bluuebunny/crossref_metadata_2025_split huggingface dataset:
Approaches to Measurement and Definition in the Epidemiology of Behavior Disorders: Ethnic Background and Child Behavior
Authors: Langner Thomas S. , Gersten Joanne C. , Eisenberg Jeanne G. 
Published: May 2005

This paper presents methods of approaching mental illness which represent alternatives to the medical model and the current diagnostic system. It also points to new ways of handling such complex independent variables as race and class to more clearly delineate the critical components of those constructs for observed relationships. These approaches are briefly discussed and then exemplified in the context of a study which investigated the types and levels of stress to which children of different ethnicity were exposed and the congruence between impairment levels and stress exposure. Differential behavior patterns by ethnicity were determined, as were the relative roles of class versus ethnicity in children's disturbed behaviors. Measures were developed from questionnaire data collected from 1034 randomly selected Manhattan mothers. White children were least exposed to social stress, Spanish most exposed to marital-parental stress, and Black most exposed to stressful parental practices. While the estimated impairment rank-order was White, Spanish, and Black, both minority groups of children were significantly higher than Whites but similar to each other in impairment level. Analyses showed strong differences in behavior patterns by ethnicity and indicated that race made a stronger contribution than class to disturbed behaviors.
Utilization of Medical Services and Quality of Life among Low-Income Patients with Generalized Anxiety Disorder Attending Primary Care Clinics
Authors: Jones Glenn N. , Ames Steven C. , Jeffries Shawn K. , Scarinci Isabel C. , Brantley Phillip J. 
Published: May 2005

Objective: Anxiety disorders appear to influence morbidity and medical utilization. However, little is known about the relationship between Generalized Anxiety Disorder, quality of life, and medical utilization, especially among low-income patients. The goals of this investigation were to 1) determine if low-income patients with GAD utilize medical services more than patients with other Axis I diagnoses, or no psychopathology, and 2) compare the health-related quality of life of these three groups. Method: Participants were randomly recruited from public primary care clinics and administered intake assessments of demographics, stress, and health-related self-report questionnaires. At the end of the first year a structured psychiatric interview was administered ( N = 431). Over the second year, patients ( n = 360) were administered a health-related quality of life measure every three months for four assessments. Medical charts were abstracted to collect information about chronic illnesses and visits to outpatient clinics and the emergency department during the two years. Results: Patients were predominantly middle-aged, low-income, uninsured African-American females. In this low-income sample, patients with GAD utilized the emergency department more and reported poorer quality of life than patients with other Axis I disorders and patients without any psychopathology. Conclusion: Low-income patients with GAD utilize the emergency department more and report poorer quality of life than patients with other Axis I disorders and patients without any psychopathology. Programs to identify and treat patients with GAD may yield improvements in quality of life, as well as reduce emergency department utilization.
Consultation-Liaison Psychiatry Fellowship in Primary Care
Authors: Steinberg Maurice D. , Cole Steven A. , Saravay Stephen M. 
Published: May 2005

Objective: This article describes the need for and development of an outpatient primary care psychiatry fellowship program. Method: The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine. Results: The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents. Conclusions: The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.
Primary Care Physician Responses to a Panic Disorder Vignette: Diagnostic Suspicion and Clinical Management
Authors: Aikens James E. , Wagner Lynne I. , Lickerman Alex J. , Chin Marshall H. , Smith Amber 
Published: May 2005

Objective: To study current patterns of panic disorder (PD) recognition and management by primary care physicians (PCPs). Method: We administered a vignette describing a female PD patient to 189 PCPs. Results: Three-quarters of respondents believed that PD was at least 50 percent probable, and the mean PD likelihood rating was 63 percent. Diagnostic suspicion was significantly higher for PD than for other anxiety disorders, major depressive disorder, and cardiac disorders. Medication was rated as significantly more necessary than medical testing and mental health referral. A benzodiazepine was suggested by 78 percent of respondents, while 35 percent suggested a serotonin reuptake inhibitor (SRI). Under half rated the patient as requiring medical testing, mostly for hyperthyroidism (70%) and/or cardiovascular disorder (62%), and half felt that the patient required mental health referral. Conclusions: The data suggest that most PCPs are able to recognize PD. However, they may be excessively inclined to prescribe benzodiazepines rather than more appropriate medications.
The Use of an Advance Directive in Consultation-Liaison Psychiatry: A Case Report
Authors: Epstein Steven A. , Martins Eduina , Crowley Margaret A. , Pennanen Marie F. 
Published: May 2005

