Ron Jemelka

Medical and psychiatric symptoms in women with childhood sexual abuse

&NA; Although there is increasing awareness of the short‐term psychological and social adaptations to childhood sexual abuse, little is known about the long‐term effects of such abuse, particularly its effect on subsequent medical utilization and the experience and reporting of physical symptoms. We re‐analyzed data from a previous study of 100 women scheduled for diagnostic laparoscopy (50 for chronic pain, 50 for tubal ligation or infertility evaluation) who received structured, physician‐administered psychiatric and sexual abuse interviews. Women were regrouped by severity of childhood sexual abuse, and we compared the groups with respect to lifetime psychiatric diagnoses and medically unexplained symptom patterns. Unadjusted odds ratios showed that risk for lifetime diagnoses of major depression, panic disorder, phobia, somatization disorder and drug abuse, and current diagnoses of major depression and somatoform pain disorder were significantly higher in the severely abused group compared with women with no abuse or less severe abuse. Logistic regression analysis demonstrated that number of somatization symptoms, lifetime panic disorder and drug dependence were predictive of a prior history of severe childhood sexual abuse. Psychiatric disorders and medical symptoms, particularly chronic pelvic pain, are common in women with histories of severe childhood sexual abuse. Clinicians should inquire about childhood sexual and physical abuse experiences in patients with multiple medical and psychiatric symptoms, particularly patients with chronic pelvic pain.

Comorbidity of gastrointestinal complaints, depression, and anxiety in the epidemiologic catchment area (ECA) study

The purpose of this investigation is to determine if the high prevalence rates of major depression, panic disorder, and agoraphobia found in tertiary-care studies of irritable bowel syndrome and medically unexplained gastrointestinal symptoms are also found in the general population. Structured psychiatric interviews on 18,571 subjects from the NIMH Epidemiologic Catchment Area (ECA) Study were reviewed for prevalence of gastrointestinal distress symptoms and selected psychiatric disorders. Medically unexplained gastrointestinal symptoms had a high prevalence in the general population (6-25%). When compared with those reporting no gastrointestinal symptoms, subjects who report at least one of these symptoms were significantly more likely to have also experienced lifetime episodes of major depression (7.5% vs 2.9%), panic disorder (2.5% vs 0.7%), or agoraphobia (10.0% vs 3.6%). Subjects with two gastrointestinal symptoms had even higher lifetime rates of depression (13.4%), panic (5.2%), or agoraphobia (17.8%). Lifetime rates of affective and anxiety disorders in the general population are higher in subjects with gastrointestinal symptoms compared with subjects without gastrointestinal symptoms. An even higher prevalence of affective and anxiety disorders is found in patients with medically unexplained gastrointestinal symptoms in tertiary-care clinics. Future studies are needed in primary-care populations where prevalence rates of psychiatric illness are probably intermediate between those of the general population and tertiary care.

Children on child protective service caseloads: prevalence and nature of serious emotional disturbance.

A multivariate, criterion-referenced approach was used to assess prevalence of serious emotional disturbance among children on protective service case loads. Of 140 recipients of protective services, 72% were statistically indistinguishable from children in Washington States most intensive mental health treatment programs. School problems, substance abuse, and antisocial behaviors were common in the sample, as were family histories of mental illness or substance abuse. Greatest service needs included family support groups, outpatient treatment, school-based treatment, and diagnostic services. These results underline the importance of structural changes to facilitate cross-system collaboration between mental health and protective services.

Psychiatric disorders and medical care utilization among people in the general population who report fatigue

Objective: To study the prevalence of fatigue in the general population and its association with psychiatric disorders, somatization, and medical utilization.Setting: The public-use data tape from the 1984 National Institute of Mental Health Epidemiologic Catchment Area Study.Participants: Household sample of 18,571 subjects.Interventions: Structured psychiatric interviews were reviewed to study the prevalences of complaints of current and lifetime fatigue and their relationship to selected psychiatric disorders.Results: Fatigue has high current (6.7%) and lifetime (24.4%) prevalences in the general population. Medically unexplained fatigue also has high current (6.0%) and lifetime (15.5%) prevalences. When compared with those reporting no current fatigue, subjects who reported current (one-month) fatigue were significantly more likely to have experienced current and lifetime episodes of major depression, dysthymic disorder, panic disorder, and somatization disorder. They also had significantly higher mean numbers of lifetime and current DSM-HI psychiatric diagnoses, medically unexplained physical symptoms (not just fatigue-related symptoms), and visits to health care providers than did patients without current episodes of fatigue.Conclusions: The high prevalence of fatigue in the general population appears to be significantly associated with increased lifetime and current risk for affective, anxiety, and somatoform disorders, as well as increased utilization of medical services. These data suggest that assessment of both medical and psychological health may be essential for the proper care of patients with fatigue.

