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Biomedical subjects

P M Miller

Publications and source records attributed to P M Miller.

At least 19 recordsLinked to original sources
PubMed2005

Dimensions and classes of psychosis in a population cohort: a four-class, four-dimension model of schizophrenia and affective psychoses.

BACKGROUND: Classification of psychosis lacks a biological basis and current diagnostic categories may obscure underlying continuities. Data reduction methods of symptom profiles within a population-based cohort of people with a wide range of affective and non-affective psychoses may permit an empirical classification of psychosis. METHOD: OPCRIT (operational criteria) analysis was performed on 387 adults aged 18-65 years in an attempted ascertainment of all patients with psychosis from a geographical area with a stable population. The data were analysed firstly using principal components analysis with varimax rotation to identify factors, and secondly to establish latent classes. Information relating to key variables known to be of relevance in schizophrenia was coded blind to the establishment of the classes and dimensions. RESULTS: Striking correspondence was obtained between the two methods. The four dimensions emerging were labelled 'depression', 'reality distortion', 'mania' and 'disorganization'. Latent classes identified were 'depression', 'bipolar', 'reality distortion/depression' and 'disorganization'. The latent classes corresponded well with DSM-III-R diagnoses, but also revealed groupings usually obscured by diagnostic boundaries. The latent classes differed on gender ratio, fertility, age of onset and self-harming behaviour, but not on substance misuse or season of birth. CONCLUSIONS: Both dimensional and categorical approaches are useful in tapping the latent constructs underlying psychosis. Broad agreement with other similar studies suggests such findings could represent discrete pathological conditions. The four classes described appear meaningful, and suggest that the term non-affective psychosis should be reserved for the disorganization class, which represents only a subgroup of those with schizophrenia.

Adolescent↗
PubMed2002

Childhood behaviour, psychotic symptoms and psychosis onset in young people at high risk of schizophrenia: early findings from the edinburgh high risk study.

BACKGROUND: Several studies suggest that many patients with schizophrenia have pre-morbid neurodevelopmental abnormalities. This study examines how behavioural abnormalities are associated with mild psychotic symptoms and later schizophrenic illness. METHODS: Maternal ratings on the Child Behavior Checklist (CBCL) of the early behaviour of 155 subjects were obtained at entry to the Edinburgh study of people at high risk of schizophrenia. These maternal ratings were compared in those with and without psychotic symptoms and used to predict the later onset of psychosis. RESULTS: The CBCL syndrome scores for the children prior to age 13 did not distinguish any of the study groups at entry to the study. In the ratings made for the subjects when aged from 13 to 16, delinquent behaviour and 'other problems' were weakly associated with these symptoms. However, with the exception of somatic symptoms and thought problems, the age 13-16 scales were significant predictors of later schizophrenic illness. This was true also for some of the ratings prior to age 13. CONCLUSIONS: Various behaviours, in particular, withdrawn and delinquent-aggressive behaviour in adolescents at risk of schizophrenia may predict later onset of the illness. These behaviours, however, are far less predictive of isolated psychotic symptoms prior to psychosis onset.

Adolescent↗
PubMed2001

A study of the attribution style, self-efficacy, and dietary restraint in female binge and non-binge eaters.

The purpose of this study was to identify the role that attribution style and self-efficacy expectations have in overweight binge and non-binge eaters. The subjects were women (n=210) enrolled for weight control treatment, who completed a questionnaire to assess attribution style and self efficacy expectations. They were categorized into three binge eating disorder (BED) groups: non-BED, borderline BED and BED. The results of the ANOVA analysis indicated that the borderline and BED groups were significantly similar in terms of all measures of attribution and self-efficacy; and logistic regression analysis that the odds of being borderline BED or BED were greater if an individual had internal attributions, and more likely in the presence of diminished self-efficacy expectations. The subjects with low levels of eating self-efficacy and internal, global, and uncontrollable attributions were also more likely to have borderline BED and BED. The implications of the borderline BED category are discussed in relationship to the DSM-IV BED diagnosis.

Analysis of Variance↗
PubMed2001

Expert witness billing practices revisited: a pilot study of further data.

This pilot study follows up an earlier study of the strategies and rationales by which psychiatric expert witnesses bill for their time on a case. Questionnaires were answered by participants at a workshop at the Annual Meeting of the American Academy of Psychiatry and Law (AAPL). In this follow-up, additional novel billing issues were addressed, some subtler than in the original study. In addition, responses to one question supported the previous finding that experts billed more reasonably when a case was simple. Additional issues included use of fee agreements and returning an unpaid-for case. The implications of these findings are discussed.

