Biomedical subjects
Publications and source records attributed to J M Rey.
API ZYM kit was used to test enzymatic activities on eighteen strains of Dermatophilus congolensis. All strains produced lipase and acid phosphatase, which act on lipids, and leucine arylamidase which act on proteins. Another 10 exoenzymes were present in at least one of the strains.
This study is concerned with the service provided to adolescent patients with eating disorders admitted to a private hospital. The patients' parents were asked to evaluate the service. Parental satisfaction was assessed by means of a questionnaire devised for this purpose and comments were elicited as to how the service could be improved. Parents of a consecutive series of 56 patients were asked to complete the questionnaire 6 months after admission; 82% (N = 46) responded. Most parents were pleased with the service provided but nevertheless many made some criticisms (35%) or suggestions for improvement (37%). The parental responses were discussed with the staff involved in treatment, resulting in changes to the service.
This study explores the factor structure of behaviours that correspond to symptoms of DSM-III-R oppositional defiant (OD) and conduct disorder (CD). It also seeks to clarify how those hypothetical factors may relate to diagnoses of OD and CD. Using exploratory factor analysis and cluster analysis of parent questionnaire data from a group of referred adolescents (N = 528) diagnosed according to DSM-III criteria the authors extracted four factors. One of them corresponded closely to DSM-III-R OD, while the others comprised different aspects of the CD construct. The findings suggest there are subtypes of conduct problems in adolescents, and give some support to the distinction between conduct and oppositional disorders.
To assess whether perceived parental care and protection varied according to age and gender of the child and whether they were associated with psychiatric diagnoses, these constructs were measured with the Parental Bonding Instrument in a cohort of non-referred adolescents (n = 762), in a clinically referred cohort (n = 1299), and in a group of adolescents from the referred cohort (n = 365) for whom DSM-III diagnoses were available. Significant differences in parental care and protection according to clinical status, age, gender and diagnosis were found. However, perceived parental affectionless control was not associated with emotional disorders in adolescents, contrary to reports in adult subjects, but with clinical status.
OBJECTIVE: Oppositional defiant disorder is a common clinical diagnosis that has attracted little research interest, and doubts about its validity as a distinct category remain. However, it underwent substantial changes from DSM-III to DSM-III-R, and more are proposed for DSM-IV. The objective of this study was to review the literature on this condition to establish its place in the psychiatric nosology. METHOD: The terms used in computerized searches of the literature included "oppositional disorder," "oppositional defiant disorder," and "oppositional behavior." Publications found by these searches were supplemented with references in articles, searches in the epidemiological literature, and noncomputerized searches. RESULTS: Findings of studies in which multivariate analyses were used support a distinction between oppositional defiant disorder and conduct disorder. In these studies, one-third of all community-based children with any psychiatric condition had a diagnosis of oppositional defiant disorder and used mental health services often. Symptoms of oppositional defiant disorder appear to be stable over time and to have a developmental profile and sex distribution different from those of conduct disorder. The reliability of the diagnosis is low. CONCLUSIONS: There is some support for oppositional defiant disorder as a category that reflects an oppositional-aggressive psychological dimension, which is different from a delinquent dimension. There is little evidence for making oppositional defiant disorder a part of the construct of conduct disorder and for making "lying" a criterion for it. Considerable impairment should be required for the diagnosis. A more detailed description of symptoms, including a threshold for considering them present, may increase reliability of the diagnosis.
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OBJECTIVES: To make clinicians aware of the methods and results of the Epidemiologic Catchment Area (ECA) study, the largest (about 20,000 subjects) undertaken in psychiatric epidemiology, and to explore implications for the management of these conditions in Australia. DATA SOURCES: The main source was the monograph that reports the overall results of the ECA project. DATA EXTRACTION: Only data that were considered to be of general interest were extracted. DATA SYNTHESIS: The ECA study found that one in every three American adults had experienced one or more of 30 major psychiatric disorders at some time in their lives. One in five had an active disorder at the time of interview. Most conditions were found to have their onset early in life (median age of onset was 16 years) and followed a chronic course. In many cases persons afflicted did not seek or receive appropriate treatment despite using medical services more often. CONCLUSIONS: Psychiatric disorders are a major public health problem. Increased emphasis on their identification and treatment is required, particularly during childhood, adolescence and early adulthood. Paradoxically, these are the age groups more neglected by current services and research.
The authors examined agreement between parent and child ratings on the Child Behaviour Checklist in a sample of 1299 referred adolescents over a period of three years. Correlations ranged between 0.72 and 0.08 (mean = 0.28), while agreement using kappa was similar but slightly lower (mean = 0.24; range 0.71-0.07). Agreement on externalizing was higher than on internalizing items, and concordance increased with age for boys, while there were no differences in parent-child agreement between boys and girls. Agreement was higher for dimensions of behaviour, e.g. depression (r = 0.40).
