PubMed Health⌕ Search

Biomedical subjects

K L Barry

Publications and source records attributed to K L Barry.

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

Conduct disorder and antisocial personality in adult primary care patients.

BACKGROUND: Conduct disorder has been linked to substance use disorders in clinical populations. This study examined the relationships of conduct disorder and antisocial personality (ASP) disorder to substance use, substance abuse problems, depression, and demographic factors in primary care settings. METHODS: As part of a larger clinical trial, a survey of 1898 patients in the offices of 64 primary care physicians was conducted using a self-administered health habits questionnaire. Childhood conduct disorder and adult antisocial personality disorder were assessed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. RESULTS: Eight percent of men and 3.1% of women met criteria for a diagnosis of ASP disorder. The frequency of a history of childhood conduct disorders was higher, with 13.4% for men and 4% for women. Antisocial personality disorder was predicted by male sex, being unmarried (single, separated, divorced), lifetime history of depression, binge drinking, self-reported history of drug problems, current smoking, and younger age. The predictors of a history of child conduct disorder were similar to those of ASP. CONCLUSIONS: Primary care physicians treat many patients who have personality disorders and other conditions such as alcohol problems and depression. These patients need to be identified because of the high potential for comorbidity and the barriers to treatment inherent in these disorders.

Adolescent↗
PubMed1996

Screening for problem drinking in older primary care patients.

OBJECTIVES: To describe potentially hazardous alcohol use among elderly patients in the primary care setting and to assess the widely used CAGE questionnaire (cut down, annoyed by criticism, guilty about drinking, eye-opener drinks) as a tool for detecting self-reported heavy and binge drinking among these patients. DESIGN: Cross-sectional study. SETTING: The offices of 88 primary care physicians at 21 sites in southeastern Wisconsin. PATIENTS: A total of 5065 consecutive consenting patients older than 60 years. MEASURES: A previously validated self-administered questionnaire that included beverage-specific questions about the quantity and frequency of regular drinking in the last 3 months, the number of episodes of binge drinking (> or = 6 drinks per occasion), and the CAGE questionnaire. RESULTS: Fifteen percent of men and 12% of women regularly drank in excess of limits recommended by the National Institute of Alcohol Abuse and Alcoholism (>7 drinks per week for women and >14 drinks per week for men). Nine percent of men and 2% of women reported regularly consuming more than 21 drinks per week. When we administered the CAGE questionnaire, 9% of men and 3% of women screened positive for alcohol abuse within 3 months. The CAGE performed poorly in detecting heavy or binge drinkers; fewer than half were CAGE positive when the standard cutoff of 2 positive answers was used. CONCLUSIONS: Alcohol consumption in excess of recommended limits is common among elderly outpatients. The CAGE questionnaire alone is insufficient to detect such drinking. Asking questions on the quantity and frequency of drinking in addition to administering the CAGE increases the number of problem drinkers detected.

Aged↗
PubMed1996

Characteristics of persons with severe mental illness and substance abuse in rural areas.

A cross-sectional study of 1,551 clients receiving care in ten community-based rural mental health care systems assessed problem behaviors and psychiatric symptoms among three groups of severely mentally ill clients: those with a current substance abuse problem, those with a history of substance abuse but no current problem, and those with no history of substance abuse problems. Clients with a current substance abuse problem were younger than clients who had no history of such problems and had more symptoms of anger, more trouble with the law, and more suicidal threats than clients in the other two groups.

Adolescent↗
PubMed1995

Assessment of alcohol and other drug disorders in the seriously mentally ill.

Brief assessment methods are needed to determine the presence of alcohol and drug problems in persons with severe mental illness. The purposes of this study were to determine the prevalence of alcohol and other drug problems in a rural population of 253 clients with severe mental illness and to determine the accuracy of case manager responses to specific alcohol and drug assessment questions about their clients. Clients were assessed for the presence of past and present alcohol and drug disorders by means of a face-to-face diagnostic interview. The specific questions the case managers were asked to complete were designed to assess the quantity and frequency of recent alcohol and drug use and the presence of three criteria for alcohol or drug dependence and to differentiate present versus past history of substance problems. On the basis of the Diagnostic Interview Schedule- Revised, 35 percent of the clients met current DSM-III-R alcohol or drug criteria for abuse, dependence, or both. There were differences between client and case manager reports on the clients' use of alcohol, marijuana, cocaine, narcotics, and unprescribed tranquilizers in the last year. The best predictor of a client's present alcohol or drug problem was whether the case manager thought that the client had substance use problems at some time in his or her life (sensitivity = 0.86, specificity = 0.75). This report provides additional evidence that case manager reports are a valid method of determining the prevalence of substance use problems in persons with severe mental illness.

