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Biomedical subjects

G Wyshak

Publications and source records attributed to G Wyshak.

At least 19 recordsLinked to original sources
PubMed1992

Psychiatric comorbidity in DSM-III-R hypochondriasis.

Forty-two DSM-III-R hypochondriacs from a general medical clinic were compared with a random sample of 76 outpatients from the same setting. Patients completed a research battery that included a structured diagnostic interview (Diagnostic Interview Schedule) and self-report questionnaires to measure personality disorder caseness, functional impairment, and hypochondriacal symptoms. Psychiatric morbidity in the hypochondriacal sample significantly exceeded that of the comparison sample. Hypochondriacs had twice as many lifetime Axis I diagnoses, twice as many Diagnostic Interview Schedule symptoms, and three times the level of personality disorder caseness as the comparison group. Of the hypochondriacal sample, 88% had one or more additional Axis I disorders, the overlap being greatest with depressive and anxiety disorders. One fifth of the hypochondriacs had somatization disorder, but the two conditions appeared to be phenomenologically distinct. Hypochondriacal patients with coexisting anxiety and/or depressive disorder (secondary hypochondriasis) did not differ greatly from hypochondriacal patients without these comorbid conditions (primary hypochondriasis). Because the nature of hypochondriasis remains unclear and requires further study, we suggest that its nosologic status not be altered in DSM-IV.

Comorbidity↗
PubMed1992

A structured diagnostic interview for hypochondriasis. A proposed criterion standard.

We developed a structured diagnostic interview for DSM-III-R hypochondriasis (SDIH) that is the first such clinician-administered instrument. The SDIH was administered to 88 general medical outpatients who scored above a predetermined cutoff on a hypochondriacal symptom questionnaire, and to 100 comparison patients randomly chosen from among those below the cutoff. Using the joint assessment method, interrater agreement on the DSM-III-R diagnostic criteria was 88% to 97% and agreement on the diagnosis was 96%. Concurrent validity was suggested by a significant correlation between the interview and the primary care physicians' ratings of hypochondriasis. A measure of external validity was demonstrated in that several clinical characteristics thought to be ancillary features of hypochondriasis were significantly more prevalent in interview-positive patients than in interview-negative patients. Finally, the SDIH appeared to have discriminant validity in that patients diagnosed as hypochondriacal had several other clinical features that distinguished them from the patients who scored above the cutoff on hypochondriacal symptomatology, but failed to be diagnosed as hypochondriacal with the SDIH.

Ambulatory Care↗
PubMed1992

Dysplastic nevi, cutaneous melanoma, and gynecologic disorders.

We compared the frequency of reproductive system diseases and disorders among 206 female patients with dysplastic nevi (DN), and/or melanoma, in comparison with random samples of women of comparable age without melanoma. The highest odds ratio (OR) for these age-related diseases and reproductive disorders occurs among the youngest age group of the patients with DN alone (mean age 35.1 +/- 1.2 yr): 44.2% of the DN subjects had one or more reproductive disorders compared with 19.8% of the random sample (OR 3.2, 95% CL (1.6, 6.5), P less than 0.001). The patients with melanoma and DN (mean age 41.5 +/- 1.4 yr) also had a significantly greater percentage of subjects with one or more reproductive disorders, though less so than the DN subjects: 49.4% compared to 33.7% (OR 1.9, 95% CL (1.1, 3.3), P = 0.02).

Abortion, Spontaneous↗
PubMed1991

Technology assessment in the Connecticut Tumor Registry.

A search of literature using the Connecticut Tumor Registry (CTR) for technology assessment produced eight articles. These articles represent a small but apparently increasing percentage (2%) of total CTR publications. By keeping pace with the development and dissemination of medical technologies, the population-based CTR has been useful for assessing them, especially their adverse effects.

Connecticut↗
PubMed1991

Comparison of psychiatric screening tests in a general medical setting using ROC analysis.

