their medication and explored patient factors associated with adherence. Patients who received a diagnosis of schizophrenia or schizoaffective disorder between October 1, 1998, and September 30, 1999, were identified in the VA National Psychosis Registry. We calculated medication possession ratios (MPRs) for patients filling prescriptions for one (n = 49,003) or two (n = 14,211) antipsychotics during the year. We examined cross-sectional relationships among adherence, type of antipsychotic, and patient characteristics and explored adherence among patients switching antipsychotics during the year. Among patients receiving one antipsychotic, 40 percent had MPRs < 0.8, indicating poor adherence. African-Americans and younger patients were more likely to be poorly adherent. Cross-sectionally, patients on atypical agents were more likely to be poorly adherent (41.5%) than patients on conventional agents (37.8%). However, among a small group of patients switching from a conventional to an atypical agent (n = 1,661) during the year, the percentage who were poorly adherent decreased from 46 percent to 40 percent. We describe the continuum of antipsychotic adherence among a large sample of patients with schizophrenia and confirm that poor adherence is common. African-Americans and younger patients are particularly at risk. Unfortunately, atypical antipsychotics may not be associated with substantial improvements in adherence. More intensive interventions are likely needed.

Adult↗

PubMed2004

Older patients with serious mental illness: sensitivity to distance barriers for outpatient care.

OBJECTIVES: To inform health services delivery and to demonstrate the appropriateness of understanding access at the individual's level, we evaluated how patient characteristics affect sensitivity to access barriers. We examined one dimension of access: geographic accessibility. We assessed age differences in sensitivity to distance barriers for outpatient psychiatric and nonpsychiatric care among active Department of Veterans Affairs (VA) patients with serious mental illness. METHODS: Among 142,055 VA patients with bipolar disorder, schizophrenia, or other psychoses in fiscal year 2000, separate random intercepts mixed models were estimated (cluster: nearest site) for outpatient psychiatric and nonpsychiatric visit day volume. In addition to distance and age group (<45, 45-65, or >65), covariates included gender, ethnicity, rural location, psychiatric diagnosis type, Charlson comorbidity level, initial treatment location, and psychiatric diagnosis X distance interactions. Differential distance effects by age were assessed using age X distance interaction terms. RESULTS: Among VA patients with serious mental illness, distance limits the volume of VA outpatient visits. For nonpsychiatric outpatient care, patients older than 65 were substantially more sensitive to distance barriers (P < 0.0001). For psychiatric outpatient care volume, patients aged 45-65 had slightly increased sensitivity; however, this difference did not have clinical significance. DISCUSSION: The impact of geographic accessibility barriers depended on personal characteristics of the individual and the outpatient service type. For nonpsychiatric outpatient care, older VA patients were most negatively affected by distance barriers. Results may inform efforts to reduce barriers to health care among patients with serious mental illness.

Age Distribution↗

PubMed2004

Role of alcohol in late-life suicide.

Suicide is among the leading causes of death in the United States, ranking 10th to 12th annually, depending on the year. Rates of suicide increase markedly among Americans over age 75, especially among white men. After age 85, rates are >5-fold higher in this group than in the general population. The relationship between alcohol use and later-life suicide is complex and currently ill defined. Substance use disorders, particularly alcohol abuse and dependence, are the second most common category of axis I disorders associated with completed suicide among adults aged 65 and older, following only depression. The co-occurrence of alcohol use disorders and depression heightens suicide risk. Most studies that have evaluated the effects of alcohol in geriatric suicide have focused on older adults who met DSM criteria for abuse and/or dependence. However, the majority of older adults who are experiencing problems related to their alcohol use do not meet alcohol abuse/dependence criteria. Therefore, the role of at-risk and problem alcohol use in geriatric suicide may be underestimated. Drinking among elders elevates suicide risk through interactions with other factors that are more prevalent in this age group, such as depressive symptoms, medical illness, negatively perceived health status, and low social support. This article reviews the literature related to alcohol use and suicide among older adults. Clinical and research recommendations for addressing this problem are also presented.

