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Biomedical subjects

R D Alarcon

Publications and source records attributed to R D Alarcon.

At least 19 recordsLinked to original sources
PubMed2001

Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder.

BACKGROUND: Virtual reality (VR) integrates real-time computer graphics, body-tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion. VR exposure (VRE) is proposed as an alternative to typical imaginal exposure treatment for Vietnam combat veterans with posttraumatic stress disorder (PTSD). METHOD: This report presents the results of an open clinical trial using VRE to treat Vietnam combat veterans who have DSM-IV PTSD. In 8 to 16 sessions, 10 male patients were exposed to 2 virtual environments: a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. RESULTS: Clinician-rated PTSD symptoms as measured by the Clinician Administered PTSD Scale, the primary outcome measure, at 6-month follow-up indicated an overall statistically significant reduction from baseline (p = .0021) in symptoms associated with specific reported traumatic experiences. All 8 participants interviewed at the 6-month follow-up reported reductions in PTSD symptoms ranging from 15% to 67%. Significant decreases were seen in all 3 symptom clusters (p < .02). Patient self-reported intrusion symptoms as measured by the Impact of Event Scale were significantly lower (p < .05) at 3 months than at baseline but not at 6 months, although there was a clear trend toward fewer intrusive thoughts and somewhat less avoidance. CONCLUSION: Virtual reality exposure therapy holds promise for treating PTSD in Vietnam veterans.

Follow-Up Studies↗
PubMed1999

The cascade model: an alternative to comorbidity in the pathogenesis of posttraumatic stress disorder.

Comorbidity has been used extensively to explain the numerous co-occurring psychiatric syndromes accompanying chronic posttraumatic stress disorder (PTSD). A cascade model is proposed as an alternative to comorbidity for the pathogenesis and clinical course of the condition. This model allows for a dynamic, integrated conceptualization of disease progression in PTSD. Findings in the clinical, epidemiological, neurobiological, and psychosocial literature which might support this model are described. Conceptual and heuristic difficulties and/or potential objections to the model are also examined. Finally, diagnostic and treatment implications as well as potential research applications of the model are discussed.

Arousal↗
PubMed1998

Cultural intersections in the psychotherapy of borderline personality disorder.

Psychotherapy can be essentially considered a journey in which two individuals embark, each carrying a formidable cultural legacy. The psychotherapeutic enterprise then becomes a succession of stops and intersections as the two protagonists struggle to identify their culturally determined behaviors, using culturally determined procedures to take care of them. In this sense, cultural procedures are not a technical term but the appropriate combination of learned concepts, experiential modifiers, and common sense indicators of contemporary realities both at the individual and collective levels. The fascinating and challenging nature of BPD does have a significant cultural component encompassing explanatory, interpretive, pathogenic, pathoplastic, diagnostic/nosological, and service management aspects. It is in the psychotherapeutic arena, however, where both patient and therapist must face a multitude of culturally determined situations that may have a significant impact on the outcome of treatment. Culture can help the therapist to dispose of misleading clinical labels, with obvious advantages for the patient's well-being. Psychotherapy can correct the pathogenic elements of the patient's culture, recognize the pathoplastic clothing of the patient's symptoms, and provide culturally sanctioned and valued success experiences that may increase self-esteem, strengthen stability and, particularly, contribute to the patient's achievement of an identity with which he or she can feel comfortable. Finally, it must be remembered that it is not up to the therapist to offer infallible explanatory models of the patient's plight, but only culturally acceptable premises on which to build such explanations. On the other hand, it is up to the therapist to recognize the "idioms of distress," both physical and psychological, that the patient conveys in the psychotherapeutic context which is, as had been said many times here, totally immersed in the environment of culture. Two vignettes illustrate several of the issues under discussion.

Adult↗
PubMed1997

Should there be a clinical typology of posttraumatic stress disorder?