Receiver operating characteristic (ROC) analysis was used to evaluate the usefulness of three self-administered screening instruments in helping primary care physicians detect anxiety and depressive disorders. This research was secondary to an investigation of hypochondriasis. The three tests were the Whitely Index (WI), the Somatosensory Amplification Scale (SAS), and the Somatic Symptom Inventory (SSI). Participating subjects were 75 patients seen in a general medical clinic and diagnosed as being free of hypochondriasis by DSM-III-R criteria. Psychiatric disorder was assessed with the Diagnostic Interview Schedule, version III-A. The three instruments delineated patients with depressive disorders versus no depressive disorders and patients with anxiety disorders versus no anxiety disorders. For depressive disorder, the areas under the curve (AUC) were 0.87, 0.75, and 0.82 for the WI, SAS, and SSI, respectively. For anxiety disorders the AUCs were 0.79, 0.76, and 0.74, respectively, for the three tests. Although the WI yielded slightly higher values, the areas under the ROC curves did not differ significantly among the three tests. Because of its relatively short length--13 items--it was concluded that the WI can be useful for screening primary care patients, both with respect to depressive and anxiety disorders.

Adult↗
PubMed1991

The relation between hypochondriasis and age.

OBJECTIVE: This study examined the relation between hypochondriasis and age while controlling for the possible confounding influences of medical morbidity, social isolation, and other psychiatric disorder. METHOD: Consecutive patients attending a general medical clinic on randomly selected days were screened with a hypochondriasis self-report questionnaire. Those whose scores exceeded a preestablished cutoff level and a random sample of those who scored below it completed a research battery consisting of self-report questionnaires and structured interviews for DSM-III-R diagnoses of hypochondriasis and other axis I disorders. The patients' medical records were audited, and their physicians completed questionnaires about them. The 60 patients who met the DSM-III-R criteria for hypochondriasis at interview constituted the study group, and 100 patients randomly chosen from among those who scored below the cutoff for hypochondriasis constituted the comparison group. RESULTS: The hypochondriacal group was not older than the comparison group. Hypochondriacal patients aged 65 years and over did not differ significantly from younger hypochondriacal patients in hypochondriacal attitudes, somatization, tendency to amplify bodily sensation, or global assessment of their overall health, even though their aggregate medical morbidity was greater. The elderly hypochondriacal patients had higher levels of disability, but this appeared to be attributable to their medical status rather than to any increase in hypochondriasis. Within the comparison sample, subjects aged 65 years and over were not more hypochondriacal than those under 65 years of age. CONCLUSIONS: Hypochondriasis is found to some degree in all patients and appears to be unrelated to age.

Age Factors↗
PubMed1991

Alcohol use and abuse in random samples of physicians and medical students.

BACKGROUND: This study sought to resolve conflicting views about whether physicians are especially prone to alcohol abuse. METHODS: Using an anonymous, mailed questionnaire on substance use, we surveyed 500 physicians, 510 pharmacists, and 974 of their students. The physicians and pharmacists were selected randomly from the state society's membership lists, and students selected were from local school lists. Follow-up surveys were sent to nonresponders at two-week intervals. RESULTS: The physicians and medical students did not drink especially heavily and were no more vulnerable to alcoholism than were their counterparts in pharmacy and other professions. Physicians differed from pharmacists in their style of drinking (greater frequency, smaller quantity), but not in total amount of alcohol consumed. Drinking habits among physicians were not associated with medical specialty or type of practice, but were positively related to gender (males drank more than females) and to age (older doctors were more apt to qualify as heavy drinkers than were younger doctors). CONCLUSIONS: Physicians were no more likely to abuse substances nonmedically than were other professionals. Any group in which alcohol use is nearly universal incurs a risk of abuse and impairment that cannot be ignored.

Adult↗
PubMed1991

The relationship between hypochondriasis and medical illness.

Forty-one Diagnostic and Statistical Manual of Mental Disorders-III-Revised hypochondriacs were accrued from a primary care practice. Seventy-five control subjects were selected at random from among the remainder of the patients in the same clinic. All subjects completed a structured diagnostic interview and standardized self-report questionnaires. Medical morbidity was assessed with a medical record audit and with primary physicians' ratings. The hypochondriacal and comparison samples did not differ in aggregate medical morbidity, although the hypochondriacal sample had more undiagnosed complaints and nonspecific findings in their medical records. Within the comparison sample, higher levels of medical morbidity were associated with higher levels of hypochondriacal symptoms. This occurred primarily because the most serious medical disorders were associated with more bodily preoccupation, disease conviction, and somatization. Within the hypochondriacal sample, no correlation was found between the degree of hypochondriasis and the extent of medical morbidity.