Adult↗
PubMed1995

Correlates of depression in primary care.

BACKGROUND: Depression is a significant health problem in the United States. This study examined the relationship between depression and substance use, substance problems, conduct disorders, and sociodemographic factors in primary care settings. METHODS: A survey of 1898 patients in 88 primary care offices was conducted using a self-administered health-habits questionnaire. Depression was assessed for both lifetime and for the past 30 days using the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R) criteria. RESULTS: A total of 21.7% of women and 12.7% of men met DSM-III-R criteria for depression in the 30 days prior to completing the survey. Lifetime rates of depression were 36.1% for women and 23.3% for men. Young women who smoke, drink, or use marijuana, and both men and women with antisocial personality disorder and a family history of mental health problems are particularly at high risk for depression. CONCLUSIONS: One in 5 women and one in 10 men who see their primary care physicians have recently been depressed.

Adolescent↗
PubMed1995

Detection of problem drinkers: the Alcohol Use Disorders Identification Test (AUDIT).

This study was conducted to test the predictive validity of a new alcohol screening test, the Alcohol Use Disorders Identification Test (AUDIT), in a general medicine teaching clinic and to assess physician recognition and treatment of alcohol and drug disorders. The research procedures included completion of the AUDIT, a standardized diagnostic alcohol and drug assessment, an exit interview, and a chart review. The random sample comprised 132 recruited subjects. The internal reliability of the AUDIT was .77. The optimal cutoff score for the AUDIT in this sample was 5, with a sensitivity of .61 and specificity of .84. The exit interviews revealed that physicians asked their patients about alcohol use and drug use with 20% (n = 26) and 17% (n = 23) of the sample, respectively. Five of the 28 patients who met DSM-IIIR criteria had a diagnosis recorded in the chart.

Adult↗
PubMed1994

Faculty development in addiction medicine: project SAEFP, a one-year follow-up study.

BACKGROUND AND OBJECTIVES: The goal of Project SAEFP (Substance Abuse Education for Family Physicians, pronounced SAFE) was to increase the number of residency teaching faculty with expertise in addiction medicine. This paper reports the results of a 12-month follow-up study conducted to assess changes in residency teaching and clinical practice of 165 residency teaching faculty who participated in this project. METHODS: The Project SAEFP work group conducted a series of 5-day courses in the fall of 1990 at 10 sites around the country. The 165 faculty participants were taught how to use a set of 12 residency teaching modules that focused on clinical areas important to primary care physicians. The follow-up study consisted of a structured telephone interview. The findings were compared to previous interviews conducted before, and 3 months after, faculty participation in the course. RESULTS: The findings suggest long-term increases in the amount of teaching, clinical practice, and consultations conducted by the family medicine faculty who participated in this faculty development project. CONCLUSION: The findings of this study suggest that an intensive 5-day course using learner-centered teaching techniques can have a significant impact on primary care teaching faculty.

Adult↗
PubMed1993

The Alcohol Use Disorders Identification Test (AUDIT) and the SMAST-13: predictive validity in a rural primary care sample.

This study was conducted to compare the validity of a new screening instrument developed by the World Health Organization, the Alcohol Use Disorders Identification Test (AUDIT), to the short version of the MAST in 287 primary care patients. Subjects were classified as meeting a lifetime or current DSM-III diagnosis of alcohol misuse and/or dependence based on the DIS-R interview schedule. Using the original WHO guidelines (score of 11 or more), 37 (13%) scored positive on the AUDIT and 103 (36%) had a weighted score of 5 or more on the SMAST-13. The internal reliability of the AUDIT was 0.86, compared to the SMAST-13 at 0.85. Cut-off scores in this sample for current alcohol problems, utilizing Receiver Operating Curves, were 7-8 for the AUDIT and 5 for the SMAST. This study confirms the utility of the AUDIT for current alcohol problems and the SMAST-13 for lifetime or past problems in a rural clinical sample.

