bluuebunny/crossref_metadata_2025_split huggingface dataset:
Symptom Differences between Older Depressed Primary Care Patients with and without History of Trauma
Authors: Cook Joan M. , Areán Patricia A. , Schnurr Paula P. , Sheikh Javaid I. 
Published: May 2005

Objective: The current study explored the relationship between past traumatic experiences and current depression in a sample of depressed older adult primary care patients. Method: Sixty-six patients were referred from primary care to a psychogeriatric clinic that specialized in the treatment of unipolar depressive disorders. All patients received an extensive psychological assessment. Results: Twenty-one percent had a history of trauma reported in their medical charts. Despite no differences found on a clinician-rated measure of depression, those with a trauma history had more depressive symptoms on a self-report measure. Conclusions: Although older patients with a history of trauma may not appear more depressed than a non-trauma comparison group, they may be in more psychological distress. The clinical implications of these findings and recommendations for mental health professionals are discussed.
Persons with Depressive Symptoms and the Treatments They Receive: A Comparison of Primary Care Physicians and Psychiatrists
Authors: Pingitore David , Snowden Lonnie , Sansone Randy A. , Klinkman Michael 
Published: May 2005

Objective: To determine if demographic differences exist in patients with depressive symptoms as the principal reason for visits to primary care physicians (PCP) versus psychiatrists. To estimate the likelihood of these patients receiving a range of mental health services from each provider group. Methods: Review and analysis of all outpatient visits made by patients with depressive symptoms using the National Ambulatory Medical Care Surveys (NAMCS) conducted in 1995 and 1996. Results: A significantly greater proportion of visits by persons with depressive symptoms as the principal reason for visit were made to psychiatrists than to primary care physicians ( T = −3.56, p = .000). However, men, African-Americans, other Non-White persons, and persons aged 65 to 74 and 75 years and over were proportionately more likely to visit a PCP than a psychiatrist. Women, whites, and persons aged 45 to 64 were proportionately more likely to make a visit to a psychiatrist than to a PCP. The overall intensity of care delivered by PCPs for patients with depressive symptoms was significantly lower than that provided by psychiatrists ( t = −2.03, p = .02). Analysis of individual services also revealed significant differences in service provision. Conclusions: Demographic differences among the patient caseloads of these physician groups have implications for mental health service delivery because of known distinctions in prevalence rates, symptom presentation, and functionality among depressed patient subgroups.
Homes or Hospitals? Contradictions of the Urban Crisis
Authors: Waitzkin Howard , Wallen Jacqueline , Sharratt John 
Published: May 2005

Medical expansion is threatening to eliminate many urban residential areas, despite criticism that argues for comprehensive planning, reduced costs, less concentrated power in the health sector, and a reversal of “medicalization.” Our research on expansion, which grew partly from personal participation in a local struggle against expanding institutions in Boston, revealed certain tensions in combining sociomedical research with concrete political practice. From events in Boston and from an exploratory review of periodicals, we recognized that medical expansion and community conflict occur frequently in cities throughout the United States. Based on general theoretical perspectives from organizational analysis and political economy, we made several hypotheses that we tested through a questionnaire sent to all hospitals in the 20 largest cities of the United States and through other data available on the same hospitals. In large part, this empirical study confirmed our theoretical expectations that (a) larger medical centers show a greater tendency toward territorial growth than smaller hospitals; (b) bureaucratic and administrative dynamics lead to facilities that do not necessarily enhance patient care; (c) despite short-term cycles of expansion and contraction in public hospital growth, expansion projects are widespread and generate considerable political conflict; (d) because of the state's contradictory roles in regulation and social capital expenditures, opposition to medical expansion comes more from community organizations than from governmental monitoring or planning bodies; and (e) the needs of capital determine that medical expansion has a more detrimental impact on housing than on commercial or industrial facilities. Future expansion of private medical facilities is more likely than that of public facilities, although much private expansion may receive public subsidization. As ideologic patterns are demystified, the contradictions between medical expansion and housing needs can provide a focus for successful community organizing.
What Factors Influence the Prescribing of Antidepressant Pharmacotherapy? An Assessment of National Office-Based Encounters
Authors: Sclar David A. , Robison Linda M. , Skaer Tracy L. , Galin Richard S. 
Published: May 2005