Objective: The following case report illustrates the use of a psychiatric advance directive in a surgical setting. Method: The case of a woman with breast cancer and debilitating pre-operative anxiety is presented. Her anxiety was so severe that it resulted in repeated refusal to have necessary surgery. An advance directive facilitated proceeding with surgery despite her objections in the immediate pre-operative period. Conclusion: Consultation-Liaison psychiatrists should consider the use of an advance directive when preoperative anxiety interferes with decision-making capacity.
Mental, Physical and Functional Status in Primary Care Attenders
Authors: Berardi Domenico , Ceroni Giuseppe Berti , Leggieri Giuseppe , Rucci Paola , Üstün Bedirhan , Ferrari Giuseppe 
Published: May 2005

Objective: The purpose of the present study was to analyze the association, in primary care attenders, between psychiatric disorders, medical comorbidity, and impairment in mental and physical function status. Methods: The study had a two-stage design. The GHQ-12 was used to screen 1647 patients, and 323 of them were then interviewed using the CIDI-PHC to obtain ICD-10 diagnoses. Severity of mental illness was assessed using the Hamilton scales for anxiety and depression. The DUSOI was used to evaluate the severity of physical illness. The MOS SF-36 was used to assess health related quality of life. Results: The estimated prevalence of ICD-10 psychiatric disorders and subthreshold disorders was 12.4 percent and 18 percent respectively. The most common psychiatric disorders were generalized anxiety, major depression, and neurasthenia. The severity of physical illness did not vary across diagnostic status categories. Significant impairment, both in physical and mental functioning was seen in patients suffering from ICD-10 full-fledged and subthreshold disorders. Severity of impairment increased from subthreshold cases to full-fledged cases, and among the latter according to the severity of depressive and anxious symptoms, assessed using Hamilton scales. The most frequent psychiatric disorders were associated with significant worsening in health related quality of life, with relevant differences between psychiatric diagnoses regarding the domains affected. Impairment associated with mental disorders was greater than that associated with physical illness. Conclusions: The results of the present study confirm that ICD-10 psychiatric disorders are common in general practice and are associated with relevant impairment in physical and mental functional status. Psychiatric morbidity is not related to severity of physical illness rated by general practitioner.
National Prescribing Patterns in the Management of Extrapyramidal Symptoms among Patients with Schizophrenia
Authors: Luo Roger D. , Belletti Daniel A. , Tran Dung , Arcona Stephen , Salen Philip N. 
Published: May 2005

Purpose: Antipsychotics, particularly typical agents, have been shown to cause extrapyramidal symptoms (EPS). We hypothesized a negative association between concomitant (at same visit) prescriptions for atypical antipsychotics and prescriptions for medications to manage EPS. Method: We combined National Ambulatory Medical Care Survey (NAMCS) data from 1993 through 1999 for visits by patients with a diagnosis of schizophrenia (ICD-9 295.0–295.9), that included a prescription for either an atypical or typical antipsychotic (but not both). We also constructed two, scale-weighted logistic regression models to separately estimate the odds and probabilities of receiving prescriptions for an antipsychotic and for a medication used to treat EPS. Results: From 1993 through 1999, there were an estimated 10,475,507 office visits with schizophrenia as a diagnosis; 7,371,625 (70.4 percent) included a prescription for a conventional (typical) antipsychotic. Thirty-four percent of visits included a prescription for a medication used to treat EPS. Being in the older age group, having Medicaid as primary coverage, belonging to an HMO, and being female significantly reduced the probability of receiving an atypical antipsychotic by 12.6 percent, 10.9 percent, 15.1 percent, and 10.2 percent, respectively. Caucasian patients were 14 percent more likely to be prescribed an atypical. Antipsychotic type had a clinically and statistically significant effect on EPS management prescribing. A prescription for an atypical antipsychotic reduced the probability of receiving a concomitant prescription for EPS management by 26.8 percent. Conclusion: As expected, we observed the hypothesized joint prescribing pattern. The results of this study suggest that atypical antipsychotic prescriptions strongly predict fewer prescriptions for EPS treatment, and, by implication, reduced need for EPS treatment in actual ambulatory care practices throughout the nation.
1984 Update on the World Economic Crisis and the Children: A United States Case Study
Authors: Miller C. Arden , Coulter Elizabeth J. , Fine Amy , Adams-Taylor Sharon , Schorr Lisbeth B. 
Published: May 2005