Adult↗
PubMed1990

Transient hypochondriasis.

Consecutive visitors to a general medicine outpatient clinic were screened with a hypochondriasis questionnaire. Two thirds (n = 41) of those exceeding a preestablished cutoff met the criteria for DSM-III-R hypochondriasis when given a structured diagnostic interview, while the other third (n = 22) did not. The latter group showed significant decreases in their hypochondriasis questionnaire scores over a 3-week interval. They had less psychiatric disorder and more medical morbidity than the DSM-III-R hypochondriacs. They also viewed their medical care more positively, and their physicians considered them less hypochondriacal. The transiently hypochondriacal group was also compared with a random sample (n = 75) of the patients below the cutoff on the screening instrument. They had more Axis I disorder, more personality disorder, reported higher levels of somatosensory amplification, and more medical disorder. The differences in psychiatric comorbidity and amplification persist when medical morbidity is controlled for by matching and analysis of covariance. This is consistent with the hypotheses that among patients confronted with a medical illness, those with personality disorder and those who are sensitive to somatic sensation are more likely to develop transient hypochondriasis.

Adult↗
PubMed1990

The prevalence of hypochondriasis in medical outpatients.

Forty-one DSM-III-R hypochondriacs were obtained by screening consecutive visitors to a general medical clinic and compared with 76 patients randomly chosen from the same setting. They completed a research battery consisting of a structured diagnostic interview (DIS) and self-report questionnaires to measure hypochondriacal symptoms and functional impairment. The criterion standard for diagnosing hypochondriasis was a structured interview of demonstrated reliability and validity. The six-month prevalence of DSM-III-R hypochondriasis was estimated to be between 4.2% and 6.3% of consecutive attenders who met the inclusion criterion of having visited the same physician before. This rate was somewhat lower than that found for generalized anxiety disorder and comparable to that of alcohol abuse. The hypochondriacal patients did not differ significantly from the comparison random sample in sociodemographic risk factors except that they were significantly more likely to be Black. Hypochondriacal symptomatology was similar in males and females; and in those over 65 and those under 65. Over a three-week interval, hypochondriacal symptoms remained stable, and hypochondriacal patients had significantly higher levels of long-term disability than did the comparison patients.

Adult↗
PubMed1990

The somatosensory amplification scale and its relationship to hypochondriasis.

Forty-one DSM-III-R hypochondriacs and seventy-five randomly chosen patients were obtained from a medical outpatient clinic, and completed a psychiatric diagnostic interview and a ten-item self-report questionnaire, the Somatosensory Amplification Scale (SSAS); The SSAS asks the respondent how much s/he is bothered by various uncomfortable visceral and somatic sensations, most of which are not the pathological symptoms of serious diseases. SSAS scores were normally distributed, and had acceptable test-retest reliability and internal consistency. They were not related to sociodemographic characteristics, or to aggregate medical morbidity. Amplification was significantly higher in the DSM-III-R hypochondriacs than in the comparison sample, and was significantly correlated with the degree of hypochondriacal symptomatology within each sample. In the comparison sample, it was also significantly associated with depressive and anxiety disorders, but not with antisocial personality or substance abuse. The association between the amplification scale and DSM-III-R hypochondriasis remained highly significant after controlling for these concurrent psychiatric disorders.

Arousal↗
PubMed1990

Assessing symptom change in Southeast Asian refugee survivors of mass violence and torture.

The authors evaluated changes in symptoms and levels of perceived distress of 21 Cambodian, 13 Hmong/Laotian, and 18 Vietnamese patients before and after a 6-month treatment period. Most of the patients improved significantly. Cambodians had the greatest and Hmong/Laotians had the least reductions in depressive symptoms. Although psychological symptoms improved, many somatic symptoms worsened. The authors conclude that refugee survivors of multiple traumata and torture can be aided by psychiatric care. They recommend investigations with larger samples and suitable control groups to further clarify the relative contributions of trauma, diagnosis, and acculturation stress to treatment outcome.

