Brad Foote - Academia.edu (original) (raw)

Papers by Brad Foote

General Hospital Psychiatry, Mar 1, 2011

Objective-Posttraumatic Stress Disorder (PTSD) is prevalent among low-income minorities and is as... more Objective-Posttraumatic Stress Disorder (PTSD) is prevalent among low-income minorities and is associated with poorer health. However, the association between PTSD and hemoglobin A1 C (A1 C) among patients with diabetes has not been fully described. The objective of this crosssectional study was to evaluate associations between PTSD and A1 C among low-income minorities with diabetes. Method-Adults with diabetes were recruited from a network of primary care clinics. Data were obtained from surveys and electronic medical records. Lifetime PTSD symptoms were assessed using the Structured Clinical Interview-DSM-IV and depressive symptoms with the Patient Health Questionnaire-9. A1 C was obtained from chart review. Results-Of 103 adults analyzed, 12% had lifetime full PTSD and 12% had subthreshold PTSD. On backward stepwise logistic regression, patients with any PTSD symptoms were significantly more likely to have an A1 C >7% compared to patients without symptoms (OR adj 2.98, 95% CI 1.04-8.52, P=.04). An A1 C >7% also was associated with an interaction between PTSD symptoms and longer diabetes duration (P<.05). Conclusion-In this cohort of low-income minorities with diabetes, lifetime PTSD symptoms were significantly associated with an A1 C >7%.

Journal of the American Academy of Child and Adolescent Psychiatry, Apr 1, 1999

Background: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that results from expo... more Background: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that results from exposure to a traumatic event and consists of intrusive and unwanted recollections; avoidance followed by emotional withdrawal; and heightened physiologic arousal. Hospitalized victims of suicide bombing attacks (SBAs) are unique because of the circumstances and severity of their injuries, which could affect the occurrence and delay the recognition of PTSD. Our objectives were to evaluate the prevalence and severity of PTSD among hospitalized SBA victims and to assess variables of physical injury as risk factors for the development of PTSD. Methods: Forty-six hospitalized SBA victims were evaluated for PTSD using the PTSD symptom scale self-report questionnaire by phone. Demographic and medical data regarding the severity and type of injury and medical treatment were collected from medical files. Injury Severity Score was used to assess severity of physical injury. Results: Twenty-four of 46 (52.2%) hospitalized SBA victims developed PTSD. Presence of blast lung injury was significantly higher in the PTSD group compared with the non-PTSD group (37.5% versus 9.1%, respectively; p Ͻ 0.04). There was no significant difference in Injury Severity Score between PTSD and non-PTSD groups. Blast lung injury and intracranial injury were found to be positive predictors of PTSD (odds ratio, 125 and 25, respectively). No correlation was found between the length of stay, length of intensive care unit stay, or severity of physical injuries and the severity of PTSD. Conclusions: Hospitalized victims of SBA are considerably vulnerable to develop PTSD. Victims should be monitored closely and treated in conjunction with their physical treatment. Blast lung injury and intracranial injury are predictors of PTSD.

American Journal of Psychiatry, Apr 1, 2006

The purpose of the study was to assess the prevalence of DSM-IV dissociative disorders in an inne... more The purpose of the study was to assess the prevalence of DSM-IV dissociative disorders in an inner-city outpatient psychiatric population. Method: Subjects were 231 consecutive admissions (84 men and 147 women, mean age=37 years) to an inner-city, hospital-based outpatient psychiatric clinic. The subjects completed self-report measures of dissociation (Dissociative Experiences Scale) and trauma history (Traumatic Experiences Questionnaire). Eightytwo patients (35%) completed a structured interview for dissociative disorders (Dissociative Disorders Interview Schedule).

