Biomedical subjects

Robert Kohn

Publications and source records attributed to Robert Kohn.

At least 19 recordsLinked to original sources

PubMed2007

Phenomenology of dreams in Parkinson's disease.

Rapid eye movement sleep behavior disorder (RBD) occurs in approximately one third of patients with Parkinson's disease (PD) and is associated with a loss of muscle atonia during REM sleep and aggressive dream content. We examined the dream characteristics of PD patients to determine whether dream content differed between patients with RBD and without RBD, men and women with RBD, and men and women with PD. One hundred-twenty patients with a diagnosis of idiopathic PD were consecutively recruited from a movement disorders clinic and were assessed for RBD using clinical diagnostic criteria of the International Classification of Sleep Disorders Revised (2001). Verbatim dream content was obtained from each patient and categorized into dream themes that were coded into nominal categories. Fisher's exact tests determined whether particular dreams were correlated with RBD versus non-RBD, men and women with RBD, and men and women with PD. RBD patients had a higher percentage of violent dreams compared to non-RBD patients. There were no significant sex differences in the dream content of RBD patients. Men with PD had more aggressive dreams compared to females with PD. Aggressive dream content was characteristic of RBD patients and sex differences exist in the dream content of the PD population.

Aged↗

PubMed2006

Regional differences in psychiatric disorders in Chile.

BACKGROUND: Psychiatric epidemiological surveys in developing countries are rare and are frequently conducted in regions that are not necessarily representative of the entire country. In addition, in large countries with dispersed populations national rates may have low value for estimating the need for mental health services and programs. METHODS: The Chile Psychiatric Prevalence Study using the Composite International Diagnostic Interview was conducted in four distinct regions of the country on a stratified random sample of 2,978 people. Lifetime and 12-month prevalence and service utilization rates were estimated. RESULTS: Significant differences in the rates of major depressive disorder, substance abuse disorders, non-affective psychosis, and service utilization were found across the regions. The differential prevalence rates could not be accounted by socio-demographic differences between sites. CONCLUSIONS: Regional differences across countries may exist that have both implications for prevalence rates and service utilization. Planning mental health services for population centers that span wide geographical areas based on studies conducted in a single region may be misleading, and may result in areas with high need being underserved.

Adolescent↗

PubMed2006

Training primary care physicians in Chile in the diagnosis and treatment of depression.

OBJECTIVES: This study evaluated the results of a brief 2-day educational training program for Chilean primary care physicians that measured changes in knowledge, attitudes and practice. This World Psychiatric Association (WPA) program was adopted to overcome diagnostic and treatment problems that are found among primary care practitioners. METHODS: 37 primary care physicians from two cities in Chile and 2589 patients participated. Physician's knowledge, attitudes and clinical practice were assessed 1 month prior and 1 month following the training program. In addition, the patients that visited the clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major depression checklist at both times. RESULTS: The results suggested that, with this group of Chilean doctors, the WPA program was effective in improving knowledge about depression and in changing some disorder-related attitudes. In addition, it had some limited impact on actual clinical practice, although the rate of diagnosis remained stable and the post-training agreement between physician diagnosis and patient self-report remained low. The physicians seemed more confident in treating patients and demonstrated increased use of antidepressant agents. CONCLUSION: The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of depression, but their competence to play a crucial role remains limited. Further training of primary care physicians to improve the management of major depression continues to be needed.

Adolescent↗

PubMed2006

Epidemiology of trauma, post-traumatic stress disorder (PTSD) and co-morbid disorders in Chile.

BACKGROUND: In this study we examined the prevalence rates of post-traumatic stress disorder (PTSD), types of trauma most often associated with PTSD, the co-morbidity of PTSD with other lifetime psychiatric disorders, which disorders preceded PTSD, and gender differences in PTSD and trauma exposure in a representative sample of Chileans. METHOD: The DSM-III-R PTSD and antisocial personality disorder modules from the Diagnostic Interview Schedule (DIS) and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic Interview (CIDI) were administered to a representative sample of 2390 persons aged 15 to over 64 years in three cities in Chile. RESULTS: The lifetime prevalence of PTSD was 4.4% (2.5% for men and 6.2% for women). Among persons exposed to trauma, rape was most strongly associated with PTSD. Onset of PTSD significantly increased the risk of developing each of the 10 other tested disorders. Among those exposed to trauma, women were significantly more likely to develop PTSD, after controlling for assaultive violence. CONCLUSIONS: This study highlights the importance of investigating the prevalence of PTSD, patterns of co-morbidity of PTSD, and gender differences in PTSD in non-English-speaking countries.

