Biomedical subjects

J Mezzich

Publications and source records attributed to J Mezzich.

11 recordsLinked to original sources

PubMed1991

Characterizing organic delusional syndrome.

We present a first comprehensive description of the clinical features of patients with organic delusional syndrome. This description is based on information from 39 patients with organic delusional syndrome among 14,889 patients who presented for initial evaluation over a 5-year period at our institution. This description includes an enumeration of the common clinical symptoms of this syndrome and the respective prevalence and mean severity of each symptom. The severity of the symptoms of organic delusional syndrome are compared with those of schizophrenia to determine which symptoms distinguish between these two diagnostic categories. Patients with organic delusional syndrome demonstrated significantly more symptoms of "acquired intellectual impairment," "impaired sensorium," and "hallucinations of smell, taste, or touch," while schizophrenic patients demonstrated more "flat affect," "emotional coldness," and "thought disorganization." In addition, associated factors are presented concerning demographics, modes of treatment, level of functioning, and current physical problems associated with organic delusional syndrome.

Delusions↗

PubMed1991

Can multiaxial diagnosis predict future use of psychiatric hospitalization?

Demographic and diagnostic intake data on about 10,000 patients at a public psychiatric facility were used to assess whether information recorded on various DSM-III axes could predict the frequency of patients' psychiatric hospitalizations over a follow-up period. Compared with patients who had been hospitalized only once or not at all, patients with three or more hospitalizations during the study period were more likely to be single and black and to come from lower social classes. They were more likely to have an axis I diagnosis of an alcohol-related disorder, a substance use disorder, or a psychotic disorder. When samples from the patient groups were matched on key demographic variables and primary axis I diagnosis, the multiaxial resources of DSM-III were not helpful in predicting future use of hospitalization. The results reinforce the importance of axis I diagnosis and demographic characteristics in assessing course and prognosis.

Adult↗

PubMed1990

Females and males in an intake psychiatric setting.

It is generally acknowledged that some psychiatric disorders are more commonly found among members of one sex rather than the other (e.g., Dohrenwend and Dohrenwend 1976; Gove and Tudor 1973; Kass et al. 1983; Robins et al. 1984; Rosenfield 1980; Weissman and Klerman 1977). Females, moreover, are consistently overrepresented in treatment populations of different sorts, and various reasons involving responses to illness and inclination to seek treatment have been offered to account for this (Finkler 1984; Kessler et al. 1981; Nathanson 1975; Verbrugge and Wingard 1987). In contrast to accepted gender differences in prevalence, incidence and inclination to use services, a prevailing view about psychopathology is that the actual content or manifestations of a disorder should be "culture free" or universal. In the theory of psychopathology (e.g., implicit in DSM-III), general descriptors of the person (i.e., demographic and cultural) play a comparatively minor role in the stipulation of the manifestations of psychiatric illness. Among socially and culturally oriented psychiatrists, on the other hand, such descriptors are considered important clues to origins of psychopathology. However, in such analyces, sociocultural is usually equated with altogether different symbolic/language traditions (e.g., Finkler 1985; Lieban 1978), although reports exist of sex differences in symptom expression in Western societies (Brown and Harris 1976; Hinkle et al. 1960; Nathanson 1979). Feminist critics assert that even within the sociocultural tradition linked to Anglo-American society, a bias exists with respect to how psychopathology is shaped, defined and handled (Kaplan 1983; Showalter 1985). The topic of gender differences in psychiatric morbidity is thus of considerable general interest and one that can be approached from a number of different perspectives. In this study we compare psychopathology in males and females who were referred to an intake setting. The DSM-III formulations and level and type of symptoms were the focus of analysis. The results are interpreted in light of findings in psychiatric epidemiology and social psychiatry.

Adult↗

PubMed1989

Interpreting the structure of diagnosis in initial evaluations: primary, auxiliary and rule out patterns.

The study evaluates DSM III as a natural taxonomy, a system of categories devised for identifying complex objects represented as clinical conditions. Adults seeking initial evaluations constitute the study's population. An individual's clinical condition is examined in terms of a diagnostic format consisting of primary, auxiliary and rule out positions in Axis I and presence and number of diagnoses in Axis II. Each clinical condition thus differs with respect to complexity and diagnostic formats of such conditions are analyzed quantitatively. Differences between the sexes and the races with respect to number of Axis I and Axis II diagnoses are presented. The frequency of use of a diagnostic category is analyzed with respect to position on Axis I, and Axis II, and ratings of the perceived salience and efficacy of treatment plans of the disorders referenced by the category. The number of symptoms in conditions that differ with respect to level of complexity (i.e., number of diagnoses) are compared. An attempt is made to understand how Axis I and Axis II of the DSM III system are used by clinicians and also how they operate as devices to codify clinical information under conditions of relative uncertainty.

Adult↗

PubMed1988

Somatoform disorder in a psychiatric setting. Systematic comparisons with depression and anxiety disorders.

Somatoform disorder (SD) is recognized as an important clinical entity in general medicine although its psychiatric nature is insufficiently appreciated. Its prevalence and descriptive validity among psychiatric patients have not been investigated. These two aspects of SD are examined by comparing it with depressive and anxiety disorders, both of which include somatic symptoms and often are confounded with it. A semistructured evaluation procedure applied in a naturalistic clinical setting yielded a diagnosis and ratings of a large array of symptoms. The relative rarity of SD stands out, as well as the unique way in which it tends to be used in diagnostic formulations of psychiatric patients seeking evaluation and care. These results may reflect these patients' reluctance to seek psychiatric care and to define their problems as mental, as well as the bias of clinicians working in psychiatric settings geared to looking for traditional psychopathology. The distinguishing symptoms of SD vis-à-vis depressive and anxiety syndromes are outlined. These symptoms suggest that SD patients resemble depressives, but harbor traits that reflect personality and interpersonal difficulties. However, rater bias may have influenced these results as well.