Attitude of Health Personnel↗
PubMed2000

Expanding the criteria for defining success when evaluating weight loss intervention programs.

In order to evaluate outcomes among former participants in a residential weight loss program, attendees were surveyed from 1 to 5 years post-intervention. A total of 187 respondents were studied for weight changes and behavioral practices. Diet practices were assessed by number of servings per day using the Food Guide Pyramid recommendations as a guideline for indicating fruit and vegetable intake. Exercise behaviors were measured in frequency, duration, and intensity, and a weighted score was computed to obtain units for describing physical activity. Maintaining a 10% weight loss from the program entry weight, consuming five or more servings per day of fruits and/or vegetables (5-a-day) and maintaining an "active" level of physical activity were included in criteria for describing intervention success. Those meeting two of the three criteria were categorized as "successful," which included 35.8% of the study population. Because each of these behaviors (5-a-day, active lifestyle, and modest weight loss maintenance) result in independent risk reduction, it is recommended that future weight loss intervention evaluations expand the criteria for describing successful impacts and outcomes to include not only weight maintenance, but also physical activity and diet compliance behaviors.

Journal Article↗
PubMed2000

Differences between patients with schizophrenia within and without a high security psychiatric hospital.

OBJECTIVE: To report and discuss differences between schizophrenic patients in the community and those in maximum security care. METHOD: Comparison of 193 community schizophrenic patients with 169 in high security care. Data included case notes, interviews and cognitive tests. RESULTS: Compared to high security patients, community patients tended to be female and married. They had higher school achievement, higher premorbid IQ and better occupational levels, were less likely to have a family history of alcohol abuse, to have had police contact and to have attempted suicide. They had more frequent shorter psychiatric admissions and fewer current and lifetime schizophrenic symptoms. Logistic regression models discriminated the groups with considerable accuracy. CONCLUSION: Patients needing high security care may be recognizable when schizophrenia is first diagnosed. Progression to the State Hospital seems to result from schizophrenia together with other factors such as deprivation rather than from a worse schizophrenic process per se.

Adult↗
PubMed2000

"Telling tales out of court": a pilot study of experts' disclosures about opposing experts.

A pilot questionnaire surveyed forensic psychiatrists and psychologists about information they would feel it appropriate to disclose to their retaining attorneys about an opposing expert witness. A spectrum of hypothetical disclosures was offered, varying in their relevance to the case at hand and in their degree of "public" versus "personal" information. Respondents agreed significantly that "public" information could be disclosed to one's attorney, but responses about disclosing "personal" information varied widely. The findings and their implications are briefly discussed.

Data Collection↗
PubMed1999

Self-efficacy in overweight individuals with binge eating disorder.

OBJECTIVE: To evaluate the relationship between self-efficacy judgments in obese individuals with binge eating disorder, "borderline" binge eating disorder, and no binge eating problems. RESEARCH METHODS AND PROCEDURES: Before participation in a residential weight management program, 79 male and female subjects were administered the Weight Efficacy Lifestyle Questionnaire (WEL) and the Binge Eating Scale (BES). Based on DSM-IV diagnostic questions, subjects were categorized as BED, Borderline BED, or non-BED. RESULTS: Krusal-Wallace Rank-Order analysis of variance revealed significant negative associations between binge eating and total WEL scores as well as the subscales of Negative Emotions, Social Pressure, Physical Discomfort, and Positive Activities. Differences were significant between the BED and the Borderline BED groups with the exception of the Social Pressure scale and the Total WEL scores. BED diagnosis as well as severity of binge eating were strongly associated with low self-efficacy ratings. DISCUSSION: These results indicate that obese individuals with binge eating disorder demonstrate lower self-efficacy than those without this condition and that self-efficacy is related to the severity of binge eating.

Body Mass Index↗
PubMed1998

Epidemiology of IgA nephropathy in central and eastern Kentucky for the period 1975 through 1994. Central Kentucky Region of the Southeastern United States IgA Nephropathy DATABANK Project.

