Comparison of blood pressure between Indiana AMA and NMA members.

OBJECTIVE: 1) To determine whether African-American physicians, compared to caucasian physicians, were at increased risk to develop hypertension; and 2) to determine whether physicians' knowledge of cardiovascular risk factors influenced their pattern of exercise. DESIGN: A mailed survey of members of the American Medical Association (AMA) and the National Medical Association (NMA) was completed to assess health status and plans for retirement. RESULTS: High-normal blood pressure was defined as systolic blood pressure of 85-89 mmHg. Mild (stage-1) hypertension was defined as systolic blood pressure of 140-159 mmHg and diastolic blood pressure of 90-99 mmHg. Gender (male), age, and body mass index (BMI) were significantly correlated with elevated levels of selected blood pressure measures. Using regression analysis to control for gender, age, and BMI, ethnicity was identified as a fourth factor accounting for elevated blood pressure. NMA physicians had 3.25 times the risk of having systolic blood pressure in the mild (stage-1) hypertension range, 5.78 times the risk for blood pressure in the high-normal diastolic hypertension range, and 5.19 times the risk for blood pressure in the mild (stage-1) diastolic hypertension range. Medical specialty and type of psychological support were not significant predictors of elevated blood pressure. CONCLUSION: These data suggest that African-American physicians may be at an increased risk to develop abnormal blood pressure, compared to caucasian physicians, potentially affecting the number of physicians available to minority communities.

A conceptual model of cultural predictors of anxiety among Japanese American and part-Japanese American adolescents.

A model integrating Japanese ethnicity, cultural identity, and anxiety was developed and assessed in Japanese American and part-Japanese American high school seniors (N = 141). Using measures from the Hawaiian High Schools Health Survey, the model incorporated the State-Trait Anxiety Inventory, the Major Life Events Scale, and the Japanese Culture Scale (JCS). Japanese American adolescents scored higher on the JCS and reported fewer anxiety symptoms than part-Japanese American adolescents. Predictors for anxiety were being Japanese American versus part-Japanese American, income, and culturally intensified events. A significant interaction of behavior by self-identification was obtained. The model had good overall fit, suggesting that cultural identity formation may contribute to anxiety experienced particularly by adolescents of mixed heritage.

Association between reported education and intellectual functioning in an ethnically diverse adult psychiatric inpatient sample.

Patients' pre-existing survival skills, educational attainment, and intellectual functioning should be included in the development and implementation of treatment planning for adult psychiatric inpatients. When considering culturally diverse inpatient populations with possible cultural and language barriers, these variables may attain additional importance. Utilizing a sample (N = 60) primarily consisting of Asian/Pacific Islander inpatients, the present study investigated: (a) the rate at which professionals from different disciplines inquired about educational attainment; (b) the association between self-reported education and standardized measures of intelligence; and (c) the correspondence between different IQ scores. Axis 1 diagnoses included schizophrenia (N = 19; 32%), schizoaffective disorder or bipolar disorder (N = 23; 38%), and organic or substance-related disorders (N = 18; 30%). Thirty-five percent of the sample (N = 21) had dual diagnoses. The results indicated that only psychologists who administered IQ tests consistently inquired about educational attainment. An expected overall positive association between self-reported education and standardized intelligence measures was found. High correlations between the Test of Nonverbal Intelligence, 2nd edition (TONI-2) and Wechsler Adult Intelligence Test-Revised (WAISQ-R) IQs suggested that both tests were valid in the assessment of intellectual functioning. Implications included the need for more systematic assessment and incorporation of pre-existing skill-based information and the utility of self-reported education and different measures of intellectual functioning (including TONI-2).

Diagnosing depression in African Americans.

Since the 1970s, articles have noted the increased presence of psychotic symptoms among depressed African Americans, the presence of diagnostic bias identified when structured clinical interviews are used, and the identification of misdiagnosis of affective illness among chronically, mentally ill, African Americans. This paper reviews this literature and describes three alternative presentations of depressive illness among African Americans that differ from the DSM IV criteria for Major Depressive Disorder: "the stoic believer," "the angry, 'evil' one" with a personality change, and "the John Henry doer." Clinicians are encouraged to recall these presentations of depression when evaluating African American patients.

Substance abuse and dependence in a public hospital: Hawaii.

