Expressed emotion and relapse in alcoholic patients

Although family members' expressed emotion (EE) predicts patients' elevated relapse rates in schizophrenia and mood disorders, little is known about the relationship between EE and relapse in alcoholism. For 86 alcoholic patients (78 men, 8 women), the association between the spouse's EE and the alcoholic patient's subsequent relapse status in the 12 months after the couple began an outpatient behavioral marital therapy (BMT) program for alcoholism was examined. Alcoholic patients with high EE spouses, when compared with their counterparts with low EE spouses, were more likely to relapse, had a shorter time to relapse, and drank on a greater percentage of days in the 12 months after starting BMT. EE continued to be associated with relapse after patients' age, education, and alcohol problem severity were taken into account. Greater use of Antabuse and more sessions of BMT were associated with reduced relapse for alcoholic patients with high EE spouses.     

Personality disorders in patients with eating disorders in Japan

The use of a mnemonic cueing system (NeuroPage) and a paper and pencil checklist in the rehabilitation of executive problems in a 50-year-old woman are described. Following a CVA 7 years earlier, the patient, despite intact general intellectual and memory functioning, had specific executive impairments of attention, planning, realizing intended actions, and also exhibited behavioral routines similar in form to obsessive-compulsive rituals. In a series of ABAB single-case experimental designs, the efficacy of 2 external cueing systems in prompting appropriately timed action is demonstrated. It is argued that the combination of external control and increased sustained attention to action were critical to the success of NeuroPage with this patient. Furthermore it is hypothesized that the checklist was effective in facilitating the patient's ability to foresee and recognize the consequences of her actions, which in turn had an impact on the probability of her changing those same actions.     

Personality disorders and treatment outcome in methadone maintenance patients

This study examined the relationship between personality disorder (PDs) and 7-month treatment outcome in 197 men admitted to methadone maintenance. Subjects reported pervasive improvement, and the amount of improvement did not significantly differ for those subjects with and without PDs. PD subjects entered treatment with more severe self-reported drug, alcohol, psychiatric, and legal problems, and despite progress, remained more problematic in those areas relative to subjects without PDs. Subjects with antisocial PD had admission and 7-month problem status similar to subjects with other PDs. The 7-month urinalysis results for opiates and cocaine showed no significant differences between subjects with and without PDs. Fewer PD subjects stayed in treatment continuously for the 7-month period. Several cluster B PDs-borderline, antisocial, and histrionic-predicted poorest overall outcomes. Methadone-maintained patients with PDs may warrant additional treatment services if they are to approach the functional level of patients without PDs.     

Personality disorders.

There are effective psychotherapy treatments for personality disorder, and they come from a variety of theoretical and practical perspectives. No single approach has proved to be superior to any other, but all those empirically examined to date are superior to no treatment. There are essentially no data available from studies that directly measure the role of the therapy relationship in determining outcome. However, many successful treatments place the therapy relationship at the center of treatment for personality-disordered individuals. Empirically informed, rational analysis of successful treatments suggests that there must be a strong alliance supported by therapist respect for and validation of the patient. Clear structure that includes reasonable limit setting also is required. M. Linehan (1993) aptly called the simultaneous delivery of validation and blocking maladaptive patterns, the dialectic between acceptance and change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Polysomnographic and subjective sleep predictors of alcoholic relapse

Previous studies indicate that subjectively reported and objectively measured sleep abnormalities at baseline can increase the risk of relapse in treated alcoholics. However, previous studies did not include both subjective and objective sleep measures in the same group of patients. We utilized polysomnography and the Sleep Disorders Questionnaire to determine if baseline polysomnography increased the ability to predict relapse beyond the prediction with subjective measures alone, after controlling for nonsleep variables that were associated with relapse. We followed 74 patients with a DSM-III-R diagnosis of alcohol dependence, of whom 36 relapsed to at least some drinking during an average follow-up interval of 5 months. Univariate analyses revealed that relapsed patients did not differ from abstinent patients at baseline in demographics or psychiatric co-morbidity, but they had more prior treatment episodes for alcoholism, more difficulty falling asleep, more complaints of abnormal sleep, and, on polysomnography, longer sleep latencies, shorter rapid eye movement sleep latencies, and less stage 4 sleep percentage than abstinent patients. With a series of logistic regression analyses, which controlled for age and gender, we demonstrated that sleep measures improved the prediction model compared with nonsleep variables alone, and that polysomnography-measured sleep latency was the most significant predictor variable. We conclude that subjective and objective measures of baseline sleep are predictors of relapse in treated alcoholic patients. These data also suggest that neurophysiological dysfunction contributes strongly to the etiology of relapse. Finally, sleep disturbance warrants clinical attention as a target of alcoholism treatment.     