Adolescent↗

PubMed2006

A community study on emotional distress among Arab and Jewish Israelis over the age of 60.

BACKGROUND: The elderly constitute a vulnerable group for psychopathology, yet research on their mental health among both Arab and Jews in Israel remains limited. The same is the case in Arab countries. This paper reports on the contrasting distribution of the mean emotional distress (ED) scores and rates of suspected clinical cases, and their related risk factors, among community residents over the age of 60. METHODS: Several national agencies conducted a survey on 5,055 elderly individuals to investigate their health status, including ED. The interview included socio-demographic and behavioral health items, as well as a modified 12 item-GHQ as a measure of ED. Total ED scores and prevalence rates for suspected psychopathology were calculated. Their respective risk factors were examined using univariate and multivariate methods. RESULTS: The ED scores were highest among Muslim Arabs (4.9), followed by Christian Arabs (4.2), Jews (3.1) and Druzes (2.8). Their estimated prevalence rates were 43.4%, 37.0%, 21.4%, and 17.0%, respectively. The gradient of these results remained unchanged in the multivariate analysis for ED scores adjusting for confounding variables. In contrast, logistic regression analysis controlling for confounding variables did not find a differential risk for suspected psychopathology between Arabs and Jews. CONCLUSION: Conceivably, the higher demoralization scores among elderly Arabs are associated with their minority status affiliation, as well as with the rapid social changes that have taken place in their midst. A cultural response style may be entertained as a possible explanation. However, these factors do not impact the risk for suspected psychopathology where no differential risk was noted after adjustments for confounders.

Age Distribution↗

PubMed2006

Course and outcomes of depression in the elderly.

Major depressive disorder is a potentially debilitating condition that often is unrecognized or undertreated in the elderly. Even when aggressively treated, the course of geriatric depression can be severe. There is growing evidence that suggests that late-life depression may carry a higher illness burden than depression with onset earlier in life, and that severity is linked to medical and psychiatric comorbidity. Data continue to accumulate in support of various treatment modalities, including medication, electroconvulsive therapy, and psychotherapy. Given the increased risk of adverse outcomes associated with geriatric depression, such as dementia and suicide, it is essential that future investigations continue to build on the evidence base supporting improved diagnosis and treatment of this complex disorder.

Age Factors↗

PubMed2006

Anticipatory stress in the population facing forced removal from the Gaza Strip.

The Israeli government decided in March 2005 to remove the settlers of the Gaza Strip, a process known as "disengagement." One person per household residing in 13 settlements was randomly selected for a telephone interview that included the Demoralization Scale of the Psychiatric Epidemiology Research Interview. Women respondents and those with fewer years of education, higher risk perception, greater alienation from government, poorer perceived health, no social support outside the West Bank or Gaza, worse religious coping, and residence in a secular settlement had enhanced risk for higher emotional distress. Positive current satisfaction with life was associated with greater place attachment, less risk perception, stronger ideological stand, less feeling of alienation from the government, a more positive view of the future, and plans to return to Gaza. This population, as others in transitional states, may be at risk for emotional distress compared with some but not all stable Israeli groups.

Adaptation, Psychological↗

PubMed2006

Lifetime and 12-month prevalence of DSM-III-R disorders in the Chile psychiatric prevalence study.

