Showing papers by "Medical University of South Carolina published in 1993"

Prognostic factors in early‐stage uterine sarcoma: A gynecologic oncology group study

Abstract: Background. A clinicopathologic evaluation of clinical Stage I and II uterine sarcoma was done by the Gynecologic Oncology Group from 1979-1988. Methods. After all eligibility criteria were met, 453 cases were evaluable and analyzed for prognostic factors. Results. Of the 301 mixed mesodermal tumors (MMT), 167 were homologous (HO), and 134 were heterologous (HE). Fifty-nine tumors were leiomyosarcomas (LM). The remaining 93 sarcomas were predominantly stromal cell and adenosarcomas. For this study, only the MMT or LM tumors were analyzed

Incidence of dementia and probable Alzheimer's disease in a general population The Framingham Study

Abstract: objective: To determine the incidence of dementia and Alzheimer9s disease (AD) in a general population sample. Background: Utilizing subjects in the Framingham Study cohort determined to be free of dementia in 1976 to 1978, or on biennial examination 17 in 1982, all new cases of dementia arising in this cohort over a maximum of 10 years of follow-up were ascertained. Methods: On biennial examination 14/15, a screening neuropsychologic examination was administered to 2,117 subjects, and cases of probable prevalent dementia were identified. Beginning on examination 17 and on all successive biennial examinations, a Mini-Mental State Examination was administered. Subjects previously free of dementia and falling below age-education levels were evaluated by a neurologist and neuropsychologist to determine if dementia was present and to ascertain the dementia type using standard criteria. Results: Five-year incidence of dementia increased with age, doubling in successive 5-year age groups. Dementia incidence rose from 7.0 per 1,000 at ages 65 to 69 to 118.0 per 1,000 at ages 85 to 89 for men and women combined. Incidence of probable AD also doubled with successive quinquennia from 3.5 at ages 65 to 69 to 72.8 per 1,000 at ages 85 to 89 years. Incidence of dementia and of probable AD did not level off with age and was not different in men and women. Conclusions: In a general population sample, we determined incidence of dementia and of probable AD and will use these incident cases for study of precursors and natural history in this elderly cohort, which has been under close surveillance for over 40 years.

Does Supplementation of Diet With 'Fish Oil' Reduce Blood Pressure?: A Meta-analysis of Controlled Clinical Trials

Abstract: Background: Several lines of evidence suggest that supplementation of diet with omega-3 polyunsaturated fatty acids (ω-3) PUFA), commonly referred to as fish oils, may reduce blood pressure (BP). However, most clinical trials of ω-3 PUFA supplementation have been of insufficient size to detect relevant BP changes. Methods: We conducted a meta-analysis of 17 controlled clinical trials of ω-3 PUFA supplementation. To estimate an overall effect of ω-3 PUFA supplementation on BP, we calculated the net BP change in each trial (BP A in ω-3 PUFA group minus BP A in control group), which was then weighted according to the inverse of the variance. Results: In the 11 trials that enrolled normotensive individuals (n=728), ω-3 PUFA supplementation led to significant reductions of systolic BP (SBP) and diastolic BP (DBP) in two and one trials, respectively. In the six studies that enrolled untreated hypertensives (n=291), significant reductions of SBP and DBP were present in two and four trials, respectively. Weighted, pooled estimates of SBP and DBP change (mm Hg) with 95% confidence intervals were —1.0 (—2.0 to 0.0) and —0.5 (—1.2 to +0.2) in the trials of normotensives, and —5.5 (—8.1 to —2.9) and —3.5 (—5.0 to —2.1) in the trials of untreated hypertensives. In 13 of 17 studies, trial duration was less than 3 months. Doses of ω-3 PUFA tended to be high (average dose >3 g/d in 11 trials). The magnitude of BP reduction was greatest at high BP but was not significantly associated with dose of ω-3 PUFA. Side effects, most commonly eructation and a fishy taste, occurred more frequently in ω-3 PUFA participants than in control participants (28% vs 13%,P Conclusions: Our analyses indicate that diet supplementation with a relatively high dose of ω-3 PUFA, generally more than 3 g/d, can lead to clinically relevant BP reductions in individuals with untreated hypertension. However, use of ω-3 PUFA as antihypertensive therapy will require demonstration of long-term efficacy and patient acceptability of lower doses. (Arch Intern Med. 1993;153:1429-1438)

Determination of vitamin D status by radioimmunoassay with an 125I-labeled tracer.