Personality disorders in sociocultural perspective

In this paper we take as a starting point the perceived high prevalence of domestic violence in marriages between Filipino women and Australian men. In in-depth interviews and structured questionnaires with service providers and with Filipinas married to Anglo-Australian and Filipino men the issue of underreporting physical and emotional violence was a recurring theme. We explore the relationships of power that characterize these marriages, the changes in balance of power that result from the externalization of anger, physical and verbal violence, and stigmatization of domestic violence experienced by Filipinas individually and in the community. We suggest that social disapproval and stereotypical representations of Filipina-Australian marriages in Australian society, and the consequent shame experienced by Filipinas, has led to underreporting of emotional and physical abuse.     

The sleep of abstinent pure primary alcoholic patients: natural course and relationship to relapse

Sleep in male pure primary alcoholic inpatients was examined at a mean of 16 days (n = 29), 19 weeks (n = 29), 14 months (n = 9), and 27 months (n = 4) of abstinence. Results were as follows: (1) the sleep of abstinent alcoholic patients is short, fragmented, and shallow early in abstinence; (2) a patient's sleep improves slowly over at least the first year of abstinence; however, (3) some facets of a patient's sleep remain abnormal even after 27 months of abstinence; (4) insomnia and sleep fragmentation after approximately 5 months of abstinence may be related to relapse by 14 months. The mechanism underlying the relationship between sleep and withdrawal in alcoholic patients is not well understood, and the issue of treating sleep problems as an adjunct to prevention of relapse warrants further investigation.     

Effect of pharmacotherapy of affective disorders on the psycho-semantics of alcoholic patients

90 alcoholic patients (II stage of alcoholism) with secondary affective disorders (anxiety, depression) were divided into 4 groups. The patients of the first group received the GABA receptor ligand baclofen during 3 weeks. Sybazon preparation was used in the second group, while the patients of the third group were treated with amitriptyline. Placebo was applied in the forth group. The clinical psychological tests demonstrated that all drugs caused quite effective relief of affective disorders. Psychosemantic tests application showed that the pharmacotherapy caused positive changes in patients of 1-3 groups. These changes touched on both system of personal estimations and relations of personality to himself and to the world around i.e. psychosemantic sphere. Such changes in psychosemantic sphere were not observed in the 4-th group of patients (placebo). Besides it was revealed that each drug caused some specific changes in psychosemantic sphere. The result obtained were supposed to have some theoretical value in comprehension of brain-psychics relations as well as the applied significance for adequate choice of affective disorders pharmacotherapy of alcoholic patients.     

Personality and personality disorders.

Reviews the support for the hypothesis that the personality disorders of the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) represent variants of normal personality traits. The focus is, in particular, on the efforts to identify the dimensions of personality that may underlie the personality disorders. The relationship of personality to personality disorders is illustrated using the 5-factor model, conceptual issues in relating normal and abnormal personality traits are discussed, and methodological issues that should be addressed in future research are considered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Positive reactions to tobacco predict relapse after cessation.

Among chronic smokers, individual differences in subjective reactions to smoking may characterize important facets of nicotine dependence that relate to abstinence-induced craving, withdrawal symptom profiles, and risk for relapse. Although the negative reinforcing properties of smoking have achieved prominent positions in models of relapse (Baker, Brandon, & Chassin, 2004), vulnerability to relapse risk may also arise from seeking positive reinforcement from smoking (Shiffman & Kirchner, 2009). In this study, 183 cessation-motivated smokers provided subjective craving, positive and negative reactions to standardized cigarettes following overnight abstinence. Level of craving, negative mood, and positive mood after overnight abstinence were significantly predictive of withdrawal on quit-day. Increased positive reactions to smoking were uniquely predictive of relapse after quitting (Hazard Ratio = 1.22, p     

Personality disorders and psychiatric symptoms in psoriasis

Two groups of psoriatic outpatients (ns = 192 and 119) were given, respectively, the Million Clinical Multiaxial Inventory-II and Foulds' Delusions-Symptoms-States Inventory. They were compared with dental (n = 192) and with general surgical (n = 190) patients. The psoriatic group presented clearly higher mean scores and frequencies on most of the personality disorder scales. On Foulds' inventory, psoriatic patients showed higher frequencies of neurotic and psychotic class allocations. A cluster analysis of personality scores provided evidence for 4 different personality clusters of patients with psoriasis: (a) Avoidant, Dependent, Schizoid, and Self-defeating (32.2%), (b) Compulsive, Narcissistic, and Aggressive (30.7%), (c) no personality disorder (18.2%), (d) Borderline, Paranoid, and Schizotypal, etc. (18.8%).     

