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Biomedical subjects

R G Kathol

Publications and source records attributed to R G Kathol.

81 records · Page 5Linked to original sources
PubMed1981

Relationship of depression to medical illness. A critical review.

The relationship between medical illness and depression is critically reviewed. Evidence for an association exists but is based on relatively few studies of adequate research design. Data suggest the period prevalence of depressive syndrome in medically ill patients is around 18% for the severely medically ill. An etiologic relationship has not established. The incidence of diseases in the medical subspecialities of endocrinology, neurology, cardiology, gastroenterology, and rheumatology appears to be increased in patients with depression. A causal relationship has been suggested in the first four.

Depression↗
PubMed1980

Propranolol in chronic anxiety disorders. A controlled study.

In a double-blind crossover study the beta-adrenergic blocking drug propranolol hydrochloride reduced symptoms in 17 of 26 patients with chronic anxiety disorders. Both somatic and psychic symptoms improved as judged by patient and observer ratings. The most frequent side effects (dizziness, fatigue, and insomnia) were difficult to distinguish from anxiety symptoms and were, for the most part, mild. The therapeutic and side effects observed suggested CNS activity of the drug. Although propranolol is of benefit to patients with anxiety, its efficacy, compared with that of other antianxiety drugs, has not been established.

Adolescent↗
PubMedDate not supplied

Natural history of symptoms of depression and anxiety during inpatient treatment on general medicine wards.

OBJECTIVE: To establish the frequency of criteria-based depression and anxiety in newly admitted medical inpatients and to determine the natural history of depressive and anxiety symptoms during hospitalization. DESIGN: Prospective structured assessment of criteria-based depression and anxiety diagnoses within 24 hours of hospitalization with routine follow-up depression and anxiety questionnaires until discharge. SETTING: A tertiary care university hospital and an affiliated Veterans Administration hospital. PATIENTS: One hundred twenty-eight adult patients admitted to internal medicine inpatient units between May 1990 and August 1990. MAIN RESULTS: On admission, 43 of the 128 patients inducted met the DSM-III criteria for major depression, while an additional six met the criteria for adjustment disorder with depressed mood. Only six patients met the criteria for panic disorder, generalized anxiety disorder, or adjustment disorder with anxious mood at the time of admission to the study. Patients with high symptom scores on the anxiety and depression scales showed significant decreases in these scores without specific psychiatric intervention. Those who remained in the hospital 20 days or longer showed initial improvement and subsequently returned to baseline symptom levels of depression and anxiety. In approximately 9% of patients, symptoms of depression persisted or worsened. CONCLUSIONS: Major depression occurs more commonly than anxiety disorder in newly admitted medical inpatients but both resolve spontaneously in the majority during the course of hospitalization without specific psychiatric intervention unless the hospitalization is prolonged. One in ten will continue to show symptoms of depression.

Anxiety↗
PubMedDate not supplied

Persistent elevation of urinary free cortisol and loss of circannual periodicity in recovered depressive patients. A trait finding.

By comparing a group of 8 normal subjects with 7 recovered depressive patients who had been dexamethasone suppression test (DST) nonsuppressors while depressed, the following differences were identified: (1) mean urinary free cortisol (UFC) levels were significantly higher for recovered depressive patients than for controls in the summer and fall as well as for the year; (2) patients who had recovered from depression lost their circannual pattern of cortisol excretion; and (3) there was a positive correlation between depressive symptoms as reflected on the Beck Depression Inventory and UFC levels in recovered patients but not controls. The elevated UFC levels in depressed patients with DST nonsuppression represents the first trait marker which persists over time. The implications of the close association between UFC levels and depressive symptoms is discussed.

Adolescent↗
PubMedDate not supplied

Rapid relief of anxiety in cancer patients with both alprazolam and placebo.

This study evaluated 36 cancer patients who were enrolled in a randomized, double-blind, placebo-controlled trial conducted over a 4-week period to evaluate the efficacy of alprazolam in the treatment of anxiety associated with cancer. Hamilton Anxiety Scale scores declined significantly between baseline and the end of the first week of the study in both treatment groups. There was no significant difference in response between the patients receiving alprazolam and placebo. Similar results were obtained from other instruments. These results suggest that nondrug factors or spontaneous improvement may play a more important role than pharmacotherapy in the treatment of anxiety associated with cancer.

Adaptation, Psychological↗
PubMedDate not supplied

One-year follow-up of medical outpatients with hypochondriasis.

To examine the diagnostic stability and outcome of hypochondriasis, the authors followed 50 patients with this disorder and 50 age- and sex-matched control subjects after 1 year. After 1 year, two-thirds of the subjects continued to meet criteria for hypochondriasis, and the remaining third had persisting hypochondriacal symptoms. The hypochondriacal subjects were improved on most measures but still differed from the control subjects with regard to attitudes, perceptions, and behaviors that had distinguished them initially. More severe symptoms, longer duration of illness, and coexisting psychiatric illness were predictive of a worse outcome. The data indicate that the diagnosis of hypochondriasis is stable over time, and that, although symptoms wax and wane, characteristic features persist. The findings underscore the importance of diagnosing and treating hypochondriasis in medical outpatients.

Adult↗
PubMedDate not supplied

Let's train psychiatric residents to use their medical skills to meet twenty-first century demands.

The health care system is moving toward the integration of medical and psychiatric services since through this mechanism more efficient care can be provided to the many high-cost and complicated patients with psychiatric comorbidity in the primary care setting. In order for psychiatry to respond to the demands resulting from these projected changes, adjustments in psychiatric residency curricula will be required. This article suggests curricular revisions that increase training in psychiatric diagnosis and treatment in outpatient and acute care medical settings, emphasize development of psychiatric skills appropriate to individuals with a medical background, and improve the ability of psychiatrists to coordinate mental health care in primary care settings.

Forecasting↗
PubMedDate not supplied

Integrating medical and psychiatric treatment in an inpatient medical setting. The type IV program.

This study compares the treatment of patients with comorbid medical and psychiatric illness admitted to a high-acuity (Type IV) integrated medicine and psychiatry inpatient program with patients having psychiatric symptoms on general internal medicine wards (IMWs). More patients in the Type IV program had agitation, suicidal ideation, or psychosis as psychiatric admission behaviors when compared to IMW patients. Medical symptom improvement was comparable in the two settings, whereas, psychiatric symptoms improved more in the Type IV Program than on the IMWs despite more significant illness and comparable lengths of stay. Integrated care on the Type IV unit allowed shorter total lengths of stay for medical patients with serious psychiatric illness than would have occurred had the traditional sequential approach to care been used. The integrated Type IV medicine and psychiatry treatment program represents an efficient and effective process improvement in the way that medical patients with comorbid medical and psychiatric illness can be treated.

Academic Medical Centers↗