Adolescent↗
PubMed1992

Patterns of substance use among students meeting lifetime DSM-II criteria for alcohol misuse.

A cross-sectional survey of 989 college students was conducted to investigate substance use patterns between students meeting lifetime DSM-III alcohol misuse criteria and students not meeting misuse criteria. Students meeting alcohol misuse criteria (n = 294) reported a significantly greater history of lifetime substance use and were more likely to have used marijuana in the 6 months prior to the receipt of the questionnaire. No significant differences in the frequency of substance use within the 6-month period were indicated between the two student groups with the exception of marijuana. Students meeting lifetime DSM-III alcohol misuse criteria also reported having experimented with marijuana at an earlier age.

Adolescent↗
PubMed1992

Liver transplantation for alcoholic liver disease.

BACKGROUND: Alcoholism is the leading cause of end-stage liver failure in the United States, but the application of liver transplantation to the treatment of alcoholic liver disease remains controversial because of medical and ethical concerns. Information about the outcome of patients who undergo transplantation for alcoholic cirrhosis would help to resolve these concerns. METHODS: The results of 41 patients (Group 1) with alcoholic liver disease were compared with those of patients who underwent liver transplantation for other medical problems (group 2) at this center. Thirty of the 32 survivors from group 1 and 30 matched subjects from group 2 were interviewed to assess substance dependence, recidivism, and activity level. RESULTS: Compared with control subjects, patients with alcoholic liver disease had equivalent patient and graft survival rates and achieved an equal level of postoperative health. These results were achieved even though patients with alcoholic liver disease had significantly worse liver failure and more morbidity before surgery, and one third of the patients in this group were not abstinent before transplantation. CONCLUSIONS: We conclude that patients with alcoholic liver disease merit equal consideration for liver transplantation compared with other causes of liver failure. Treatment of the addictive disorder should be included before and after surgery.

Actuarial Analysis↗
PubMed1991

Health locus of control in a primary care sample of alcoholics and nonalcoholics.

This study examined differences between alcoholics and nonalcoholics in a primary care population on the internal, chance, and powerful others subscales of the Multidimensional Health Locus of Control Scale (MHLC). Two hundred eighty subjects were divided into four groups (alcoholics with a family history of alcoholism, alcoholics with no family history of alcoholism, nonalcoholics with a family history of alcoholism, and nonalcoholics with no family history of the disease) based on DSM-III criteria for alcoholism and a family history of alcoholism. There were no differences between groups on the internal and powerful others scales. Nonalcoholics with a family history of alcoholism scored significantly lower on the chance scale than did alcoholics with a family history of the disease.

Adolescent↗
PubMed1991

The effectiveness of alcoholism screening in an ambulatory care setting.

Two hundred and eighty subjects in three ambulatory care clinics participated in this study designed to assess the psychometric properties of the SMAST using DSM-III criteria for alcoholism as the diagnostic standard. Eighty-two subjects (30%) who completed the NIMH Diagnostic Interview Schedule met DSM-III criteria for alcohol abuse and/or dependence. The sensitivity of the SMAST, using the generally accepted weighted cut-off score of five or greater, was .56 and the specificity was .83. An unweighted cut-off score of two or greater produced a sensitivity of .72 and a specificity of .64. The results of this study suggest that, when the SMAST is used for screening in an ambulatory care clinic population, the optimum balance of sensitivity and specificity is achieved using an unweighted cut-off score of two or greater. In addition, the alcohol subscale of the Diagnostic Interview Schedule was easy to administer and should be considered for use as the diagnostic standard in clinical settings.

Adolescent↗
PubMed1991

Risk factors associated with alcohol abuse in college students.

A survey of 989 college students was conducted to investigate risk factors--gender, family history of alcohol abuse, family history of depression and mental illness, childhood hyperactivity, and antisocial personality-associated with alcohol abuse. Two hundred ninety-four subjects (29%) completing the alcohol subscale of the Diagnostic Interview Schedule met lifetime DSM-III criteria for alcohol abuse. Utilizing a loglinear model, expression of childhood and early adolescent deviant behavior, family history of depression, and gender were shown to be significantly associated with alcohol abuse among students.

