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Biomedical subjects

J H Atkinson

Publications and source records attributed to J H Atkinson.

At least 19 recordsLinked to original sources
PubMed1995

Is gender dysphoria dysphoric? Elevated depression and anxiety in gender dysphoric and nondysphoric homosexual and bisexual men in an HIV sample. HNRC Group.

Few if any studies before the AIDS epidemic suggested that male homosexuals may on average have higher levels of depression than male heterosexuals. However, several samples of homosexual and bisexual men in HIV studies suggest that depression and anxiety are high in these populations, and that this psychiatric morbidity began before the AIDS epidemic. We tested the hypothesis that high childhood gender nonconformity (CGN) is associated with depression and anxiety, and so might account for differences in these variables among samples of homosexuals. A total of 254 homosexual or bisexual male subjects were assessed for depression, anxiety, and associated symptoms using various self-report and interview measures, as well as for CGN (using the Freund Feminine Gender Identity scale, FGI). For comparison purposes only, we also evaluated the subjects for the DSM-III diagnosis of Ego-Dystonic Homosexuality. Highly gender nonconforming men (high FGI scores) were more likely to have current symptoms of anxiety and depression by self-report, and to have had a lifetime history of depression by clinical interview. This association was more often due to FGI items dealing with childhood than adulthood. When the FGI was broken into subscales by a prior factor analysis, stepwise regression suggested that the subscale measuring core gender identity nonconformity (so-called "gender dysphoria") was more reliably associated with depression and anxiety than were the factors measuring nonconformity in the areas of masculine and feminine gender roles, or genitoerotic (sexual) roles. This subscale was also the only FGI measure correlating with Ego-Dystonic Homosexuality. AIDS (CDC stage and HIV serostatus) and age did not account for these findings. We conclude that the often-reported higher levels of depression, anxiety, and associated symptoms among homosexual and bisexual men in AIDS studies are more common in the subgroup of such men who are gender dysphoric. Theoretical and clinical implications of these data are discussed.

Adult↗
PubMed1995

Psychiatric morbidity associated with acquired immune deficiency syndrome-related grief resolution.

This study examined acquired immune deficiency syndrome (AIDS)-related grief resolution and psychiatric morbidity in 286 human immunodeficiency virus (HIV)-positive and HIV-negative gay men examined between 1989 and 1993 in San Diego, CA. Psychiatric morbidity, mood ratings, and bereavement assessments were obtained using the Structured Clinical Interview for DSM-III-R, Hamilton Rating Scales for Depression and Anxiety, and Texas Revised Inventory of Grief. Sixty percent of the men (N = 171) reported a loss within the previous 12 months. Eighteen percent of the bereaved met criteria for unresolved grief. No differences were evident in lifetime psychiatric disorders, yet men with unresolved grief demonstrated an elevated prevalence of current major depression and panic disorder when compared with resolved grievers. Clinician sensitivity to the grief process and its relationship to psychiatric complications is an important component of comprehensive psychiatric and medical care of men at high risk for HIV during this era of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Neuroleptic treatment of HIV-associated psychosis. HNRC group.

The aim of this rater-blinded randomized study was to evaluate the efficacy and side effects of haloperidol and thioridazine in the treatment of new-onset psychosis in HIV-positive individuals. Participants were 13 men who had no history of psychosis prior to infection with HIV, and whose psychosis was not attributable to delirium or to non-HIV-related organic factors. Participants were evaluated at baseline after at least one month without neuroleptic treatment and then weekly for six weeks of the experimental treatment using several rating scales. The mean daily dose in chlorpromazine equivalents was 124 mg. Both neuroleptics produced modest but significant reduction in overall level of psychosis and in positive symptoms, but not in negative symptoms. All the haloperidol-treated patients developed extrapyramidal side effects and required treatment with anticholinergic medication, whereas three of the five thioridazine-treated patients had noticeable side effects. We make recommendations for the treatment of HIV-associated psychosis with neuroleptics.

AIDS Dementia Complex↗
PubMed1994

Natural history of neuropsychiatric manifestations of HIV disease.

