Biomedical subjects

V Manicavasagar

Publications and source records attributed to V Manicavasagar.

At least 19 recordsLinked to original sources

PubMed1996

Anxiety and depression in general practice patients: prevalence and management.

OBJECTIVE: To determine the prevalence of anxiety and depression in general practice patients and assess management of these conditions by general practitioners (GPs). METHOD: A random sample of 212 GPs were approached to be interviewed and to conduct a patient survey and audit on 50 consecutive patient consultations during 1993. PARTICIPANTS: 117 GPs (55% response rate) and 4867 patients (85%) who completed questionnaires suitable for analysis. SETTING: General practices in two areas (divisions of general practice) in Sydney, New South Wales. RESULTS: Thirty-six per cent of patients had abnormal scores on a General Health Questionnaire (GHQ-12); they were more likely to be women or to be unemployed. Twenty per cent of these patients had been treated for depression or anxiety in the previous 12 months; 52% were prescribed drug therapy, and were more likely to be older, male or unemployed. Seventy per cent of patients reported having been offered therapy by their GP that did not involve drugs. Twenty-four per cent had been referred to another health professional; they were more likely to be younger, or men, or patients attending their usual doctor. CONCLUSIONS: A brief screening instrument may improve GPs' detection rate of patients with anxiety or depression. The high prevalence of these conditions in unemployed people deserves particular attention by GPs. Both drug and non-drug therapies are being more appropriately applied in general practice than previously.

Adult↗

PubMed1995

Is early separation anxiety a specific precursor of panic disorder-agoraphobia? A community study.

The present study aimed to examine memories of early separation anxiety symptoms in a community sample of women at heightened risk to neurotic disorder. The chief finding was that subjects with a lifetime history of panic disorder-agoraphobia (PD-Ag) returned statistically higher scores on a retrospective measure of early separation anxiety compared to subjects with either generalized anxiety or other phobic disorders, a result which was not accounted for by differences in neuroticism or General Health Questionnaire scores. Although limited by its retrospective design and the problem of co-morbidity in subclassifying the anxiety disorders, the present study does provide added support for the hypothesis--endorsed by DSM-III-R--that there is a developmental link between early separation anxiety and panic disorder.

Adult↗

PubMed1995

Genetic factors in early separation anxiety: implications for the genesis of adult anxiety disorders.

An important contemporary conceptualization of anxiety has suggested that heightened early separation anxiety is specifically associated with the risk of adult panic disorder, with hereditary factors underlying that cluster of anxiety disorders. Yet there is a dearth of studies examining whether early separation anxiety is inherited. The present twin study, based on a retrospective approach, revealed a substantial genetic contribution to separation anxiety in females but not in males, with unique environmental influences being important in both gender groups. Although speculative, an evolutionary explanation is offered to account for the apparent gender difference in the inheritance of early separation anxiety. It is hypothesized that, in some women, phylogenetic vestiges of separation anxiety may conflict with their need to compete in an individualistic manner in the modern workplace. Whether such an attachment-autonomy conflict accounts for the increased rate of panic disorder and agoraphobia in women is worthy of further study.

Adolescent↗

PubMed1995

Impact of recounting trauma stories on the emotional state of Cambodian refugees.

Twenty Cambodian refugees with premigration histories of trauma received an average of 16 sessions of individual therapy from a Cambodian bicultural counselor at a trauma treatment center in Sydney, Australia. Nineteen of the 20 patients reported that during treatment they had been willing to talk about their trauma histories, a finding that raises doubts about the commonly held belief that Asians are not psychologically minded and avoid disclosing emotionally sensitive information to health care workers. However, self-disclosing therapy alone did not appear to benefit these patients. Only four patients found talking about their trauma story directly helpful in improving their emotional state, and three of the four found the relief to be transitory.

Adaptation, Psychological↗

PubMed1994

Type A personality in Australian twins.