OBJECTIVE: The current classification of posttraumatic stress disorder in acute, chronic and delayed-onset types is incomplete and of limited usefulness. The present paper explores the possibilities of a clinically-based typology that would reflect both the patients' syndromic presentation and modern research findings. METHOD: Review of current clinical and research literature, with a critical examination of proposed typologies, parameters utilised, applicability and relevance; elaboration of theoretical and practical bases of a clinical typology of posttraumatic stress disorder. RESULTS: None of the existing posttraumatic stress disorder typologies presents a clinically comprehensive scope. A typology supported by literature findings and clinical observations is proposed. The six clinical types are depressive, dissociative, somatomorphic, psychotomorphic, organomorphic and 'neurotic-like'. Substance abuse and personality disorder-like variants remain as areas of investigation. CONCLUSIONS: The proposed typology, while accepting the nuclear manifestations of posttraumatic stress disorder, highlights prominent coexisting symptoms that define the clinical appearance of different patients. The typological approach in posttraumatic stress disorder does not carry the ambiguities of comorbidity, and facilitates a more specific and appropriate management of the cases.

Humans↗
PubMed1995

Culture and psychiatric diagnosis. Impact on DSM-IV and ICD-10.

Psychiatric diagnosis is a clinical activity subjected to more clinical determinants than many others. Based on a unique human encounter, it resorts to a variety of informational sources and interpretive mechanisms that reflect strong cultural biases. Each diagnostic system has mirrored the period of history in which it became established. This article examines the effect of culture on the two best-known diagnostic and classificatory systems: the DSM-IV and the ICD-10 Section V. It is important to minimize the ethnocentrism of disease categories in psychiatry and to highlight sources of possible cultural biases in the diagnostic interview and the diagnostic process in general, including assessment of comorbidity levels of stress, multiaxial impairment, everyday functioning, and management recommendations. Research on these issues and on diagnostic and measurement instruments must be pursued without sacrificing mainstream conventions.

Cross-Cultural Comparison↗
PubMed1995

The economics of pain. Mental health care costs among minorities.

In this article, we have underlined the importance of providing high-quality health and mental health services to the ethnic minority populations of the United States. We also have highlighted the complexities associated with the provision of these services, with special attention to the factors affecting health insurance coverage and the patients' socioeconomic conditions. Finally, we have advanced some potential solutions to the current health care crisis, particularly as they relate to minorities. In reviewing these solutions, we have focused primarily on the role of the service providers, third-party payors, poverty, and cultural and language barriers.

Culture↗
PubMed1993

A predictive study of obsessive-compulsive disorder response to clomipramine.

Studies on predictive factors of the obsessive-compulsive disorder response to pharmacologic treatment, specifically clomipramine, are relatively scarce. Forty-five patients treated for a mean period of 18.6 months were classified as having poor response, intermediate response and excellent response, defined by change scores on the Yale-Brown Obsessive-Compulsive Scale. Poor and intermediate response patients were grouped together and compared with the excellent response subgroup. Univariate analysis showed length of illness, family history (siblings), initial compulsiveness score, and cleaning rituals as significant predictors. Two multiple regression analyses with these as independent or predictive variables showed higher initial scores on the Yale-Brown Obsessive-Compulsive Scale associated with poorer response to treatment but, most importantly, cleaning rituals as a predictor of poor or modest response to clomipramine. It may be important for the clinician to assess cleaning habits separately from the more frequently mentioned obsessive-compulsive symptom, hand washing. This distinction may have important clinical, therapeutic, and prognostic implications.

Adult↗
PubMed1992

Concordance of the MCMI-II, the MMPI, and Axis I discharge diagnosis in psychiatric inpatients.

Discriminant functions of the MMPI and the MCMI-II were compared in a sample of 166 hospitalized psychiatric patients with discharge diagnoses of affective disorder (63), schizophrenia (26), substance abuse (35), and other disorders (42). Of special interest was the comparative diagnostic utility of the two instruments in regards to DSM-III-R Axis I diagnoses. Both tests performed reasonably well in the discriminant function analyses; however, the MCMI-II achieved a somewhat superior overall hit rate with this sample of inpatients (79% to 68%). This difference was tied to greater accuracy of the MCMI-II for identifying the affective disorders group.