Aged↗

PubMed2004

Disruptive behaviors in Veterans Affairs nursing home residents: how different are residents with serious mental illness?

OBJECTIVES: To determine the prevalence and correlates of behavior problems of residents of Veterans Affairs (VA) nursing homes and to compare residents with serious mental illness (SMI) with other resident groups. DESIGN: This study combined cross-sectional resident assessments with administrative data for all residents in VA nursing homes. Multivariate ordinal logistic regression was used to evaluate associations between resident characteristics and problem behaviors. SETTING: Nursing home care units in the VA healthcare system. PARTICIPANTS: A total of 9,618 nursing home residents assessed as part of the VA's April 2001 national resident census. MEASUREMENTS: The Patient Assessment Instrument assessed each resident's verbally disruptive, physically aggressive, and socially inappropriate behaviors in the prior 4 weeks. Functional limitations in eating, mobility, toileting, and transfer were assessed. Diagnoses were evaluated for the stay and up to 6 months before assessment. RESULTS: Almost one-fifth (17.9%) of residents received a diagnosis of SMI. Residents with SMI or dementia had greater behavior problems than residents with neither condition. Residents with SMI (and without dementia) exhibited more verbal disruption than residents with dementia (and without SMI), but the two subgroups did not differ in physically aggressive or socially inappropriate behavior. CONCLUSION: Many VA nursing home residents have SMI. Their level of behavior problems is comparable with that of residents with dementia. Clinical practice and nursing home staff training must encompass geriatric mental health and behavior management to meet the needs of residents with SMI.

Aged↗

PubMed2004

Benzodiazepine use among depressed patients treated in mental health settings.

OBJECTIVE: Most depression treatment guidelines emphasize treatment with antidepressant medication and recommend that benzodiazepine use be minimized, particularly among elderly patients. However, little is known about patterns of benzodiazepine use in specialty mental health settings. The authors examined benzodiazepine use among a large sample of depressed patients treated in U.S. Department of Veterans Affairs (VA) mental health settings. METHOD: The VA National Registry for Depression was used to identify patients treated for depression in specialty mental health settings in 129 VA facilities during the first 3 months of fiscal year 2001 (October 1 to December 31, 2000) (N=128,029). The VA pharmacy database was used to identify outpatients who filled a prescription for benzodiazepines. The authors report on the prevalence and patterns of outpatient benzodiazepine use during the study year (fiscal year 2001) and evaluate patient demographic and clinical factors associated with use. RESULTS: During the study year, 36% of the depressed patients filled a benzodiazepine prescription and 89% filled an antidepressant prescription. Most users (78%) received > or = 90 days' supply of benzodiazepines, and 61% received > or = 180 days' supply. Older patients, whites, Hispanics, and patients with comorbid anxiety disorders were more likely to use benzodiazepines. Older patients were also more likely to receive > or = 90 days' supply of benzodiazepines, compared with younger patients, but were treated with lower doses. Benzodiazepine use varied significantly with region of the country and facility. CONCLUSIONS: Depressed patients treated in mental health settings commonly receive long-term treatment with benzodiazepines in combination with antidepressants, a pattern of use that is inconsistent with guideline recommendations. Elderly patients are particularly likely to receive benzodiazepines. Further research on the effectiveness of this widespread practice is needed.

Adult↗

PubMed2004

Age-related modifiers of clinical presentation and health service use among veterans with bipolar disorder.