Population-based incidence data for IgA nephropathy (IgAN) are available for some countries but not for the United States. The purpose of this study was to determine the incidence of IgAN in central and eastern Kentucky for 5- and 10-yr periods between 1975 and 1994 and to examine differences among patient groups between those periods. The incidence of IgAN was 5.4 cases per one million population per year (MPPY) for period 1A (1975 through 1979), increasing to 12.4 cases per MPPY for period 2B (1990 through 1994) (P < 0.001). Males had a 2.7 times higher incidence than females for period 1 (1975 through 1984) and 2.2 times higher for period 2 (1985 through 1994). For period 1A, the incidence for Fayette County, which includes the city of Lexington, was lower than that of the rest of the study area (P=0.26), whereas for period 2 the incidence was higher for Fayette County (P=0.052). During period 1, the highest incidence of IgAN for any age and gender group was 24.3 cases per MPPY for males ages 30 through 39. For period 2, the incidence for males was similar for each decade between ages 20 and 59 (approximately 19 cases per MPPY). No African-American was diagnosed during period 1, but in period 2 incidences for blacks and whites were similar (10.7 and 10.2 cases per MPPY, respectively). For the last 5 yr of the study (1990 through 1994), the incidence of end-stage renal disease (ESRD) due to IgAN was 5.5 cases per MPPY: 8.4 for males and 2.7 for females. The incidence of IgAN in Kentucky for period 2B was still much lower than that in European studies, but the incidence of ESRD due to IgAN may be similar. Thus, IgAN may be as important a condition with respect to ESRD in Kentucky as it is in other regions of the world.

Adolescent↗
PubMed1997

Increased recognition of IgA nephropathy in African-American children.

Based upon the percentage of cases of IgA nephropathy (IgAN) in biopsy series, a lower prevalence has been assumed for African-Americans compared with Americans of European descent. This may be due to a racial difference in the basic underlying pathology of IgAN or to racial differences in patterns of referral and biopsy selection practices. Over the past decade (1985-1994), we have found similar incidences of IgAN in Caucasian and African-American children from Shelby County, Tennessee. The incidence was 3.0 cases per million per year for Caucasian and 5.7 cases per million per year for African-American children. IgAN may be more common in African-American children than previously appreciated. Population-based incidence studies will be necessary to determine whether or not our experience has become a more widespread phenomenon.

Adolescent↗
PubMed1997

The relationship of parental style to depression and self-esteem in adulthood.

Previous studies have implicated low parental care and parental overprotection as risk factors for depression in adulthood. The present study further examined the association between perceived parental style and depression in two samples of medical students. In general, both low maternal and paternal care were associated with depression. Furthermore, maternal overprotection in the U.S. sample and paternal overprotection in the Scottish sample were also associated with depression. However, when results were analyzed separately for men and women, clear gender differences emerged, indicating that the observed relationships were occurring chiefly in the men, although there were some indications that low paternal care was associated with depression in women. Because such gender differences have not been previously reported, women medical students may be a unique group with respect to these relationships. Also intriguing was that although parental style characteristics demonstrated significant associations with self-esteem, this was clearly true only for men and not for women. Finally, the study provided the first partial support for the hypothesis that self-esteem mediates the relationship between parental style and depression.

Adolescent↗
PubMed1996

Drinking, smoking, and illicit drug use among 15 and 16 year olds in the United Kingdom.

OBJECTIVE: To examine patterns of self reported drinking, smoking, and illicit drug use among a representative United Kingdom sample of people born in 1979. DESIGN: Cross sectional, single phase survey based on a stratified cluster sample of 70 United Kingdom secondary schools during March and April 1995. Pupils completed a 406 item standardised questionnaire under examination conditions. SETTING: United Kingdom state and private secondary schools. SUBJECTS: 7722 pupils aged 15 and 16. MAIN OUTCOME MEASURES: Reported use of alcohol, tobacco, and illicit drugs. RESULTS: Almost all the pupils had drunk alcohol, 36% (2772/7689) had smoked cigarettes in the past 30 days, and 42.3% (3264/7722) had at some time used illicit drugs, mainly cannabis. 43% (1546/3546) of boys and 38% (1529/4009) of girls had tried cannabis. Higher levels of smoking were associated with poorer school performance (20.4% (783/3840) with average performance v 44.1% (214/486) with below average performance, F = 79.06, P < 0.01). Levels of drug use in 15 and 16 year olds in 1995 were higher in Scotland than in England, Wales, or Northern Ireland. CONCLUSIONS: Drug experimentation was high among 15 and 16 year olds, and use of cannabis was particularly high among smokers. Cigarette smoking was more common among girls than boys.

Adolescent↗
PubMed1996

Feed the hungry bee: using positive peer reports to improve social interactions and acceptance of a socially rejected girl in residential care.

We studied how rewarding peers for publicly reporting positive aspects of a socially rejected girl's behavior affected her social interactions and acceptance. The results indicated that positive peer reports reduced negative social interactions (to near zero) and increased positive interactions (to above 70%). In addition, social acceptance ratings of the girl increased from pre- to postintervention.