UNLABELLED: A pilot study of the prevalence of substance abuse disorders was completed on the only open unit of the only state psychiatric hospital in Hawaii to address the following questions: 1) What were the substances of abuse and dependence in this population? 2) What was the pattern of abuse and/or dependence in this sample? 3) How did these patterns compare to the patterns observed in the published literature? 4) What was the predominant Stage of Change of these patients? 5) Was the staff perception that these patients were in denial an accurate perception? METHODOLOGY: All patients admitted to the unit between 1st June and 31st August 1999 comprised the sample, N = 35. Each patient was assigned diagnoses based upon the DSM-IV criteria and level of change was assessed. RESULTS: The demographic characteristics of the sample follow: 60% were ages 20-39, 89% were male; 92% were currently single, 71% had an education of high school or college, and 66% had a diagnosis of schizophrenia or schizoaffective disorder. The racial composition reflected the diversity of Hawaii. Although 20% of the sample had no substance abuse problem, 66% of the remaining patients were multiply dependent upon alcohol, cannabis, crystal methamphetamine, or cocaine with 48% of these patients in the Precontemplative Stage of Change (denial). The patterns of multiple substances of abuse and dependence were higher than in the reported literature. Further studies are needed.

The Kulia Program: psychiatric rehabilitation in Hawaii.

The Kulia Program was a culturally oriented, psychiatric rehabilitation program. It was developed in the only in-patient psychiatric hospital serving the 2 million multi-ethnic residents of the island state of Hawaii. From 1992-1999 the Kulia program was implemented on the only open, 36-bed unit of the Hawaii State Hospital with the mission of facilitating the reintegration of the chronically mentally ill into the community by encouraged its patients "to strive for the highest." Of the 238 patients discharged between 1992 and 1999 only 7% were re-hospitalized. Comparisons with other four treatment units during this period were not appropriate because of the difference in patient populations. These units provided long-term institutionalization of the criminally mentally ill, the behaviorally disoriented, mentally retarded and/or traumatically brain injured, and the behaviorally disoriented demented elderly. Their lengths of stay varied from 8 years to over 20 years in the hospital during this time period.

Two-year outcomes of psychosocial rehabilitation of black patients with chronic mental illness.

OBJECTIVE: Outcome as measured by psychosocial functioning was examined in a two-year follow-up study of 46 patients with chronic mental illness, 44 of whom were African American, who participated in an intensive psychosocial rehabilitation program based in a community mental health center. METHODS: Patients attended a program that operated seven days a week in a predominantly urban, black section of Baltimore. Level of functioning was determined at baseline and at six and 12 months using a scale based on data from the 1972 International Pilot Study of Schizophrenia. Parameters assessed included the length of time patients stayed out of the hospital, the frequency and depth of social relationships, dysfunction in work, the presence of symptoms, the ability to maintain personal hygiene, and the ability to participate in leisure activities. RESULTS: The sample was divided into three diagnostic groups: patients with schizophrenia alone (N=27), patients with a mood disorder (N= 12), and patients with a dual diagnosis of schizophrenia and a substance use disorder (N=7). Scores on the level-of-functioning measure were significantly correlated between baseline and six months, between six months and 24 months, and between baseline and 24 months. Statistical tests indicated a substantial and significant increase in level of functioning from baseline to 24 months for all groups. CONCLUSIONS: The results provide evidence for the effectiveness of an intensive psychosocial rehabilitation program for urban, black patients with chronic psychiatric illness, including those with a dual diagnosis.

Issues in the psychiatric treatment of African Americans.

African Americans constitute about 12 percent of the United States population. Sixty percent of African Americans live in urban areas, and 25 percent have incomes below the poverty level. Issues in the psychiatric assessment and evaluation of African-American patients include diagnostic bias that has resulted in overdiagnosis of schizophrenia. Use of screening instruments can help standardize assessment, but appropriate screening instruments that have been evaluated and found reliable in this population must be used. Issues in treatment and outcome for African Americans include challenges in establishing rapport in interethnic situations, racial identity as a focus in psychotherapy, and awareness of biological characteristics that affect response to medications. Many African Americans live in high-crime areas where high rates of drug abuse and violence create chronic stresses. Patients with dual diagnoses of chronic mental illness and substance use or abuse need targeted interventions. Strategies for prevention and treatment of the effects of having experienced or witnessed violence have been proposed. Additional research is needed to clarify the true prevalence of specific mental disorders among African Americans and to determine the most effective combinations of treatment strategies for various disorders.

Ommoord district residents: prevalence and treatment of depression.