Acculturation↗
PubMed1990

Hypochondriasis and somatosensory amplification.

A self-report questionnaire completed by 177 out-patients showed that hypochondriasis and amplification had a zero-order correlation of 0.56, and in stepwise multiple regression amplification accounted for 31% of the variance in hypochondriasis, after sociodemographic variables had been accounted for. Fears of ageing and death, and a childhood history of illness in the family, increased the R2 to 0.50. Amplification was more powerful in women than in men and was also a significant (although weaker) correlate of somatisation, explaining 12% of the variance. Somatisation also correlated with being female, the propensity to seek medical care, and a diminished sense of efficacy over one's health. Our findings are consistent with the possibility that somatosensory amplification occurs in hypochondriasis.

Adolescent↗
PubMed1989

Nonalcoholic carbonated beverage consumption and bone fractures among women former college athletes.

We report on data relating to nonalcoholic carbonated beverage consumption and bone fractures in 5,398 college alumnae, 2,622 former college athletes and 2,776 nonathletes, who responded to a detailed mailed questionnaire. A statistically significant association between nonalcoholic carbonated beverage consumption and bone fractures was found only in the former athletes, not the nonathletes. Among the athletes, the age-adjusted odds ratio (OR) for the association of drinkers (yes/no) with any fracture (yes/no) was 1.35, 95% confidence limits (CL) (1.14, 1.59). The dose-response relationship between the amount of carbonated beverages consumed daily and the number of bone fractures of the athletes was also statistically significant. Results of multiple logistic regression analysis, which included only alumnae greater than or equal to 50 years of age and which controlled for current exercise and other potential confounding factors, were as follows: (a) for athletes, the OR for the association of drinking nonalcoholic carbonated beverages and a first bone fracture at or after age 40 was 2.28, 95% CL (1.36, 3.84); (b) for all alumnae, a low milk diet was a risk factor for first bone fractures at or after age 40, OR = 1.92, 95% CL (1.15, 3.16); (c) former college athletes had a significantly lower risk of first fractures at or after age 40 than did nonathletes; OR = 0.63, 95% CL (0.40, 0.99). The deleterious effect of nonalcoholic carbonated beverage consumption on the risk of bone fractures has not been reported, as far as we know.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Hypochondriasis and related health attitudes.

Since hypochondriasis can be thought of as a complex of health attitudes, bodily concerns, and beliefs about disease, it is logical to ask what other attitudes, values, and beliefs might be related to it. By means of self-report questionnaires, the authors studied hypochondriasis, the tendency to amplify somatic sensations, and a series of health-related attitudes and concerns in a random sample of 177 outpatients at a general medicine clinic. Hypochondriasis was positively related to amplification, to fears of aging and death, to the importance placed on health, to a sense of bodily vulnerability to illness and injury, and to the importance placed on one's physical appearance. Cluster analysis disclosed three discrete clusters of patients with distinct profiles on these variables.

Adolescent↗
PubMed1989

Reproductive factors and melanoma of the skin among women.

A higher risk of reproductive system disorders, (which include benign tumors, endometriosis, dilation and curettage, hysterectomy, and other disorders requiring gynecologic biopsies) exist among women with cutaneous melanoma as compared to women with skin cancers: The odds ratio (OR) is 3.2, 95% confidence limits (1.0, 10.1), p = 0.049; as compared to a random sample of women with no melanoma or skin cancers, the OR is 3.9, 95% confidence limits (1.2, 12.4), p = 0.021. Confirming the observations of others, the authors found that melanoma was associated with red hair. The data also confirmed the finding that melanoma is associated with significantly fewer pregnancies. The mean numbers of pregnancies in the melanoma group is 1.83 +/- 1.6 (mean and standard deviation) compared to 2.99 +/- 1.9 in the skin cancer group and 2.93 +/- 1.9 in the random sample (p less than or equal to 0.05).

Analysis of Variance↗