Objective: This study was designed to identify: 1) predictors of antidepressant pharmacotherapy among patients diagnosed with depression; and 2) predictors of prescription for either a selective-serotonin reuptake inhibitor (SSRI), or a serotonin-norepinephrine reuptake inhibitor (SNRI). Method: Data from the 1995 National Ambulatory Medical Care Survey (NAMCS) were used to discern the number of office-based encounters documenting a diagnosis of depression (ICD-9-CM codes 296.2–296.36; 300.4; or 311) among patients eighteen years of age or older. Logistic regression-derived odds ratios (OR) and 95 percent confidence intervals (CI) were used to elucidate factors predictive of receipt of antidepressant pharmacotherapy, and, more specifically, factors predictive of receipt of an SSRI or an SNRI. Model variables included age (18–49 years as compared to ⩾ 50 years); race (white as compared to nonwhite, inclusive of Hispanics); gender; self-report of depression as a reason for the office-based encounter; and payer type (private insurance program as compared to public). Results: Among the estimated 18,046,293 office-based visits resulting in a diagnosis of depression, 56.2 percent of patients self-reported depression as a reason for the office-based encounter; 67.5 percent were prescribed or continued a regimen of antidepressant pharmacotherapy; and 48.3 percent were prescribed an SSRI or an SNRI. Factors predictive of receipt of antidepressant pharmacotherapy included age less than fifty years (OR = 1.30, CI = 1.01–1.67); female gender (OR = 1.45, CI = 1.13–1.85); and self-report of depression as a reason for the office-based encounter (OR = 1.98, CI = 1.57–2.51). Factors predictive of receipt of an SSRI or an SNRI included age less than fifty years (OR = 1.31, CI = 1.03–1.65); female gender (OR = 1.55, CI = 1.23–1.95); and self-report of depression as a reason for the office-based encounter (OR = 1.56, CI = 1.25–1.95). In addition, having private insurance increased the likelihood of having been prescribed an SSRI or SNRI by 46 percent (OR = 1.46, CI = 1.13–1.89). Conclusions: Among patients with a diagnosis of depression, the pattern of prescribing antidepressant pharmacotherapy is influenced by a patient's age, gender, self-report of depression, and type of insurance coverage. Further research is required to discern the reasons for these observed effects and to advance clinically rational and equitable access to pharmacotherapeutic innovation.
The Use of Methylphenidate for Cognitive Decline Associated with HIV Disease
Authors: Brown George R. 
Published: May 2005

Objective: Complaints of cognitive changes are often expressed by patients at all stages of HIV infection. Such changes include decreased memory and attention span, diminished concentration, apathy, and “slowing.” Methylphenidate (MPD) has been used in several clinical studies in men with late-stage HIV disease in an attempt to ameliorate these difficulties. The objectives of this review article are to review salient psychopharmacological characteristics of MPD and to describe the research and clinical literature supporting the use of MPD in patients at all stages of HIV infection. Methods: Seven studies, case reports, or abstracts from International Conferences on AIDS were available in the English literature through August, 1993, directly addressing the use of MPD in patients with HIV disease. Twenty-nine papers were reviewed for pharmacokinetic data, eighteen for safety and side effects issues, and seventeen for relevant contributions from the neuropsychological testing literature. Results: Studies in clinical settings have used doses ranges from 10–90 mg. per day in two or three divided doses with reportedly good results in improving both affective and cognitive symptoms associated with HIV disease. Side effects have been relatively mild and patient satisfaction with treatment has been high. However, no studies have been conducted in early stage HIV disease, where a significant minority of patients have similar complaints in the absence of clinically apparent immunosuppression. Likewise, placebo-controlled, dose-finding studies in AIDS patients are entirely lacking, and no studies in women with HIV disease and cognitive changes have been published. Conclusions: In spite of these important research shortcomings, clinical experience with MPD treatment of cognitive changes in men with HIV/AIDS is consistent with the notion that this medication holds significant promise to improve the quality of life for persons living with HIV/AIDS. Controlled studies to test this hypothesis are warranted.
Diagnostic Errors of Primary Care Screens for Depression and Panic Disorder
Authors: Leon Andrew C. , Portera Laura , Olfson Mark , Kathol Roger , Farber Leslie , Lowell Kira N. , Sheehan David V. 
Published: May 2005

Objective: As the health care reimbursement system has changed, brief screens for detecting mental disorders in primary care have been developed. These efforts have faced the formidable task of identifying patients with mental disorders, while at the same time minimizing the number of misclassified cases. Here we consider the balance between sensitivity and positive predictive value. Primary care patients with false positive and false negative results on screens for depression and panic disorder are compared with regard to comorbidity and functional impairment. Methods: This was a cross- sectional psychometric study. The study sample included 1001 primary care patients from the Department of Internal Medicine at Kaiser Permanente in Oakland, California. The Symptom-Driven Diagnostic System for Primary Care (SDDS-PC) screens and Sheehan Disability Scale were completed by the subjects. The SDDS-PC diagnostic interviews were administered to all subjects. Results: Patients with false positive results on the panic disorder screen did not differ from patients with false negatives results with regard to rates of other psychiatric disorders, functional impairment, or mental health service utilization. In contrast, patients with false negative depression screen results had significantly more psychiatric disorders and functional impairment than those with false positive depression results. Conclusions: A substantial number of patients with either false positive or false negative screen results met diagnostic criteria for other mental disorders. Given the nominal burden of follow-up assessments for patients with positive screens, these data suggest that erring on the side of sensitivity may have been preferable when algorithms for these screens were selected.
The Union, the Mining Company, and the Environment: Steelworkers Build a Multi-Stakeholder Model for Corporate Accountabilityat Phelps Dodge
Authors: Lewis Sanford 
Published: May 2005

