Showing papers by "Janet B. W. Williams published in 1995"

Health-Related Quality of Life in Primary Care Patients With Mental Disorders: Results From the PRIME-MD 1000 Study

Abstract: Objective. —To determine if different mental disorders commonly seen in primary care are uniquely associated with distinctive patterns of impairment in the components of health-related quality of life (HRQL) and how this compares with the impairment seen in common medical disorders. Design. —Survey. Setting. —Four primary care clinics. Subjects. —A total of 1000 adult patients (369 selected by convenience and 631 selected by site-specific methods to avoid sampling bias) assessed by 31 primary care physicians using PRIME-MD (Primary Care Evaluation of Mental Disorders) to make diagnoses of mood, anxiety, alcohol, somatoform, and eating disorders. Main Outcome Measures. —The six scales of the Short-Form General Health Survey and self-reported disability days, adjusting for demographic variables as well as psychiatric and medical comorbidity. Results. —Mood, anxiety, somatoform, and eating disorders were associated with substantial impairment in HRQL. Impairment was also present in patients who only had subthreshold mental disorder diagnoses, such as minor depression and anxiety disorder not otherwise specified. Mental disorders, particularly mood disorders, accounted for considerably more of the impairment on all domains of HRQL than did common medical disorders. Finally, we found marked differences in the pattern of impairment among different groups of mental disorders just as others have reported unique patterns associated with different medical disorders. Whereas mood disorders had a pervasive effect on all domains of HRQL, anxiety, somatoform, and eating disorders affected only selected domains. Conclusions. —Mental disorders commonly seen in primary care are not only associated with more impairment in HRQL than common medical disorders, but also have distinct patterns of impairment. Primary care directed at improving HRQL needs to focus on the recognition and treatment of common mental disorders. Outcomes studies of mental disorders in both primary care and psychiatric settings should include multidimensional measures of HRQL. ( JAMA . 1995;274:1511-1517)

The Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II): I. Description.

Abstract: The history and description of the Structured Clinical Interview for DSM-HI-R Personality Disorders (SCID-II) is presented. The SCID-II is a clinician-administered semistructured interview for diagnosing the 11 Axis II personality disorders of the Diagnostic and Statistical Menual of Mental Disorders (3rd ed., rev.), plus the Appendix category self-defeating personality disorder. The SCID-II is unique in that it was designed with the primary goal of providing a rapid clinical assessment of personality disorders without sacrificing reliability or validity. It can be used in conjunction with a self-report personality questionnaire, which allows the interview to focus only on the items corresponding to positively endorsed questions on the questionnaire, thus shortening the administration time of the interview.

The Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). II: Multi-site test-retest reliability study

Abstract: A test-retest reliability study of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) was conducted on 284 subjects in four psychiatric patient sites and two nonpsychiatric patient sites. For the patient sites, kappas ranged from .24 for obsessive—compulsive personality disorder to .74 for histrionic personality disorder, with an overall weighted kappa of .53. For the nonpatients, however, agreement was considerably lower, with an overall weighted kappa of .38. Mean duration of administration time was 36 minutes. Results of this study and other studies using the SCID-II suggest that the reliability and validity of the SCID-II are comparable with other instruments that diagnose Axis II disorders of the Diagnostic and Statistical Manual of Mental Disorders, but this new instrument has the advantage of a shorter time of administration.

Psychiatric Comorbidity, Health Status, and Functional Impairment Associated With Alcohol Abuse and Dependence in Primary Care Patients: Findings of the PRIME MD-1000 Study

Abstract: The psychiatric comorbidity, health, and functioning of primary care patients with alcohol abuse and dependence (AAD) were investigated in a sample of 1,000 patients. Psychiatric symptomatology was assessed with the Primary Care Evaluation of Mental Disorders (PRIME-MD) diagnostic system. Health and functional status was assessed with the Medical Outcomes Study Short Form General Health Survey (SF-20). Results indicated that use of the PRIME-MD system brought about a 71% increase in physician recognition of AAD. AAD patients were diagnosed with substantial psychiatric comorbidity, and they reported poorer health and functioning than did patients without any psychiatric disorders. However, they reported less impairment and psychiatric comorbidity than did patients with other psychiatric disorders. Results also indicated that AAD patients' health and functioning were associated with the presence or absence of psychiatric comorbidity.

Axis I psychiatric symptoms associated with HIV infection and personality disorder.

Abstract: Objective The prevalences of personality disorders among HIV-positive and HIV-negative homosexual men were compared, and the presence of personality disorders was related to axis I psychiatric disorders, psychiatric distress, and impaired functioning. Method The subjects were 162 homosexual men who either were HIV seronegative (N = 52) or were seropositive and had absent to moderate physical symptoms (N = 110). Lifetime and current histories of DSM-III-R axis I disorders, current diagnoses of DSM-III-R personality disorders, and levels of anxiety, depression, hopelessness, and adaptive functioning were assessed. Results In both the seropositive and seronegative groups, 19% of the study participants were diagnosed with personality disorders. The seropositive participants with personality disorders reported higher levels of psychiatric symptoms and poorer functioning than all participants without personality disorders, and they were over six times as likely as the seronegative participants without personality disorders to have current axis I disorders. Conclusions These findings indicate that HIV infection and personality disorders may interactively increase the likelihood of clinically significant psychiatric symptoms.

Risk of Human Immunodeficiency Virus Type 1-Related Neurologic Disease in a Cohort of Intravenous Drug Users

Abstract: Background: Although the proportion of cases of acquired immunodeficiency syndrome related to intravenous drug use has increased dramatically over the past decade, there has been no longitudinal examination of primary neurologic disease in this group. Objective: To study the development of neurologic disease in human immunodeficiency virus (HIV)—negative and HIV-positive men and women who were intravenous drug users over a 3.5-year period. Design: Prospective observational cohort study. Setting: Subjects were recruited from an infectious disease clinic at a New York City Hospital or from a methadone maintenance program. Participants: Ninety-nine HIV-negative (62 men and 37 women) and 124 HIV-positive (85 men and 39 women) intravenous drug users volunteered. Main Outcome Measure: The development of clinically significant manifestations in six neurologic domains. Results: With multivariate adjustment for current and past substance abuse, age, education, and head injury, we examined the odds of developing HIV-related neurologic disease. Extrapyramidal signs and reduced motor ability became increasingly apparent over time in HIV-infected men as their CD4 cell count declined and as the subjects developed the acquired immunodeficiency syndrome. Fewer neurologic signs were seen in the women. Conclusions: The impact of HIV infection among intravenous drug users parallels that in homosexual men and is independent of alcohol and other drug use.

Should Dsm Be the Basis for Teaching Social Work Practice in Mental Health? Yes!

Abstract: Point/Counterpoint is a regular feature of the Journal of Social Work Education. Its purpose is to provide a vehicle for the expression of contrasting views on controversial topics in social work education. Our goal is to illuminate important debates and explore the diverse perspectives that are shaping social work education. In each issue of the Journal several social work educators are invited to comment on a topic about which they have differing viewpoints. The commentators are given an opportunity to make a brief rebuttal. In this issue, Janet Williams (Professor, Columbia University College of Physicians and Surgeons), Robert Spitzer (Professor, Columbia University College of Physicians and Surgeons), Herb Kutchins (Professor, California State University, Sacramento), and Stuart Kirk (Professor, University of California, Los Angeles) address the question: Should DSM be the basis for teaching social work practice in mental health?