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Biomedical subjects

S C Marcus

Publications and source records attributed to S C Marcus.

17 recordsLinked to original sources
PubMed2000

Understanding disability in mental and general medical conditions.

OBJECTIVE: This study characterized the prevalence, characteristics, and impact of mental and general medical disabilities in the United States. METHOD: The 1994-1995 National Health Interview Survey of Disability was the largest disability survey ever conducted in the United States. A national sample was screened for disability, defined as limitation or inability to participate in a major life activity. Analyses compared cohorts who attributed their disability to physical, mental, or combined conditions. RESULTS: Of 106,573 adults, 1.1% reported functional disability from mental conditions, 4.8% from general medical conditions, and 1.2% from combined mental and general medical conditions. Disabilities attributed to a mental condition were predominantly associated with social and cognitive difficulties, those attributed to general medical conditions with physical limitations, and combined disabilities with deficits spanning multiple domains. In multivariate models, comorbid medical and mental conditions were associated with a twofold increase in odds of unemployment and a two-thirds increase in odds of support on disability payments compared to respondents with a single form of disability. More than half the nonworking disabled reported that economic, social, and job-based barriers contributed to their inability to work. One-fourth of working disabled people reported discrimination on the basis of their disability during the past 5 years. CONCLUSIONS: An estimated three million Americans (one-third of disabled people) reported that a mental condition contributes to their disability. Mental, general medical, and combined conditions are associated with unique patterns of functional impairment. Social and economic factors and job discrimination may exacerbate the functional impairments resulting from clinical syndromes.

Adolescent↗
PubMed1999

Psychiatric patients and treatments in 1997: findings from the American Psychiatric Practice Research Network.

Despite extensive studies on the epidemiology of mental disorders and advances in the treatment of these conditions, there is a paucity of detailed information concerning the characteristics of psychiatric patients and how treatments are administered in routine psychiatric practice. This 1997 observational study collected detailed information from 417 psychiatrists on the demographic, diagnostic, clinical, and treatment characteristics of a systematic sample of 1228 patients. Six hundred thirty-seven patients (51.9%) were women and the mean patient age was 41.9 years. The most common diagnostic category (53.7%) was mood disorders, followed by schizophrenia/psychotic disorders (14.6%), anxiety disorders (9.3%), and disorders of childhood (7.7%). Six hundred seventy-one patients (54.6%) had at least one comorbid Axis I condition and almost half (49.8%) had a history of psychiatric hospitalization. Patients received a mean of 2.0 psychotherapeutic medications, most commonly antidepressants (62.3%). Findings demonstrate that psychiatrists in routine practice treat a patient population with severe, complex conditions.

Adolescent↗
PubMed1999

Trends in office-based psychiatric practice.

OBJECTIVE: The authors examine trends in the composition and duration of visits to psychiatrists in office-based psychiatric practice. METHOD: An analysis was performed of physician-reported data from the 1985 and 1995 National Ambulatory Medical Care Surveys focusing on visits to physicians specializing in psychiatry. Secular changes in visit characteristics were assessed, and mean visit durations were determined for selected sociodemographic and clinical groups. RESULTS: In the decade between 1985 and 1995, visits in office-based psychiatry became shorter, less often included psychotherapy, and more often included a medication prescription. The proportion of visits that were 10 minutes or less in length increased. A shortening in visit duration was most evident for younger patients, privately insured patients, and patients who were not prescribed a psychotropic medication. In the 1995 survey, 6.8% of the psychiatric visits included patient contact with another health care professional. CONCLUSIONS: Changing financial arrangements and new pharmacologic treatments may have contributed to these changes in practice style.

Adolescent↗
PubMed1999

Therapeutic drug monitoring of mood stabilizers in Medicaid patients with bipolar disorder.

OBJECTIVE: The authors' goal was to determine the extent and pattern of blood serum monitoring of mood stabilizers in Medicaid patients with bipolar disorder. METHOD: Data were drawn from a Medicaid medical claims data set from Pittsburgh and the surrounding region. The authors identified bipolar patients using lithium, valproate, and carbamazepine (N = 718) and then examined the patient demographic, diagnostic, and service use variables associated with therapeutic drug monitoring. RESULTS: A substantial proportion of lithium users (36.5%), valproate users (42.4%), and carbamazepine users (42.2%) with bipolar disorder diagnoses did not receive therapeutic drug level testing during the 12-month study period. Carbamazepine users who were male or in the 30-49-year age range were significantly less likely to be tested for serum drug level. Lithium users who did not receive partial-hospitalization psychiatric services and valproate users who received mental health case management were also less likely to be tested for serum drug level. Over one-half of the lithium users (54.1%) did not receive thyroid function tests, and few (4.2%) received renal function tests. Patients who did receive tests for serum drug level were likely to receive the other recommended tests. CONCLUSIONS: Many Medicaid patients with bipolar disorder received no therapeutic drug monitoring. Patient sociodemographic characteristics contributed little to explaining this omission, although some types of service utilization were related to rates of serum drug level testing.

