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Biomedical subjects

M E McCahill

Publications and source records attributed to M E McCahill.

13 recordsLinked to original sources
PubMed2001

Reported trauma, post-traumatic stress disorder and major depression among primary care patients.

BACKGROUND: Trauma is a necessary diagnostic criterion for post-traumatic stress disorder (PTSD). However, the nature of traumas experienced (e.g. assaultive versus non-assaultive) may influence whether any mental disorder will arise. Traumatic experiences may also be associated with other mental disorders, particularly major depressive disorder (MDD). This report examines the relationship of trauma history to the likelihood of full or partial PTSD and MDD. In addition, the study examines the frequency with which assaultive and non-assaultive traumas are reported by patients with full or partial PTSD and MDD. METHODS: Three hundred eighty-six primary care patients completed psychiatric symptom measures during their clinic visit. A subset of 132 participants completed a diagnostic interview within 2 weeks following the screening. RESULTS: Most patients reporting traumas did not meet criteria for a mental disorder. Patients reporting traumas were more likely to experience current MDD (27.8%) than current full or partial PTSD (20.0%) although a high percentage of patients with traumas (41.1%) had experienced full or partial PTSD diagnosis in their lifetime. Respondents reporting assaultive events as their most severe trauma, when compared with those whose most severe trauma was non-assaultive, were more likely to have met criteria for either full or partial PTSD in their lifetime, and were more likely to have current MDD. CONCLUSIONS: These findings suggest that trauma history is often not associated with psychopathology, and when it is, trauma is often associated with major depression rather than PTSD. The likelihood of psychopathology is increased for individuals reporting assaultive traumas.

Adult↗
PubMed1999

Depression in a primary care clinic: the prevalence and impact of an unrecognized disorder.

BACKGROUND: This study assesses depression among primary care patients, the relationship between depression and functioning, and how frequently depressed individuals receive mental health treatment. METHODS: Two hundred and thirteen participants completed a diagnostic interview and measures of functional impairment and service utilization. RESULTS: Sixty-two clinic patients were depressed, and depressed individuals experienced significant functional impairment even after controlling for comorbid anxiety disorders and medical problems. However, less than 40% of depressed individuals were receiving treatment for depression. Severity of impairment was related to likelihood of receiving mental health services. LIMITATIONS: Several factors to consider when evaluating this study are the cross-sectional design, use of self-report data, and lack of random sampling. CONCLUSIONS: These results show that depression has a unique and significant impact on the functioning of primary care patients, and emphasize the need for identification of depressive disorders in primary care.

Adolescent↗
PubMed1999

Social phobia in the primary care medical setting.

BACKGROUND: Social phobia (social anxiety disorder) is a common disorder that is receiving more attention as new treatments become available. Little is known about social phobia as it appears in the primary care setting. The purpose of our study was to determine the prevalence of social phobia in a primary care clinic, the rates of comorbidity with other anxiety and mood disorders, the extent of disability, and patterns of healthcare utilization. METHODS: A total of 511 English-speaking adults presenting for routine medical care participated in a 2-stage screening consisting of the administration of a self-report measure for social phobia followed by a structured diagnostic interview. We determined current (1-month) prevalence of social phobia, current comorbid disorders, and we ascertained use of health care in the previous 6 months. We also administered brief functional impairment and disability indices. RESULTS: A lower-bound estimate of 7.0% of primary care attendees suffered from social phobia as defined in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. Comorbidity with major depression (58.3% of cases of social phobia) was extensive, somewhat less so with panic disorder (27.8%) and generalized anxiety disorder (30.6%). Social phobics reported significantly more impairment in all functional domains than primary care patients without mental disorders; this was most pronounced in patients with the generalized subtype of social phobia. Social phobics made greater use of health care resources than patients who were not mentally ill, yet few (<20%) were receiving appropriate psychotropic medications. CONCLUSIONS: Patients with social phobia frequently present to primary care medical settings, and manifest impairment in multiple functional domains. But, on the basis of the low rate of psychotropic prescription, it seems that social phobia is either undiagnosed or felt by physicians to be unlikely to benefit from such treatments. Social phobia is highly comorbid with major depression and with other anxiety disorders in the primary care setting. Attention by family physicians to the presence of depression or panic attacks should signal the need to query patients about possible social phobia.

Adolescent↗
PubMed1995

The elderly patient with multiple complaints.

"Thick chart" patients often have both a stated and an unstated agenda. Failure to recognize the latter can create a crisis of confidence that may prompt the patient to search for a more empathetic physician. So in addition to making a diagnosis in the face of confusing data, the physician must establish confidence by listening carefully and involving the patient in treatment decisions.

Aged↗
PubMed1995

Somatoform and related disorders: delivery of diagnosis as first step.