Abstract: We report here the first radioimmunoassay for a vitamin D metabolite utilizing a radioiodinated tracer. Antibodies were generated in a goat immunized with the vitamin D analog 23, 24, 25, 26, 27-pentanor-C(22)-carboxylic acid of vitamin D, coupled directly with bovine serum albumin. The 125I-labeled tracer was prepared by reacting a 3-amino-propyl derivative of vitamin D-C(22)-amide with Bolton-Hunter reagent. The primary antiserum, used at a 15,000-fold final dilution, cross-reacted equally with all cholecalciferol and ergocalciferol metabolites tested except 1,25-dihydroxycalciferol metabolites and the parent calciferols; the antiserum did not cross-react with dihydrotachysterol. Calibrators were prepared in vitamin D-stripped human serum. 25-Hydroxycholecalciferol was quantitatively extracted from serum or plasma (50 microL) with acetonitrile. The assay consists of a 90-min incubation at room temperature with primary antiserum, followed by a 20-min incubation with a second antiserum and separation of bound from free fractions by centrifugation. The detection limit of the assay was 2.8 micrograms/L for 25-hydroxycholecalciferol. Results with the present assay compared well with those from a liquid-chromatographic procedure involving specific ultraviolet detection of 25-hydroxycalciferol in plasma.

Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations.

Abstract: Gastrointestinal tract duplications are uncommon congenital abnormalities. By definition, they are located in or adjacent to the wall of part of the gastrointestinal tract, have smooth muscle in their walls, and are lined by alimentary tract mucosa. The lining mucosa is not necessarily that of the adjacent segment of the gastrointestinal tract. The only clinically important ectopic tissues are gastric mucosa and pancreatic tissue. Although ectopic gastric mucosa is found in duplications at all levels of the gastrointestinal tract, it is most prevalent (43%) in esophageal duplications. Peptic ulcer within this ectopic tissue can account for unusual, often misleading symptoms. Ectopic pancreatic tissue is most common (37%) in gastric duplications and is associated with pancreatitis and elevated amylase levels. Detection of associated vertebral anomalies is a helpful clue in the radiographic diagnosis of duplications. Barium studies usually reveal an intraluminal, intramural, or extrinsic mass, and ultrasono...

Gender differences in substance use disorders.

Abstract: Objective The goals of this study were to explore gender differences in demographic variables, psychiatric comorbidity, and personality disorders in individuals with substance use disorders. Method A total of 100 treatment-seeking substance users (50 men and 50 women) admitted to a university-based and a university-affiliated private chemical dependency hospital were compared with regard to demographic variables and comorbid psychiatric and personality diagnosis according to the Structured Clinical Interview for DSM-III-R after 14-21 days in treatment. Results Men were significantly more likely to have a higher household income and to be alcohol dependent. Women were significantly more likely to have another axis I disorder in addition to substance use disorder, particularly anxiety disorders, but these gender differences were not substantially different from the gender prevalence of these disorders in the general population. Men had more affective disorders relative to women than would be expected from the general population data. Female alcoholics had substantially more psychopathology than male alcoholics, and generally these differences were consistent with the ratios of these disorders in the general population. For cocaine users, female/male ratios of anxiety and affective disorders were inconsistent with general population ratios and indicated more psychopathology than would be expected in male cocaine users. There were no gender differences in axis II diagnoses. Conclusions Some of the gender differences in psychopathology in substance users are at odds with gender differences for psychopathology in the general population. Further exploration of these differences could have important theoretical and treatment implications.

Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders

Abstract: In a randomized clinical trial, multisystemic family preservation was shown to significantly reduce rates of criminal activity and incarceration in a sample of 84 serious juvenile offenders and their multi-need families. In the current study, archival records were searched for re-arrest an average of 2.4 years post-referral. Survival analysis showed that youths who received multisystemic family preservation were less likely to be re-arrested than were youths who had received usual services. Such results represent the first controlled demonstration that family preservation, when delivered via a clearly specified treatment model, has lasting effects with serious juvenile offenders. Implications for family preservation and juvenile justice research are discussed.

Taxol induces internucleosomal DNA fragmentation associated with programmed cell death in human myeloid leukemia cells.