OBJECTIVE: This retrospective analysis of a large Department of Veterans Affairs (VA) database evaluated differences in clinical presentation, health service use, and use of psychotropic medications between older and younger adults with bipolar disorder. METHODS: The results presented in this article focus on veterans with bipolar disorder who were active in the VA's National Psychosis Registry in federal fiscal year 2001 (FY01). RESULTS: The registry listed 65,556 individuals as having bipolar disorder in FY01. In FY01, nearly 25 percent of veterans with bipolar disorder (more than 16,000 individuals) were aged 60 years or older, and more than 10 percent were aged 70 years or older. Elderly persons were hospitalized at similar or slightly lower rates than middle-aged persons but tended to have longer hospital stays. Use of outpatient services was also higher in older populations. Patterns of use of psychotropic medications indicated that valproate is the most commonly used mood-stabilizing agent in the VA, in use by 72.9 percent of patients who receive a mood stabilizer. Use of lithium is substantial as well, with more than 40 percent of patients taking this agent. In addition, just over 40 percent of all veterans with bipolar disorder receive antipsychotic medication. CONCLUSIONS: Bipolar disorder affects large numbers of veterans across the entire life span, and use of VA resources by this population becomes greater with advancing age. Data from this study provide new information about the unique treatment requirements and clinical presentations of older patients with bipolar disorder.

Age Factors↗

PubMed2004

Herbal products and other supplements: use by elderly veterans with depression and dementia and their caregivers.

The use of herbal products and other "natural" supplements among the US population is on the rise. Limited data suggest that such use among the elderly may correlate with higher education levels as well as psychiatric symptoms. The authors examined herbal/supplement use among elderly veterans with depression and/or dementia (n = 82) and their primarily elderly caregivers (n = 56). Eighteen percent of subjects and 16% of caregivers used herbals/supplements. Seventy-five percent of subjects who used these products during the study period were also taking potentially interacting medications. Given the prior association of herbal/supplement use with higher education levels, a surprising number of elderly veterans with depression and/or dementia (the majority of whom had high school or less education) used these products. As evidenced by missing documentation in many physician notes, subjects may not have discussed their usage of herbals/supplements with their physicians. In light of the possibility of potentially harmful drug interactions, physicians who treat elderly patients should regularly inquire about the use of these products.

Aged↗

PubMed2004

Treatment effects from UPBEAT: a randomized trial of care management for behavioral health problems in hospitalized elderly patients.

The purpose of this study was to examine the impact of the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) Program, an interdisciplinary mental health care management program, on the behavioral health symptoms of elderly veterans. Participants, 60 years and older, included 2637 veterans recruited from medical/surgical units who screened positively for significant depressive or anxiety symptoms and/or at-risk alcohol drinking. Participants were randomized to UPBEAT or to usual care. Primary outcomes were measured at baseline and at 6, 12, and 24 months. Participant nonadherence to the protocol was common and is a major limitation. There were no differences between UPBEAT and usual care patients on symptom or functional outcomes at any follow-up point. Exploratory analyses suggested that among participants with more physical health problems, there were greater improvements in depressive symptoms in those assigned to UPBEAT care. Despite a theoretical and practically sound intervention, participation was low and treatment outcomes, while generally good, appeared unaffected by the addition of the program.

Aged↗

PubMed2004

Use of Alcohol Screening and Brief Interventions in Primary Care Settings:Implementation and Barriers.

Although evidence indicates that brief alcohol screening and interventions are effective across primary care settings, implementation of these techniques has been problematic. The primary objective of this study was to determine current practices and barriers for screening and interventions with primary care patients across randomly selected clinics in a large health care system, the Veterans Health Administration. Focus groups and mailed structured surveys were used. Results from providers indicated that 85% of patients treated in primary care received some screening for alcohol use disorders. The CAGE was the predominant screening tool. The primary clinical focus was on treatment referrals for patients who met abuse/dependence criteria. Lack of time was the most important perceived barrier to implementing screening and brief alcohol interventions for at-risk and problem drinkers. Implications for implementation of screening and intervention programs for a range of drinkers (at-risk use, problem use, abuse, dependence) are discussed.

Adult↗

PubMed2003

Individual and social/environmental predictors of alcohol and drug use 2 years following substance abuse treatment.

