William R. Yates

Prevalence of DSM-III personality disorders in the community

SummaryA community sample of adults with a standardized DSM-III, Axis II self-report instrument yielded an age adjusted community prevalence of 11.1% of DSM-111 personality disorders. When those with personality disorders (PDs) (n = 26) were compared to those without personality traits (n = 467) the PD group had less education 14.9 (3.0) years vs 16.5 (3.3) years,p = 0.02) and a greater percentage with difficulty with alcohol (19% vs 0.6%,p = 0.0001). Of those married, more 1 PDs reported marital difficulties (29% vs 3.5%,p = 0.002). There was a trend for the PD group to have longer unemployment (p = 0.07).

Psychosexual effects of three doses of testosterone cycling in normal men.

BACKGROUND Testosterone is receiving increased attention for contraceptive and therapeutic indications. The potential psychosexual side effects of testosterone therapy and withdrawal are unclear. METHODS Healthy men between the ages of 21 and 40 years were recruited via advertisement for a randomized, controlled, double-blind study of acute and withdrawal effects of three doses of testosterone. Two weeks of placebo injections were followed by one of three randomized weekly doses of testosterone cypionate (100 mg, 250 mg, or 500 mg) for the next 14 weeks. Twelve weeks of placebo injections followed during the withdrawal phase of the study. Psychosexual effects were monitored throughout the study. RESULTS All doses of testosterone demonstrated only minimal effects on measures of mood and behavior during acute and withdrawal phases for all study completers. There were no effects on psychosexual function. There was no evidence of a dose-dependent effect on any measure. One noncompleter on 500 mg of testosterone developed a brief syndrome with symptoms similar to an agitated and irritable mania. CONCLUSIONS Doses of testosterone up to five times physiologic replacement dose appear to have minimal risk of adverse psychosexual effects in the majority of normal men; however, beginning at around 500 mg per week of testosterone cypionate, a minority of normal men may experience significant adverse psychological effects. Because illicit anabolic steroid users may use larger doses of multiple drugs under less restrictive conditions, our study may significantly underestimate the psychological effect of steroid use in the community.

Illicit anabolic steroid use in athletes A case series analysis

Because of recent anabolic steroid abuse scandals at all levels of athletic competition ranging from high school sports to the 1988 Olympics in Seoul, Korea, the investigators closely examined the anabolic steroid use histories of 20 competitive and noncompetitive weight lifters. Steroid efficacy studies only examine the anabolic effects of individual drugs. However, these 20 steroid users consistently practiced polypharmacy. During steroid use cycles lasting between 7 and 14 weeks, athletes commonly used two or three oral agents and two long-acting injectable products. Dos ages of oral preparations tended to be similar to those used in efficacy studies, whereas dosages of the long- acting injectable agents were approximately three to eight times greater than those used in controlled stud ies. Subjects reported significant increases in body weight and strength. In addition, mental status changes were reported that included symptoms of depression, hostility, aggression, and paranoia. Based on the pat tern of anabolic steroid use currently being practiced in the United States, it is apparent that past efficacy and toxicology studies are of limited value in delineating the benefits and hazards of these drugs.

Effect of exogenous testosterone on prostate volume, serum and semen prostate specific antigen levels in healthy young men

PURPOSE We investigate and define the effects of exogenous testosterone on the normal prostate. MATERIALS AND METHODS A total of 31 healthy volunteers 21 to 39 years old were randomized to receive either 100, 250 or 500 mg. testosterone via intramuscular injection once a week for 15 weeks. Baseline measurements of serum testosterone, free testosterone and prostate specific antigen (PSA) were taken at week 1. Semen samples were also collected for PSA content and prostate volumes were determined by transrectal ultrasound before testosterone injection. Blood was then drawn every other week before each testosterone injection for the 15 weeks, every other week thereafter until week 28 and again at week 40. After the first 15 weeks semen samples were again collected, and prostate volumes were determined by repeat transrectal ultrasound. RESULTS Free and total serum testosterone levels increased significantly in the 250 and 500 mg. dose groups. No significant change occurred in the prostate volume or serum PSA levels at any dose of exogenous testosterone. Total semen PSA levels decreased following administration of testosterone but did not reach statistical significance. CONCLUSIONS Despite significant elevations in serum total and free testosterone, healthy young men do not demonstrate increased serum or semen PSA levels, or increased prostate volume in response to exogenous testosterone injections.

Postmastectomy reconstruction: comparative analysis of the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous flap versus breast implant reconstruction.

