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Biomedical subjects

J Westermeyer

Publications and source records attributed to J Westermeyer.

At least 37 records · Page 2Linked to original sources
PubMed1997

Course and severity of substance abuse among patients with comorbid major depression.

The authors assessed the course and severity of substance-related disorder (SRD) among patients with comorbid major depressive disorder (MDD) by means of both retrospective and concurrent data. A total of 642 patients were assessed. Data on course included lifetime use, age at first use, years of use, use in the last year; periods of abstinence, and current diagnosis. Data on severity included two measures of SRD-associated problems, substance abuse vs. dependence, self-help activities, and number of substances being abused. SRD-MDD patients tended to manifest lower levels of cannabis, opiate, and cocaine use, and more SRD-only patients were abusing three or more substances. Men with SRD-MDD demonstrated longer mean durations of abstinence compared with men with SRD-only, whereas SRD-MDD women demonstrated shorter mean durations of abstinence, compared with women with SRD-only. MDD-SRD patients showed slightly less substance abuse, but SRD severity was comparable with SRD-only patients.

Adult↗
PubMed1996

Physical disorders among Southeast Asian refugee outpatients with psychiatric disorders.

OBJECTIVE: The study assessed the prevalence and duration of axis III physical disorders and the resulting level of disability among Southeast Asian refugee outpatients with axis I psychiatric disorders. METHODS: A total of 266 consecutive patients who were evaluated in a psychiatric outpatient clinic were assessed for the presence of axis III conditions through questions about physical symptoms, a medical history and review of records, physical examination, and laboratory screening. The sample included 158 Hmong, 58 Laotian, 43 Vietnamese, and seven Cambodian patients. RESULTS: Fifty-five percent of the patients had one or more axis III disorders, most of which were chronic and were not associated with extreme disability. Neurological conditions were most common, and the sequelae of war-related trauma were prominent. No associations were found between the presence of axis III conditions and age, gender, marital status, or ethnic group. In 48 cases, the axis III condition may have caused or exacerbated the axis I condition. CONCLUSIONS: Routine medical history and a physical examination, including a neurological examination, are recommended for all psychiatric patients, including outpatients.

Adult↗
PubMed1996

Predictors of English fluency among Hmong refugees in Minnesota: a longitudinal study.

The objective of this study was to assess factors associated with later acquisition of English language fluency among Hmong refugees in Minnesota. Fluency in a society's lingua franca is a critical skill in psychosocial adaptation and mental health. A longitudinal study design was used, in which premigration and early postmigration factors were related to subsequent English fluency. The first group of 102 Hmong refugees located in Minnesota by the Immigration and Naturalization Service participated, and were interviewed in their homes. Hmong research assistants collected data using a questionnaire format at 1.5 years following resettlement in the U.S. Eight years later, two measures of English language competence were obtained: a self-assessment and an objective measure of English language fluency. Self-assessed fluency and performance on a brief English test showed good correlation. Greater English fluency on both measures was predicted by the following: younger age, male gender, education or vocational training in Laos prior to migration, occupation in Laos requiring literacy, study of English while in Asia, less proximity to other Hmong households in the U.S., any educational involvement in the U.S. (except English as a second language or ESL training), and not receiving welfare. Self-assessment of English fluency appeared to be a valid measure of competence in English. Demographic characteristics, certain premigration experiences, and early postmigration experiences predicted English fluency after 10 years in the U.S. ESL training was not associated with eventual English fluency on either self-assessment or objective testing. Recommendations are made to enhance English fluency, and hence the psychosocial adaptation of refuguees and other immigrants to the U.S.

Adolescent↗
PubMed1995

Cultural aspects of substance abuse and alcoholism. Assessment and management.

Cultures and ethnic groups within cultures prescribe, proscribe, or tolerate use of various psychoactive substances for social or personal purposes. In the United States, these ethnic strictures and practices vary widely. Ethnic enculturation into particular psychoactive substances can either reduce the risk of substance abuse or greatly increase this risk. To function effectively in a multiethnic society, psychiatric physicians of North America should learn to assess the cultural and ethnic dimensions and effects of substance abuse among their patients. In addition, they should be culturally sensitive to those aspects of treatment that can impede or augment successful outcomes. Finally, any and all attempts at primary prevention, early recognition and intervention, and rehabilitation should reflect the complex cultural, political, economic, and religious factors that influence substance use and abuse.

Alcoholism↗
PubMed1994

Substance disorder among 100 American Indian versus 200 other patients.