Crisis-the Journal of Crisis Intervention and Suicide Prevention, Feb 10, 2023

Psychiatric Services, 1984

General Hospital Psychiatry, 2011

Objective-Posttraumatic Stress Disorder (PTSD) is prevalent among low-income minorities and is as... more Objective-Posttraumatic Stress Disorder (PTSD) is prevalent among low-income minorities and is associated with poorer health. However, the association between PTSD and hemoglobin A1 C (A1 C) among patients with diabetes has not been fully described. The objective of this crosssectional study was to evaluate associations between PTSD and A1 C among low-income minorities with diabetes. Method-Adults with diabetes were recruited from a network of primary care clinics. Data were obtained from surveys and electronic medical records. Lifetime PTSD symptoms were assessed using the Structured Clinical Interview-DSM-IV and depressive symptoms with the Patient Health Questionnaire-9. A1 C was obtained from chart review. Results-Of 103 adults analyzed, 12% had lifetime full PTSD and 12% had subthreshold PTSD. On backward stepwise logistic regression, patients with any PTSD symptoms were significantly more likely to have an A1 C >7% compared to patients without symptoms (OR adj 2.98, 95% CI 1.04-8.52, P=.04). An A1 C >7% also was associated with an interaction between PTSD symptoms and longer diabetes duration (P<.05). Conclusion-In this cohort of low-income minorities with diabetes, lifetime PTSD symptoms were significantly associated with an A1 C >7%.

Comprehensive Psychiatry, 1998

The present study examined the relationship between dissociative symptomatology and a range of ag... more The present study examined the relationship between dissociative symptomatology and a range of aggressive behavior in a general psychiatric outpatient population. Of the total sample (n = 122), 29% scored above 25 on the Dissociative Experiences Scale (DES). Patients with high DES scores (>25) were significantly more likely than patients with lower DES scores (<25) to report a history of childhood sexual abuse, to have attempted suicide, and to report more assaultive behavior, irritability, and negativism. There were no differences between the patients with high versus low DES scores on homicidal behavior. To better manage and treat outpatients with dissociative symptomatology, it is important to clarify the association between outwardly aggressive behavior and dissociative experiences.

American Journal of Psychotherapy, 1999

The diagnostic validity o f dissociative identity disorder (DID) continues to inspire controversy... more The diagnostic validity o f dissociative identity disorder (DID) continues to inspire controversy, with som e commentators claiming that DID is a modern variant o f "hysteria"; that is, attention-seeking behavior. The author asserts that DID is indeed a valid psychiatric disorder, and believes that this skeptical reaction can largely be attributed to a specific set o f transference/ countertransference interactions that these patients tend to inspire. The paper delineates several clinical features o f DID that can easily be mistaken fo r hysterical phenomena, and attempts to fin d the roots o f this confusion in the DID patients' experience o f interpersonal powerlessness, which leads them to present their symptoms in an unconvincing, "hysterical" manner. Confusion betw een the vertical split seen in the dissociative disorders and the horizontal split characteristic o f the classic hysterical personality is discussed, as is the pow erful effect o f observer bias in creating hysterical-appearing phenomena. The term "pseudo-hysteria" is used to denote a situation in which a genuine psychiatric disorder, DID, is perceived as an hysterical production.

American Journal of Psychotherapy, 2016

Dialectical Behavior Therapy (DBT), created by Marsha Linehan, has been shown to be an effective ... more Dialectical Behavior Therapy (DBT), created by Marsha Linehan, has been shown to be an effective therapy for the treatment of borderline personality disorder (BPD) and for suicidal and self-harming behavior. Dissociative identity disorder (DID) is a complex post-traumatic disorder which is highly comorbid with BPD, shares a number of clinical features with BPD, and which like BPD features a high degree of suicidality. The DID treatment literature emphasizes the importance of a staged approach, beginning with the creation of a safe therapeutic frame prior to addressing traumatic material; DBT is also a staged treatment, in which behavioral and safety issues are addressed in Stage 1, and trauma work reserved for Stage 2. The authors describe adapting DBT, and especially its techniques for Stage 1 safety work, for work with DID patients. Basic theoretical principles are described and illustrated with a case example.

Journal of Nervous & Mental Disease, 2008

American journal of psychotherapy, 1999

In recent years Dissociative Identity Disorder (DID), formerly known as Multiple Personality Diso... more In recent years Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder (MPD), despite the controversy that surrounds virtually every aspect of the phenomenology, diagnosis, and treatment of this condition, has been diagnosed and treated with increasing frequency. Careful studies using reliable and valid screening measures and structured interviews have demonstrated that previously undiagnosed DID is a rather common disorder, occurring in between 3-6% of psychiatric inpatients and 5-18% of patients in substance-abuse treatment settings (studies summarized in Ross [11 and Kluft [21). Although some have argued that DID is a North American culture-bound condition (3), the inpatient studies summarized above included cohorts from the United States, Canada, the Netherlands, Norway, and Turkey, and all demonstrated roughly comparable findings. Although cultural forces may have been prevalent in the North American cohorts, and, to a lesser extent, in the Nether...

