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Biomedical subjects

J R Rundell

Publications and source records attributed to J R Rundell.

At least 19 recordsLinked to original sources
PubMed2000

Psychiatric issues in medical-surgical disaster casualties: a consultation-liaison approach.

Psychiatrists can increase the efficacy of their response to disaster victims in the immediate aftermath of a disaster if they utilize a consultation-liaison approach to assessment and management of casualties. Medical-surgical disaster responders use an algorithmic, stepwise approach to assess disaster or trauma victims. This approach ensures that patients with life-threatening injuries who are not expectant are treated first. Then, secondary physical assessments ensure proper triage of other victims so that disaster response resources are used most wisely. A tertiary psychiatric assessment can assist with differential diagnosis of post-disaster neuropsychiatric symptoms and signs to ensure valuable medical-surgical resources are targeted to the correct patients. Psychiatric triage can also identify those victims most in need of early preventive and therapeutic psychiatric intervention.

Disaster Planning↗
PubMed1999

Anxiety and neurological disorders.

Anxiety disorders occur quite frequently in patients who have neurologic disorders. In fact, several studies show that anxiety disorders occur more frequently than mood disorders in patients with neurologic conditions. Despite high prevalence rates, investigators have neglected the study of anxiety disorders in these patients. Two major reasons for the neglect are the diagnostic hierarchy and exclusion criterion found in Diagnostic and Statistical Manual (DSM)-III-R and DSM-IV. This article discusses problems in the diagnosis of anxiety disorders in patients with neurologic conditions and presents a brief literature review of the relationship between anxiety and neurologic disorders. In addition, the authors describe the differential diagnosis of anxiety in neurologic conditions and treatment options.

Anxiety↗
PubMed1998

Dual agency, dual relationships, boundary crossings, and associated boundary violations: a survey of military and civilian psychiatrists.

We hypothesized that psychiatrists with high dual-agency potential (military and health maintenance organization [HMO] psychiatrists) were more likely than non-HMO civilian psychiatrists to engage in dual relationships, report pressures to do so, participate in other general boundary-crossing activities, and report associated counter-therapeutic outcomes (boundary violations). Ninety military and 191 demographically matched civilian psychiatrists reported the number of boundary-crossing activities (including dual relationships) and associated counter-therapeutic outcomes in the preceding year with adult patients. Military and HMO psychiatrists reported greater external pressures than non-HMO civilian psychiatrists to engage in dual relationships; however, all three groups were similar in their reported numbers of dual relationships. The reported boundary-crossing activities and dual relationships studied here are not necessarily associated with reported boundary violations. The relative risk of a particular boundary crossing associating with harm to a patient likely depends on the therapeutic context and should be determined on a case-by-case basis.

Adult↗
PubMed1994

Working memory in individuals with HIV infection.

The central executive component (CE) of Baddeley's working memory model (Baddeley, 1992) was evaluated in 26 asymptomatic human immunodeficiency virus-infected individuals (HIV+) and 23 HIV-control subjects using a dual-task working memory paradigm. The HIV+ and HIV- groups showed an equivalent reduction in performance on both the primary task (visual vigilance) and the secondary task (letter span) when they were performed concurrently relative to when either task was performed alone. This result suggested normal CE functioning in these HIV+ subjects. In contrast, the HIV+ subjects had significantly longer response latencies on reaction time measures relative to the HIV- control group. These findings indicated that slowed processing in early stage HIV-infected individuals is not associated with a working memory deficit.

AIDS Dementia Complex↗
PubMed1993

A prospective study of psychiatric aspects of early HIV disease in women.

