Help-seeking patterns of community residents with depressive symptoms.

From a community sample, fifty-five individuals identified as having three or more symptoms of depression were asked if and where they had sought help and how they found or would find treatment. Only 20 subjects (33.9%) reported having sought professional help. No demographic differences were found between help-seekers and non-help-seekers. Eighty percent of the help-seekers had seen a mental health professional while 20% had seen a non-psychiatric physician. However, non-psychiatric physicians and friends or personal acquaintances were most frequently cited as the first point of contact for locating treatment. Results suggest that most individuals with a moderate number of depressive symptoms do not seek professional assistance but that, among those who do, a majority is eventually seen by a mental health professional. Virtually all utilize intermediaries other than mental health professionals, however, to locate assistance. The non-psychiatric physician plays a prominent role in locating help for depressed individuals, which suggests the need to educate physicians about appropriate treatment referral.

Prevalence of various depressive symptoms in a sample of the general population.

Data on prevalence of and demographics associated with various symptoms of depression are reported for a sample of the general population. Of the nine symptoms assessed, the most frequently occurring were dysphoric mood (17.8%), increased sleep (15%), and loss of interest in other people or activities previously enjoyed (11.8%). 39% of subjects reported one or more symptoms of depression. 8% of subjects reported wondering if life is worth living, a symptom that in and of itself is suggestive of clinically significant depression. The number of depressive symptoms reported was related to income, education, age, and residence (city versus county), but not to sex. The findings provide evidence that various symptoms of depression may be more common in the general population than previously suspected.

Three types of obsessive compulsive disorder in a community sample.

Until recently, prior estimates of the prevalence of obsessive compulsive disorder (OCD) have been based on clinical data. The present investigation studied point prevalence and demographic data that pertain to three ritual-based forms of OCD in a sample of the adult general population of the greater St. Louis area. Two hundred fifty male and 247 female subjects were administered a structured interview designed to identify the presence of symptoms associated with OCD according to DSM-III criteria. The overall prevalence rate of OCD was 2.8%. The most prevalent form of OCD involved checking (1.6%), followed by a miscellaneous category that included repeating, counting and collecting rituals (1.0%) and, finally, washing compulsions (.8%). Subjects with OCD did not differ demographically from the rest of the sample except that they were more likely to live in the city. Results indicate that OCD is more prevalent than previously supposed and that checking compulsions may be the most common form of ritual in nonclinical samples.

Four types of social phobia in a community sample.

Point prevalence rates and demographic characteristics associated with four specific forms of social phobia (public speaking/performing, writing in front of others, eating in restaurants, and use of public restrooms) were examined in a sample of adult residents of the greater St. Louis area. Diagnoses were determined by structured interview in accordance with DSM-III criteria. An unadjusted prevalence rate of 22.6% was found for all four social phobias combined. Application of DSM-III significant distress criteria resulted in a prevalence rate of 2.0%. Public speaking/performing phobias were by far the most common (20.6%). Prevalence rates of 2.8%, 1.2%, and 0.2% were found for phobias related to writing, eating, and use of public restrooms, respectively. Social phobias were more common among women than men. No other demographic differences were found between social phobics and the rest of the sample. Results of this study suggest a higher prevalence of social phobia than has been indicated by prior research. Explanations for and implications of these findings are discussed.

Effects of depression upon reading: a case for distinguishing effortful from automatic processes.

This study was designed to test the view that depression would have selective effects upon effortful but not automatic aspects of reading. Relationships were determined between 59 fifth graders' depression scores (on the Children's Depression Inventory and a teacher's rating of depression) and their performance on measures of automatic aspects of reading (word recognition and word attack skills) and effortful aspects of reading (comprehension). A stepwise multiple regression, using statistical controls for sex and mental ability, showed expected relationships of depression to over-all comprehension for the 7 teachers' ratings, but not for the inventory. As expected, relationships of depression to word recognition and word attack scores were statistically non-significant.

An NMR study of lithium responding manic depressive patients.

Manic depressive patients on long-term prophylactic therapy with lithium carbonate are examined by nuclear magnetic resonance imaging of the brain. Their ventricular brain ratios and cerebral grey and white matter spin lattice relaxation times (T1) are within normal limits. The implication of these findings in the light of previous studies using other techniques is discussed.

Teaching Medical Students How to Talk with Patients about Cardiovascular Risk Factor Modification.

Although medical students are increasingly taught about the nature and importance of cardiovascular risk factors, they are less often taught how to talk about them with patients and how to encourage patients to modify certain behaviors (e.g., smoking), which are associated with high risk for cardiovascular disease. The authors describe a short educational module designed to help third year psychiatry clerks learn some practical, patient-oriented aspects of preventive cardiology. From a small group discussion that encourages active participation, students learn to assess and explore environmental factors, skill deficits, cognitive distortions and emotions that may prevent patients from changing high-risk behavior. Strategies for change are then suggested, discussed and assessed for effectiveness in sample situations. This type of module is readily adoptable into most medical school psychiatry curricula and, if widely used, could promote the necessary skills to effectively change high-risk behaviors and lead to a further reduction in cardiovascular disease.

Value of a single night-time dose of potassium clorazepate in anxiety: a controlled trial comparison with diazepam.

A total of 29 patients with anxiety or anxiety/hysteria, participated in a double-blind, cross-over trial of two benzodiazepine anxiolytics, diazepam and potassium clorazepate. The problems of a 'carry-over' effect and a possible order of drug administration effect are discussed in relation to analysis of results. Clorazepate proved the more effective drug, as shown by a reduction in total symptom scale of Kellner Symptom Rating Test and the reduction in sub-scales for anxiety, depression, somatic complaints and general neurotic symptoms with parallel symptom reduction in linear analogue scales. Side effects were infrequent with both drugs and posed no clinical problem. Potassium clorazepate in a single nightly dose of 15 mg proved to be more effective than thrice daily (5 mg) diazepam.

Economic and laboratory considerations in screening for vitamin B12 deficiency in psychiatric practice.

Two alternative methods for detecting vitamin B(12) deficiency in a psychiatric population have been compared: the ;direct' approach by microbiological assay of serum vitamin B(12) levels in all patients, and the ;indirect' approach where all patients are first screened for antigastric parietal cell antibodies and thereafter all positive reactors and other ;high-risk' patients have serum vitamin B(12) assayed. The indirect approach was found to be cheaper.