Adolescent↗
PubMed1998

Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties.

CONTEXT: Psychotropic medications are widely prescribed, but how new classes of psychotropic medications have affected prescribing patterns has not been well documented. OBJECTIVE: To examine changes between 1985 and 1994 (data from 1993 and 1994 were combined) in the prescribing patterns of psychotropic medications by office-based primary care physicians, psychiatrists, and other medical specialists. DESIGN: National estimates for the number of visits during which a physician prescribed a psychotropic medication based on the National Ambulatory Medical Care Surveys conducted in 1985, 1993, and 1994. SETTING: Office-based physician practices in the United States. PARTICIPANTS: A systematically sampled group of office-based physicians. MAIN OUTCOME MEASURES: National estimates of visits that included a psychotropic medication. RESULTS: The number of visits during which a psychotropic medication was prescribed increased from 32.73 million to 45.64 million; the proportion of such visits, as a proportion of all visits, increased from 5.1% to 6.5% (P< or =.01). Antianxiety or hypnotic drug visits, previously the largest category, decreased as a proportion of psychotropic drug visits (P< or =.01) and are now surpassed by antidepressant visits. Visits for depression increased from 10.99 million in 1988 to 20.43 million in 1993 and 1994 (P< or =.01). Stimulant drug visits increased from 0.57 million to 2.86 million (P< or =.01). Although visits for depression doubled for both primary care physicians and psychiatrists, the proportion of visits for depression during which an antidepressant was prescribed increased for psychiatrists but not for primary care physicians. CONCLUSIONS: The patterns of psychotropic medication use in outpatient medical practice changed dramatically during the study period, especially in psychiatric practice.

Data Collection↗
PubMed1998

Antidepressant prescribing practices of outpatient psychiatrists.

BACKGROUND: The authors examined recent changes in the number and proportion of patients prescribed antidepressants by psychiatrists in outpatient private practice and characterized antidepressant prescription patterns by patient age, sex, race, payment source, and clinical diagnosis. METHODS: The authors analyzed physician-reported data from the 1985 and 1993-1994 National Ambulatory Medical Care Survey, focusing on visits to physicians specializing in psychiatry. Logistic regressions were used to examine associations between survey year and antidepressant prescription, adjusting for the presence of other variables. RESULTS: The proportion of outpatient psychiatric visits in which an antidepressant was prescribed increased from 23.1% (95% confidence interval [CI], 19.7%-26.5%) in 1985 to 48.6% (95% CI, 47.5%-49.7%) in 1993-1994. After controlling for several patient variables, psychiatric patients were approximately 2.3 (95% CI, 1.8-2.9) times more likely to receive an antidepressant in 1993-1994 than in 1985. In 1993-1994, selective serotonin reuptake inhibitors accounted for approximately half of the psychiatric visits with an antidepressant prescription. Increases in the rate of antidepressant prescription were particularly evident for children and young adults; whites; new patients; and patients with adjustment disorders, personality disorders, depression not otherwise specified or dysthymia, and some anxiety disorders. CONCLUSIONS: During the late 1980s and early 1990s, there was a significant increase in the prescription of antidepressants by office-based psychiatrists. This increase was greatest for patients with less severe psychiatric disorders.

Adjustment Disorders↗
PubMed1998

Detecting errors in a scoring program: a method of double diagnosis using a computer-generated sample.

This paper discusses a new method for locating errors in diagnostic computer scoring programs for structured clinical interviews. It was proposed as a test of the accuracy of the scoring program for the Composite International Diagnostic Interview, version 1.1. The proposal was to create an independent scoring program in a different computer language but serving the same criteria. Both programs were then applied to the same large set of valid (i.e., logically consistent) computer-generated test cases, and differences in diagnostic assignments reviewed. The method described can identify the program steps that account for the sources of the errors. Corrections can be made and the programs run again on new sets of test cases until discrepancy-free results are achieved. While this method cannot discover errors that are repeated in the two programs, it does discover more of the errors in a scoring program than we have previously been able to identify. This technique provides a systematic and rigorous approach to assuring the accuracy of scoring programs based on established algorithms.

Algorithms↗
PubMed1998

Characterizing psychiatry with findings from the 1996 National Survey of Psychiatric Practice.

OBJECTIVE: The authors' goal was to characterize psychiatric practice by reporting findings from the 1996 National Survey of Psychiatric Practice. METHODS: A random sample of 1,481 APA members was selected to participate in the study; 1,375 APA members were determined to be eligible for study participation. The authors report data from 970 respondents (70.5% response rate) and compare them with data from previous surveys of psychiatrists. RESULTS: Twenty-five percent of the participating psychiatrists were women, compared with 19% in a 1988-1989 survey. Since 1988-1989, the proportion of psychiatrists 39 years old or younger has decreased and the proportion of those 55 years old or older has increased. In 1996, psychiatrists saw, on average, 35.4 unduplicated patients and worked an average of 46.4 hours in a typical week. Patients with mood disorders as their primary diagnoses accounted for the greatest proportion of psychiatrists' caseloads, followed by patients with anxiety disorders, then those with schizophrenia and other psychotic disorders. Public sources of payment and uncompensated care were the main sources of payment for psychiatrists services for 41.7% of patients. The primary payment mechanism for psychiatrists' patient care services was fee-for-service, accounting for 52.5% of psychiatrists' income from direct patient care. Twenty-nine percent of psychiatric patients received care through some form of managed care system, and 41.6% received treatment through a nonmanaged public or private health plan. CONCLUSIONS: As psychiatry moves into the next century, findings from the National Survey of Psychiatric Practice will form a baseline for monitoring changes and trends in the delivery and financing of mental health services.