The purpose of this study was to identify individual and social/environmental predictors of alcohol and drug use 2 years following substance abuse treatment. Participants (n=180) self-administered questionnaires within their first month of substance abuse treatment and completed a 2-year follow-up interview. Individual factors (coping, self-efficacy, resource needs, and expectations for sober fun), social/environmental factors (craving, exposure, negative social influences, and involvement in substance-using leisure activities), and background characteristics measured during treatment were used to predict alcohol and drug use during a 2-year follow-up using manifest variable regression analysis. Results suggest that poorer self-efficacy, greater involvement in substance-using leisure activities, being single, and less income predicted alcohol use directly, whereas greater resource needs and involvement in substance-using leisure activities, being of minority status, and being single predicted drug use directly. Income, gender, problem severity, marital status, and race also predicted alcohol and drug use indirectly. Findings highlight differential predictors of posttreatment substance use that may be useful in developing alternative approaches to prevent relapse.

Adolescent↗

PubMed2003

Feasibility of using an interactive laptop program in the emergency department to prevent alcohol misuse among adolescents.

STUDY OBJECTIVE: Alcohol, the most commonly used substance among adolescents, is frequently associated with injury. Effective interventions to prevent adolescent alcohol use and misuse in acute care settings are lacking. A laptop-based alcohol prevention program could reinforce other prevention efforts that adolescents may receive. We determined the feasibility of using an interactive laptop program with adolescent emergency department (ED) patients to prevent alcohol use and misuse. METHODS: We used the recruitment phase of a randomized controlled trial at an academic medical center and an urban teaching hospital. Patients were aged 14 to 18 years and presented within 24 hours of an acute injury. Measures included patient recruitment, mechanism of injury, injury severity score, alcohol use characteristics, and patients' opinion of the computer program. RESULTS: Of 843 eligible patients, 671 (79.6%) were enrolled and 655 (77.7%) completed the program. Parent or guardian reluctance was the most frequent reason for refusal. The participants averaged 16.0 years of age (range 14 to 18 years; SD 1.5 years), 66.9% were male, and 68.3% were white. Approximately 71% reported "ever" drinking. Recent alcohol use (past 3 months) by those "ever" drinking was as follows: 62.3% drank, 31.2% got drunk, and 37.4% binge drank. Seventy-four percent of recent drinkers reported that the program made them rethink their alcohol use. Ninety-four percent of participants liked the program. Only 5.3% required assistance with the program. CONCLUSION: Use of an interactive computer program in the ED appears feasible. Further work is being done to evaluate the effectiveness of the program in reducing alcohol-related behaviors among adolescents.

Academic Medical Centers↗

PubMed2003

Depressive symptoms among pregnant women screened in obstetrics settings.

OBJECTIVES: This study aimed to describe the prevalence of depressive symptomatology during pregnancy when seen in obstetric settings, the extent of treatment in this population, and specific risk factors associated with mood symptoms in pregnancy. METHODS: A total of 3472 pregnant women age 18 and older were screened while waiting for their prenatal care visits in 10 obstetrics clinics using a brief (10 minute) screening questionnaire. This screen measured demographics, tobacco and alcohol (TWEAK problem alcohol use screening measure), and depression measures, including the Center for Epidemiological Studies-Depression scale (CES-D), use of antidepressant medications, past history of depression, and current treatment (i.e., medications, psychotherapy, or counseling) for depression. RESULTS: Of women screened, 20% (n = 689) scored above the cutoff score on the CES-D, and only 13.8% of those women reported receiving any formal treatment for depression. Past history of depression, poorer overall health, greater alcohol use consequences, smoking, being unmarried, unemployment, and lower educational attainment were significantly associated with symptoms of depression during pregnancy. CONCLUSIONS: These data show that a substantial number of pregnant women screened in obstetrics settings have significant symptoms of depression, and most of them are not being monitored in treatment during this vulnerable time. This information may be used to justify and streamline systematic screening for depression in clinical encounters with pregnant women as a first step in determining which women may require further treatment for their mood symptoms. As elevations in depressive symptomatology have been associated with adverse maternal and infant outcomes, further study of the impact of psychiatric treatment in gravid women is essential.

Adult↗