Receiver Operating Characteristics (ROC) analysis of six depression scales extracted from the Child Behavior Checklist (CBCL) and Youth Self-report (YSR) in a clinically referred sample of adolescents (N = 667) showed that their performance in discriminating between depressed and not depressed patients was comparable to other specifically designed depression rating scales (area under the ROC curves between 0.75 and 0.82). Performance was better for boys than for girls. These results suggest that specific depression self-report rating scales may be unnecessary in adolescents if CBCL or YSR data are available, and that self-reports are not more accurate than parent-reports in the identification of depression in this age group.
The Parental Bonding Instrument (PBI) was administered to 54 adolescent patients with anorexia nervosa. Scores were compared with those of matched groups of normal and of nonanorectic adolescents referred for assessment to an adolescent psychiatric unit. Significant differences between the 3 groups were demonstrated with respect to care and protection dimensions. Overall scores of subjects in the anorectic group resembled those of normals rather than those of referred patients. Anorexia nervosa patients described their fathers and mothers as being more caring and their mothers as being less overprotective than did psychiatrically referred peers. The study raised questions concerning the use of the PBI in adolescents, in particular those with anorexia nervosa, and the role of the family in the aetiogenesis of this condition.
Using receiver operating characteristic methods, the authors planned to assess the diagnostic accuracy of a measure of depression extracted from the Child Behavior Checklist in a group of 667 referred adolescents with DSM-III diagnoses. This depression scale was based on a depression factor found by Nurcombe et al. in Child Behavior Checklists from adolescent inpatients. Receiver operating characteristic analysis showed that Child Behavior Checklist-Nurcombe scores were able to discriminate between subjects with and without major depression with an accuracy comparable to that reported for the Dexamethasone Suppression Test (area under the receiver operating characteristic curve = 0.78).
Reports of suicidal behaviour from four countries using the same measures were higher for girls than for boys, and higher in self-reports than in parent reports for both referred and normal adolescents. In a sample of 480 referred adolescents, patterns of 'low' and 'high' suicidal scores were different when age, sex and diagnosis were considered. The probability of high scores for girls showed only a marginal increase with age, while there was a striking rise for boys. An affective diagnosis doubled the probability of high scores for both boys and girls, while it had no effect on low scores. Psychosocial stressors also increased the probability of high suicidal scores, particularly in adolescents with an affective disorder. Sex differences in suicidal behaviour were marked in the low-scoring groups.
Using a clinical sample of adolescents (n = 207), an attempt was made to find whether a multi-purpose, multi-informant instrument which measures a number of symptom domains, such as the Child Behavior Checklist (CBCL)/Youth Self-Report (YSR), could be used to extract Children's Depression Inventory (CDI) scores. Using item analysis procedures, a cluster of 15 items was selected from the YSR, which yielded a correlation of 0.74 with the CDI. The internalising scale of the YSR also correlated highly (0.73) with the CDI score. The corresponding CBCL items and scales showed poor capacity in predicting CDI scores.
Two hundred forty-six patients with acute appendicitis were randomly assigned to one of two groups. One group of 120 patients received systemic clindamycin preoperatively. Another group of 126 patients received, in addition to systemic clindamycin, a solution of topical ampicillin applied to subcutaneous tissues. No differences were found in the characteristics of the two groups. Combined prophylaxis with clindamycin and ampicillin significantly reduced wound infection to 4%, compared with clindamycin alone (p less than 0.02). A decrease in the surgical wound infection rate in the group treated with clindamycin and ampicillin was mainly observed in patients with advanced (gangrenous and perforated) appendicitis (p less than 0.05). A significant decrease in wound infection rates in patients with positive culture results was also found. We conclude that prophylaxis with a combination of systemic clindamycin and topical ampicillin solution, when compared with clindamycin alone, more effectively prevents wound infection after emergency appendectomy, especially in patients with serious wound contamination.
In order to ascertain whether there was a relationship between parenting style and the development of conduct (CD) and oppositional (OD) disorder, the authors compared ratings on a self-report measure of perceived parenting (Parental Bonding Instrument) by normal adolescents (N = 62) and by adolescents with CD (N = 62) or OD (N = 49). No differences were found between the CD and OD groups. However, there were significant differences between the clinical groups and the normal control group: adolescents with CD or OD perceived their parents as more overprotective and less caring.
A review of the 2,256 admissions to a general hospital psychiatry unit between April 1982 and December 1987 showed that 129 (6%) had been treated with electro-convulsive therapy (ECT); 91% of these had a diagnosis of mood disorder. Most patients were taking concurrent psychotropic medication and received an average of 9 treatments per course of ECT. Men and patients taking benzodiazepines had shorter convulsions. However, there were no differences in seizure length and number of treatments between younger and older patients and between those taking and not taking tricyclic antidepressants.
The authors report a reliability study of the DSM-III diagnostic system in a series of 393 adolescent referrals diagnosed by two clinicians over a period of 3 years. Overall reliability (kappa) was 0.59. However, most of the frequently used diagnoses had reliabilities of 0.7 or higher. Dysthymic, Adjustment, Overanxious and Avoidant Disorders showed poor diagnostic agreement (kappa below 0.4). The patterns of agreement across this and other studies suggest that diagnostic criteria for Affective, Anxiety and Adjustment Disorders are in need of further improvement.
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