The neuropsychiatric manifestations of HIV disease include neurobiologic and psychobiologic phenomena. The former consist of primary CNS complications caused directly by HIV, and include cognitive disorders (mild neurocognitive disorder and HIV-associated dementia) and other CNS diseases such as myelopathy and the demyelinating neuropathies; and secondary disorders (principally deliria) occasioned by opportunistic infections, neoplasms, cerebrovascular events, and the effects of metabolic derangements and medications. The latter (psychobiologic) phenomena reflect efforts to cope with various nodal, or transition points, in HIV disease; such points of transition include time of serostatus determination, adaptation to asymptomatic seropositivity, response to early medical symptomatology, and later transition to frank AIDS. Anxiety symptoms and various efforts to cope with anxiety (e.g., denial, anger, withdrawal, hypochondriacal preoccupation) all can punctuate these transition points. Additionally, there may be reactivation of long-standing psychopathology (e.g., depression) in seropositive individuals who tend to belong to a group that has an elevated prevalence of pre-infection psychiatric disorder. These interacting neurobiologic and psychobiologic phenomena pose challenges to the psychiatrist who must develop a good understanding of the medical aspects of HIV infection, as well as the neuropsychiatry of AIDS. In this way psychiatric physicians can play an important role in early identification of neuropsychiatric complications, assist the medical team to anticipate emotional and behavioral disturbances, and develop treatment plans that maximize our ability to help those with HIV infection achieve the best possible quality of life.

AIDS Dementia Complex↗
PubMed1992

Incidence of AIDS dementia in a two-year follow-up of AIDS and ARC patients on an initial phase II AZT placebo-controlled study: San Diego cohort.

In a prospective study to determine the incidence of clinical dementia in patients with AIDS and ARC, 29 men and 3 women, 19 with ARC and 13 with AIDS, were examined neurologically and neuropsychologically every 6 months for 2 years during a placebo-controlled zidovudine (AZT) licensing trial. Most received two MRI brain scans. Although no patient was clinically demented at baseline, 9 (28%) developed dementia during the 2 years. Progression to dementia was associated with neuropsychological deterioration and with worsening on MRI during a preceding 6-month period, but not with baseline treatment group assignment. The results suggest that patients at CDC Stage IV who do not receive antiretroviral treatment earlier in their illness may develop clinical dementia at an annual rate of about 14%.

AIDS Dementia Complex↗
PubMed1990

Negative and positive cognition in depressed and nondepressed chronic-pain patients.

Several studies have suggested that depressed pain patients evidence more cognitive distortion than nondepressed pain patients and healthy controls. Although these studies have generally supported notions relating cognitive distortion to depressive functioning, other aspects of dysfunctional cognition have not been assessed in the chronic-pain population. The present study examined negative and positive automatic thoughts and attributional style in depressed pain patients, nondepressed pain patients, and healthy controls. Depressed chronic-pain patients were found to exhibit significantly more negative automatic thoughts than nondepressed pain patients and healthy controls. Conversely, nondepressed chronic-pain patients reported significantly more positive automatic thoughts than did depressed patients and healthy controls. No significant differences were found for attributional style. These results suggest that different cognitive-behavioral interventions might be considered for depressed compared to nondepressed chronic-pain patients.

Back Pain↗
PubMed1990

Neurogenic and psychogenic behavioral correlates of HIV infection.

In this chapter, we have suggested that neurobehavioral phenomena in HIV-infected individuals can be usefully grouped according to underlying pathogenesis. Neurogenic phenomena are those that result from direct involvement of the brain either by HIV-1 (primary neurogenic disorder) or from opportunistic infection, neoplasia, or side effects of treatment (secondary neurogenic disorder). These phenomena should be distinguished from disturbances resulting from a second pathogenetic mechanism--the psychogenic disorders. We define psychogenic disorders as those that reflect primarily psychological responses to knowledge of HIV infection and/or progression of disease, and resultant of social ramifications. In proposing the neurogenic and psychogenic groupings, we do not intend to harken back to antique "mind-body" distinctions. We recognize fully that diseases of the brain can and do cause disturbances in mood, thought, and behavior, and that preexisting psychogenic disturbances might, in fact, be substantially worsened by onset of such neuropathology. Nevertheless, for the sake of clarity and also of determining appropriate treatment, we feel that the distinction we propose is a heuristically useful one. Challenges that lie ahead include defining more precisely the incidence and natural course of HIV-associated neurogenic disorder. Although there is little doubt that CDC IV individuals have higher prevalence of both subclinical and clinical "organic mental" symptomatology, the time of onset and rate of progression of such changes are not understood. At present, it seems likely that early in the course of HIV infection, the CNS is spared; at some point, however, rate of neuropsychiatric abnormality probably increases, and this may not be directly related to progression of the immunological aspect of the disease. In regard to psychogenic phenomena, it is clear that anxiety syndrome can occur as a direct product of knowledge of HIV serostatus and may be exacerbated by progression of disease. It is possible also that some subgroups of HIV + individuals (e.g., military samples) may be at heightened risk for suicide. These observations pose challenges for focused intervention with these groups. Accumulating data both on neurogenic and psychogenic phenomenology underscore also the importance of conceptualizing HIV infection in neurobehavioral as well as immunologic-virologic terms.

