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Biomedical subjects

M S Swartz

Publications and source records attributed to M S Swartz.

10 recordsLinked to original sources
PubMed1990

Social outcomes related to age of onset among psychiatric disorders.

Analyses are presented that examine the impact of a diagnosis of affective disorder, anxiety disorder, and substance abuse before and after age 20 on multiple measures of education, socioeconomic and employment status, childbearing, marital status, and instability in a random sample (N = 3,000) of community respondents from the Piedmont Health Survey. Results indicate that all categories are associated with social outcomes regardless of age of onset, particularly for marital and family outcomes. For socioeconomic outcomes, the correlates of anxiety disorder are more pervasive, and the effects of a substance abuse diagnosis are stronger for early onset.

Adolescent↗
PubMed1989

Antisocial and related disorders in a southern community. An application of grade of membership analysis.

Symptoms of antisocial personality disorder (ASPD) and of psychiatric conditions reported to be related to ASPD were subjected to grade of membership analysis, a relatively new procedure for medical classification, to identify the pure types that would empirically emerge in the absence of prior assumptions about the clustering of those symptoms. The sample consists of 914 respondents who participated in the NIMH Epidemiologic Catchment Area Program at the North Carolina site. Symptom and diagnostic data were obtained using the Diagnostic Interview Schedule. Seven pure types emerged from the grade of membership analysis. Two pure types closely resemble the DSM-III portrait of ASPD. Two other pure types consisted of alcohol abuse/dependence symptoms and indicators of illicit drug use for recreational purposes. Only two of the symptomatic pure types were common among women. The first of these was characterized by marital instability, other domestic problems, and employment difficulties; as such this type resembles the DSM-III description of borderline and/or histrionic personality disorder. The other female pure type was characterized by multiple symptoms of depression and selected symptoms of other axis I disorders. The final pure type was characterized by an absence of psychiatric symptoms and served as a comparison group against which the symptomatic pure types were compared.

Adolescent↗
PubMed1989

Identification of borderline personality disorder with the NIMH Diagnostic Interview Schedule.

No lay-administered interviews are currently available to identify persons with borderline personality disorder. The authors studied 79 subjects with the NIMH Diagnostic Interview Schedule (DIS), a lay-administered interview, and the Diagnostic Interview for Borderline Patients (DIB) and used the results to construct a DIS-based diagnostic index to identify borderline personality disorder. Using the clinician-administered DIB as the diagnostic standard, the authors found that the DIS borderline index had a sensitivity of 85.7%, a specificity of 86.2%, and a kappa of 0.67. The DIS borderline index is a promising extension of the DIS that will facilitate studies of borderline personality disorder in clinical and community settings.

Adolescent↗
PubMed1989

Oscillations of attachment in borderline personality disorder.

The authors propose that oscillations of attachment in borderline personality disorder stem from a central problem with regulation of interpersonal distance. This problem derives from borderline patients' conflicts between fears of abandonment and domination. When they move closer to others, they fear that they will be dominated; when they move away, they fear that they will be abandoned. Whichever direction they move, they experience negative feedback. This gives rise to recurrent oscillations between attachment to and detachment from others. Because the oscillations are reinforced by the ambivalent reactions of significant others and the involvement of third parties, family therapy is often indicated.

Borderline Personality Disorder↗
PubMed1988

AIDS testing and informed consent.

This article examines whether hospitals should obtain specific informed consent for HIV testing in addition to the general consent for routine procedures that is obtained upon admission. The article argues that specific consent should be obtained in all instances in which the HIV test is ordered. When the test is ordered to protect health care workers rather than to benefit the patient, the patient must be informed of the true purpose of the test: special care must be taken to avoid claims of fraud or duress that might invalidate the patient's consent. Furthermore, testing patients for the sole purpose of protecting health care workers should be discouraged, since the protection of health care workers can already be accomplished through universal blood and bodily fluid precautions. In balancing the inconvenience caused by universal blood and bodily fluid precautions against the privacy rights of patients, the patients' rights should prevail.

AIDS Serodiagnosis↗
PubMed1987

What constitutes a psychiatric emergency: clinical and legal dimensions.

In true medical emergencies, informed consent is presumed or implied without application of the usual standard. In the litigation over the right to refuse treatment in psychiatry, a limited right for involuntarily committed patients to refuse treatment has been upheld, absent a finding of a psychiatric emergency. Increasingly, clinicians may find that their sole extrajudicial option in instituting treatment over the patient's objection is in invoking a psychiatric emergency. The purpose of this communication is to discuss the clinical and legal issues in defining and invoking a psychiatric emergency in treatment refusal. The substantive and procedural issues in the use of the emergency exception in treatment refusal are discussed with recommendations for their use in clinical practice.

Adult↗
PubMed1987

A study of somatization disorder in a community population utilizing grade of membership analysis.

A new multivariate analytical technique for the analysis of medical classification, Grade of Membership analysis, is utilized to examine somatization disorder in a community population. The authors examine whether somatic symptoms will cluster into a clinical syndrome resembling somatization disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), if no prior assumptions are made about the inter-relationship of somatic symptoms or their clustering into clinical syndromes. Using respondents in the US National Institute of Mental Health Epidemiologic Catchment Area project of the Piedmont Region of North Carolina, Grade of Membership analysis was applied to all respondents reporting 3 or more somatic symptoms from the somatization disorder section of the Diagnostic Interview Schedule. Seven 'pure' types, roughly analogous to clusters in cluster analysis emerged from the analysis. One 'pure' type in the analysis is nearly identical to DSM-III somatization disorder and is associated with demographic characteristics found among patients with DSM-III somatization disorder. The results indicate that symptoms associated with somatization disorder cluster in a highly predictable fashion and represent a strong validation of the natural occurrence of an entity resembling somatization disorder.

Adult↗
PubMed1986

Emergency room management of conversion disorders.

The authors present guidelines for diagnosing and managing conversion disorders in an emergency room setting. Assessment of the patient must be based on a careful physical and psychiatric evaluation that will identify any underlying physical illness or concurrent psychopathology. An accurate assessment is also vital to the clinician's decision about whether to use simple supportive interventions, to refer or hospitalize the patient, or to try to uncover the conflicts generating the conversion symptoms. If there are no contraindications to uncovering the conflicts, such as chronic symptomatology or a pathological family network, the clinician may use such techniques as hypnosis or a sodium amytal interview.

Adult↗