A previously published report by these authors on the impact in the United States of recession on children's health emphasized four points: 1) available monitoring systems are not adequate for reporting on the health of children in a timely fashion; 2) the monitoring of maternal and child health must emphasize data on population subgroups, i.e., minorities, the poor and those hardest hit by recession; 3) the health of poor children is adversely affected and their numbers dramatically increased during the recession of 1981–82; and 4) comparisons between the recession of 1974–75 and that of 1981–82 suggest that expansion of health services and social support systems during the recession of 1974–75 had a cushioning effect that protected the health of children, while the curtailment of many of these programs during the 1981–82 recession is associated with adverse health trends, especially among the most vulnerable population subgroups. Data on these issues are appreciably better now than they were nine months ago, thus further validating the points made above. As with the previous report, officially released current data are abundant for economic indicators (even for early 1984), but are sparse for health status indicators. The previous report also observed that the health status of children is influenced by interdependent and interlocking factors that include economic well-being and access to health services and social supports. A new analysis attempts to unlock those relationships and measure the impact of lost welfare benefits, implemented as a result of the Omnibus Reconciliation Act of 1981 (OBRA), and the separate impact of the serious recession of 1981–82. That analysis shows the poverty rate for children increased by 7.6 percentage points between 1981 and 1982. Approximately 60 percent of the increase is attributable to the recession and 40 percent to social policy changes effected after 1981.
Individual Difference Correlates and Measures of Predisposition to Obesity and to Anorexia
Authors: Mehrabian Albert , Nahum Ilana V. , Duke Vince 
Published: May 2005

A questionnaire of eating and related habits was developed and factor analyzed to yield verbal report measures of predisposition to obesity, binge eating, physical activity, and predisposition to anorexia. The latter was composed of three intercorrelated components: food phobia, inability to eat, and abhorrence of full stomach (vomiting). Predisposition to obesity correlated .42 with binge eating and –.55 with the ponderal index (a measure of the elongated-rounded quality of body shape). Predisposition to anorexia correlated .14 with predisposition to obesity, showing that those predisposed to anorexia had a weak tendency to perceive themselves as prone to gain weight. However, contrary to clinical observations, predisposition to anorexia did not correlate significantly with binge eating or with physical activity. Across the entire sample, binge eating correlated .15 with abhorrence of full stomach (vomiting) showing that the incidence of bulimia is very low. A three-dimensional temperament framework and its associated measures of trait pleasure-displeasure, arousability, and trait dominance-submissiveness was used to explore personality correlates of eating habits. Predisposition to obesity was associated with arousability, and secondarily, with submissiveness, indicating anxious or dependent temperament types to be prone to obesity. Both binge eaters and those predisposed to anorexia exhibited unpleasant, arousable, and submissive (i.e., anxious) temperament characteristics. Physical activity was associated with trait dominance and trait pleasure; that is, relaxed or exuberant temperament qualities. Compared with males, females were significantly more predisposed to obesity, binge eating, and anorexia.
To Screen or Not to Screen: Symptoms Identifying Primary Care Medical Patients in Need of Screening for Depression
Authors: Carmin Cheryl N. , Klocek John W. 
Published: May 2005

Objective: It is estimated that 5 percent to 10 percent of primary care patients meet criteria for Major Depressive Disorder with an additional 10 percent to 30 percent experiencing significant subclinical depression. However, only 18 percent to 50 percent of depressed primary care patients are so diagnosed by their primary care physicians and even fewer receive professional mental health care. The current study proposes a quick and efficient means to assist physicians in determining for which patients the resource intensive process of thoroughly screening for depression should be engaged. Method: The present study examined responses of 358 consecutively reporting patients to a midwest university-based primary care clinic on the Beck Depression Inventory. Results: Among individuals reporting high levels of depressive symptomatology, five questions from the Beck Depression Inventory were endorsed by 90 percent or greater of the participants. Analyses by gender indicated that while the same five items were endorsed by males and females, three additional items were frequently endorsed by males. Conclusions: These findings suggest that a means for efficiently identifying individuals who warrant screening for depression may be readily available to primary care physicians. Surprisingly, this screening was found to emphasize psychological rather than vegetative symptoms. Thus, attending to these symptoms and/or complaints during the course of an office visit may serve as an indicator that a thorough screening for depression, or possibly referral, is warranted.
What Man has told Children about Death
Authors: Schur Thomas J. 
Published: May 2005

This article begins with the assumption that one can gather some picture of the history of man's attitude toward death by examining the literature he has written for children. And so, it proceeds to survey death in children's literature from the early, anonymous works such as Mother Goose, to contemporary picture books like The Dead Bird. This literature is basically divided into four periods: Anonymous, Puritan, Intermediate and Contemporary. At least one representative example and further references follow the explanation of the values and principles of each period. The conclusion points out that, aside from the merits of this survey as a literature study and an indication of man's attitudes towards death through history, it can serve the important role of challenging the reader to examine his own death attitudes.
Paramenstrual Aggression in Mentally Retarded Adult Ameliorated by Buspirone
Authors: Colella Raymond F. , Ratey John J. , Glaser Alan I. 
Published: May 2005