This is a case study of ongoing relations between the Phelps Dodge mining company, a United Steelworkers local representing 560 employees at the company's Chino Mines in New Mexico, and an array of other concerned stakeholders. This case study shows that labor can be a full partner in environmental advocacy, and even take a leadership role in building a strong multi-stakeholder alliance for corporate accountability. While the case also shows that corporate jobs blackmail is alive and well in the global economy, the labor community-coalition that has emerged at the mining complex has broken some new ground. The approach taken attends to diverse stakeholder interests—cultural protection issues of Native-American and Mexican-American ethnic groups; conservation, groundwater and Right-to-Know issues of traditional environmental constituencies; and environmental liability and disclosure concerns of corporate shareholders. Among the key developments are: A new approach to corporate reporting to shareholders as an enforcement and right-to-know tool; The use of the internet as an information dissemination and action tool; The potential for environmentally needed improvements to serve as a receptor for employment of workers at a mine during periods of reduced production.
Mania Due to General Medical Conditions: Frequency, Treatment, and Cost
Authors: Carroll Brendan T. , Goforth Harold W. , Kennedy John C. , Dueñto Otto R. 
Published: May 2005

Objective: Mania due to general medicine conditions may occur in patients in a variety of settings. Methods: We reviewed the charts of patients admitted to an adult psychiatric service over a nine-year period (Jan. 1985 to Dec. 1993). Patients were diagnosed with Organic Affective Syndrome (ICD-9 code 293.83) in 241 episodes ( N = 227 patients). There were forty-seven manic or mixed episodes in forty patients (0.72% of all admissions). Results: When DSM-IV criteria for Mood Disorder due to a General Medical Condition manic or mixed type (MDGMC) was applied, we found twenty-five patients with twenty-seven episodes ( N = 30 treatment trials). Irritable mood predominated in twenty-seven (90%) of the thirty trials. Conclusions: Treatment included anticonvulsants in 63 percent, neuroleptics 63 percent, and lithium 40 percent. Favorable responses to anticonvulsants were seen; however combination therapy was used more frequently. Further research in this area is needed.
Ictal and Psychiatric Aspects of Suicide in Epileptic Patients
Authors: Mendez Mario F. , Doss Robert C. 
Published: May 2005

Objective: To evaluate the ictal and psychiatric aspects underlying the high risk of suicide among epileptic patients. Method: We surveyed the records of 1611 epileptic patients seen in a neurology clinic during an eight-year period, found four who died by suicide, and characterized their ictal and psychiatric features. Results: All four epileptic patients had partial complex seizures and temporal lobe foci. Two had an associated paranoid schizophrenia with suicidal ideation, and good or improving seizure control at the tine of their deaths. Another patient killed himself during a brief psychotic episode associated with increasing epileptiform discharges. The fourth patient had ictal depression and committed suicide during a flurry of partial complex seizures. Conclusions: These findings suggest that the high suicide rate among epileptic patients has a greater association with psychotic behaviors and psychic auras than with major depression or the psychosocial burden of being epileptic. We further review other reported risk factors for suicide in epilepsy.
Psychiatric Diagnoses in Inner City Outpatients with Moderate to Severe Asthma
Authors: Brown E. Sherwood , Khan David A. , Mahadi Susan 
Published: May 2005

Objective: Psychiatric symptoms may be associated with increased asthma morbidity and mortality. However, no investigations have identified syndromal psychiatric diagnoses in asthma patients using current diagnostic criteria or examined treatment received for mental illness. Method: We conducted structured clinical interviews on 32 patients with moderate to severe asthma to identify current and past psychiatric illness. Results: Twenty-five percent of subjects had current major depressive disorder, but only 25 percent of these received antidepressants. Anxiety disorders, including panic disorder (16 percent), and social (13 percent) and specific phobias (28 percent) were also common. All subjects with panic disorder were receiving appropriate therapy. Conclusions: Asthma patients with moderate to severe asthma treated at community health facilities may have high rates of often untreated mood and anxiety disorders. Interventions aimed at identifying and treating psychiatric disorders in this population are needed.
Health Education: Can the Reformers Be Reformed?
Authors: Brown E. Richard , Margo Glen Elgin 
Published: May 2005

