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Biomedical subjects

J W Goethe

Publications and source records attributed to J W Goethe.

At least 19 recordsLinked to original sources
PubMed2007

Physiogenomic comparison of weight profiles of olanzapine- and risperidone-treated patients.

Atypical antipsychotics induce pre-diabetic symptoms in some but not all patients, characterized most notably by elevated weight. The side effect profiles of the various drugs in the class differ, however, raising the possibility of drug-specific mechanisms for similar side effects. We used physiogenomic analysis, an approach previously employed to study the genetics of drug and diet response, to discover and compare genetic associations with weight profiles observed in patients treated with olanzapine and risperidone as an approach to unraveling contrasting mechanistic features of both drugs. A total of 29 single nucleotide polymorphisms (SNPs) were selected from 13 candidate genes relevant to two potential pharmacological axes of psychotropic-related weight profiles, appetite peptides and peripheral lipid homeostasis. We applied physiogenomic analysis to a cross-section of 67 and 101 patients being treated with olanzapine and risperidone, respectively, and assessed genetic associations with the weight profiles. Weight profiles in patients treated with olanzapine were significantly associated with SNPs in the genes for apolipoprotein E, apolipoprotein A4 and scavenger receptor class B, member 1. Weight profiles in patients treated with risperidone were significantly associated with SNPs in the genes for leptin receptor, neuropeptide Y receptor Y5 and paraoxonase 1. These results are consistent with contrasting mechanisms for the weight profile of patients treated with these drugs. Genes associated with olanzapine weight profiles may be related to peripheral lipid homeostatic axes, whereas those associated with risperidone's may be related to brain appetite peptide regulation. Future physiogenomic studies will include neurotransmitter receptor SNPs and validation in independent samples.

Adolescent↗
PubMed2001

The impact of depressive symptoms on the functional status of inner-city patients with asthma.

BACKGROUND: Functional deficits are common in patients with asthma. If there is cooccurring depression, these deficits may be more severe and/or more persistent. OBJECTIVE: This study was undertaken to determine 1) the prevalence and severity of depressive symptoms in a sample of inner-city patients being treated for asthma and 2) the impact of these symptoms on functional status. METHODS: Three hundred seventeen enrollees in an inner-city asthma program were evaluated using the health status questionnaire and the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and at 3- and 6-month follow-ups. Two groups were created based on patients' CES-D baseline scores, using a commonly used cutpoint to define "caseness" for depression. The two groups were compared using ANOVA, chi2, and the general linear model for repeated measures. RESULTS: Of the sample, 55.01% had a CES-D score greater than the cutpoint for depression. The mean was 29.3 +/- 11.95, well above the scores commonly used to indicate the presence of depression. The depressed group had lower scores on many measures of functional capacity at baseline; whereas both depressed and nondepressed patients improved over time on the physical performance measure (the physical performance measure subscale of the health status questionnaire), the mean score for the depressed group was consistently lower. CONCLUSIONS: The prevalence of depressive symptoms was greater than expected. Depression was persistent and had a major impact on functional capacity. Routine depression screening may be especially important in inner-city patients and other groups thought to be at increased risk for poor outcome.

Adolescent↗
PubMed2001

Characteristics of people lost to attrition in psychiatric follow-up studies.

In a large (N = 1,744) study of previously hospitalized psychiatric patients, multiple follow-up attempts were made to contact the ex-patients over a 1-year period after their discharges. When contacted they were asked to provide information about their posthospital adjustment; 59.5% of the sample was reached at least once and usable data obtained either in a telephone interview or from a mailed survey form. The contacted and noncontacted people represented very different subpopulations, both demographically and in terms of typical psychiatric descriptors. Those who were of lower socioeconomic status, male, unmarried, racial minorities, and those with records of substance abuse or assaultiveness, and who were generally more severely impaired during the baseline hospitalization were underrepresented in the contacted group. Possible reasons for these sample biases, the implications for hospitals conducting outcome assessments (i.e., for research and program evaluation purposes), and strategies for dealing with this kind of methodological problem are discussed.

Adolescent↗
PubMed2000

Herbal medicines with psychiatric indications: a review for practitioners.

The use of herbal medicines remains controversial despite their wide use by consumers. By U.S. standards few of these products have been sufficiently evaluated in scientific studies to determine with certainty their efficacy and safety. The authors review the herbal medicines with reputed psychiatric indications and discuss the potential adverse events with which physicians should be familiar. Whatever their potential benefits, some of these herbal products have potentially serious side effects, and many can interact with prescription medications. Patients frequently do not tell their physicians about their use of alternative medicines, and practitioners must ask specifically about products patients may be taking for health promotion and disease prevention as well as for the treatment of the presenting complaint.

Connecticut↗
PubMed1998

Anxiety and alcohol abuse in patients in treatment for depression.

Anxiety may be an important factor in explaining the prevalence of alcohol abuse among depressive patients. However, it is unclear whether anxiety has effects that are independent of other core symptoms in depression, and whether it is linked to alcoholic problems in both sexes. The present study of hospitalized depressive patients found a strong association between anxiety and alcohol abuse for women, and a weaker association for men. These effects were independent of severity of depression and global pathology. Whereas the correlation appeared to be linear for men, with each higher level of anxiety being associated with more alcohol problems, for women depressives those in a moderate-anxiety subgroup had the most difficulty with alcohol.