OBJECTIVE: Although several epidemiological studies of the prevalence of psychiatric disorders have been conducted in Latin America, few of them were national studies that could be used to develop region-wide estimates. Data are presented on the prevalence of DSM-III-R disorders, demographic correlates, comorbidity, and service utilization in a nationally representative adult sample from Chile. METHOD: The Composite International Diagnostic Interview was administered to a stratified random sample of 2,978 individuals from four provinces representative of the country's population age 15 and older. Lifetime and 12-month prevalence rates were estimated. RESULTS: Approximately one-third (31.5%) of the population had a lifetime psychiatric disorder, and 22.2% had a disorder in the past 12 months. The most common lifetime psychiatric disorders were agoraphobia (11.1%), social phobia (10.2%), simple phobia (9.8%), major depressive disorder (9.2%), and alcohol dependence (6.4%). Of those with a 12-month prevalence diagnosis, 30.1% had a comorbid psychiatric disorder. The majority of those with comorbidity had sought out mental health services, in contrast to one-quarter of those with a single disorder. CONCLUSIONS: The prevalence rates in Chile are similar to those obtained in other studies conducted in Latin America and Spanish-speaking North American groups. Comorbidity and alcohol use disorders, however, were not as prevalent as in North America.

Adolescent↗

PubMed2006

Mental health services for homebound elders from home health nursing agencies and home care agencies.

OBJECTIVE: This study examined the practices of home care agencies and home health nursing agencies in the management and treatment of homebound clients with behavioral problems, dementia, and undiagnosed mental illnesses. METHODS: A survey was mailed to all 54 directors of agencies in Rhode Island in 2003; 53 responded, either by mail or telephone. RESULTS: Data indicated a lack of psychiatric services, a reluctance to address behavioral problems, and a failure to identify undiagnosed disorders. There was also a bias against accepting individuals with primary psychiatric disorders. CONCLUSIONS: Although the population of homebound elders with mental illness is increasing, their needs are not being met by these agencies.

Aged↗

PubMed2006

Intimate partner violence and long-term psychosocial functioning in a national sample of American women.

Using a nationally representative sample of American married or cohabiting women, this prospective study examined women who reported or denied intimate partner violence (IPV) at wave 1 and compared them on a range of psychosocial outcomes at a 5-year follow-up. This study also examined the rate of divorce or separation during the 5-year interval among women who reported IPV at wave 1 and explored whether certain predictors were related to ending an abusive relationship with an intimate partner during the period. Women with IPV at wave 1, compared to women without IPV, were significantly more likely to experience a greater degree of depressive symptoms and functional impairment and less self-esteem and life satisfaction at the 5-year follow-up. Also, nearly half of the women in an abusive relationship left the relationship within the period. Leaving the abusive relationship was associated with lower individual income and more social support at wave 1.

Adult↗

PubMed2006

Mood and sleep in Parkinson's disease.

OBJECTIVE: To determine whether severity of depression and severity of anxiety were associated with particular types of sleep disturbance in patients with Parkinson's disease. METHOD: 120 patients with a diagnosis of idiopathic Parkinson's disease were consecutively recruited from a movement disorders clinic from July 2004 to May 2005. Idiopathic Parkinson's disease was diagnosed by a board-certified neurologist (J.H.F) and defined by the presence of 3 of the 4 cardinal signs of Parkinson's disease: resting tremor, rigidity, bradykinesia, and postural instability. Patients were administered the Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety, Covi Anxiety Scale, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). Patients were assessed for nightmares and rapid eye movement (REM) sleep behavior disorder (RBD) using a structured questionnaire and dream log. Multivariate analyses evaluated whether severity of depression and severity of anxiety correlated with the sleep outcome measures (PSQI, ESS, nightmares, and RBD). RESULTS: The mean +/- SD age of the patients was 71 +/- 10.8 years with a mean Parkinson's disease duration of 7.3 +/- 4.7 years. Thirty-eight percent were female, 41.7% had a psychiatric history, 53.3% had nightmares, and 30% had clinically defined RBD. Severity of depression and severity of anxiety significantly correlated with poor sleep quality, daytime somnolence, and nightmares. Severity of depression contributed significantly to the overall variance in poor sleep quality and nightmares. Severity of anxiety contributed significantly to the overall variance in daytime somnolence. CONCLUSIONS: Depressive and anxiety symptoms were associated with sleep disturbances in patients with Parkinson's disease. It is important to examine for the presence of depression and anxiety in patients presenting with sleep disorders, as depression and anxiety impair quality of life and are treatable conditions.