American Journal of Psychotherapy, 1999

Current Psychiatry Reports, 2008

Schizophrenia and dissociative identity disorder (DID) are typically thought of as unrelated synd... more Schizophrenia and dissociative identity disorder (DID) are typically thought of as unrelated syndromes-a genetically based psychotic disorder versus a trauma-based dissociative disorder-and are categorized as such by the DSM-IV. However, substantial data exist to document the elevated occurrence of psychotic symptoms in DID; awareness of these features is necessary to prevent diagnostic confusion. Recent research has also pointed out that schizophrenia and DID overlap not only in psychotic symptoms but also in terms of traumatic antecedents, leading to a number of suggestions for revision of our clinical, theoretical, and nosologic understanding of the relationship between these two disorders.

Journal of Trauma & Dissociation, 2007

A Review of DISSOCIATIVE DISORDERS: AN EXPANDING WINDOW INTO THE PSYCHOBIOLOGY OF MIND. Richard A... more A Review of DISSOCIATIVE DISORDERS: AN EXPANDING WINDOW INTO THE PSYCHOBIOLOGY OF MIND. Richard A. Chefetz, MD (Ed.). Psychiatric Clinics of North America, March 2006, Vol. 29, Number 1, 342 Pages. , edited by Richard A. Chefetz, MD Psychiatric Clinics of North America is a high-quality, extremely well respected publication that appears quarterly, with each issue consisting of articles on a single topic overseen by a guest editor. Psychiatric Clinics’ choice in 1984 to devote an issue to Multiple Personality Disorder (edited by Bennett Braun, and containing memorable chapters by Kluft, Putnam, Spiegel, and many others) could be considered one of the early indications that dissociative disorders were “making it” into the awareness of the greater mental health community. Twenty-two years later, Dr. Richard Chefetz has assembled an outstanding collection of sixteen articles, covering a wide range of topics in dissociation. The result is a work that represents the best scholars and the most current thought in the field, with extraordinary breadth and depth. The dialectic “art versus science” has long been a particularly relevant one for practitioners in the dissociative disorder field. For many years, scientific study of the dissociative disorders lagged behind the

General Hospital Psychiatry, Mar 1, 2011

Objective-Posttraumatic Stress Disorder (PTSD) is prevalent among low-income minorities and is as... more Objective-Posttraumatic Stress Disorder (PTSD) is prevalent among low-income minorities and is associated with poorer health. However, the association between PTSD and hemoglobin A1 C (A1 C) among patients with diabetes has not been fully described. The objective of this crosssectional study was to evaluate associations between PTSD and A1 C among low-income minorities with diabetes. Method-Adults with diabetes were recruited from a network of primary care clinics. Data were obtained from surveys and electronic medical records. Lifetime PTSD symptoms were assessed using the Structured Clinical Interview-DSM-IV and depressive symptoms with the Patient Health Questionnaire-9. A1 C was obtained from chart review. Results-Of 103 adults analyzed, 12% had lifetime full PTSD and 12% had subthreshold PTSD. On backward stepwise logistic regression, patients with any PTSD symptoms were significantly more likely to have an A1 C >7% compared to patients without symptoms (OR adj 2.98, 95% CI 1.04-8.52, P=.04). An A1 C >7% also was associated with an interaction between PTSD symptoms and longer diabetes duration (P<.05). Conclusion-In this cohort of low-income minorities with diabetes, lifetime PTSD symptoms were significantly associated with an A1 C >7%.