Adolescent↗
PubMed1991

How to recognize obsessive-compulsive disorder.

Your patient is anxious, depressed, and nervous, yet the complaint you are being asked to address is a respiratory infection. You suspect that the real problem may be obsessive-compulsive disorder. What should you do? How do you confidently and accurately reach the diagnosis? Dr Alarcon shares his expertise in recognition and management of this increasingly common disorder.

Antidepressive Agents↗
PubMed1991

Paranoid and aggressive behavior in two obsessive-compulsive adolescents treated with clomipramine.

Obsessive-compulsive disorder is increasingly recognized in patients of different age groups. Serotonergic agents, such as clomipramine, have been recently found to be useful in the management of this condition. However, unexpected side effects, such as dysphoria, aggressiveness, and paranoid ideation, may occur with therapeutic doses of this compound, as evidenced in the cases of two male adolescents presented here. Possible pathogenetic factors, involving serotonin and serotonin-receptor abnormalities are discussed. Management of these side effects is based on adequate dose reduction and monitorization.

Adolescent↗
PubMed1989

Trimipramine-induced neuroleptic malignant syndrome after transient psychogenic polydipsia in one patient.

A case of neuroleptic malignant syndrome (NMS) was induced by the antidepressant trimipramine in a 47-year-old woman with obsessive compulsive disorder and major depression. NMS symptoms were associated with a brief episode of polydipsia, and both conditions may have had dopaminergic dysfunction as a common etiology. The patient improved with bromocriptine and dantrolene.

Depressive Disorder↗
PubMed1988

Psychopathology of chronic haemodialysis: is it a behavioural cognitive continuum?

Neuropsychiatric complications of chronic renal haemodialysis cover a wide gamut of clinical syndromes. These pictures can be diagnostically classified as non-psychotic and psychotic-like syndromes. On the basis of a review of the literature, some nosological precisions are formulated, and a hypothesized cognitive-behavioural psychopathological continuum is presented. The hypothesis postulates that a central cognitive disturbance, due to multiple organic aetiopathogenic factors, results in a step-wise decline, initially disguised as an affective, neurotic or personality disorder, and further deteriorating into the well-known "dialysis dementia", with a variety of other clinical presentations in between. Additional research in the biological and psychosocial areas is needed to verify different aspects of these conditions, their validity in the context of the authors' hypothesis, and their relevance to the overall "quality of life" of chronic haemodialysis patients.

Cognition Disorders↗
PubMed1988

Clinical correlations of one-carbon metabolism abnormalities.

1. Ninety psychiatric inpatients with a DSM III diagnosis of schizophrenia, mania, or major depression were studied. 2. Upon admission/transfer to the Clinical Studies Unit, and prior to discharge, measurements of symptom severity (BPRS, Ham-D, Young's Mania Scale) and blood samples were obtained. 3. Erythrocytes from these paired (admission and discharge) blood samples were assayed for methionine adenosyltransferase (MAT) activity and phosphatidylcholine (PC) content. 4. Comparisons were made between the changes in MAT Vmax, or % PC, and changes in symptom severity. 5. For the majority of the patients (79.3% of the schizophrenics; 84.6% of the depressives; and 93.8% of the manics), clinical improvement was associated with a "normalization" of enzyme activity. The association between changes in % PC and clinical response did not achieve significant correlation.

Bipolar Disorder↗
PubMed1987

Toward a profile of medically ill psychiatric patients.

We reviewed 564 consecutive psychiatric inpatient admissions. In support of previous studies, we found 51.9% to have significant medical disorders, nearly half of them "new" or previously unsuspected. Women, the elderly, substance abusers, and patients with nonschizophrenic functional psychoses had a higher prevalence of medical disorders. Using this information as a starting point, further work should be done to define a profile of the psychiatric patients at highest risk for medical illnesses.

Adult↗