Who will relapse? Symptoms of nicotine dependence predict long-term relapse after smoking cessation.

Results of a prospective examination (n?=?618) of factors associated with smoking relapse are reported. At 1-yr follow-up, a modified version of the Fagerstrom Tolerance Questionnaire (Dependence Index; DI) and a measure of craving entered the logistic model (odds ratio of 2.7 [p?p?p?p?     

Coping styles predict change in personality disorders

The present follow-up study is the first to investigate whether dispositional coping styles prospectively influence change in the Millon Clinical Multiaxial Inventory (MCMI-II) personality disorders. The sample consisted of 155 psychiatric outpatients who where investigated twice--namely six and seven years after their admission to the clinic. Coping styles prospectively predicted change in most of the MCMI-II personality disorders, whereas sex and age did not affect the outcome. The use of problem-focused coping and the seeking of social support improved the patient levels on the MCMI-II personality disorder scores. Dysfunctional coping styles such as selfdistraction, disengagement, use of alcohol or drugs, and venting of emotions, however, aggravated the patient MCMI-II personality disorders. Furthermore, the effects of coping patterns tended to be specific for single personality disorders.     

Changes in alcoholic patients' coping responses predict 12-month treatment outcomes.

Patient subtypes (Types A and B alcoholism), determinants, and outcomes associated with changes in coping responses of 133 alcoholic patients in the year following admission to treatment were examined. In general, patients' use of avoidance coping declined and use of approach coping increased. Type B patients used more avoidance coping than did Type A patients, but the subtypes did not differ in rate of change in coping. As a determinant of coping, cognitive appraisal of threat showed a trend toward predicting avoidance coping at 6- and 12-month follow-ups. Decreased cognitive avoidance coping (e.g., daydreaming) predicted fewer alcohol, psychological, and interpersonal problems. Increased behavioral approach coping (e.g., taking action) predicted lower severity of alcohol problems. Further study of changes in the cognitive aspects of coping (i.e., appraisals and cognitive avoidance coping) is needed to determine mechanisms underlying cognitive processes associated with treatment outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol cue reactivity, negative-mood reactivity, and relapse in treated alcoholic men.

Relapsed alcoholic individuals frequently report that negative emotional states trigger their return to drinking. A parametric laboratory study was conducted to assess the separate and combined effects of exposure to alcohol-related stimuli and induced negative moods in abstinent alcoholic persons. The authors also sought to determine if reactivity to alcohol cues or reactivity to negative mood induction predicted relapse soon after treatment. Men with alcoholism (N?=?50) undergoing inpatient treatment participated in a guided imagery procedure designed to induce negative moods and were then exposed to either their favorite alcoholic beverage or to spring water. Results indicated that both alcoholic beverage presentation and negative affect imagery led to increased subjective reporting of desire to drink. These effects were additive but not multiplicative (i.e., the interaction of mood state with beverage type was not significant). Reported urge to drink during the trial that combined negative mood imagery with alcoholic beverage exposure predicted time to relapse after inpatient discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Which relapse criteria best predict the mortality risk of treated alcoholics?

We examined which relapse criteria best predict the mortality risk of treated male alcoholics. The subjects were 172 male alcoholics who had previously been hospitalized. Using three criteria which defined relapse as failure to maintain abstinence from alcohol, alcohol abuse, or dependence, the relapse of each subject had been evaluated during a previous 3-year outcome study. Relative mortality risks in the next 3 years classified by the three relapse criteria were compared. The follow-up rate was 93.6% and 31 subjects died. The age-corrected relative mortality risk for subjects failing to maintain abstinence compared with abstainers was 5.32, while the relative mortality risks for the group abusing alcohol and for the group suffering alcohol dependence were 2.23 and 2.56, respectively. These results suggest that relapse defined as failure to maintain abstinence predicts a higher relative mortality risk than do criteria defining in terms of alcohol abuse and alcohol dependence.     

The correction of the immune and microcirculatory disorders in patients with chronic hepatitis of alcoholic and viral etiologies

A simple, rapid and sensitive method for the clean-up and analysis of cefoxitin in serum and tissue is described. Serum (0.5 ml) and tissue (100 mg) samples after homogenization underwent high speed centrifugation. Chromatography was performed on a muBondapak C18 cartridge using a mobile phase of 0.005 M potassium dihydrogen phosphate-acetonitrile-glacial acetic acid (77.5:22:0.5, v/v/v) with a flow-rate of 2.0 ml/min. Ultraviolet detection occurred at 235 nm. The procedure produced a linear curve for the concentration range 100-5000 ng/ml. The assay produced accurate, repeatable and rapid results for both tissue and serum samples without the need for chemical extraction.