AIDS Dementia Complex↗
PubMed1990

Quality of life in a placebo-controlled trial of zidovudine in patients with AIDS and AIDS-related complex.

We measured quality of life using the Karnofsky Performance Status and Quality of Well-Being scale (QWB) for 31 patients with AIDS and AIDS-related complex in a placebo-controlled trial of zidovudine. Sixteen patients were randomized to zidovudine and 15 to placebo. We recorded nine scores for each patient during 1 year. During the blinded trial, 3 patients receiving placebo died; at 1 year, one had died in the zidovudine group and 10 in the placebo group. Repeated-measures analysis of variance demonstrated that mean scores declined less for the zidovudine group than for the placebo group during the blinded trial (p less than 0.03) and during 1 year (p less than 0.002). However, because the QWB incorporates death into its score, these results largely reflected differences in mortality. When data from those who died were excluded, Karnofsky scores were higher for the zidovudine group at the end of the blinded trial (p less than 0.02), but at 1 year no significant differences were observed between groups. The QWB and other quality-of-life measures may contribute to more comprehensive evaluation of AIDS treatments, and may detect treatment effects earlier. Whether existing measures can detect real differences among survivors will require testing in patients with less advanced disease.

AIDS-Related Complex↗
PubMed1988

Prevalence of psychiatric disorders among men infected with human immunodeficiency virus. A controlled study.

We used structured diagnostic interviews and rating scales to assess lifetime prevalence of psychiatric disorders, by DSM-III criteria, among an unselected sample of 56 ambulatory homosexual men in four groups: men with acquired immunodeficiency syndrome (AIDS), men with AIDS-related complex (ARC), men asymptomatic or mildly symptomatic but seropositive for antibody to human immunodeficiency virus (HIV), and HIV-seronegative men. An age- and demographically matched comparison group of 22 healthy, heterosexual controls was also studied. The homosexual men had lifetime rates of alcohol or nonopiate drug abuse (22/56 [39.3%]), generalized anxiety disorder (22/56 [39.3%]), and major depression (17/56 [30.3%]) that often preceded diagnosed medical illness or knowledge of HIV status. The six-month point prevalence of these disorders in homosexual men was also high, especially alcohol abuse in patients with AIDS-related complex, and the occurrence of a DSM-III disorder within the previous six months significantly exceeded that in heterosexual controls. The data suggest that there may be a higher prevalence of anxiety disorder and major depressive illness in homosexual men when compared with sociodemographically matched heterosexual men and that the psychiatric morbidity may have preceded the onset of the AIDS epidemic. These findings indicate that awareness of psychiatric history is necessary to comprehensive medical care of men at high risk for AIDS, even among relatively healthy outpatients.

AIDS-Related Complex↗
PubMed1988

Depressed mood in chronic low back pain: relationship with stressful life events.

This study investigated the relationship between stressful life events and depressed mood in chronic low back pain (CLBP), using both self-report and observer-rated assessments of life happenings and depression. We hypothesized that CLBP patients with depressed mood (N = 15) would report significantly more untoward life events and ongoing life difficulties compared to CLBP patients without depressed mood (N = 17) and controls (N = 19). This prediction was confirmed. Subjects also were rated as being either in a high stress or low stress condition. Patients with depressed mood were more likely to be in the high stress condition than were either non-depressed patients or volunteers. Furthermore, the increased stress reported by the distressed group appeared to be a direct consequence of back pain-related life events, rather than from other life problems. We conclude that previously reported associations between life events and CLBP are a function of the relationship between stressful life events and depressive symptoms, which are prevalent in CLBP.

Adult↗
PubMed1988

Human immunodeficiency virus-associated neurobehavioural disorder.