We examined the genetic and environmental determinants of Type A behavior in 200 pairs of same-sex twins as measured by the structured interview (SI) of Rosenman and Friedman and by the Bortner questionnaire (BARS). As noted previously, these measures are poorly correlated (r = .30). Quite different heritabilities were found for the two measures (63% for SI, 23% for BARS), and the correlation between the two was found to be largely genetic. Although the sample size meant that differences in correlation between MZ and DZ twins on the BARS were not significant in univariate analyses, they were suggestive of twin competition effects, as other twin studies have found. We conclude that further genetic analyses should concentrate on component behaviors rather than the overall Type A construct.

Adolescent↗

PubMed1993

Mood disorders among mothers of infants admitted to a mothercraft hospital.

The mothers (n = 100) of consecutive infants admitted to a mothercraft residential facility were asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Only one of the women had been identified prior to the infant's admission as having postnatal depression, but 39% scored above the cut-off point for likely major depressive disorder. No specific infant problem correlated significantly with a higher depression score. The extent of serious mood disorders in the post-partum population has remained generally unacknowledged despite an upsurge of recent research activity in the field. Nevertheless, this problem has considerable public health significance, impinging as it does on the health of all members of the family. Possible screening and intervention strategies are discussed.

Adult↗

PubMed1993

Adults who feared school: is early separation anxiety specific to the pathogenesis of panic disorder?

Although juvenile separation anxiety disorder is maintained to be a predisposing factor to adult panic disorder in DSM-III-R, past research has failed to clarify (a) whether it is separation anxiety per se or school refusal that is the pathogenic risk factor and (b) whether affected youngsters are specifically at risk of developing panic disorder rather than symptoms of general anxiety or phobias in later life. The present study of 74 adults who responded to media publicity found that a measure of early separation anxiety but not a history of school refusal was associated with risk of adult panic disorder according to DSM-III-R criteria. In contrast, separation anxiety scores were not associated with the presence or absence of general anxiety symptoms or phobic-avoidance in adulthood. Subjects with higher separation anxiety scores were more likely to have either a sibling or child with school refusal. Although the present study is limited in its method to mailed survey responses and, in part, to retrospective data, the results do provide additional support for Klein's influential separation anxiety theory of panic disorder.

Adult↗

PubMed1993

Variations in therapeutic interventions for Cambodian and Chilean refugee survivors of torture and trauma: a pilot study.

The treatment of refugee survivors of torture and trauma has attracted increasing clinical attention. The present study surveyed therapists concerning the emphasis that was placed on disclosure of previous traumatic experiences in therapy with refugees from Chile and Cambodia. Significant differences were found between the two groups with trauma story discussion being judged by therapists to be more important to treatment outcome in Chilean patients. The problem of potential therapist bias limits definitive conclusions, however we suggest that differences in cultural preparedness for psychotherapy aimed at uncovering previous traumatic experiences may be the main reason for variations in styles of therapy offered to these distinctive ethnic groups. Other possible explanations are differences in diagnostic profiles and types of previous traumatic experiences.

Acculturation↗

PubMed1993

The development of the Separation Anxiety Symptom Inventory (SASI).

Separation anxiety continues to be implicated as an early risk factor to adult emotional disorder but recent research findings are somewhat contradictory. Inconsistencies in approaches to measuring memories of early separation anxiety may have contributed to this lack of clarity. We report the development of a brief self-report instrument, the Separation Anxiety Symptom Inventory (SASI), which was designed to overcome some of these deficiencies in measurement. The SASI was shown to have a coherent factorial structure, high internal consistency (Cronbach's Alpha > .80) and test-retest reliability over an average of 24 months (Intraclass Correlation Coefficient = .89), with serial scores not being affected by changes in contemporaneous anxiety levels. Some index of the validity of the measure was achieved by (a) comparing SASI scores of index twins with descriptors of their "insecure" behaviours in early life provided by corresponding co-twins; (b) comparing SASI scores with retrospective DSM III-R diagnoses of early anxiety disorders obtained by structured interviews; and (c) examining SASI scores in subjects with histories of school refusal. The SASI provides a useful standardised measure which will aid in the further testing of the separation anxiety hypothesis of adult emotional disorder.

Adolescent↗

PubMed1993

Reported early separation anxiety symptoms in patients with panic and generalised anxiety disorders.