The purpose of this study was to examine the demographic and clinical characteristics among American Indian (AI) patients and other patients with Psychoactive Substance Use Disorders (PSUD). The study was conducted at a university-based, alcohol-drug program in the Upper Midwest. One hundred AI patients presenting sequentially with PSUD were contrasted with 200 other patients (selected at random from 620 patients) presenting at the same clinical facility during the same period with PSUD. Data included demographic characteristics, current DSM-III-R PSUD diagnoses, previous treatment for PSUD, and family history of PSUD. Findings indicated several special aspects of PSUD among AI patients, which have implications for program planning and treatment evaluation.

Adolescent↗
PubMed1994

Substance abuse and associated psychiatric disorder among 100 adolescents.

One hundred adolescents aged 14 to 20 were studied in treatment programs located in two states (Minnesota and Oklahoma). The purpose of the study was to assess the course of substance use, number and type of substance disorder diagnoses, severity of substance disorder, treatment history for substance disorder, and psychiatric comorbidity. Duration of course, frequency of substance use, abuse vs. dependence, types of substances used, and associated problems are described as a function of age. Areas of psychiatric and social assessment included: (1) psychiatric self rating scales in those 17 years and older (BDI and SCL-90); (2) psychiatrist rated scales (Hamiltons for anxiety and depression, BPRS, GAS); (3) psychosocial status (Hollingshead and Redlich SES, DSM-III Axes 3 and 4); (4) associated Axis 1 psychiatric diagnoses; (5) family history of mood and other psychiatric disorder; (6) childhood history; and (7) history of previous psychiatric treatment. These data confirm the severity of substance use among younger adolescents presenting to clinical facilities with substance disorder, but further reveal progressive substance disorder severity as these adolescents age. Both self rated and psychiatrist rated scales showed increased depressive symptoms with increasing age. Eating Disorders occurred more often among older adolescents. Loss of either parent in childhood was associated with younger current age.

Adolescent↗
PubMed1992

Substance use disorders: predictions for the 1990s.

Numerous factors will affect the course of alcohol-drug services over the next decade, including technological-scientific advances, legislation, professional training standards, case law, availability and cost of substances, and social policy toward users. Despite some apparent lessening of substance use, high levels of substance abuse are likely to continue due to fetal damage in high-risk offspring, younger onset of substance abuse, and solo-parent families. Care givers must be prepared to treat more youth, elderly, women, minority, and "dual disorder" patients. Federal and local statecraft against substance production and use remains crude and does not show signs of the increasing sophistication observed elsewhere in the world. Although these forces favor continued high levels of substance abuse problems, the funding mechanisms to provide care are under increasing assault by both the private and public sectors. Areas in which professional practice are apt to improve include clinical assessment-reassessment, treatment outcome research, monitoring during recovery, and out-patient treatment. Professional groups and treatment organizations will become more proactive in the financial support and management of treatment services.

Cross-Sectional Studies↗
PubMed1991

Fluoxetine-induced tricyclic toxicity: extent and duration.

Combined fluoxetine-tricyclic medication has been recommended for patients who are partial responders or nonresponders to tricyclic medication alone. Three cases were encountered in which the addition of fluoxetine to tricyclic medication resulted in toxic, potentially dangerous elevations in tricyclic blood level, amounting to approximately 100-300% increases over recent tricyclic levels. In reducing the tricyclic dosage after fluoxetine, blood level decreases were behind dosage decreases; and blood level and dosage decreases were not well correlated with each other. Symptoms associated with toxic levels are described. Due to the long half-life of fluoxetine, such increases in tricyclic medication must be anticipated well in advance of initiating treatment with these two compounds. Based on these few cases, a procedure is tentatively recommended for patients on combined fluoxetine-tricyclic regimens, until such time as a definitive regimen can be developed.

Adult↗
PubMed1991

Problems with managed psychiatric care without a psychiatrist-manager.

Seven critical cases in which patients at major psychiatric risk received less than adequate managed care are presented. Five patients committed suicide, one patient progressed to psychosis, and one became permanently physically disabled. In all seven cases, the patient's care was managed by a non-psychiatrist--by a bachelor's-level therapist or case manager in three cases and a family physician, a cardiologist, a nurse, and a master's-level social worker in the other four cases. In the cases in which psychiatric consultation was sought, psychiatrists, either in the managed care setting or outside it, were used mainly as psychopharmacological consultants. In three cases, their recommendations were not followed or were poorly implemented. In six cases, mismanagement of psychotropic medications was a factor in the fatal or serious outcome.

Adolescent↗