Adolescent↗
PubMed1997

Self-reported anxiety, general medical conditions, and disability bed days.

OBJECTIVE: This study examined the effect of self-reported anxiety on the number of days persons with various general medical conditions spend in bed owing to disability. METHOD: Self-reported medical illness and disability data from a nationally representative household survey sample (N = 20,884) were analyzed. RESULTS: Among respondents with general medical conditions, those with self-reported anxiety had a nearly fourfold greater length of disability (mean = 18.0 bed days) than the nonanxious respondents (mean = 4.8 bed days). After adjustment for differences in demographic characteristics and burden of general medical illness, anxiety was associated with an additional 3.8 bed days. CONCLUSIONS: Self-reported anxiety in combination with general medical conditions may be associated with extensive functional impairment.

Adult↗
PubMed1996

A short computer interview for obtaining psychiatric diagnoses.

OBJECTIVE: To determine whether a short computer interview could be used in place of a full diagnostic interview to obtain psychiatric diagnoses, the authors examined the short interview's sensitivity, specificity, and diagnostic agreement with the full interview. METHODS: Patients recently discharged from a university psychiatric service were interviewed in two back-to-back sessions, one in which a full diagnostic interview was used and the other in which a short computer interview was used. Based on diagnoses derived from both interviews, the sensitivity and specificity of the short interview and kappa values reflecting the diagnostic agreement of the two interviews were calculated. RESULTS: The short interview had high sensitivity and specificity and excellent diagnostic agreement with the full interview for most disorders. It also had a significantly shorter administration time. However, it missed a substantial percentage of cases of generalized anxiety disorder and misclassified as in remission a substantial proportion of patients with active cases of post-traumatic stress disorder. CONCLUSIONS: With few exceptions, the short interview may be substituted for the full interview when missing an active case is not important or when a count of individual symptoms and subtyping of disorders are not needed. Such uses include screening subjects for inclusion in a study and obtaining an overview of a patient's lifetime psychiatric status.

Adult↗
PubMedDate not supplied

Diagnostic certainty of a voluntary bipolar disorder case registry.

BACKGROUND: Strategies for identifying and recruiting persons with bipolar disorder are of importance as interest in studying this relatively uncommon, but highly disabling illness increases. The development and implementation of a bipolar disorder case registry and the assessment of diagnostic certainty of the resulting sample are described. METHODS: Eight hundred and four individuals who self-reported a history of bipolar disorder were recruited. Telephone interviewers gathered demographic information and clinical, medical and treatment history information. One hundred randomly-selected registrants completed an in-person structured diagnostic interview. Self-report of diagnosis was compared to the results of the diagnostic interview. RESULTS: Ninety three percent of registrants interviewed met criteria for a lifetime bipolar spectrum diagnosis; of those, 76.3% were diagnosed with bipolar I disorder. Agreement between self-reported and SCID diagnoses was 93%, indicating that self-report of a bipolar diagnosis is highly reliable. Two-thirds had experienced at least one other lifetime Axis I diagnosis, with substance abuse/dependence (55.9%) and panic disorder (19.4%) the most common comorbidities. LIMITATIONS: Since nearly all of the sample have previously been diagnosed as having bipolar disorder by a professional, the sample's representativeness of the population as a whole may be somewhat limited. CONCLUSIONS: Persons with bipolar disorder can accurately identify themselves as having the disorder via a telephone interview, indicating that a case registry method is a useful strategy for recruiting very large samples of persons with this disorder. Such large samples will allow for further study of treatment variations among patient subgroups, of pathways to treatment, and of the effectiveness of new treatments.

Adolescent↗
PubMedDate not supplied

Referrals to psychiatrists. Assessing the communication interface between psychiatry and primary care.

The Study of Outpatient Referral Patterns was conducted in 1998 to examine the nature of the communication relationship between psychiatrists and primary care physicians regarding outpatient referrals. Nationally representative psychiatrists were surveyed (N = 542) regarding their aggregate experience with outpatient referrals from non-psychiatric physicians in the previous 60 days. Data regarding frequency and type of information and mode of communication were gathered. Results indicate that primary care physicians represent a significant source of referrals to psychiatrists and that psychiatrists are generally satisfied with the communication interface with the referring physicians. Psychiatrists' level of satisfaction was related to the quantity and quality of information provided by referring physicians.

Ambulatory Care↗