Journal of the American Academy of Child and Adolescent Psychiatry, Apr 1, 1999

Background: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that results from expo... more Background: Posttraumatic stress disorder (PTSD) is a psychiatric disorder that results from exposure to a traumatic event and consists of intrusive and unwanted recollections; avoidance followed by emotional withdrawal; and heightened physiologic arousal. Hospitalized victims of suicide bombing attacks (SBAs) are unique because of the circumstances and severity of their injuries, which could affect the occurrence and delay the recognition of PTSD. Our objectives were to evaluate the prevalence and severity of PTSD among hospitalized SBA victims and to assess variables of physical injury as risk factors for the development of PTSD. Methods: Forty-six hospitalized SBA victims were evaluated for PTSD using the PTSD symptom scale self-report questionnaire by phone. Demographic and medical data regarding the severity and type of injury and medical treatment were collected from medical files. Injury Severity Score was used to assess severity of physical injury. Results: Twenty-four of 46 (52.2%) hospitalized SBA victims developed PTSD. Presence of blast lung injury was significantly higher in the PTSD group compared with the non-PTSD group (37.5% versus 9.1%, respectively; p Ͻ 0.04). There was no significant difference in Injury Severity Score between PTSD and non-PTSD groups. Blast lung injury and intracranial injury were found to be positive predictors of PTSD (odds ratio, 125 and 25, respectively). No correlation was found between the length of stay, length of intensive care unit stay, or severity of physical injuries and the severity of PTSD. Conclusions: Hospitalized victims of SBA are considerably vulnerable to develop PTSD. Victims should be monitored closely and treated in conjunction with their physical treatment. Blast lung injury and intracranial injury are predictors of PTSD.

American Journal of Psychiatry, Apr 1, 2006

The purpose of the study was to assess the prevalence of DSM-IV dissociative disorders in an inne... more The purpose of the study was to assess the prevalence of DSM-IV dissociative disorders in an inner-city outpatient psychiatric population. Method: Subjects were 231 consecutive admissions (84 men and 147 women, mean age=37 years) to an inner-city, hospital-based outpatient psychiatric clinic. The subjects completed self-report measures of dissociation (Dissociative Experiences Scale) and trauma history (Traumatic Experiences Questionnaire). Eightytwo patients (35%) completed a structured interview for dissociative disorders (Dissociative Disorders Interview Schedule).

Crisis-the Journal of Crisis Intervention and Suicide Prevention, Feb 10, 2023

Psychiatric Services, 1984

General Hospital Psychiatry, 2011

Objective-Posttraumatic Stress Disorder (PTSD) is prevalent among low-income minorities and is as... more Objective-Posttraumatic Stress Disorder (PTSD) is prevalent among low-income minorities and is associated with poorer health. However, the association between PTSD and hemoglobin A1 C (A1 C) among patients with diabetes has not been fully described. The objective of this crosssectional study was to evaluate associations between PTSD and A1 C among low-income minorities with diabetes. Method-Adults with diabetes were recruited from a network of primary care clinics. Data were obtained from surveys and electronic medical records. Lifetime PTSD symptoms were assessed using the Structured Clinical Interview-DSM-IV and depressive symptoms with the Patient Health Questionnaire-9. A1 C was obtained from chart review. Results-Of 103 adults analyzed, 12% had lifetime full PTSD and 12% had subthreshold PTSD. On backward stepwise logistic regression, patients with any PTSD symptoms were significantly more likely to have an A1 C >7% compared to patients without symptoms (OR adj 2.98, 95% CI 1.04-8.52, P=.04). An A1 C >7% also was associated with an interaction between PTSD symptoms and longer diabetes duration (P<.05). Conclusion-In this cohort of low-income minorities with diabetes, lifetime PTSD symptoms were significantly associated with an A1 C >7%.

Comprehensive Psychiatry, 1998

The present study examined the relationship between dissociative symptomatology and a range of ag... more The present study examined the relationship between dissociative symptomatology and a range of aggressive behavior in a general psychiatric outpatient population. Of the total sample (n = 122), 29% scored above 25 on the Dissociative Experiences Scale (DES). Patients with high DES scores (>25) were significantly more likely than patients with lower DES scores (<25) to report a history of childhood sexual abuse, to have attempted suicide, and to report more assaultive behavior, irritability, and negativism. There were no differences between the patients with high versus low DES scores on homicidal behavior. To better manage and treat outpatients with dissociative symptomatology, it is important to clarify the association between outwardly aggressive behavior and dissociative experiences.

American Journal of Psychotherapy, 1999

The diagnostic validity o f dissociative identity disorder (DID) continues to inspire controversy... more The diagnostic validity o f dissociative identity disorder (DID) continues to inspire controversy, with som e commentators claiming that DID is a modern variant o f "hysteria"; that is, attention-seeking behavior. The author asserts that DID is indeed a valid psychiatric disorder, and believes that this skeptical reaction can largely be attributed to a specific set o f transference/ countertransference interactions that these patients tend to inspire. The paper delineates several clinical features o f DID that can easily be mistaken fo r hysterical phenomena, and attempts to fin d the roots o f this confusion in the DID patients' experience o f interpersonal powerlessness, which leads them to present their symptoms in an unconvincing, "hysterical" manner. Confusion betw een the vertical split seen in the dissociative disorders and the horizontal split characteristic o f the classic hysterical personality is discussed, as is the pow erful effect o f observer bias in creating hysterical-appearing phenomena. The term "pseudo-hysteria" is used to denote a situation in which a genuine psychiatric disorder, DID, is perceived as an hysterical production.