Abstract: The present results demonstrate that the exposure of human myeloid leukemia HL-60 and KG-1 cells to clinically achievable concentrations of taxol produced internucleosomal DNA fragmentation of approximately 200 base-pair multiples, and the morphologic changes characteristic of cells undergoing programmed cell death (PCD) or apoptosis. Taxol-induced PCD was associated with a marked inhibition of suspension culture growth and clonogenic survival of HL-60 cells. In addition, taxol treatment decreased BCL-2 oncogene expression, which is known to block PCD. The exposure to taxol moderately decreased c-myc expression, but did not induce c-jun expression--which has been previously noted for a variety of DNA interactive, antileukemic drugs. These findings indicate that taxol may induce leukemic cell death partly by the alternative but gene-directed and active mechanism of PCD.

Cytoskeletal role in the contractile dysfunction of hypertrophied myocardium.

Abstract: Cardiac hypertrophy in response to systolic pressure loading frequently results in contractile dysfunction of unknown cause. In the present study, pressure loading increased the microtubule component of the cardiac muscle cell cytoskeleton, which was responsible for the cellular contractile dysfunction observed. The linked microtubule and contractile abnormalities were persistent and thus may have significance for the deterioration of initially compensatory cardiac hypertrophy into congestive heart failure.

Repeated Episodes of Ethanol Withdrawal Potentiate the Severity of Subsequent Withdrawal Seizures: An Animal Model of Alcohol Withdrawal “Kindling”

Abstract: Prior experience with ethanol (EtOH) withdrawal may sensitize an individual to subsequent withdrawal episodes. It has been hypothesized that the progressive intensification of the EtOH withdrawal syndrome following repeated episodes of EtOH intoxication and withdrawal may represent the manifestations of a "kindling" mechanism. The purpose of this study was to develop an animal model of EtOH withdrawal that is sensitive to the effects of prior withdrawal experience. Adult male C3H mice were chronically exposed to EtOH vapor in inhalation chambers prior to withdrawal testing. A multiple withdrawal (MW) group received 3 cycles of 16 hr EtOH vapor separated by 8-hr periods of abstinence; a single withdrawal (SW) group received a single bout of EtOH exposure (16 hr); a third group (SW-CONT) experienced a single withdrawal episode after receiving the equivalent amount of EtOH intoxication as the MW group (16 x 3 = 48 hr), but in a continuous (uninterrupted) fashion; and a fourth group (C) served as controls, not receiving any EtOH exposure throughout the study. Severity of the withdrawal response was assessed by scoring handling-induced convulsions hourly for the first 10 hr and then at 24 hr postwithdrawal. The results indicated that the severity of EtOH withdrawal seizures was significantly greater in animals that had a prior history of withdrawal episodes (MW group) in comparison to a separate group of animals that were tested following a single withdrawal from the same 16-hr intoxication period (SW group).(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality Rates and Risk Factors for Coronary Disease in Black as Compared with White Men and Women

Abstract: Background Currently recognized risk factors for coronary artery disease have been identified primarily from investigations of white populations. In this investigation, we estimated mortality rates for coronary disease and for any cause and identified risk factors for death from coronary disease among whites and blacks. Methods Data collected over a 30-year period in the Charleston Heart Study were used to estimate mortality rates and quantify associations with risk factors assessed at the base-line examination in 1960 and 1961 of 653 white men, 333 black men, 741 white women, and 454 black women. Results There were no significant racial differences in the rate ratios for death from coronary disease; however, women had significantly lower death rates than men. Over the 30-year period, the mortality rates for coronary disease per 1000 person-years were 5.2 for white men (95 percent confidence interval, 4.1 to 6.3), 4.6 for black men (3.0 to 6.2), 2.1 for white women (1.6 to 2.6), and 3.2 for black women (2...

Glycation and oxidation: a role in the pathogenesis of atherosclerosis

Abstract: Reactions involving glycation and oxidation of proteins and lipids are believed to contribute to atherogenesis. Glycation, the nonenzymatic binding of glucose to protein molecules, can increase the atherogenic potential of certain plasma constituents, including low-density lipoprotein (LDL). Glycation of LDL is significantly increased in diabetic patients compared with normal subjects, even in the presence of good glycemic control. Metabolic abnormalities associated with glycation of LDL include diminished recognition of LDL by the classic LDL receptor; increased covalent binding of LDL in vessel walls; enhanced uptake of LDL by macrophages, thus stimulating foam cell formation; increased platelet aggregation; formation of LDL-immune complexes; and generation of oxygen free radicals, resulting in oxidative damage to both the lipid and protein components of LDL and to any nearby macromolecules. Oxidized lipoproteins are characterized by cytotoxicity, potent stimulation of foam cell formation by macrophages, and procoagulant effects. Combined glycation and oxidation, "glycoxidation," occurs when oxidative reactions affect the initial products of glycation, and results in irreversible structural alterations of proteins. Glycoxidation is of greatest significance in long-lived proteins such as collagen. In these proteins, glycoxidation products, believed to be atherogenic, accumulate with advancing age: in diabetes, their rate of accumulation is accelerated. Inhibition of glycation, oxidation, and glycoxidation may form the basis of future antiatherogenic strategies in both diabetic and nondiabetic individuals.