BACKGROUND: Ommoord District residents of Rotterdam, The Netherlands, age 55 and older, completed a two-stage interview to assess the risk factors for chronic disease and disability. METHODS: In the in-home Stage I interview (N = 7,983), demographic data and medical history were collected by a trained lay interviewer. During Stage II, a physician interview and examination were conducted at the study center. Subjects (N = 7,129) were asked about their history of psychiatric disorders and 6,596 responded. RESULTS: The lifetime prevalence of self-reported psychiatric disorders was 5.44% for unipolar and bipolar depressive disorders combined, 0.27% for psychotic disorders, 0.08% for alcoholism, 0.05% for drug addiction, and 3.71% for other diagnoses. Residents reporting a psychiatric diagnosis of depression were more likely to be currently taking an antidepressant medication (p < .001) and an antipsychotic medication (p < .0001), to be in current outpatient treatment (p < .001), to have been hospitalized for psychiatric illness (p < .001), to have undergone electroconvulsive treatments (p < .001), and to report a history of having made suicide attempts (p < .001). CONCLUSION: The self-reported lifetime prevalence of affective disorders was similar to the rates found in the Stirling County Study (Canada) and the Epidemiologic Catchment Area Survey (United States). The lower prevalence rates of the other psychiatric disorders may reflect underreporting or an age cohort effect, or may be due to the nonresponse bias.

Delirium episodes during the course of clinically diagnosed Alzheimer's disease.

A retrospective review was conducted of 122 charts of patients with clinically diagnosed Alzheimer's disease (CDAD) who had participated in a longitudinal dementia study at the Mayo Clinic from 1965 to 1970. DSM-III-R diagnoses were assigned based on the longitudinal description of symptoms detailed in the Mayo Clinic medical records of the hospitalizations; clinic, home, and nursing home visits; and state hospital admissions. Thirty patients (25%) were found to have a delirium episode during their course of CDAD that occurred during inpatient admissions; 50% (15 of 30) of the delirium episode occurred in patients ages 80 to 89. Among patients with a delirium episode, 50% died within one year of the delirium episode and 64% died within two years. Of 13 patients, 10 (77%) had multiple delirium episodes within two years. Admitting diagnoses were mainly primary degenerative dementia of the Alzheimer's type (PDDAT) or PDDAT with delirium. Only 3 (10%) demented patients experienced delirium episodes during a medical admission. No deaths occurred during hospitalization for the years covered by this study. A psychiatric consultation was requested in only 17 (14%) patients; 88% of these patients received diagnoses involving PDDAT, late onset. An additional diagnosis included depressive disorders. Psychopharmacology was the major management strategy (82% of patients with a delirium episode received medication) with a resolution of symptoms within 48 hours. At discharge, only 2 (7%) patients failed to clear the increased degree of confusion.

A study of familial aggregation of depression, dementia and Parkinson's disease.

Depression is often accompanied by other disorders including Alzheimer's disease and Parkinson's disease. We studied the familial aggregation of these disorders in order to examine the possibility of a shared genetic origin. In a population-based study of 6596 subjects, we studied the association of self-reported depression, which required treatment by a psychiatrist, to family history of psychiatric disease, dementia, and Parkinson's disease. A family history of psychiatric disease was significantly associated with overall depression as well as with unipolar (n = 303 patients) and bipolar (n = 27 patients) depression. The risk of unipolar depression was associated with the presence of two or more demented individuals among their first degree relatives (e.g. parents, siblings and children). Since there was no evidence for familial aggregation in subjects with only one demented relative, our study suggests that unipolar depression may be associated specifically to a strongly familial, form of dementia. The risk of bipolar depression was increased for those with one or more relatives with dementia and, perhaps, for those with relatives with Parkinson's disease. The familial aggregation of depression with dementia and perhaps Parkinson's disease suggests that there may be shared susceptibility gene(s) underlying these diseases. Our study indicates further that there may be differences in the genetic etiology between unipolar and bipolar depression.

Characteristics of depressive symptoms in elderly urban and rural African Americans.