Adult↗
PubMed1997

Measurement of depression and anxiety for hospitalized depressed patients.

Standard scales for measuring anxiety and depression did not distinguish between these two psychological constructs in a sample of 295 inpatients with major depressive disorder. Items from these scales were used to form new measures, based on the results of a factor analysis. The new depression and anxiety subscales were internally consistent and only moderately correlated with one another, compared with the standard measures, which were highly correlated. When the factorial procedure was repeated with a subsample of patients with only mild to moderate symptoms, there was no discrimination between depression and anxiety. This finding suggests that when measured in a sample with a restricted range of symptom severity, anxiety and depression have poor discriminant validity.

Adolescent↗
PubMed1997

Physician compliance with practice guidelines.

BACKGROUND: Physician adherence to established practice standards has become an important national issue. Despite the proliferation of formal standards of practice, there is little evidence that the mere availability of guidelines results in changes in physician practices. This paper presents the results of a study of the effectiveness of a computerized monitoring and notification system in increasing physician compliance with treatment guidelines. METHODS: This study prospectively compared medical staff practices in two one-year periods utilizing a computer system which tabulated noncompliance and provided reminders. RESULTS: Overall, there was a statistically-significant decrease in the number of alerts issued in year two compared to year one; alerts were issued on 15% vs 29% of all patients (P < .001). The average number of alerts per patient decreased to .20 from .41. CONCLUSIONS: The study results indicate that a clinical decision support system such as that described can improve adherence to treatment guidelines.

Adult↗
PubMed1997

Assessing outcomes: identifying psychiatric patients with severe and persistent illness.

BACKGROUND: Identification of psychiatric patients with severe and persisting impairments can facilitate treatment, aid in program planning, and provide data for cost-of-care projections. METHODS: In this prospective study of patient outcomes, 1,679 inpatients were classified on admission using a functional status measure developed by the authors. Consenting subjects were reassessed at discharge and at 3, 6, and 12 months postdischarge to determine what proportion of patients classified as low functioning on admission remained so at follow-up. RESULTS: Patients classified as low functioning on admission represented 23.4% of the sample; the proportion that remained low functioning at the follow-ups ranged from 56.1% to 65.2%. Compared to the high functioning group, three times more low functioning patients were rehospitalized within 12 months of discharge (9.4% vs 32%). CONCLUSIONS: Patients with increased risk of persisting disability can be identified on admission using commonly available clinical measures. Of patients with low functioning on admission, more than half will have long-term impairment.

Adolescent↗
PubMed1995

Functional impairment in depressed inpatients.

The Sickness Impact Profile (SIP) was administered to 95 patients with major depression. The SIP includes 12 subscales, each representing a specific area of sickness-related dysfunction. To relate these measures to psychiatric symptoms, patients also completed a measure of depression severity. Consistent with earlier findings, there were high levels of functional impairment. Impairment was correlated with symptoms but, as noted elsewhere, functional status does not always parallel symptom severity. The SIP, widely used with medical disorders but, to our knowledge, underutilized to assess psychiatric patients, may provide more precise assessment of the impact of psychiatric disorders on the individual's daily life.

Activities of Daily Living↗
PubMed1995

Functional capabilities of depressed patients one year after hospitalization.

During hospitalization and at one-year follow-up, 48 patients with a diagnosis of major depression completed the Inventory to Diagnose Depression and the Sickness Impact Profile (SIP). Overall change scores revealed statistically significant and clinically important improvements in depression and functioning. SIP subscale scores showed no deficits in some functions (communication and bodily care) at baseline, restoration of functioning in other activities at one-year follow-up, and continuing dysfunctions in emotionality, alertness, recreation, socialization, and work. The SIP appears useful for measuring disability and patterns of recovery in depressed patients.

Activities of Daily Living↗
PubMed1995

Validity of the diagnostic interview schedule for detecting alcoholism in psychiatric inpatients.

This study examined the accuracy of the Diagnostic Interview Schedule (DIS) for indicating alcohol use disorder in a sample of patients hospitalized for depression. The Michigan Alcoholism Screening Test (MAST), with its established validity, was considered a good criterion against which to evaluate the DIS, and preferable to the clinician-assigned diagnosis in this regard. The rates of alcoholism in the sample were 31, 33, and 22.5% as yielded by the DIS, MAST, and physician's diagnosis of alcohol disorder, respectively. (The lower rate for physician's diagnosis may be due to the physician's not applying this diagnosis to recovered or currently abstinent alcohol patients.) Using the MAST's standard cutoff of five points as indicative of alcoholism, agreement with the DIS occurred in 91% of the cases, corresponding to a product moment coefficient of .79. It was concluded that the DIS alcoholism scale could be used, with reasonable confidence in its validity, for assessing alcoholism in psychiatric settings.

Adolescent↗
PubMed1995

Self-defeating personality disorder. A cross-national study of clinical utility.