Cyclophosphamide and low-dose prednisone therapy in patients with systemic sclerosis (scleroderma) with interstitial lung disease.

Abstract: Fourteen patients with systemic sclerosis (SSc, scleroderma) and interstitial lung disease were treated with oral cyclophosphamide (1-2 mg/kg/day) and low dose prednisone (< 10 mg/day). There was a significant improvement in FVC after 6 months compared to entry values (2.21 +/- 0.19 l vs. 2.03 +/- 0.15 l, p < 0.02). Improvement was maintained at 12 months (2.27 +/- 0.27 l, p < 0.05) and 18-24 months (2.60 +/- 0.28 l, p < 0.001). In 12 cases followed for 18-24 months, FVC was stable or improved. No significant improvement or decline was noted for the DLCO. Side effects included cytopenia (2), infection (1), and hemorrhagic cystitis (2), and one possible related malignancy. A controlled prospective trial of cyclophosphamide is warranted in patients with SSc and active interstitial lung disease.

The Kids' Eating Disorders Survey (KEDS): A Study of Middle School Students

Abstract: Objective Anorexia nervosa and bulimia nervosa are known to occur in children although prevalence studies are lacking. Method Using a newly developed self-report instrument, the Kids' Eating Disorders Survey (KEDS), 3,175 students (1,610 females, 1,565 males) enrolled in grades 5 to 8 were surveyed. Results More than 40% of respondents reported feeling fat and/or the wish to lose weight. These frequencies of weight control behaviors were reported, many of which were significantly greater in girls than boys (p Conclusions Findings demonstrate that development of prevention programs aimed at recognizing problem eating behavior in children is indicated.

Management of complicated parapneumonic effusions

Abstract: Pneumonia remains one of the most common infections in both the community and the hospital (1), and it is associated with a 36 to 57% incidence of pleural effusions (2-4), resulting in an estimated one million people a year in the United States developing parapneumonic effusions. Parapneumonic effusions (pleural fluids associated with pneumonia) may be uncomplicated, free-flowing effusions that resolve spontaneously with antibiotic therapy, or complicated effusions that require pleural space drainage for resolution of pleural sepsis (2, 5-8). The natural course of a complicated parapneumonic effusion is to develop a single loculus or multiple loculations and to progress to an empyema cavity. Empyema, from the Greek meaning accumulation of pus in a body cavity, represents the end stage of a complicated parapneumonic effusion. The best analytical approach to diagnosis and the optimal modality of treatment of complicated parapneumonic effusions are controversial because of the lack of prospective, randomized trials. Furthermore, the value of early pleural fluid markers to predict the transformation of uncomplicated to complicated parapneumonic effusions is still disputed (2, 5, 6, 8-10). The availability of new options for management of complicated parapneumonic effusions further confounds clinical decision making. The heterogeneous responses from a recent American College of Chest Physicians interactive session on pleural space infections was confirmatory (11).

Alexithymia in the Eating Disorders

Abstract: Eating disorder patients appear to have high degrees of alexithymia, a diminished capability to verbally describe feelings, although little data exist. We administered the Toronto Alexithymia Scale (TAS) to 114 females with DSM-III-R defined eating disorders. Patients, regardless of subtype, scored significantly higher than 370 college-aged females. TAS scores were significantly correlated to self-ratings of affective symptoms, but not weight or binge-purge frequency. © 1993 by John Wiley & Sons, Inc.

Body size values of white and black women.

Abstract: The purpose of this naturalistic study was to compare values held by 36 white and 31 black women related to body size, and to identify factors that influence these values and linkages between body size values and weight management activities. Black women of lower SES were significantly different from black women of higher SES and white women, regardless of SES, in that they were heavier, viewed themselves as heavier, and perceived attractive body size as heavier. Black lower status women had to become a great deal heavier than the other groups before they defined themselves as overweight. We suggest that black lower social status women have a wider range of "normal" and attractive body size and that this wider range is developed from comparisons of other women in their social milieu and influences the initiation of weight loss activities.

