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Joel Yager

Publications and source records attributed to Joel Yager.

At least 19 recordsLinked to original sources
PubMed2006

Eating disorders and celiac disease: a case report.

OBJECTIVE: Although chronic physical illness may be associated coincidentally with an eating disorder, some clinicians may overlook the possibility that another medical illness may coexist and contribute concurrently to symptoms such as peculiar eating behaviors, restrictive eating, and/or vomiting accompanied by body dissatisfaction. We present a 31-year-old single woman initially diagnosed with an atypical eating disorder. METHOD: After a gastroenterology consultation prompted by the atypical characteristics of her eating disturbance, the diagnosis of celiac disease was established. RESULTS: Cause-and-effect relationships between anorexia nervosa and celiac disease are unclear, and celiac disease may lead to confusion in the differential diagnosis of anorexia nervosa. CONCLUSION: Particularly in atypical cases, and in cases where nausea and bloating are prominent complaints, workup for celiac sprue may reveal the presence of this condition. In such instances, patients may achieve additional relief through the implementation of gluten-free diets.

Adult↗
PubMed2006

The impact of the changing health care environment on the health and well-being of faculty at four medical schools.

PURPOSE: Increased pressure for clinical and research productivity and decreased control over the work environment have been reported to have adverse impacts on academic faculty in limited studies. The authors examined whether work-related stressors in academic medicine negatively affected the physical and mental health, as well as life and job satisfaction, of academic medical school faculty. METHOD: A 136-item self-administered anonymous questionnaire modified from a small 1984 study was distributed to 3,519 academic faculty at four U.S. medical schools following institutional review board approval at each school. Validated scales measuring depression, anxiety, work strain, and job and life satisfaction; a checklist of common physical and mental health symptoms; and questions about the impact of institutional financial stability, colleague attrition, and other work-related perceptions were used. Responses were analyzed by sex, academic rank, age, marital status, faculty discipline, and medical school. RESULTS: Responses were received from 1,951 full-time academic physicians and basic science faculty, a 54.3% response rate. Twenty percent of faculty, almost equal by sex, had significant levels of depressive symptoms, with higher levels in younger faculty. Perception of financial instability was associated with greater levels of work strain, depression, and anxiety. Significant numbers of faculty acknowledged that work-related strain negatively affected their mental health and job satisfaction, but not life satisfaction or physical health. Specialties were differentially affected. CONCLUSIONS: High levels of depression, anxiety, and job dissatisfaction-especially in younger faculty-raise concerns about the well-being of academic faculty and its impact on trainees and patient care. Increased awareness of these stressors should guide faculty support and development programs to ensure productive, stable faculty.

Adaptation, Psychological↗
PubMed2005

Weight fluctuations during early refeeding period in anorexia nervosa: case reports.

OBJECTIVE: This study reports wide weight fluctuations during a week of early refeeding for 2 patients with anorexia nervosa and discusses possible mechanisms. METHOD: Laboratory tests that consist of complete blood count, biochemistry panel, and serum protein levels were performed. Fluid intake and daily urine output of the patients were measured. RESULTS: Laboratory tests were within normal limits for both patients except for leukopenia in one patient. By the end of the Week 1, both patients had achieved significant weight gain (9 kg and 3 kg, respectively) concurrent with edema. Their daily fluid intake and urine output measurements indicated increased total body water levels. DISCUSSION: Although the pathophysiology of refeeding edema is not entirely understood, it is well known that insulin induces sodium retention by increasing distal tubular sodium reabsorption. In our patients, refeeding-induced insulin secretion may be chiefly responsible for the edema and weight gain during the early refeeding period.

Adolescent↗
PubMed2004

Child maltreatment prevalence and mental disorders outcomes among American Indian women in primary care.

OBJECTIVE: To examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services. METHODS: A cross-sectional study was conducted among 234 American Indian women, age 18-45 who presented for outpatient ambulatory services at a community-based Indian Health Service Hospital in Albuquerque, New Mexico. Dependent measures included mood, substance abuse, and anxiety disorders as well as posttraumatic stress disorder (PTSD) as measured by the Composite International Diagnostic Interview. CAN was assessed using the Childhood Trauma Questionnaire. RESULTS: Approximately three-quarters of respondents (76.5%; 95% CI = 70.4, 81.7) reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a dose response manner with lifetime diagnosis of mental disorders. After adjusting for social and demographic correlates, severe child maltreatment was strongly associated with lifetime PTSD (prevalence ratio [PR] 3.9; 95% CI = 1.9, 8.0); and was moderately associated with lifetime substance use disorders (PR = 2.3; 95% CI = 1.6, 3.3); mood disorders (PR = 2.1; 95% CI 1.4, 3.2); and with two or more disorders (PR = 2.3; 95% CI = 1.6, 3.4). CONCLUSION: CAN was common in our sample of American Indian women in primary care and was positively associated with lifetime psychiatric disorders outcomes. Screening for CAN and psychiatric disorders would enhance the treatment of patients seeking primary care services. Primary prevention of child maltreatment might reduce the high prevalence of mental disorders among American Indian women.

Adult↗
PubMed2004

The Institute of Medicine's report on Research Training in Psychiatry Residency: Strategies for Reform--background, results, and follow up.