Adult↗
PubMed1991

The alcohol use disorders identification test (AUDIT) in a college sample.

This study was conducted to estimate the psychometric properties of the questionnaire section of the Alcohol Use Disorders Identification Test (AUDIT) in a college sample using DSM-III criteria for alcohol abuse as the criterion standard. This alcohol screening test was developed for the 10 country AMETHYST project. In this young adult sample the instrument exhibited a sensitivity of .84 and specificity of .71 when utilizing the recommended cut-off score of 11. The 10-item questionnaire section of the AUDIT appears to have important advantages over other alcohol screening instruments such as the CAGE and the MAST.

Adult↗
PubMed1991

A three-sample test of a masked alcohol screening questionnaire.

The study tested an expanded version of a masked alcohol screening instrument developed by Wallace and Haines [Use of a questionnaire in general practice to increase recognition of patients with excessive alcohol consumption. British Medical Journal 290, 1949-1953 (1985)]. The alcohol subscales include the CAGE, consumption, trauma, medical advice, past problems, and present problems with alcohol. There is preliminary evidence of the construct validity and reliability of the Health Screening Survey (HSS). As expected the HSS was sensitive in known populations of alcoholics (0.96; 0.95) correctly identifying at least 95% of the alcoholic patients recruited from two treatment centers. Specificity was adequate with identified nonalcoholics (0.80; 0.70). It was also sensitive in a community primary care sample, correctly classifying 78% of the subjects meeting DSM-III criteria for alcohol abuse and/or dependence. There were gender differences in the validity of the subscales in the community sample with alcoholic males more likely to report problems on the questionnaire than alcoholic females. Based on results, the HSS was revised to improve validity.

Adult↗
PubMed1990

Family cohesion, expressiveness and conflict in alcoholic families.

This study estimated family cohesiveness, expressiveness, and conflict in a primary care sample of alcoholics and non-alcoholics with and without a family history of alcoholism. Subjects completed the NIMH Diagnostic Interview Schedule alcohol subscale, based on DSM-III criteria, and a family environment scale. Alcoholics with a family history of alcoholism (Alc+FH+) reported significantly less cohesion and expressiveness, and more conflict in their present families than did either non-alcoholics with a family history of alcoholism (Alc-FH+) or non-alcoholics with no family history of alcoholism (Alc-FH-). Non-alcoholics who grew up in alcoholic families (Alc-FH+) reported present family relationships similar to non-alcoholics with no family history of alcoholism (Alc-FH-). Results suggest a family history of alcoholism alone was not associated with differences in perceptions of present family relationships. The findings of this study raise questions about the general perception that individuals who grew up in alcoholic families experience more family dysfunction in adulthood. The presence of two factors together--family history and alcohol problems in the subject--produced the perception of family dysfunction.

Adolescent↗
PubMedDate not supplied

Longitudinal assessment of inpatient use and functioning of seriously mentally ill veterans with and without co-occurring substance use disorders.

The purpose of this study was to delineate differences in inpatient service utilization and functional and subjective outcomes between veterans with a serious mental illness (SMI) and those with co-occurring serious mental illnesses and substance abuse (SA) disorders. This study assessed 2-year inpatient utilization and outcomes for 682 SMI veterans enrolled in specialized psychosocial treatment programs which did not have a substance abuse focus. Outcomes included psychiatric symptomatology, impairment in activities of daily living, global life satisfaction, days of hospitalization per year, and number of hospital admissions per year. Of the 682 patients, 198 (29%) had secondary diagnoses of substance abuse/dependence. Patients with co-occurring serious mental illness and substance use disorders had significantly more inpatient admissions per year than other SMI patients but did not differ in cumulative inpatient stays. The SMI/SA patients improved more than the other patients in terms of clinician rating of Global Assessment of Functioning. Patients with SMI/SA had significantly fewer psychiatric symptoms on the Brief Psychiatric Rating Scale, and all patients showed improvement on the BPRS, instrumental activities of daily living, and general life satisfaction rating. Seriously mentally ill patients with co-occurring substance use disorders fared as well as other SMI patients when enrolled in intensive, specialized state-of-the-art treatment programs.

Adult↗