Adult↗

PubMed1987

Adjustment disorder and psychiatric practice: cultural and historical aspects.

A universal concern of healers and health practitioners of all social groups is that of caring for individuals reacting to social and interpersonal hardships. One could view individuals experiencing such hardships as prototypical patients of a society's health profession, however this may be defined. In contemporary psychiatry, such individuals are diagnosed as showing an "adjustment disorder." In view of the time-honored legitimacy of caring for individuals meeting criteria for an adjustment disorder, it is ironic that the status of this "disorder" in the discipline's contemporary nosology is controversial and anomalous. In this paper, these and related issues are discussed. Emphasis is given to some of the cultural, historical and clinical-epidemiologic factors that render disturbances that can be diagnosed as adjustment disorder important in psychiatry and, indeed, worthy of inclusion in DSM-III. Theoretical and empirical problems that would render this entity a more legitimate one in contemporary biomedical psychiatry are reviewed.

Adjustment Disorders↗

PubMedDate not supplied

Black-white differences in psychopathology in an urban psychiatric population.

The study was conducted in a psychiatric setting that services a large metropolitan population. It relied on the semi-structured Initial Evaluation Form which is completed by expert trained clinicians and which is geared to a comprehensive evaluation along the lines stipulated in DSM-III. The symptoms of a large sample of white and black patients are compared. The study relied on an Analysis of Variance (ANOVA) procedure which controlled for age, gender and education and concentrated exclusively on ethnic differences in clinically homogenous subgroups. The sample was partitioned into relatively pure groups of DSM-III diagnoses that are frequent in the population, including schizophrenia, affective and anxiety disorders, dementia, paranoid and manic disorders. Prominent black/white differences in psychopathology were noted, but in only a few instances included items generally thought of as typical of a specific disorder. Some differences appeared to be due to selection factors and others raised the question of alternate expressions of psychopathology among blacks as versus whites. The significance of the results obtained is discussed together with questions requiring further research. Some of the issues involved in the study of black/white differences in psychopathology are critically analyzed.

Adult↗

PubMedDate not supplied

Variation in cognitive functioning in nonorganic psychiatric disorders.

Level of cognitive function is usually conceptualized as a feature of organic psychiatric disorders. Classically, its assessment is part of the mental status examination. Standardized tests, such as the Folstein battery, are used to screen for organic disorders by measuring level and possible impairment of cognitive function through the stipulation of cutoff points. However, contemporary definitions of psychiatric disorders do not embrace such a categorical view of cognitive function. It is important to measure the level of cognitive function in all types of psychiatric disorders in relation to demographic characteristics. Consequently, it is better to view cognitive function as a continuous variable. The Cognitive Function Inventory (CFI), which can also yield a Folstein score, was used to assess cognition in patients diagnosed as having nonorganic psychiatric disorders. A number of different parameters of cognitive function are examined. Differences associated with demographic background and type of disorder are reported. The implications of these results are discussed.

Adjustment Disorders↗

PubMedDate not supplied

Explaining diagnostic complexity in an intake setting.

A one patient-one illness paradigm is implicit in the history and theory of psychiatry, and in basic research. Yet, in clinical practice and treatment populations in general, more than one diagnosis per patient is frequently encountered. How clinicians formulate comorbidity by means of DSM-III has rarely been investigated. In this study, the ideas of clinical condition and that of its diagnostic complexity are used to analyze descriptive features of a large number of patients seen in an intake setting. Axis I of DSM-III is used to measure diagnostic complexity. Complexity is analyzed in relation to demographic variables, to ratings entered in the remaining axes of DSM-III formulations, to symptom levels of patients, and to decisions involving disposition. Results indicate that analysis of diagnostic complexity by means of DSM-III yields a definable structure and that it can be related meaningfully to clinical factors. The idea of information uncertainty in diagnosis, i.e., the opacity versus transparency of a clinical condition, is also used to explain results. The ideas introduced and studied are shown to have value for social psychiatric research.

Adaptation, Psychological↗

PubMedDate not supplied

On the homogeneity of personality disorder clusters.

This study was conducted using as subjects persons seeking psychiatric care in a public intake facility. Patients who received a diagnosis of a personality disorder (PD) on axis II constituted the study sample. The study is unique in that it attempts to analyze in a treatment population the relationships between all of the personality disorders (PD) stipulated in DSM-III with emphasis on their relationships to the associated features recorded in the remaining axes of DSM-III. The specific aim of the study was to determine the variation that exists with respect to clinical and demographic variables across the PD clusters categorized in DSM-III and across the PD types of each of the DSM-III PD clusters. In general, considerable inhomogeneity was shown within and across clusters in both demographic and clinical variables, although differences among clusters were noted as well. Cluster B differs prominently from its cohorts with respect to demographic and clinical characteristics. Some of the limitations of these results are emphasized.

Adult↗

PubMedDate not supplied

Characterizing organic hallucinosis.

A first comprehensive description of the clinical features of patients with the rare diagnosis of organic hallucinosis (OH) is presented, based on information from 11 OH patients among 14,889 patients who presented for evaluation over a 5-year period at our institution. This characterization is of particular current relevance to diagnosticians and clinicians because of the proposed major changes in the diagnostic system for OH in the upcoming DSM-IV and because of the virtual total lack of published information concerning this syndrome. This description includes a listing of the prevalence and mean severity of each symptom. The severity of the symptoms of OH are then compared with those of its crude "functional" equivalent of schizophrenia to determine which symptoms distinguish between these categories. Associated factors are also presented concerning demographics, modes of treatment, level of functioning, and current physical problems associated with OH.

Adult↗