The prevalence of chronic pelvic pain and irritable bowel syndrome in two university clinics

AbstractVery little is known about the prevalence of chronic pelvic pain or its comorbidity with irritable bowel syndrome. In order to obtain a prevalence estimate of chronic pelvic pain, a questionnaire was given to 651 women in two university clinics. Approximately 38% of the women had a lifetime prevalence of chronic or intermittent pelvic pain, and 12% reported current pain. Women with pelvic pain were also significantly more likely than women without pain to express other pain and aversive symptoms such as bowel problems, menstrual and sexual dysfunction, and to have higher psychological distress scores on the General Health Questionnaire. Of the 250 women who reported pelvic pain, 79% also met criteria for probable irritable bowel syndrome. Patients meeting criteria for both chronic pelvic pain and irritable bowel syndrome were more likely to have relatives with pain, meet caseness criteria for psychiatric diagnosis on the General Health Questionnaire and had a greater number of other types of pain ...

Forecasting Recidivism in Mentally Ill Offenders Released From Prison.

Little research has focused on assessing the risk of mentally ill offenders (MIOs) released from state prisons. Here we report findings for 333 mentally ill offenders released from Washington State prisons. Logistic regression identified sets of variables that forecasted felony and violent reconviction as accurately as state-of-the-art risk assessment instruments. Sums of simple recoded versions of these variables predicted reoffense as well as complex logistic regression equations. Five of these 9 variables were found to be relative protective factors. Findings are discussed in terms of the value of stock correctional variables in forecasting risk, the need to base actuarial risk assessments on local data, the importance of protective factors in assessing MIO risk, and the need for dynamic, situational, and clinical variables that can further sharpen predictive accuracy of emergent risk in the community.

When Inmates Misbehave: The Costs of Discipline

Reduction of infraction rates may serve as one measure of the efficacy of in-house treatment programs for psychologically disturbed inmates. To address the related issue of cost-effectiveness, the authors analyzed the costs of infractions at a medium-security prison, yielding an estimated average cost of

An Open Trial of Nortriptyline in Women with Chronic Pelvic Pain

970 per infraction. These fixed costs do not respond to marginal changes in numbers of infractions but help to estimate the additional system costs that successful treatment may prevent in the long run. Like the costs of imprisonment in the free community, these costs need to be considered in disciplinary and treatment policies within prisons.

EVALUATING THE EFFECTIVENESS OF RESIDENTIAL TREATMENT FOR PRISONERS WITH MENTAL ILLNESS

Although antidepressants have been used in the management of several types of chronic pain there have been no systematic trials of these medications in women with chronic pelvic pain. The authors report on the use of nortriptyline in fourteen women with chronic pelvic pain. Seven women dropped out of the study. These seven subjects were significantly different from the treated group only in lower tolerance of antidepressant side effects. Six of the seven treated subjects reported complete or partial relief from pain. Fifty seven percent of the drop-outs and the one nonresponding treated subject had histories of childhood sexual abuse. This open trial suggests that antidepressants may be effective in the treatment of some women with chronic pelvic pain. However, the frequent association of sexual abuse with this disorder indicates that accepted treatment trial designs may need to be altered.

Living in Prison After Residential Mental Health Treatment: A Program Follow-Up

An intermediate-care residential program for mentally ill male prison inmates in Washington provides medication monitoring, skills training, and a supportive milieu to help participants cope with life in prison. Participants were substantially less symptomatic when they left the program than when they entered. Comparisons of preprogram and postprogram behavior showed significant reductions in staff assaults, infractions, and use of expensive resources, as well as higher rates of work and school participation. A minority of inmates continued to be difficult to manage despite program interventions. Effectiveness measures are discussed in relation to the obligation to provide medically necessary care to inmates with severe mental illness.