Expression of homeobox genes Msx-1 (Hox-7) and Msx-2 (Hox-8) during cardiac development in the chick

Abstract: The vertebrate homeobox genes Msx-1 and Msx-2 are related to the Drosophila mshgene and are expressed in a variety of tissues during embryogenesis. We have examined their expression by in situ hybridisation during critical stages of cardiac development in the chick from stages 15 + to 37. Msx-1 expression is apparent in a number of non-myocardial cell populations, including cells undergoing an epithelial to mesenchymal transformation in the atrioventricular and the outflow tract regions that play an integral role in heart septation and valve formation. Msx.2 expression is restricted to a distinct subpopulation of myocardial cells that, in later stages, coincides morphologically with the cardiac conduction system. The timing of Msx-2 expression suggests that it plays a role in conduction system tissue formation and that it identifies precursor cells of this specialised myocardium. The pattern of Msx-2 expression is discussed with reference to current models of conduction tissue development. © 1993 Wiley-Liss, Inc.

Pre-Exposure to Glucosamine Induces Insulin Resistance of Glucose Transport and Glycogen Synthesis in Isolated Rat Skeletal Muscles: Study of Mechanisms in Muscle and in Rat-1 Fibroblasts Overexpressing the Human Insulin Receptor

Abstract: Increased routing of glucose through the hexosamine-biosynthetic pathway has been implicated in the development of glucose-induced insulin resistance of glucose transport in cultured adipocytes. Because both glucosamine and glucose enter this pathway as glucosamine-6-phosphate, we examined the effects of preincubation with glucosamine in isolated rat diaphragms and in fibroblasts overexpressing the human insulin receptor (HIR-cells). In muscles, pre-exposure to glucosamine inhibited subsequent basal and, to a greater extent, insulin-stimulated glucose transport in a time- and dose-dependent manner and abolished the stimulation by insulin of glycogen synthesis. Insulin receptor number, activation of the insulin receptor tyrosine kinase in situ and after solubilization, and the total pool of glucose transporters (GLUT4) were unaffected, and glycogen synthase was activated by glucosamine pretreatment. In HIR-cells, which express GLUT1 and not GLUT4, basal and insulin-stimulated glucose transport were unaffected by glucosamine, but glycogen synthesis was markedly inhibited. Insulin-stimulated activation of protein kinases (MAP and S6) was unaffected, and the fractional velocity and apparent total activity of glycogen synthase was increased in glucosamine-treated HIR-cells. In pulse-labeling studies, addition of glucosamine during the chase prolonged processing of insulin proreceptors to receptors and altered the electrophoretic mobility of proreceptors and processed α-subunits, consistent with altered glycosylation. Glucosamine-induced insulin resistance of glucose transport appears to be restricted to GLUT4-expressing cells, i.e., skeletal muscle and adipocytes; it may reflect impaired translocation of GLUT4 to the plasmalemma. The glucosamine-induced imbalance in UDP sugars, i.e., increased UDP- N -acetylhexosamines and decreased UDP-glucose, may alter glycosylation of critical proteins and limit the flux of glucose into glycogen.

WT1-Mediated Growth Suppression of Wilms Tumor Cells Expressing a WT1 Splicing Variant

Abstract: A human Wilms tumor cell line (RM1) was developed to test the tumor suppressor activity of WT1, a zinc finger transcription factor that is expressed in the developing human kidney and is mutationally inactivated in a subset of Wilms tumors. Transfection of each of four wild-type WT1 isoforms suppressed the growth of RM1 cells. The endogenous WT1 transcript in these cells was devoid of exon 2 sequences, a splicing alteration that was also detected in varying amounts in all Wilms tumors tested but not in normal kidney. Production of this abnormal transcript, which encodes a functionally altered protein, may represent a distinct mechanism for inactivating WT1 in Wilms tumors.

Prognostic significance of hormone receptors in endometrial cancer.

Abstract: Background. Endometrial carcinoma is the most common female pelvic genital malignancy. Many studies suggest that approximately 75% of all endometrial cancers are clinical Stage I. More than 50% of cancer deaths are in patients with clinical Stage I disease. As a result, prognostic factors have been evaluated in an attempt to identify those patients with presumed early stage disease who will be at high risk for recurrence. Recently, hormone receptor status (estrogen [ER], progesterone [PR]) in endometrial cancer has been suggested to be a prognostic factor

Interphotoreceptor retinoid-binding protein (IRBP). Molecular biology and physiological role in the visual cycle of rhodopsin.