Adolescent↗
PubMed1995

Partners in adversity. V: Support, personality and coping behaviour at the time of crisis.

This paper presents further results from a study of married women in Edinburgh who had just suffered an adverse experience: either their husband's non-fatal myocardial infarction, their husband's death or their own arrival in a Women's Aid refuge for battered women. Interviews were carried out 4-6 weeks following the adverse experience and, where possible, again approximately 3 months later. Symptoms were assessed using the 30-item General Health Questionnaire and criterion-based measures of depression and anxiety derived from it. The extent and nature of crisis support from household members and from groups of people outside the household, and also of failures in expected support, was measured at first interview. A modified version of Tyrer and Alexander's (1979) personality schedule was administered at the follow-up interview, and the resulting personality data were then reduced to six factors using principal components analysis. An interviewer assessment of how well the subject was coping was made at both interviews. The vast majority of the sample received extensive practical and emotional support from family and friends, and perhaps because such positive support was so prevalent, variations in it seemed to have little effect on symptoms. However, subjects who were unexpectedly 'let down' or criticised by friends or family tended to show higher symptom levels, although, surprisingly, this was less true for the bereaved wives than for the others. The six personality factors that emerged were labelled nervousness (similar to neuroticism) impulsivity, social withdrawal, helplessness, inferiority and aggressiveness. There was evidence that subjects high on nervousness remained symptomatic longer following the adverse experience. The aggressiveness factor showed a curvilinear trend with high and low aggressives showing higher symptom levels than middle aggressives. However, for the coronary wives the trend was linear with low aggressives having high symptoms. Subjects low on impulsivity were more affected by being 'let down' by friends and family. The interviewer-assessed coping measure was linearly related to nervousness and showed a curvilinear relationship with aggressiveness.

Adaptation, Psychological↗
PubMed1995

IgA nephropathy: long-term prognosis for pediatric patients.

OBJECTIVE: The determination of the ultimate prognosis for patients with IgA nephropathy diagnosed in childhood requires long-term follow-up of identified patients. The purpose of this study was to obtain such follow-up for patients from two centers where the disease has been diagnosed for more than 20 years. METHODS: Clinical data at the apparent onset of symptoms and renal histologic data were obtained for 103 patients in whom IgA nephropathy was diagnosed before age 18 years. Clinical status at last follow-up was obtained from office records or from direct contact with the patient. Predicted kidney survival was determined by the Kaplan-Meier method. Follow-up of more than 10 years from the time of biopsy was available for 40 of the patients. RESULTS: Fourteen of the patients have progressed to end-stage renal disease; three others have progressive chronic renal insufficiency as defined by an estimated creatinine clearance of less than 50 ml/min per 1.73 m2. Severity of the renal histologic findings and the degree of proteinuria at the time of biopsy were associated with poor outcome. For all patients, predicted kidney survival from the time of apparent onset was 94% at 5 years, 87% at 10 years, 82% at 15 years, and 70% at 20 years. Age at clinical onset and gender were not associated with poor outcome, but black race and severity of renal histologic findings were. CONCLUSION: With follow-up into adulthood, the outcome for pediatric patients with IgA nephropathy appears to be as serious as that reported in adult patients. Follow-up of a pediatric patient with persistent clinical findings should be maintained after the patient's care is transferred to a physician caring for adults.

Adolescent↗
PubMed1994

Partners in adversity. III. Mood status after the event.

This paper presents further results from a longitudinal study of three groups of married women undertaken in Edinburgh. Each group shared a common stressful experience. In the first group the marital partner had recently died; in the second the marital partner had recently experienced a myocardial infarction (MI) and the third group consisted of women recently entering a Women's Aid refuge. Interviews were completed shortly following the adverse experiences and where possible again about 3 months later. This report presents details of the (self-reported) mood status of the respondents at both assessment occasions in terms of the degree, form and change in symptomatic distress over what were equivalent time periods for the three groups. Mood status was determined on the basis of the conventionally scored 30-item GHQ (General Health Questionnaire) and according to a criterion-based scoring procedure. On this basis at initial interview almost 8 out of 10 of the widows were above the advised GHQ cut-point, almost 6 out of 10 of the refuge seekers and over 4 out of 10 of the coronary wives. At follow-up these proportions had almost halved for the widows and coronary wives but had changed very little for those few refuge-seekers successfully re-interviewed. According to a criterion-based measure at initial interview, the recent widows had an anxiety rate 5.2 times and a depression rate ten times that of a general population sample of women. Details of the changes in mood status amongst the groups over the follow-up are presented.

Adaptation, Psychological↗