The care of patients with diagnoses on the somatoform spectrum represents a challenge to all primary care physicians and is a matter of frustration to some. These patients tend to "doctor shop," and studies indicate that they generate health care costs that are at least six to 14 times higher than health care costs generated by control subjects. For all disorders on the somatoform spectrum, the most effective management is regular follow-up with the primary care physician. To accomplish this goal, a therapeutic delivery of the diagnosis to the patient is essential to firmly establish the therapeutic alliance. An approach is suggested for "administering" the diagnosis as the first step in treatment for patients with several types of somatoform and related disorders. These techniques allow the patient's emotional needs to be met, enable the patient to save face when necessary and solidify the doctor-patient relationship. A good relationship allows the physician to provide long-term management with empathetic, safe and cost-effective medical care. Physicians may at times dread somatic patients, and these useful techniques can help them begin a more satisfying relationship with their very challenging patients.

Conversion Disorder↗
PubMedDate not supplied

Posttraumatic stress disorder in the primary care medical setting.

Posttraumatic stress disorder (PTSD) is a prevalent disorder that adversely affects 2-5% of the general population. Little is known about PTSD in the primary care setting. The purpose of the present study was to evaluate the utility of a screening instrument for PTSD (the PCL-C) in primary care and to examine comorbidity, disability, and patterns of healthcare utilization among persons with PTSD in this setting. Adult, English-speaking patients attending for routine medical care (N=368) participated in a two-stage screening consisting of the administration of a self-report measure for posttraumatic stress disorder (the PCL-C) followed by a structured diagnostic interview. Current (1-month) prevalence of PTSD was determined, as were current comorbid disorders. Brief functional impairment and disability indices were administered, and healthcare utilization in the prior 6 months was ascertained. 11.8% (standard error 1.7%) of primary care attendees met diagnostic criteria for either full or partial PTSD. Comorbidity with major depression (61% of cases of PTSD) and generalized anxiety disorder (39%) was common, but less so with social phobia (17%) and panic disorder (6%). Substance use disorder comorbidity (22%) was also fairly common. Patients with PTSD reported significantly more functional impairment than patients without mental disorders. Patients with PTSD also made greater use of healthcare resources than not mentally ill patients. PTSD frequently is encountered in primary care, and is associated with considerable functional impairment and healthcare utilization. Comorbidity with other mood and anxiety disorders is extensive. It remains to be seen if greater awareness and more aggressive treatment of PTSD in primary care will lead to improved functioning and reduced (or more appropriate) healthcare utilization. These are topics for further study.

Adult↗
PubMedDate not supplied

Development of a brief diagnostic screen for panic disorder in primary care.

OBJECTIVE: The purpose of this study was to determine the utility of a brief screening tool for panic disorder in the primary care setting. METHODS: A total of 1476 primary care outpatients in three primary care medical clinics on the West Coast of the United States were studied. Patients completed a brief self-report measure, the five-item Autonomic Nervous System Questionnaire (ANS), while in the waiting room. The presence of DSM-IV panic disorder was subsequently determined in groups of "screen-positive" and "screen-negative" subjects using the Composite International Diagnostic Interview. A subset of patients (N = 511) also completed the 21-item Beck Anxiety Inventory. Indices of diagnostic utility were calculated using receiving operating characteristic analyses to guide the selection of optimal cutoff levels. RESULTS: The two-question version of the ANS had excellent sensitivity (range = 0.94-1.00 across the three clinic sites) and negative predictive value (0.94-1.00) but low specificity (0.25-0.59) and positive predictive value (range 0.18-0.40). The three- and five-question versions of the ANS had only modestly improved specificity, and this was achieved at the cost of reduced sensitivity and increased respondent burden to complete the questionnaire. The 21-item Beck Anxiety Inventory had maximal clinical utility at a cutoff level of > or =20, but sensitivity was lower than desirable for a screening instrument (0.67). CONCLUSIONS: The two-question version of the ANS shows promise as a screening instrument for panic disorder in the primary care setting.

Adult↗
PubMedDate not supplied

Physicians who are certified in family practice and psychiatry: who are they and how do they use their combined skills?

BACKGROUND: The American Board of Family Practice (ABFP) and the American Board of Psychiatry and Neurology (ABPN) have jointly established their guidelines for a combined residency training program in family practice-psychiatry. As the new combined programs develop, it is of interest to learn about those physicians who are already board certified in both family practice and psychiatry. METHODS: The ABFP provided a list of the 39 physicians in the United States who in 1995 held certification by both the ABFP and the ABPN. A questionnaire eliciting demographic data, information on practice patterns, and comments was mailed to each of them. RESULTS: Ninety percent of the physicians responded. Sixty percent reported that they practice both family medicine and psychiatry, 20 percent practice in communities with a population of 30,000 or less, and the great majority were very satisfied with their choice of specialties. CONCLUSION: The responding family physician-psychiatrists chose their specialties one at a time, in sequence. Although their practice patterns are interesting, we believe residents who select a combined residency will have different practice patterns, choosing to practice both specialties from the outset. After graduates of these newly emerging combined residencies have entered practice, it will be useful to study how they make use of their combined skills.

Certification↗