Attachment theory has proposed that early separation anxiety is a risk factor for adult anxiety disorder, with the recent focus being particularly on panic disorder. The results of empirical studies examining this link are, however, contradictory, possibly because of inconsistencies across studies in measuring memories of early separation anxiety. In the present study, a psychometrically sound measure, the Separation Anxiety Symptom Inventory (SASI) was used to compare memories of such early symptoms in panic disorder (including those with mild phobic-avoidance), generalised anxiety disorder and control subjects. Anxiety patients as a group returned higher SASI scores (p < 0.001) with a non-significant trend for panic disorder patients to score higher than those with generalised anxiety. These results suggest that early separation anxiety may be a harbinger of adult anxiety and that risk of panic disorder may be higher in the most severely affected youngsters. As a risk factor, early separation anxiety does not however appear to be uniquely related to adult panic disorder.

Adult↗

PubMed1993

Non-sexist Sexual Experiences Survey and Scale of Attraction to Sexual Aggression.

Sixty-six male and 51 female second year medical students anonymously completed the Sexual Experiences Survey (SES) and the Attraction to Sexual Aggression (ASA) Scale, both modified so that women could report behaviours in which they were aggressors, and men, behaviours in which they were victims. Men's aggression scores on the two scales were significantly correlated. As expected, more men than women reported both the likelihood and the experience of being sexual aggressors, although 6% of women reported being so aroused they couldn't stop when their partner didn't want intercourse and 13% of men reported having intercourse against their will. In men sexually coercive behaviours correlated positively with the masculinity scale of the Bem Sex Role Inventory. Fewer female medical students reported experiencing sexually aggressive behaviours compared to US or New Zealand university students; however, the percentage of male students who reported using or threatening to use physical force was in the same range as that of US students. Significant attention to the issue of sexual coercion would appear necessary in the education of medical students.

Adult↗

PubMed1991

Parental representations of patients with panic disorder and generalised anxiety disorder.

Previous studies using the Parental Bonding Instrument have shown a general trend for neurotic subjects to score their parents as less caring and more protective. Such a finding was broadly replicated in a study of 80 clinically anxious subjects and age- and sex-matched controls. Although direct comparisons of PBI scores failed to reveal clear-cut differences between generalised anxiety (GA) and panic disorder (PD) subgroups, logistic regression analyses revealed higher odds ratios for parental assignment to aberrant categories in the GA group, with PD patients reporting a more limited pattern of overprotective parenting only. Our findings suggest that adverse parental behaviour may be relevant to the pathogenesis of GA, while parental 'affectionate constraint' may be a parental response to early manifestations of PD.

Adult↗

PubMed1990

Perceptions of general and specific therapist behaviors.

In the process of developing a two-part therapist rating scale, we obtained questionnaire responses from a large sample of subjects who had undergone one of a variety of psychotherapies. Our data support the importance of perceived therapist care as a strong correlate of patient satisfaction, and patients seemed able to discriminate clearly between psychodynamic and cognitive-behavioral therapies. In the first (nonspecific) questionnaire, we derived five dimensions (Care-Concern, Directive-Control, Critical-Confronting, Understanding, and Charisma) from principal-components analyses, with the first two dimensions being relatively independent of each other. A multiple-regression analysis revealed that combined scale scores accounted for 50% of the variance of patient satisfaction ratings, with the Care dimension accounting for most of this effect. In the second questionnaire, data were analyzed from respondents who had undergone therapy with known cognitive-behavioral or psychodynamic therapists; but, in a minority of subjects who were recruited through the media, we depended on detailed descriptive vignettes to allocate them to one or another of these "specific" types of psychotherapy. Six scales emerged, three characterizing cognitive-behavioral therapies (Behavioral Task Orientation, Organization, and Cognitive Focus) and three representing psychodynamic therapies (Transference, Inner Conflict, and Relationship). Subjects' ratings on all scales strongly discriminated between the two broad modalities of therapy, suggesting that patient reports may provide valid measures of therapist styles. We conclude that questionnaires such as the one we are developing may provide economical measures for assessing therapist consistency when comparing different modalities of psychotherapy.