Over 40,000 postmastectomy breast reconstructions are performed annually. In this study, we investigated the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous (TRAM) flap versus breast implant reconstruction. Thirty-three women who had undergone postmastectomy breast reconstruction were contacted by telephone and agreed to participate in the study. Twenty-two women completed the self-assessment questionnaires regarding their quality of life, psychological symptoms, functional status, body image, and global satisfaction. The TRAM and implant groups contained 8 and 14 patients, respectively. The groups were well matched for age, employment status, marital status, race, religion, and severity of medical and surgical illnesses. The average follow-up was 36 months. Statistical analysis of the responses revealed that women who had undergone TRAM flap reconstruction were more satisfied with how their reconstructed breast felt to the touch (p=.01), and there was a trend toward greater satisfaction with the appearance of their reconstructed breast (p=.08). However, these same patients identified more difficulties as far as functioning at work or school, performing vigorous physical activities, participating in community or religious activities, visiting with relatives, and interacting with male friends (p<.04). There were no statistically significant differences in body image or overall satisfaction. In this small cohort study, both the TRAM flap group and the implant group were satisfied with the results of their breast reconstruction, but the TRAM flap group was more satisfied with how their breast felt and tended to be more satisfied with the cosmetic result. The TRAM flap group reported greater psychological, social, and physical impairments as a result of their reconstruction.

An adoption study of drug abuse/dependency in females.

In a sample of 102 women who had been adopted at birth, drug abuse/dependency was found by log-linear analyses to have a major pathway of genetic etiology that started with a biologic parent with antisocial personality and led to an adoptee with conduct disorder and then through aggressivity to drug abuse/dependency, as well as from conduct disorder directly to drug abuse. This result was similar to findings from a male sample collected from the same agencies and at the same time, wherein antisocial biologic parents produced aggressive and conduct-disordered off-spring, who in turn became drug abusers/dependents as adults. Results are compatible with family studies demonstrating that female drug abusers stem from deviant families and themselves demonstrate socially deviant behavior early in life. The present study shows that one element of familial factors is genetic, and that, in addition, the family environment directly affects behavior (aggressivity) that leads to drug abuse/dependency.

Psychiatric Symptoms Associated with Anabolic Steroids: A Controlled, Retrospective Study

AbstractThis investigation characterized the symptom patterns and mental status changes precipitated by anabolic steroid abuse. Twenty male weightlifters who were currently using anabolic steroids were compared to 20 male weightlifters who had never used steroids. The steroid users had significantly (p < 0.005) more somatic, depressive, anxiety, hostility, and paranoid complaints when using steroids than when they were not using the drugs. When contrasted to the weightlifter controls, the steroid users had a significantly (p < 0.005) greater number of complaints of depression, anxiety, and hostility during cycles of steroid use. However, no differences in the frequency of major mental disorders were found between the two groups. It is concluded that the organic affective changes associated with anabolic steroid abuse usually present as a subsyndromal depressive disorder of insufficient severity to be classified as a psychiatric disorder.

Rate of inpatient weight restoration predicts outcome in anorexia nervosa.

OBJECTIVE To examine weight restoration parameters during inpatient treatment as predictors of outcome in anorexia nervosa (AN). METHOD Adolescent and adult females admitted for inpatient eating disorder treatment were recruited for an ongoing longitudinal study. This analysis examined several weight restoration parameters as predictors of clinical deterioration after discharge among participants with AN. RESULTS Rate of weight gain was the only restoration parameter that predicted year 1 outcome. Clinical deterioration occurred significantly less often among participants who gained >or=0.8 kg/week (12/41, 29%) than those below this threshold (20/38, 53%) (chi(2) = 4.37, df = 1, p = .037) and remained significant after adjustment for potential confounders. DISCUSSION Weight gain rate during inpatient treatment for AN was a significant predictor of short-term clinical outcome after discharge. It is unclear whether weight gain rate exerts a causal effect or is rather a marker for readiness to tolerate weight restoration and engage in the recovery process.

Cardiovascular risk factors in affective disorder

100 patients with affective disorder (unipolar affective disorder and bipolar affective disorder) were evaluated for evidence of increased risk for the major cardiovascular risk factors including hypertension, hypercholesterolemia, obesity, and cigarette use. Unipolar affective disorder patients showed no evidence of increased cardiovascular risk compared to population controls. Bipolar affective disorder patients displayed increased systolic blood pressure, definite hypertension, and use of cigarettes. These findings are consistent with a link between affective disorders and excess cardiovascular mortality.

The Academy of Psychosomatic Medicine Practice Guidelines for Psychiatric Consultation in the General Medical Setting

This practice guideline seeks to provide guidance to psychiatrists who regularly evaluate and manage patients with medical illnesses. The guideline is intended to delineate the knowledge base, professional expertise, and integrated clinical approach necessary to effectively manage this complex and diverse patient population. This guideline was drafted by a work group consisting of psychiatrists with clinical and research expertise in the field, who undertook a comprehensive review of the literature. The guideline was reviewed by the executive council of the Academy of Psychosomatic Medicine and revised prior to final approval. Some of the topics discussed include qualifications of C-L consultants, patient assessment, psychiatric interventions (e.g., psychotherapy, pharmacotherapy), medicolegal issues, and child and adolescent consultations.