OBJECTIVE: The National Institute of Mental Health (NIMH) determined that declines in the psychiatrist-researcher workforce are harming public needs and that significant steps are necessary to alter current trends. METHOD: The NIMH commissioned the Institute of Medicine (IOM) to examine the undersupply and recommend solutions. The NIMH subsequently appointed a National Psychiatry Training Council (NPTC) to facilitate implementation of the IOM's recommendations. RESULTS: The IOM recommendations and preliminary NPTC actions to address them are described. CONCLUSIONS: Increasing the psychiatrist-researcher workforce will require interventions involving many institutions. The NPTC's efforts may offer practical solutions for approaching complex and admittedly challenging difficulties.

Education↗
PubMed2004

Prevalence and correlates of mental disorders among Native American women in primary care.

OBJECTIVES: We examined the lifetime and the past-year prevalence and correlates of common mental disorders among American Indian and Alaska Native women who presented for primary care. METHODS: We screened 489 consecutively presenting female primary care patients aged 18 through 45 years with the General Health Questionnaire, 12-item version. A subsample (n = 234) completed the Composite International Diagnostic Interview. We examined associations between psychiatric disorders and sociodemographic variables, boarding school attendance, and psychopathology in the family of origin. RESULTS: The study participants had high rates of alcohol use disorders, anxiety disorders, and anxiety/depression comorbidity compared with other samples of non-American Indian/Alaska Native women in primary care settings. CONCLUSIONS: There is a need for culturally appropriate mental health treatments and preventive services.

Adolescent↗
PubMed2003

How competent are we to assess psychotherapeutic competence in psychiatric residents?

BACKGROUND: The Residency Review Committee (RRC) for Psychiatry has mandated that training programs "must demonstrate that residents have achieved competency in at least the following forms of treatment: brief therapy, cognitive-behavioral therapy, combined psychotherapy and psychopharmacology, psychodynamic therapy, and supportive therapy." AIM: To analyze the extent to which programs can realistically demonstrate that residents have achieved summative competency in these modalities. METHOD: We briefly review methods from other fields for assuring procedural competence, review methods available to psychiatric educators for assuring competencies in psychotherapy, and assess these methods for their adequacy. RESULTS: Available and foreseeable assessment methods are incapable of demonstrating that residents achieve summative competency in the five specified psychotherapies or of definitively distinguishing potentially dangerous practitioners from safe practitioners. At best, educators may be able to assure formative competencies, including mastery of core knowledge of the psychotherapies, actual undertaking of these psychotherapies, and adequate performance in selected elements of these psychotherapies. CONCLUSIONS: Since it is unrealistic to assume that training programs will ever be able to confirm summative competencies in these psychotherapies, we advise programs to define precisely the levels of formative competence they expect, and design curriculum and measures accordingly. Further, we urge the RRC to revise their requirements to address expectations more honestly, and to re-state the expected competencies more modestly. We believe that the RRC can expect programs to show that all residents can demonstrate knowledge about the evidence base, theories and rules of practice supporting at least the following forms of treatment: brief therapy, cognitive-behavioral therapy, combined psychotherapy and psychopharmacology, psychodynamic therapy, and supportive therapy. We also believe that programs might be asked to demonstrate by means of patient logs and other forms of documentation that all residents have at least conducted such types of psychotherapy under qualified supervision.

Accreditation↗
PubMed2003

Recruitment of U.S. medical graduates into psychiatry: reasons for optimism, sources of concern.

The authors explain the importance of recruiting U.S. medical graduates into psychiatry, give reasons for optimism about future recruitment, express concerns about problems that could hinder it, and recommend ways to address these concerns. Reasons for optimism include: features of the specialty, such as its focus on the doctor/patient relationship; its increasing job availability and incomes; its scientific achievements; the peaking and possible fading of the National Generalist Initiative; and a 5-year upward recruitment trend. Concerns are: low "overt" interest in psychiatry among entering medical students; clerkship directors' perceptions of a negative educational impact of managed care; graduating seniors' suboptimal satisfaction with their psychiatry clerkships; and what is likely to be a small impact of New Mexico legislation on prescribing privileges for psychologists. The authors make recommendations for addressing these concerns.

Career Choice↗
PubMed2003

Suggested guidelines for e-mail communication in psychiatric practice.

BACKGROUND: Physicians and patients are increasingly communicating with one another by e-mail concerning administrative issues, medications, and other aspects of care. The objective of this article is to review existing guidelines for general physicians communicating with patients by e-mail as the basis for developing more specific guidelines for psychiatric practice. METHOD: We review e-mail guidelines previously developed by the American Medical Informatics Association, subsequently promulgated by the American Medical Association, and consider each suggestion for clinical and administrative practice from the perspective of psychiatric practice. Case vignettes illustrate several of these issues. RESULTS: We suggest expansion and/or modification of existing guidelines to address more directly issues of specific concern in psychiatric practice. CONCLUSION: Existing general guidelines concerning the use of e-mail in medical practice are useful starting points for psychiatric practice. Psychiatrists must pay particular attention to issues of confidentiality, communicative tone, and professional boundaries. With cautious application, e-mail may provide a useful tool for enhancing communication and treatment options for psychiatrists and their patients.

Adult↗
PubMed2002

The 2002 psychologist prescribing law in New Mexico: the psychiatrists' perspective.

In March 2002 New Mexico passed the first state statute permitting the development of a process leading to prescriptive authority for doctoral level psychologists who obtain requisite training and certification. This article reviews the background of these events, the political processes by which this expanded scope of practice for psychologists evolved, the current state of regulatory discussions regarding this statute, forecasts of the practical impact of this legislation on practitioner patterns, and prospects for the future.

Clinical Competence↗