Adult↗

PubMed1988

Neurotic depression: delineation of symptom profiles and their relation to outcome.

Ninety-one subjects diagnosed clinically as having a 'neurotic depression' were interviewed and then re-assessed at 6 weeks and 20 weeks. Four symptom profiles of clinical features were derived: 'negative cognition', 'lack of drive', 'anxiety', and 'arousal', the last being independent of the other three dimensions and of the severity of depression. Symptom profile scores were then examined against antecedent risk variables and outcome. Links between profile scores and personality variables suggest that personality may colour the clinical presentation of neurotic/reactive depressions, and challenge the assumption that a typology of these depressive disorders based on clinical features is achievable. The break-up of an intimate relationship in the preceding 12 months was a strong predictor of a good outcome. Further analyses suggested, firstly, that there was a distinct subgroup delineated by this life event, with features weighted to the 'arousal' symptom profile, including many symptoms often associated with diagnosis of 'endogenous depression'; and, secondly, that this life event and a good outcome were directly linked, being uninfluenced by personality or other mediating variables.

Anxiety↗

PubMed1986

Childhood bereavement circumstances associated with adult depression.

Seventy-nine women whose mothers had died during the subjects' childhood and whose fathers had remarried were studied to determine how bereavement might dispose to depression in adulthood. Lower social class appeared the most consistent predictor. The sudden death of the mother, the older age of the child, the perception of family support as being deficient in the immediate post-bereavement phase, a longer delay between the mother's death and the stepmother's assuming a maternal role, and the judgement of any replacement mother-figure as being inadequate were associated with adult depression. An important negative finding was that depression in the bereavement phase was neither predictive of a subsequent episode of depression nor of higher levels of state and trait depression in adulthood.

Adult↗

PubMed1984

Depression in general practice.

The nature and course of depressive disorders in a group of general practice patients were assessed by screening 564 subjects who attended representative practices in Sydney by means of a self-report depression inventory. Of these, 25% of women and 17% of men reported significant depressive symptoms. An interview was sought with these "potential depressives" to determine, in particular, the extent to which they might be considered to have a psychiatric disorder, using the PSE case-finding procedure. Of those interviewed, 83% scored as psychiatric "cases", while the mean duration of their depression was nine months. A longitudinal component to the study suggested that the mental condition of the sample had improved minimally at six weeks' and at 20 weeks' follow-up assessments.

Adult↗

PubMed1984

Publishing in the parish.

A consecutive series of 500 papers submitted to the 'Australian and New Zealand Journal of Psychiatry' is evaluated to provide information on Journal publication procedures, to assess the Journal peer review process and to examine factors associated with the outcome of submissions. While the majority of submissions was by psychiatrists and psychologists, the highest acceptance rates were for papers presented by psychiatric registrars and by psychiatrists. Of the submissions for which a final decision had been made, 50% were accepted for publication and very few papers were accepted without revision. Regional differences in submission rates were noted and, more importantly, regional differences in acceptance rates were quantified. A subsidiary analysis suggested that the latter differences reflected a general pattern and were not peculiar to, or a reflection of, Journal policy.

Australia↗

PubMedDate not supplied

Depression in general practice attenders. "Caseness", natural history and predictors of outcome.

Assessment of 564 routine attenders of 12 Sydney general practices established that 25% of the women and 17% of the men scored as "potential depressives". Thirty-five agreed to an interview and review over 6 months, with 83% of this group initially rating as a "psychiatric case" on the Present State Examination. The sample could be characterized as being chronically depressed (mean duration of 9 months), as predominantly (86%) female, in having relatively stable but dysfunctional relationships, and by having experienced chronic and acute-on-chronic stressors. The degree of which subjects improved in the following 20 weeks could be predicted by their degree of improvement in the first few weeks and as early as the 6th day after assessment. While overall improvement was minimal, several baseline predictors of a better outcome were suggested: a history of having episodic or recurrent episodes, a more severe depression, lower social class, break-up of an intimate relationship as a precipitant, a neutralizing life event and family support. Married subjects and those with young children had a poor outcome.

Adjustment Disorders↗