Few studies of psychiatric morbidity associated with HIV disease have included women. The authors prospectively studied a cohort of HIV-seropositive women, none of whom had AIDS, to assess changes in their psychiatric status over time. All seropositive women admitted to the U.S. Air Force's HIV evaluation unit for comprehensive evaluations since 1987 were eligible for enrollment in an open-ended prospective study. Forty-three women without AIDS enrolled between 1987 and 1991 (83% of those eligible), 29 of whom have been interviewed at least twice. The Structured Clinical Interview for DSM-III-R and a semistructured interview were administered to assess psychiatric diagnoses, suicidality, sexual functioning, affective status, and other psychosocial variables. Women were more likely to have a psychiatric diagnosis at follow-up, largely accounted for by a substantial increase in sexual dysfunction (41% of reevaluated group). None engaged in suicidal behavior or required psychiatric hospitalization during the 86.9 woman-years of observation. High-risk sexual behavior occurred after seroconversion in at least 35% of the group, with no interval decline. Most women with early stage disease were free of major psychiatric disorders at both assessments. Many developed sexual dysfunction that impaired intimate relationships and detracted from quality of life. The psychiatric natural history of HIV infection in women appears to differ from that observed in studies of men.

AIDS Serodiagnosis↗
PubMed1993

Relating cognitive function to military aviator performance in early HIV infection.

There has been controversy about whether cognitive changes occur in early human immunodeficiency virus (HIV) disease. In those studies reporting cognitive changes, these are typically subclinical, and their relationship to daily and/or occupational functioning has not been addressed. The potential effects of changes may vary as a function of occupational demands. This is germane to military performance, where occupational demands cover a wide spectrum of complexity. In particular, such effects are important to consider in the many cognitively demanding specialties associated with military aviation. This paper will explore ways in which possible HIV-related military performance decrements in aviators may be measured empirically. First, studies from Walter Reed Army Medical Center (WRAMC), which have shown cognitive changes in early HIV disease, will be described. This will be followed by a summary of presentations and discussions at a conference in November 1990, entitled 'HIV and Military Performance: Assessment Methodologies' held at WRAMC. The third section of the paper will describe a programme of research, which is developing measures to detect cognitive difficulties in civilian aviators. The application of measures from this research to research on HIV will be discussed. Finally, a research programme being developed to examine the possible impact of HIV-related cognitive changes on military aviator performance will be described.

Aerospace Medicine↗
PubMed1993

Neuropsychiatric morbidity in early HIV disease: implications for military occupational function.

The Military Medical Consortium for Applied Retroviral Research Program's (MMCARR) Behavioral Medicine Human Immunodeficiency Virus (HIV) Research component is conducting a tri-service, comprehensive, and longitudinal research study in military HIV-infected personnel at all stages of infection. Identification of neuropsychiatric and psychosocial outcomes and their determinants will help the military minimize the impact of the HIV epidemic on military readiness and function. Neuropsychiatric and psychosocial findings are among the most common complications seen in early HIV disease and among the most likely to have an adverse impact on military readiness and function. The study has demonstrated that the average HIV-infected service person experiences at least transient military occupational difficulty following notification of HIV status. More than 15% at any given time have levels of clinical or subclinical anxiety or depression that are referrable for mental health intervention. Ten per cent of study subjects have a current major mood disorder and 5% have a psychoactive substance use disorder. Finally, 17% of study subjects have experienced serious suicidal ideation or behaviours at least once since notification of seropositivity. Fortunately, however, data also indicate at least partial effectiveness of current primary, secondary and tertiary preventive efforts. Only about 1% of Air Force HIV-infected persons are discharged for psychiatric reasons prior to eventual medical discharge. Further, a large majority of active-duty patients demonstrate solid military occupational and social performance. Though military HIV neurobehavioural research is still in progress, preliminary data identify social support and pre-HIV psychiatric predisposition as important factors associated with current neuropsychiatric status.

Aerospace Medicine↗
PubMed1993

Neuropsychological performance, mood, and complaints of cognitive and motor difficulties in individuals infected with the human immunodeficiency virus.