Objective: This case examined the efficacy of buspirone therapy as a reductive technique for severe treatment resistant paramenstrual aggression. Method: Aggressive outbursts of an institutionalized mentally retarded adult were analyzed and correlated with menstrual cycling. Behavior was closely monitored, and after ineffective trials of antipsychotics, benzodiazepines and beta blockers, a trial of buspirone was initiated. Results: Buspirone therapy resulted in a marked decrease in aggressive incidences, and substantial increases in desirable behaviors. As a result of the subjects improvement, doses of concurrent psychotropic medications were reduced or discontinued altogether. Conclusions: The authors conclude that buspirone is an effective pharmacotherapy for paramenstrual aggression in the developmentally disabled, and encourage similar experimentation when behavior seems to be otherwise unbeatable.
Problems of the Evolution of the Technical Press
Authors: Witkiewicz T. , Pilak Z. 
Published: May 2005

As the reader of this journal know, the effective communication of technological research and development is causing world-wide concern. Should scientists and engineers be selective in reporting technology? Can standards be set up for selectivity? What is the responsibility of the technical press? These and other problems are discussed by the authors of this illuminating report originating from Wroclaw Technical University, Poland.
Stand-Alone Computer Systems — Our Educational Future
Authors: Bork Alfred 
Published: May 2005

We can sketch a number of scenarios for the future of education. All these scenarios involve heavier use of the computer than at present. A number of important or auxiliary devices, such as the videodisc, will also play a role. The trends in modern technology suggest that stand-alone systems, perhaps incorporating the videodisc, will represent the major systems of the future. These systems will be widely available in homes, libraries, and educational institutions. Their use in education will expand greatly. Alfred Bork is director of the Physics Computer Development Project at the University of California, Irvine. He holds a joint appointment in physics and in computer science. The Irvine group has a worldwide reputation for the development of effective computer-based learning material, and for the development of courses employing such material along with other media. Of particular concern is the development of authoring systems for producing such material. Bork has published extensively in this area; a list of papers is available on request. He received a Distinguished Service Award from The American Association of Physics Teachers in 1976 and was the Millikan Award Lecturer in 1978. Bork is the Physics Series editor for CONDUIT, and is on the Steering Committee of the Conference on Computers in the Undergraduate Curriculum.
Cost-Benefit & Cost-Effectiveness Analysis of the Rapid Onset of Selective Serotonin Reuptake Inhibitors by Augmentation
Authors: Tome Maria B. , Isaac Michael T. 
Published: May 2005

Objective: This article describes a method for evaluating the value of the increased cost of pharmacologic augmentation of an antidepressant. Method: Data to illustrate the method and interpretation of results were derived from a randomized, placebo controlled double blind trial. Eighty outpatients meeting ICD-10 criteria for depressive disorder and scoring > 18 on the Montgomery-Åsberg Depression Rating Scale (MADRS) were recruited from a primary care population. All patients received SSRI antidepressant and either “augmenting agent” or placebo. The trial period was six weeks, during which the patients were monitored for changes in depressive symptoms using the MADRS. The economic analysis is based only on direct costs of treatment. The analytic approach includes decision analysis, cost-effectiveness and cost-benefit techniques, and a sensitivity analysis. Results: The economic analysis was performed on both the intention-to-treat population and the per-protocol population. Intention-to-treat and per-protocol results show that the direct cost of six weeks' treatment with the combination of “augmenting agent” and SSRI antidepressant, if the acceleration effect is taken into account, was more cost effective than the SSRI antidepressant and placebo. Conclusion: The direct costs of treatment are higher than those of previous pharmacoeconomic studies, but the rate of onset of antidepressant action must be taken into account. The application of the evaluative model appears valid and useful. The model is pragmatic and should be expanded for generalizability.
A Systems Model of Communication Processes
Authors: Bruckmann C. G. 
Published: May 2005

In the teaching of communication studies to engineering and commerce students, the time available for teaching communication principles and models did not allow for a detailed study of the various models currently in use. A systems model based on a consistent and limited terminology was developed. This model consists essentially of three subsystems; the human system, the message transfer system, and intermediate receiver-storage-transmitter systems. With the use of this system approach, it is possible to construct models of any human communication system and to use these models to analyze and compare the strengths and weaknesses of the different systems.