Aged↗

PubMed2005

Prevalence, risk factors and aging vulnerability for psychopathology following a natural disaster in a developing country.

OBJECTIVES: This study explored the psychopathological reactions to a natural disaster and their respective risk factors among the elderly in Honduras and their vulnerability as compared to other adults. STUDY SUBJECTS AND SAMPLE: Eight hundred respondents of both genders aged 15 years and above, of which 103 were 60 and over, were selected from high, middle and low residential status areas in Tegucigalpa that had suffered high and low exposure to the devastating effects of Hurricane Mitch. RESEARCH INSTRUMENTS: CIDI was used to diagnose PTSD and the Impact of Events Scale was administered as a measure of severity of post-traumatic reaction. Depression and alcohol misuse were examined using screening instruments. The SRQ was used as both a measure of emotional distress and dichotomized to screen for probable psychiatric disorder. RESULTS: PTSD, depression and SRQ-case were found, respectively in 13.6%, 18.8%, and 21.4% of the elderly. Their reactions did not differ in frequency than of those of younger adults. Among the elderly, pre-hurricane psychological problems and the intensity of exposure were associated with increased risk for all outcomes measured except for alcohol misuse. CONCLUSION: No evidence was found for a differential vulnerability on the part of the elderly as compared with younger adults. Among the elderly increasing age was not a factor.

Adolescent↗

PubMed2005

Training Latin American primary care physicians in the WPA module on depression: results of a multicenter trial.

BACKGROUND: In order to improve care for people with depressive disorders and to reduce the increasing burden of depression, the American Regional Office of the World Health Organization has launched a major region-wide initiative. A central part of this effort was directed to the primary care system where the diagnosis and treatment of depression are deficient in many countries. This study evaluated the materials developed by the World Psychiatric Association in a training program on depression among primary care physicians by measuring changes in their knowledge, attitudes, and practice (KAP). METHOD: One hundred and seven physicians and 6174 patients from five Latin American countries participated in the trial. KAP were assessed 1 month before and 1 month following the training program. In addition, the presence of depressive symptoms was measured in patients who visited the clinic during a typical week at both times using the Zung Depression Scale and a DSM-IV/ ICD-10 major depression checklist. RESULTS: The program slightly improved knowledge about depression and modified some attitudes, but had limited impact on actual practice. There was no evidence that the diagnosis of depression was made more frequently, nor was there an improvement in psychopharmacological management. The post-training agreement between physician diagnosis and that based on patient self-report remained low. The physicians, however, seemed more confident in treating depressed patients after training, and referred fewer patients to psychiatrists. CONCLUSIONS: Traditional means of training primary care physicians in depression have little impact on clinical practice regardless of the quality of the teaching materials.

Adolescent↗

PubMed2005

Psychiatric disorders among the Mapuche in Chile.

BACKGROUND: The Mapuche are the largest indigenous group in Chile; yet almost all data on the mental health of indigenous populations are from North America. AIM: The study examines the differential DSM-III-R prevalence rates of psychiatric disorders and service utilization among indigenous and non-indigenous community residence. METHODS: The Composite International Diagnostic Interview (CIDI) was administered to a stratified random sample of 75 Mapuche and 434 non-Mapuche residents of the province of Cautín. Lifetime prevalence and 12-month prevalence rates were estimated. RESULTS: Approximately 28.4% of the Mapuche population had a lifetime, and 15.7% a 12-month, prevalent psychiatric disorder compared to 38.0% and 25.7%, respectively, of the non-Mapuche. Few significant differences were noted between the two groups; however, generalized anxiety disorder, simple phobia, and drug dependence were less prevalent among the Mapuche. Service utilization among the Mapuche with mental illness was low. CONCLUSIONS: This is a preliminary study based on a small sample size. Further research on the mental health of indigenous populations of South America is needed.

Adolescent↗

PubMed2005

What is in a name? Professionals and service users' opinions of the Hebrew terms used to name psychiatric disorders and disability.