American Journal of Psychotherapy, 2016

Dialectical Behavior Therapy (DBT), created by Marsha Linehan, has been shown to be an effective ... more Dialectical Behavior Therapy (DBT), created by Marsha Linehan, has been shown to be an effective therapy for the treatment of borderline personality disorder (BPD) and for suicidal and self-harming behavior. Dissociative identity disorder (DID) is a complex post-traumatic disorder which is highly comorbid with BPD, shares a number of clinical features with BPD, and which like BPD features a high degree of suicidality. The DID treatment literature emphasizes the importance of a staged approach, beginning with the creation of a safe therapeutic frame prior to addressing traumatic material; DBT is also a staged treatment, in which behavioral and safety issues are addressed in Stage 1, and trauma work reserved for Stage 2. The authors describe adapting DBT, and especially its techniques for Stage 1 safety work, for work with DID patients. Basic theoretical principles are described and illustrated with a case example.

Journal of Nervous & Mental Disease, 2008

American journal of psychotherapy, 1999

In recent years Dissociative Identity Disorder (DID), formerly known as Multiple Personality Diso... more In recent years Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder (MPD), despite the controversy that surrounds virtually every aspect of the phenomenology, diagnosis, and treatment of this condition, has been diagnosed and treated with increasing frequency. Careful studies using reliable and valid screening measures and structured interviews have demonstrated that previously undiagnosed DID is a rather common disorder, occurring in between 3-6% of psychiatric inpatients and 5-18% of patients in substance-abuse treatment settings (studies summarized in Ross [11 and Kluft [21). Although some have argued that DID is a North American culture-bound condition (3), the inpatient studies summarized above included cohorts from the United States, Canada, the Netherlands, Norway, and Turkey, and all demonstrated roughly comparable findings. Although cultural forces may have been prevalent in the North American cohorts, and, to a lesser extent, in the Nether...

American Journal of Psychotherapy, 1999

Current Psychiatry Reports, 2008

Schizophrenia and dissociative identity disorder (DID) are typically thought of as unrelated synd... more Schizophrenia and dissociative identity disorder (DID) are typically thought of as unrelated syndromes-a genetically based psychotic disorder versus a trauma-based dissociative disorder-and are categorized as such by the DSM-IV. However, substantial data exist to document the elevated occurrence of psychotic symptoms in DID; awareness of these features is necessary to prevent diagnostic confusion. Recent research has also pointed out that schizophrenia and DID overlap not only in psychotic symptoms but also in terms of traumatic antecedents, leading to a number of suggestions for revision of our clinical, theoretical, and nosologic understanding of the relationship between these two disorders.

Journal of Trauma & Dissociation, 2007

A Review of DISSOCIATIVE DISORDERS: AN EXPANDING WINDOW INTO THE PSYCHOBIOLOGY OF MIND. Richard A... more A Review of DISSOCIATIVE DISORDERS: AN EXPANDING WINDOW INTO THE PSYCHOBIOLOGY OF MIND. Richard A. Chefetz, MD (Ed.). Psychiatric Clinics of North America, March 2006, Vol. 29, Number 1, 342 Pages. , edited by Richard A. Chefetz, MD Psychiatric Clinics of North America is a high-quality, extremely well respected publication that appears quarterly, with each issue consisting of articles on a single topic overseen by a guest editor. Psychiatric Clinics’ choice in 1984 to devote an issue to Multiple Personality Disorder (edited by Bennett Braun, and containing memorable chapters by Kluft, Putnam, Spiegel, and many others) could be considered one of the early indications that dissociative disorders were “making it” into the awareness of the greater mental health community. Twenty-two years later, Dr. Richard Chefetz has assembled an outstanding collection of sixteen articles, covering a wide range of topics in dissociation. The result is a work that represents the best scholars and the most current thought in the field, with extraordinary breadth and depth. The dialectic “art versus science” has long been a particularly relevant one for practitioners in the dissociative disorder field. For many years, scientific study of the dissociative disorders lagged behind the