Health educators have created a new professional role that emphasizes the changing of individuals rather than their social conditions. The article shows how historical roots, ideological perspectives, and structural constraints have combined to create an ambiguous, generally conservative role for the health education profession. Epidemiological evidence is presented that contradicts many implicit notions of disease etiology that underlie health education approaches. Finally, the authors suggest an “ecological” model of health education that takes account of the multiple causes of disease and is committed to progressive social change.
Pheochromocytoma Presenting as Exacerbation of Post Traumatic Stress Disorder Symptomology
Authors: Lambert Michael T. 
Published: May 2005

Objective: The following case report and discussion is intended to increase awareness of the difficulties in diagnosing pheochromocytoma when a primary psychiatric diagnosis is first suspected. Method: The case of a middle-aged combat veteran who was admitted with agitation and flashbacks is presented. Episodes of hypertension were initially believed to be related to agitation or alcohol withdrawal. When the hypertensive episodes persisted, further evaluation revealed a pheochromocytoma. In three years' follow-up since removal of the tumor, the patient has shown considerable improvement in the symptoms of Post Traumatic Stress Disorder (PTSD). Conclusions: Pheochromocytoma should be considered in patients with psychiatric disorders if a pattern of hypertensive episodes persists or worsens. The case highlights the importance of medical evaluation in patients presenting with psychiatric complaints.
Chloroquine Induced Mania
Authors: Akhtar Sayeed , Mukherjee Sujoy 
Published: May 2005

Objective: To find out whether chloroquine by itself can induce a manic syndrome and to study the course of illness in such cases. Method: All cases of manic episodes occurring in clear consciousness were scrutinized and those occurring after the use of chloroquine were included in the study. One case seen by one of the authors in the community was included. The cases were followed for variable periods. Result: Six cases of chloroquine induced mania were identified of which two subtypes could be delineated with heterogeneous course, variable severity and difference in susceptibility of recurrence with rechallenge. Conclusion: It is concluded that chloroquine can cause secondary mania and it should be used cautiously in the predisposed.
An Organic Psychosis Due to a Venlafaxine-Propafenone Interaction
Authors: Pfeffer F. , Grube M. 
Published: May 2005

Objective: An extraordinary case of an organic psychosis during the treatment of a patient with a bipolar affective disorder. Methods: Clinical observation and further investigations including monitoring of serum levels (case report). Results: A significant interaction between venlafaxine and propafenone causes markedly increased serum levels of venlafaxine correlating with unexpected psychopathological changes. Conclusions: There is a potentially dangerous interaction between venlafaxine and propafenone. Serum levels of venlafaxine should be monitored if propafenone is added.
Emotional Responses of Burned Children in a Pediatric Intensive Care Unit
Authors: Seligman Roslyn , Carroll Shirley , MacMillan Bruce G. 
Published: May 2005

A thirty-bed hospital for acute and reconstructive treatment of thermal injuries in children has afforded an opportunity to investigate: 1) early development and personality in the pre-burn child, 2) emotional responses to the injury and hospitalization, 3) the role of emotions in the clinical course of treatment, and 4) long-term adjustment to the physical and emotional trauma of burns. The focus is on clinical observations and evaluations made by a consultant in child psychiatry on a four-bed intensive care unit. The role of the intensive care unit environment, immobilization, and the interplay of patients on one another, as well as the environment-mind-body interrelationships, are illustrated by four case vignettes. Psychological thoughts regarding somatic responses of ulcers, hypertension, and central nervous system manifestations of hallucinatory-like and seizure-like phenomena are made. These vignettes attempt to show how the emotional needs of a burned child, especially in an intensive care unit, must receive the same emphasis as his physical needs.
In Defense of the National Health Service
Authors:   Radical Statistics Health Group
Published: May 2005

Many influential British groups have taken the opportunity provided by the Royal Commission on the National Health Service to put forward proposals which would fundamentally damage that service. In this paper we discuss the implications of some of these proposals, and explain why we defend the NHS as the basis of an equitable method of providing health care. We consider the various methods which have been suggested to increase the revenue of the NHS. We compare the experiences of several Western countries, and show that the method of financing inevitably affects the pattern of medical care and the indices of health and illness. We examine the underlying motives of many critics of the NHS, and document the development of private medicine in the United Kingdom. We continue by discussing ways in which less money could be spent on health care without detriment to the patient. As an example, we look at several surgical procedures in detail and demonstrate the costs of uncertainty in surgical practice. Finally, we consider the continuing power of the medical profession, how it is maintained, and its implications. We conclude by summarizing why we support the NHS despite its imperfections, and why attempts to undermine it should be resisted.