Seventy-nine military medical beneficiaries infected with human immunodeficiency virus (HIV+) and 27 HIV-seronegative control subjects (HIV-) completed a neuropsychological evaluation and a semistructured interview inquiring about difficulties in function. More HIV+ than HIV- subjects reported difficulties. HIV+ subjects reporting difficulties were significantly more likely to be deficient on attention, response speed, motor function, and memory than those not reporting difficulties. Findings for early-stage HIV+ subjects were similar. HIV+ individuals who complained of difficulties reported depression and anxiety symptoms significantly more frequently than those who did not complain, but these symptoms were not related to neuropsychological performance. Complaints of difficulties by HIV+ individuals may reflect either actual neuropsychological deficiency or mood disturbance, but the effects of each appear to be independent.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Measuring performance decrements in aviation personnel infected with the human immunodeficiency virus.

There is controversy over whether cognitive impairment occurs in early human immunodeficiency virus (HIV) disease. When impairment is reported, findings are typically subclinical, affect only a minority, and their relationship to occupational functioning has not been established. Despite such findings, it has been recommended that HIV-seropositive pilots be disqualified from flying. This paper reviews research relevant to measuring performance decrements in HIV-infected aviators. Based upon current data, we conclude that although subtle neurobehavioral dysfunction may occur in some asymptomatic HIV-seropositive individuals, there is no research which has demonstrated associated decrements in aviation-related skills. Thus, it may be premature to recommend medical disqualification of all HIV-seropositive aviators. We propose, instead, that sensitive neurocognitive measures, incorporated into a comprehensive neurodiagnostic evaluation, could be used to evaluate asymptomatic HIV-seropositive aviators. Only those who are impaired on evaluation would be disqualified from flying. Concurrently, research investigating the relationship between abnormalities and aviation abilities would be conducted.

Aerospace Medicine↗
PubMed1990

Prospective study of psychiatric morbidity in HIV-seropositive women without AIDS.

Prospective studies of psychiatric morbidity in HIV-seropositive women without AIDS have not been previously reported. As part of a 5-year longitudinal study, psychiatric diagnoses are described in 20 employed, educated women who are not intravenous drug abusers. This population is markedly different from the urban, minority, intravenous drug dependent groups previously studied and may be more representative of women who acquire the virus through heterosexual contact. Heterosexual transmission was the rule; 20% had HIV-seropositive spouses. All women were largely asymptomatic and in the early stages of infection. Mean length of knowledge of seropositivity was 14.4 months. Fifty percent were found to have an Axis I diagnosis (35% if minor diagnoses are excluded). None developed major depression or became dependent on drugs; 5% abused alcohol. Fifteen percent exhibited subtle signs of cognitive decline. Suicidal behavior and psychiatric hospitalization were absent. Sexual functioning was disrupted in a majority, with 20% meeting criteria for new onset hypoactive sexual desire disorder. Consistently "safe sex" practices were adhered to in 40%; in spite of intensive and repeated HIV education, 60% engaged in unprotected intercourse after knowledge of seropositivity. Progression of HIV infection was found to be three times faster than in a comparable male sample.

Adult↗
PubMed1990

Associations between cerebrospinal fluid parameters and high degrees of anxiety or depression in United States Air Force personnel infected with human immunodeficiency virus.

The relationship between anxiety and depression, and serum and cerebrospinal fluid (CSF) immune parameters was studied in 98 patients randomly selected from those undergoing routine medical evaluation for human immunodeficiency virus seropositivity as part of the U.S. Air Force's mandatory screening program. A total of 95% of the sample did not have acquired immunodeficiency syndrome (AIDS). The population was subdivided into high and low anxiety or depression groups for statistical purposes. Significant correlations were obtained between high Hamilton Rating Scale for Depression scores (greater than 10) and CSF nucleated cell count and protein levels. High Hamilton Rating Scale for Anxiety (greater than 10) scores were positively correlated with CSF nucleated cell count and absolute CD4a counts. There were no statistically significant group differences with respect to mean laboratory values between high and low anxiety or depression subgroups. Serum viral titers to Epstein-Barr virus and cytomegalovirus were not correlated with anxiety or depression scores. These results suggest a complex relationship between CSF and systemic immune abnormalities and degree of anxiety and depression.

Adult↗