AIDS, ARC, and other HIV-associated diseases were originally conceptualised exclusively in terms of defects in cell-mediated immunity and its consequences. But it is now becoming clear that HIV disease can also be a primary neuropsychiatric disorder, although the precise mechanism by which the retrovirus causes impairment in brain function and, ultimately, structural brain damage, remains obscure. The work presented here indicates another shift in our thinking concerning HIV infection. Until recently it was believed that neurological and neuropsychiatric phenomena tended to occur in the late stages of HIV disease. While that might be true for the more severe form of symptomatology that has been termed the AIDS dementia complex, we believe there is at least preliminary evidence that cognitive change can occur earlier in the course of illness, perhaps even in some medically asymptomatic HIV+ individuals. Other investigators have also noted increased neuropsychological abnormality in patients before they developed AIDS or ARC. For example, Janssen et al. found that about half their patients with lymphadenopathy syndrome (LAS) had some neuropsychological test deficits. Durara et al. recently reported on cerebral metabolic rates for glucose in seven HIV+ asymptomatic individuals, compared to 10 HIV- controls. Four of the HIV+ individuals had abnormal asymmetry in frontal and temporal regions suggesting focal reduction in cerebral glucose metabolism. Further indirect evidence that virus can enter the central nervous system early in the course of HIV disease comes from the work of McArthur and associates.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1987

Evidence for early central nervous system involvement in the acquired immunodeficiency syndrome (AIDS) and other human immunodeficiency virus (HIV) infections. Studies with neuropsychologic testing and magnetic resonance imaging.

Although a high prevalence of central nervous system disease is seen in persons with the acquired immunodeficiency syndrome (AIDS), the natural history of brain involvement with human immunodeficiency virus (HIV) remains poorly understood. Neuropsychologic evaluations of 55 ambulatory homosexual men revealed abnormalities in 13 of 15 with AIDS, 7 of 13 [corrected] with AIDS-related complex, 7 of 16 [corrected] with HIV-seropositivity only, and 1 of 11 with HIV-seronegativity. Common neuropsychologic problems included impaired abstracting ability, learning difficulties, and slowed speed of information processing. Magnetic resonance imaging had abnormal findings in 9 of 13 patients with AIDS and 5 of 10 patients with AIDS-related complex who were available for scans. The commonest abnormalities were sulcal and ventricular enlargement and bilateral patchy areas of high signal intensity in the white matter. We postulate that central nervous system involvement by HIV may begin early in the course of AIDS and cause mild cognitive deficits in otherwise asymptomatic persons.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Neuroendocrine responses in psychiatric and pain patients with major depression.

Basal and postdexamethasone concentrations of cortisol and prolactin were studied in three groups of male patients: chronic pain patients with no psychiatric diagnosis (n = 12), chronic pain patients with coexisting major depression by Research Diagnostic Criteria (RDC) (n = 24), and pain-free psychiatric patients meeting RDC criteria for major depression (n = 28). Basal cortisol concentrations were significantly higher in pain-major depression and psychiatric-major depression patients compared to pain patients without psychiatric illness. The frequency of cortisol nonsuppression after dexamethasone was significantly greater in pain patients with major depression (41.7%) compared to pain patients without psychiatric disorder (8.3%), and was comparable to that of psychiatric patients (21.4%). Prolactin concentrations, but not cortisol levels, were significantly correlated with observer-rated severity of depression in pain patients. These findings suggest that cortisol and prolactin abnormalities in chronic pain may be related to psychiatric disorder rather than to pain per se, at least in male patients, and may indicate a role for cholinergic mechanisms in the interface of pain and depression.

Adult↗
PubMed1986

MMPI subgroups and affective disorder in chronic pain patients.

Patients with chronic pain syndromes are commonly depressed. Chronic pain populations also contain distinct subgroups of personality profiles as defined by the MMPI. To assess the relevance of personality subtype to affective disorder we determined the relationship of psychiatric diagnoses defined by Research Diagnostic Criteria (RDC) to MMPI subgroups in a sample of hospitalized patients with predominantly chronic low back pain. RDC psychiatric diagnoses for the sample were major depression (44.2%), minor depression (19.2%), other psychiatric disorder (13.5%), and no mental disorder (21.6%). Patients satisfying RDC criteria for major depression were significantly associated with discrete MMPI personality subtypes. No other psychiatric diagnoses were significantly associated with distinct personality subgroups. No relationship was observed between personality profile and presence of demonstrable organic etiology for pain. These findings indicate that behavioral and pharmacological interventions directed at depression as well as pain are important in the treatment of chronic pain populations, especially in selected subgroups.

Adult↗