Showing papers by "Janet B. W. Williams published in 1996"
TL;DR: Difficult patients are prevalent in primary care settings and have more psychiatric disorders, functional impairment, health care utilization, and dissatisfaction with care, whereas demographic characteristics and physical illnesses were not associated with difficulty.
Abstract: OBJECTIVE: To determine the proportion of primary care patients who are experienced by their physicians as “difficult,” and to assess the association of difficulty with physical and mental disorders, functional impairment, health care utilization, and satisfaction with medical care.
373 citations
TL;DR: It is suggested that one of the most important aspects of a primary care physician's care of female patients is to screen for and treat common mental disorders, and the HRQL scores were poorer in women than men, although most of this difference was accounted for by the difference in prevalence of mental disorders.
230 citations
TL;DR: Investigation of personality disorders in homosexual men found that PDs may contribute to increased risk for onset of Axis I disorders and serious impairment among homosexual men regardless of HIV serologic status.
Abstract: Background: A longitudinal study was conducted to investigate whether personality disorders (PDs) increase risk for the development of future Axis I disorders and serious functional impairment among human immunodeficiency virus (HIV)—seropositive and HIV-seronegative homosexual men. Method: Baseline assessments of PDs, Axis I disorders and symptoms, and Global Assessments of Functioning were conducted with a community sample of 107 (66 HIV-positive and 41 HIV-negative) homosexual men partici-pating in a longitudinal study with semiannual interviews over 3 years. Results: Logistic regression analysis indicated that PDs predicted onset of subsequent Axis I disorders after controlling for both HIV status and lifetime Axis I history (adjusted odds ratio, 4.31; P =.01; 95% confidence interval, 1.39 to 13.32). Of the 21 participants with PDs, 16 (76%) were subsequently diagnosed with Axis I disorders on at least one occasion. By contrast, only 36 (42%) of the 86 participants without PDs were subsequently diagnosed with Axis I disorders. Further, 33% of the participants with PDs, in comparison with only 8% of those without PDs, were assigned Global Assessments of Functioning scores of 50 or lower, indicating serious impairment during the postbaseline study period (adjusted odds ratio, 5.70; P Conclusion: Personality disorders may contribute to increased risk for onset of Axis I disorders and serious impairment among homosexual men regardless of HIV serologic status.
30 citations
TL;DR: The studies of gay men and IDU cohorts suggest that HIV can affect cognition early, even when the patient is medically asymptomatic; cognitive difficulties worsen as the severity of HIV infection increases; and the advent of clinically significant neurologic signs is associated with progression to more severe cognitive deficits.
Abstract: We followed a cohort of 223 intravenous drug users (99 HIV - and 124 HIV + ) for up to 3.5 years, examining change in performance over time as a function of HIV status, disease severity, and neurological signs and symptoms. Analyses were performed by applying generalized estimating equations (GEE) to regression analyses with repeated measures, and controlled for age, education, and length of substance use. None ofthe subjects had AIDS at baseline. There were 147 men (85 HIV + and 62 HIV - ) and 76 women (39 HIV + and 37 HIV - ). Memory performance was worse in the HIV + than HIV - women. In the men, performance on the memory, executive, language, and attention factors improved significantly over time, but this improvement was attenuated in the HIV + men for the attention and orientation factors. In the HIV + women, AIDS was associated with worsening performance on attention tests. The presence or onset of clinically significant neurological findings was associated with poorer language and motor speed performance. In the HIV + men, memory performance was worse when the CD4 count fell below 200; it declined over time in men with AIDS but not in those without. A learning effect for language was attenuated in men who developed AIDS. The presence or development ofa clinically significant neurological sign was associated with poorer memory, executive, language, attention, and motor speed performance. Our findings parallel those that we previously reported in a prospectively followed cohort of gay men. In combination, our studies of gay men and IDU cohorts suggest that (a) HIV can affect cognition early, even when the patient is medically asymptomatic; (b) cognitive difficulties worsen as the severity of HIV infection increases; and (c) the advent of clinically significant neurologic signs is associated with progression to more severe cognitive deficits. Our data suggest that the neurological and neuropsychological changes are both manifestations of the central effect of HIV on the CNS.
9 citations
TL;DR: Although 1 component of PRIME-MD is a 1-page screening procedure, patients who are screened positive are then evaluated by the physician with a brief structured diagnostic interview, thus, unlike the screening procedures mentioned by Goodwin,PRIME- MD is a diagnostic procedure.
Abstract: To the Editor. —The discussion by Dr Goodwin 1 of procedures for diagnosing depression states: "Although not used to establish the diagnosis, self-administered screening instruments, such as the General Health Questionnaire (with its subscale for depression), the Beck Depression Inventory, the Zung Self-rating Scale, and the PRIME-MD screening test, can be valuable aids in finding patients who require a more thorough diagnostic evaluation.... Although these screening instruments are sensitive (few false negatives), they are not specific (many false positives)." Although 1 component of PRIME-MD is a 1-page screening procedure, patients who are screened positive are then evaluated by the physician with a brief structured diagnostic interview. Thus, unlike the screening procedures mentioned by Goodwin, PRIME-MD is a diagnostic procedure. Furthermore, in the PRIME-MD 1000 study 2 using the psychiatric diagnoses of mental health professionals who made blind interviews of patients as the criterion standard, diagnoses made by primary care physicians
4 citations
1 citations