Heart rate and blood pressure in panic disorder, major depression, and comorbid panic disorder with major depression.

Secondary major depression is common in patients with panic disorder (PD) and has been reported to worsen prognosis. Little is known about the effect of comorbid depression on the autonomic symptoms associated with PD. In this study, the heart rate and blood pressure of 44 patients with PD, 20 patients with major depression (MD), and 12 patients with both panic disorder and depression (PDD) were measured during postural challenge. Patients with PDD were found to have higher diastolic and systolic pressures throughout (P < 0.05), and to have a higher resting cardiac load (P < 0.05). This heightened autonomic arousal remained when the effects of age, race, and the frequency of panic attacks were removed. The results suggest that PDD patients may have increased autonomic dysfunction.

Gay and lesbian issues in child and adolescent psychiatry training as reported by training directors.

OBJECTIVE: Although increased evidence of disproportionate psychosocial risk and other health problems encountered by lesbian, gay male, and bisexual (LGB) youths has emerged, no study has described how the topic of homosexuality is addressed within child and adolescent residency psychiatry training. METHOD: Residency training directors in U.S. child and adolescent psychiatry programs were asked questions about instruction on the topic of homosexuality and the care of LGB patients, the department's view of whether homosexuality represents a pathological condition, the director's awareness of LGB colleagues and residents, and the director's opinion of LGB residents' disclosure of their homosexuality to their patients and patients' families. Asking similar questions facilitated a comparison of survey results with those of an earlier study of general psychiatry training directors. RESULTS: The reported departmental attitudes about whether homosexuality represents a pathological condition were essentially equivalent in general and child programs. Child and adolescent training directors were, however, less likely to have a favorable view of disclosure of sexual orientation to patients, less likely to know LGB residents or faculty, and less likely to report LGB residents an asset to their departments. CONCLUSIONS: The prediction that the majority of child and adolescent training programs would reflect a heightened awareness of the vulnerability of LGB youths was not confirmed.

Serum cholesterol levels in patients with generalized anxiety disorder (GAD) and with GAD and comorbid major depression.

OBJECTIVE: To investigate risk for cardiovascular disease in patients with GAD, as well as the effects of comorbid major depression (MD). METHOD: Predrug-trial serum cholesterol and triglyceride levels were assessed in 38 patients with pure GAD and compared with those of 21 patients with mixed GAD and comorbid (MD). RESULTS: Significantly higher cholesterol and triglyceride levels were found in the GAD group. CONCLUSION: Increased noradrenergic activity may be responsible for elevations in lipid levels in patients with pure GAD.

Follow-up survey of support services for lesbian, gay, and bisexual medical students.

PURPOSE: To replicate and extend a pilot study conducted in 1990 regarding support services for lesbian, gay, and bisexual (LGB) medical students. METHOD: In 1994 the authors surveyed all 320 members of Lesbian, Gay, and Bisexual People in Medicine, a standing committee of the American Medical Student Association. Chi-square analyses were used to compare responses by subgroups. RESULTS: Responses were received from 185 students (58%) at 92 medical schools. Students who had access to school or community support groups were significantly more likely to disclose their sexual orientation and to know faculty with whom to discuss LGB issues. Nonwhite students were significantly less likely to know faculty with whom to discuss gay-related concerns, to disclose their orientation, and to know of support services. No difference between the academic experiences of lesbians and gay men was reported. Additionally, 115 (62%) of the students reported exposure to anti-gay comments, and 28 (15%) indicated they would not choose to enter the medical field if they were in college today. CONCLUSION: Although the needs of LGB medical students appear to be receiving increased attention (albeit with great variability from school to school), the survey results suggest that more student-faculty liaisons and more support groups are needed, that LGB patient care should be taught more widely, and that all medical students have too little exposure to non-pejorative descriptions of LGB patients.

HIV, TB, and mental illness in a health clinic for the homeless.

The authors reviewed the medical records of both mentally ill and non-mentally ill patients in a clinic for the homeless population of New Orleans. The records of all psychiatric patients (n = 52) and a randomly selected comparison group (n = 236) of clinic patients without mental illness were chosen for review. Five of the 52 homeless mentally ill who were tested for HIV had a positive test (9.6%), as did 7 of the 129 homeless people without mental illness (5.4%). Regarding TB, only 5 of the 29 mentally ill tested for TB were PPD positive (17.2%), as compared to 34 (29.3%) of the non-mentally ill, a strong trend (r = 0.11, p = 0.09). Differing trends were found regarding HIV and TB in the two homeless groups under study. Further work with a larger sample is needed to determine the factors, if any, which facilitate the spread of HIV and inhibit that of TB.

Influence of a freshman-year panel presentation on medical students' attitudes toward homosexuality.

PURPOSE: To explore medical students' changes in group attitude toward homosexuality following mid-year exposure as freshmen to a panel presentation on the topic and, later, following clinical experiences. METHOD: At the beginning, middle, and end of 1991-92 and during the psychiatry clerkship in 1993-94, all 186 students in the class of 1995 at the Louisiana State University School of Medicine in New Orleans were asked to complete anonymously the Index of Attitudes toward Homosexuals. The two subsequent entering classes were also surveyed, at the beginning and in the middle of their freshman year. RESULTS: Group attitudes among the three consecutive classes were remarkably consistent. The original cohort displayed a decrease in group homophobic attitude over time, with the reduced mean score at mid-year continuing its downward trend at year's end, though rebounding somewhat by the junior year. However, the group mean score remained in the low-grade homophobic category throughout the three-year study. CONCLUSION: That the mean scores of the three classes remained at the low-grade homophobic level suggests the desirability of establishing an ongoing forum to enable students to examine all deeply held beliefs that may affect patient care.