OBJECTIVES: Stigma constitutes the hidden burden of mental disorders. Its ubiquitous presence may be reinforced by iatrogenic factors, such as the terms used to name mental disorders and disability. This preliminary study examines opinions with regard to the use of these terms in Hebrew. METHODS: Two samples of convenience, mental health professionals (n=330) and service users (n=75), were asked to complete a self-administered questionnaire about their respective acceptance of the current term in use to name psychiatric disorders and disability, as well as their preference for alternative terms that may carry a lesser degree of stigma. The distribution of responses was compared within and between these two groups. RESULTS: There was consensus in both groups that a substantial proportion of service users reject the current term used to name mental disorder, mahalat nefesh (disease of the soul). Mental health professionals had a statistically significant acceptance of this term compared to service users. The term hafra'a nafshit (disorder of the soul) was reported to carry a lesser degree of stigma. No specific term was selected by more than a third of the respondents to best define disability resulting from a psychiatric disorder. CONCLUSION: A case for study and possible subsequent action was established by this pilot inquiry.

Attitude of Health Personnel↗

PubMed2005

The public mental health significance of research on socio-economic factors in schizophrenia and major depression.

This paper reviews the epidemiological research evidence on the role of socio-economic factors in the origins and disease experience of schizophrenia and major depression. The studies were conducted in different countries over many years. Although their findings are divided in their support of either the social causation or the drift hypothesis, all of them agree that persons with these disorders are at high disadvantage in society. Several factors for this have been identified. These studies provide the rationale for community-based interventions that have to be guided by principles of equity in the distribution of resources and grounded in biopsychosocial models of care that comprehensively answer the needs of the affected populations.

Journal Article↗

PubMed2004

The treatment gap in mental health care.

Mental disorders are highly prevalent and cause considerable suffering and disease burden. To compound this public health problem, many individuals with psychiatric disorders remain untreated although effective treatments exist. We examine the extent of this treatment gap. We reviewed community-based psychiatric epidemiology studies that used standardized diagnostic instruments and included data on the percentage of individuals receiving care for schizophrenia and other non-affective psychotic disorders, major depression, dysthymia, bipolar disorder, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), and alcohol abuse or dependence. The median rates of untreated cases of these disorders were calculated across the studies. Examples of the estimation of the treatment gap for WHO regions are also presented. Thirty-seven studies had information on service utilization. The median treatment gap for schizophrenia, including other non-affective psychosis, was 32.2%. For other disorders the gap was: depression, 56.3%; dysthymia, 56.0%; bipolar disorder, 50.2%; panic disorder, 55.9%; GAD, 57.5%; and OCD, 57.3%. Alcohol abuse and dependence had the widest treatment gap at 78.1%. The treatment gap for mental disorders is universally large, though it varies across regions. It is likely that the gap reported here is an underestimate due to the unavailability of community-based data from developing countries where services are scarcer. To address this major public health challenge, WHO has adopted in 2002 a global action programme that has been endorsed by the Member States.

Adolescent↗

PubMed2004

[An educational training program for physicians for diagnosis and treatment of depression].

OBJECTIVE: The American Regional Office of the WHO has launched a major initiative to reduce the prevalence of affective disorders region-wide that includes focusing on the primary health care system. This study evaluated the results of an educational training program for Brazilian primary care physicians that measured changes in knowledge, attitudes, and practice. METHODS: A total of 17 primary care physicians and 1,224 patients participated in the study. Physician's knowledge, attitudes, and clinical practice were assessed one-month prior and one-month following the training program. In addition, the patients that visited the clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major depression checklist at both times. RESULTS: The training program showed limited benefits in this small sample of physicians. The program was unable to demonstrate benefit in improving knowledge about depression and in changing disorder-related attitudes. There were no changes in the diagnostic rates of major depression. There was some evidence to support improvement in psychopharmacological management. The physicians seemed more confident in treating patients, as there was a reduction of referrals to the specialists. Lack of statistical power prevented the latter two findings from reaching statistical significance. CONCLUSIONS: The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of depression. However, more effective methods of training Brazilian primary care physicians in the management of major depression need to be tested.

Chi-Square Distribution↗