The clinical utility of the DSM-II-R-proposed diagnostic category self-defeating personality disorder (SDPD) was assessed through the presentation of prototypic case histories to American and British psychiatrists and clinical psychologists. The most frequent diagnoses assigned were SDPD and personality disorder not otherwise specified; no alternative diagnoses were consistently provided. More than one in two professionals reported treating patients with a condition similar to the SDPD cases, and approximately 65% of these patients were reported to be female. American and British nonpatients were also assessed through the administration of an SDPD self-report questionnaire. The results suggest that the reported high prevalence of SDPD in the practitioners' patients is not a result of the expression of a general personality trait, and the reported greater incidence of SDPD in women is not a reflection of a normal, culturally learned, female behavior pattern.

Adolescent↗
PubMed1993

Severity as a key construct in depression.

Mild, moderate, and severely depressed subgroups were operationally defined in a sample of hospitalized patients clinically diagnosed as depressed. Women were overrepresented among the severely depressed patients, but no other demographic differences among subgroups were found. Generalized anxiety and psychic disorganization were significantly more pronounced in patients who were severely depressed. Severely depressed people also reported more role-performance impairments than did those who were less seriously depressed. Among women, a secondary diagnosis of substance abuse was present significantly less often in the severely depressed. Based on self-reports at admission and 4 weeks later, marked improvement was seen only among the moderately depressed. There was not a statistically significant symptom change in the mildly depressed group; for the severely depressed, the change over time was significant but the patients remained highly symptomatic. The authors discuss the importance of the construct of severity for clinical practice, hospital policy, and future research.

Adolescent↗
PubMed1993

Shifts in diagnostic frequencies of schizophrenia and major affective disorders at six North American psychiatric hospitals, 1972-1988.

OBJECTIVE: This study tested the impression that there have been significant shifts in the relative diagnostic frequencies of schizophrenia and major affective disorders. METHOD: Data on discharge diagnoses from 1972 to 1988 were gathered from six North American psychiatric teaching hospitals (data from one extended through 1991), and rates for schizophrenia and major mood disorders were evaluated. RESULTS: Total annual discharges increased by 6.6% during the study period. Large reciprocal shifts in the frequencies of diagnoses of schizophrenia and major affective disorders were found; schizoaffective disorder was a minor diagnosis. Beginning in the early 1970s, a gradual increase in the frequency of diagnoses of major affective disorders at all sites was accompanied by a corresponding decrease in diagnoses of schizophrenia at five of the six centers. Schizophrenia diagnoses decreased from a peak of 27% in 1976 to 9% in 1989 (a threefold decrease), and diagnoses of major affective disorders rose from a low of 10% in 1972 to 44% in 1990 (a fourfold increase). CONCLUSIONS: Several forces may have influenced these changes. 1) DSM-III narrowed the definition of schizophrenia and broadened the category of major affective disorders. 2) Treatment-oriented diagnostic bias associated with the availability of lithium and other mood-altering agents may have encouraged consideration of affective disorders. 3) Economic and social forces, including better third-party reimbursement rates, may have favored affective diagnoses. 4) True increases in the incidence of affective disorders may have occurred. 5) Although a real decrease in new cases of schizophrenia may have occurred, this effect was probably minor and dominated by a larger shift of such diagnoses to affective categories.

Canada↗
PubMed1991

Comparison of Diagnostic Interview Schedule to psychiatrist diagnoses of alcohol use disorder in psychiatric inpatients.

This study provides data about the extent of alcohol use disorders among general adult psychiatric inpatients. The accuracy of alcohol use disorder diagnoses given by the lay-administered Diagnostic Interview Schedule (DIS) and by staff psychiatrists, as compared to each other, was investigated. From consecutive admissions to a private psychiatric hospital, 55 patients with alcohol use disorders were identified by trained research assistants using the DIS (n = 162). A comparison of DIS diagnoses to clinicians' diagnoses revealed that 66 patients (40.7% of all admissions) were given an alcohol diagnosis by the DIS or clinician, 35 patients (21.6%) by DIS and clinician, 20 (12.3%) by DIS only, and 11 (6.8%) by clinician only. The two diagnostic approaches were also compared using several accuracy measures (sensitivity and specificity ratios, percentage of agreement, and kappa). With psychiatrists' diagnoses as reference, the DIS sensitivity ratio was 76 and specificity ratio 83. There were 12.3% false positive and 6.8% false negative diagnoses assigned by the DIS. Kappa was .56 and percentage of agreement 80.9%. Recomputing accuracy measures for the psychiatrist, using the DIS as the reference, clinician assessment sensitivity was 64 and specificity 90. Compared to each other, the DIS "overdiagnosed" and the staff psychiatrists "underdiagnosed" by about 1 in 20 cases. Among those alcohol use diagnoses upon which both clinician and DIS agreed, alcohol abuse was the predominant diagnosis. Among all patients with an alcohol diagnosis, the main nonsubstance abuse diagnoses (as assigned by the clinician) were: major depressive, dysthymic, bipolar, schizophrenic, and personality disorders.

Adult↗