Gay and lesbian issues in u.s. Psychiatry training as reported by residency training directors.

This study reports the results of a survey of U.S. residency training directors that explored the training milieu of gay and lesbian psychiatric residents. Of the 198 training directors surveyed, 134 (67.7%) completed the questionnaire. All but four of the directors reported the inclusion of gay and lesbian issues in the curriculum, most frequently in PGY-3. Using a 5-point rating scale, 47.3% reported that homosexuality was regarded at their programs as "normal" or "somewhat normal," 51.2% as "neutral," and 1.5% as "somewhat pathological" or "pathological." In general, the directors' overall assessment of departmental attitudes about homosexuality paralleled the findings previously reported by lesbian and gay residents, with some discrepancy concerning the disclosure of sexual orientation to psychotherapy patients. In the earlier study, nearly one-third of gay and lesbian residents reported such disclosure; in the current study, only three training directors (2.5%) regarded this practice favorably. The results of the present study reflect the diversity of opinion found among residency training directors on the topic of gay and lesbian issues.

Long-term follow-up of generalized anxiety disorder.

The diagnostic stability and long-term prognosis of generalized anxiety disorder (GAD) remain the subjects of considerable controversy. We report the results of an investigation of the long-term outcome of an original sample of 44 subjects who participated in a medication trial. Subjects were reinterviewed approximately 16 months after completion of the study, using structured interviews. Fifty percent continued to fulfill criteria for GAD. Other concurrent axis I diagnoses were as follows: dysthymia, 11%; major depression, 7%; and social phobia, 7%. Regarding axis II comorbidity, subjects with chronic GAD were more likely to fulfill criteria for one or more personality disorders, especially in clusters B and C. In addition, follow-up subjects with GAD and with remitted GAD reported a statistically equivalent number of recent life events, although subjects with chronic GAD were more likely to report significant dissatisfaction with life. The findings indicate that although many subjects with GAD do not follow a chronic course, many others remain symptomatic. The results also suggest that GAD symptoms are not simply the result of a subject's recent negative experiences, and that life satisfaction measures are an accurate reflection of GAD outcome.

Gay and lesbian issues in residency training at u.s. Psychiatry programs.

The authors conducted a survey that explored the training milieu of gay and lesbian psychiatric residents at various sites throughout the United States. In some ways, the residents surveyed have greater institutional support than was found in an earlier study of homosexual medical students. But there are clear and disturbing differences among residents based on gender, with men more likely than women to consider their program supportive of their sexual orientation. In spite of this relative advantage, gay men and lesbians, medical students and residents alike, would prefer that their training institutions be more supportive of their sexuality and more adept at facilitating sensitive care of homosexual patients.

How the topic of homosexuality is taught at U.S. medical schools.

In 1991 the authors surveyed all U.S. medical schools to assess both the number of curriculum hours devoted to the topic of homosexuality and the instructional strategies employed in its academic treatment; responses were sought from faculty with responsibility for teaching the topic (mostly directors of medical student education in psychiatry). Of the 126 schools, 82 (65%) responded. The mean number of hours reported was 3 hours and 26 minutes, with significant differences based on geographic region. The most frequently cited strategy was lectures in human sexuality, followed distantly by panel presentations and meetings with gay men or lesbians (both health care providers and others). To enhance sensitivity and comfort with gay and lesbian issues and to counter stereotypic responses, the authors propose that the topic of homosexuality be wholly integrated throughout the curriculum.

Support services for homosexual students at U.S. medical schools.

This study reports the results of a national survey conducted to assess current programs directed toward gay and lesbian medical students and to identify their perceptions, needs, and wishes. Support services are limited and those that do exist vary on the basis of class size, institutional affiliation, and geographic region. The topic of homosexuality is taught in most medical schools in a circumscribed way. Implications of the findings concern the medical education of all students, irrespective of their sexual orientations.

Corticotropin-releasing activity in the rat gastric antrum.

Rat gastric antrum, duodenum, pancreas, and spleen were extracted in acetic acid, treated with acetone, and purified on a C-18 cartridge. These extracts, in a dose equivalent to one respective organ, were examined for CRF bioactivity in vitro using rat half pituitaries, with gastric antrum extract showing a significant CRF activity. The antrum extract showed a dose-related CRF activity in vitro using rat pituitary cell culture, and the dose-response curve appeared to be parallel with that of synthetic rat hypothalamic CRF. Subsequent ion-exchange chromatography on a SP-Sephadex column showed that antrum CRF coeluted with basic materials (SP-III fraction), while rat hypothalamic CRF coeluted with weakly basic materials (SP-II fraction). The SP-III fraction was further purified by gel filtration on Sephadex G-50. CRF activity was eluted in two areas: large mol wt fraction (10,000-15,000) and small mol wt fraction (1500-2000). Hypothalamic CRF was eluted between them. The CRF activities of the two fractions were completely abolished by trypsin digestion, suggesting a peptide nature. The large molecular weight fraction exhibited a steeper dose-response curve than the hypothalamic CRF in vitro using cell culture, and the response to a dose equivalent to two antra exceeded the maximum response exhibited by the hypothalamic CRF. However, the fraction failed to increase serum corticosterone when injected in pharmacologically blocked rats. On the other hand, the small molecular weight fraction showed a lesser CRF activity and a similar dose-response curve to that of the hypothalamic CRF as tested in vitro. This fraction significantly stimulated corticosterone secretion in vivo as well. The small molecular weight activity did not appear to be due to other peptides or amines which have been reported as causing ACTH release. Although the physiological roles of the small molecular weight antrum CRF are unknown, it is possible that this CRF plays a role during stress as a tissue CRF.