Abstract: The regeneration of visual pigment in rod photoreceptors of the vertebrate retina requires an exchange of retinoids between the neural retina and the retinal pigment epithelium (RPE). It has been hypothesized that interphotoreceptor retinoid-binding protein (IRBP) functions as a two-way carrier of retinoid through the aqueous compartment (interphotoreceptor matrix) that separates the RPE and the photoreceptors. The first part of this review summarizes the cellular and molecular biology of IRBP. Work on the IRBP gene indicates that the protein contains a four-fold repeat structure that may be involved in binding multiple retinoid and fatty acid ligands. These repeats and other aspects of the gene structure indicate that the gene has had an active and complex evolutionary history. IRBP mRNA is detected only in retinal photoreceptors and in the pineal gland; expression is thus restricted to the two photosensitive tissues of vertebrate organisms. In the second part of this review, we consider the results obtained in experiments that have examined the activity of IRBP in the process of visual pigment regeneration. We also consider the results obtained on the bleaching and regeneration of rhodopsin in the acutely detached retina, as well as in experiments testing the ability of IRBP to protect its retinoid ligand from isomerization and oxidation. Taken together, the findings provide evidence that, in vivo, IRBP facilitates both the delivery of all-trans retinol to the RPE and the transfer of 11-cis retinal from the RPE to bleached rod photoreceptors, and thereby directly supports the regeneration of rhodopsin in the visual cycle.

Anti-oxidized low-density lipoprotein antibodies in patients with coronary heart disease and normal healthy volunteers.

Abstract: We have developed a solid-phase enzyme immunoassay for anti-oxidized low-density lipoprotein antibodies. Most sera showed some degree of non-specific binding to plates coated with oxidized low-density lipoprotein and the autoantibodies to oxidized low-density lipoprotein often appeared to have a relatively low affinity. To differentiate between specific and non-specific binding each sample was tested untreated and after absorption with oxidized low-density lipoprotein. The optical densities obtained with dilutions of the absorbed sample were considered to reflect non-specific binding and were subtracted from values obtained with identical dilutions of the unabsorbed sample, to yield corrected values from which the concentrations of anti-oxidized low-density lipoprotein antibody were calculated. Similar absorptions with native low-density lipoprotein and oxidized human serum albumin failed to induce a significant reduction in binding to immobilized oxidized low-density lipoprotein proving that the antibodies measured by this assay are primarily specific for oxidized low-density lipoprotein. We studied sera from two groups of individuals: (1) 33 subjects submitted to coronary angiography and split into two subgroups depending on the degree of coronary stenosis and (2) 64 healthy individuals also split into two subgroups according to lipid levels. Anti-oxidized low-density lipoprotein antibodies were detected both in patients and healthy individuals. Higher levels were detected in patients with moderate coronary disease and hyperlipemic healthy individuals, but the differences between patients and healthy volunteers or between their respective subgroups did not reach statistical significance. Our results suggest that autoantibodies to oxidized low-density lipoprotein are relatively frequent in both symptomatic and asymptomatic individuals. The investigation of their potential role as a risk factor will require mass screening and long-term follow-up.

Psychiatric comorbidity in patients with generalized anxiety disorder.

Abstract: OBJECTIVE The goal of this study was to test the validity of generalized anxiety disorder as an independent diagnostic entity and to evaluate the prevalence and type of other psychiatric disorders coexisting with generalized anxiety disorder. Although a few published studies have addressed the subject, this study presents data from a larger group of subjects and excludes concurrent major depression as a potential confound. METHOD The authors studied patients with a primary diagnosis of generalized anxiety disorder assigned after evaluation with the Structured Clinical Interview for DSM-III-R. Patients with a concurrent major depressive episode were excluded. All diagnoses for which the patient met criteria were determined, including lifetime occurrence of major depressive episode and substance use. RESULTS One hundred nine patients with generalized anxiety disorder were included in the analysis. Twenty-eight (26%) of these patients were not given any other lifetime psychiatric diagnosis. The most prevalent comorbid diagnoses were social phobia (25 [23%] of the patients) and simple phobia (23 [21%] of the patients). Forty-six (42%) of the patients with generalized anxiety disorder had experienced at least one major depressive episode during their lifetime. CONCLUSIONS These results support previous findings of high rates of psychiatric comorbidity in generalized anxiety disorder and validate the usefulness of generalized anxiety disorder as a separate diagnostic entity.