BACKGROUND: Despite considerable progress in the epidemiology of late life depression, little data have been documented in the scientific literature on depressive symptoms among elderly African Americans. The present investigation identifies characteristic symptoms of depression in African American community-resident elders. METHOD: Ninety-six African American men and women aged 60 years and older, with equal representation from urban and rural counties in west Tennessee, composed the sample. The sample was stratified in each of the two counties into three age categories; 60-69, 70-79, and 80 and older. Data from the Center for Epidemiological Studies-Depression scale were compared with the association of medical illness, medication use, social network, level of physical function in activities of daily living, and demographic characteristics. RESULTS: Residents screening positive for the presence of depressive symptoms showed an increased report of hypertension (p < .036), arteriosclerosis (p < .035), and circulatory problems (p < .008). There was an increased report of symptoms of depression among those who had six or more different chronic illnesses (p < .001) and among those who reported using four or more different prescription medications in the past month for chronic illnesses (p < .015). Regression analyses of data indicated that medical illness (p < .001) and social network (p < .041) were the most important predictors of depressive symptoms among residents. CONCLUSIONS: Considering the projected increase of African Americans reaching age 60, and because depressive illness is an important public heath concern, early identification of salient risk factors for depression is critical in instituting early intervention programs for the ethnic minority elderly population.

Survey of the cross-cultural content of U.S. psychiatry residency training programs.

To establish the extent of cross-cultural content contained in the 224 psychiatric residency training programs, the Directors of Residency Training were surveyed by mail. Thirty-seven percent (N = 83) of Directors responded; 92% (N = 76) had cross-cultural content, 99% (N = 82) had opportunities to work with minority patients, and 77% (N = 64) had supervision by some minority faculty. Responding programs reported a need for teaching videotapes (85%, N = 71), cross-cultural references (78%, N = 65), academic psychiatrists familiar with different cultural groups (76%, N = 63), and cross-cultural supervision (75%, N = 62).

A Spanish version of the geriatric depression scale in Mexican-American elders.

OBJECTIVE: The purpose of this study was to establish the sensitivity of a Spanish translation of the 15-item Geriatric Depression Scale (GDS-S) in a sample of 41 elderly Mexican-American psychiatric patients with a diagnosis of depressive disorders. METHOD: Utilizing the reverse translation technique and bilingual Mexican-American psychiatrists as evaluators, patients with DSM-III-R diagnoses of affective disorder who were sequential admissions to an inpatient psychiatric unit were enrolled in the study. The GDS-S was administered by trained interviewers within 2-4 weeks of admission to 28 patients with major depressive disorder (MDD) and 13 patients with other depressive disorders (ODD). No other screening instruments for depressive symptoms were used. RESULTS: Using the original cut-scores of GDS, the sensitivity was 39% in patients with MDD and 77% in patients with ODD. When a revised cut-score of 4 and above was identified as reflective of depressive symptoms, the sensitivity improved to 75% for patients with MDD and 85% for patients with ODD. Because there were no true negatives, specificity was not determined. CONCLUSIONS: The GDS-S may have limited value in screening community-resident Mexican-American elders for depressive symptoms unless they have significant medical problems which limit their function and are associated with a dysthymic disorder. Screening instruments for depression which include neurovegetative or somatic items may be a better choice in this population.

Screening African-American elderly for the presence of depressive symptoms: a preliminary investigation.

Several authors have reported that older African-Americans with multiple medical problems and decreased activities of daily living are at an increased risk of reporting symptoms of depression. African-Americans were more likely to report symptoms of anger, irritability, denial of illness, and to spontaneously report symptoms that did not reflect a change in mood, but rather forbearance of a difficult time or somatic complaints. This paper describes the results of a study to assess the presence of depressive symptoms in older African-American community residents. A new instrument, the Baker Belief Scale, is compared with the Center for Epidemiologic Studies-Depression Scale (CES-D) and the association of medical illnesses, social network, and level of physical function in activities of daily living (ADL). Ninety-six African-American men and women, aged 60 years or older, with equal representation from urban and rural counties in western Tennessee comprised the sample. The sample was stratified, in each of the two counties, into three age categories; 60-69, 70-79, and 80 years and older. A screening battery consisting of the Short Portable Mental Status Questionnaire, the CES-D, the Lubben Social Network Scale, and the Katz ADL were administered to the sample. Current medical illnesses were recorded with demographic data. There was a significant association between the CES-D score and the BBS score for those who screened positive for symptoms of depression. In addition there was a significant relationship between CES-D score and specific medical illnesses, social network, physical function in ADL, and residence (urban vs. rural). Residents who screened positive (N = 19) for depressive symptomatology with CES-D scores of 16 or higher exhibited a higher frequency of hypertension, arteriosclerosis, and circulatory problems than those who tested negative (N = 77). More urban residents (N = 13) than rural residents (N = 6) screened positive for symptoms of depression. Approximately 21% (N = 20) of the 96 respondents had scores of 20 or less on the Lubben Social Network Scale, suggesting a group of "at risk" for social isolation.