Aggressive and impulsive behavior in military psychiatric inpatients

OBJECTIVE: To investigate the risk of cancer associated with exposure to air pollution among bus drivers and tramway employees. METHODS: A retrospective cohort study of 18,174 bus drivers or tramway employees in Copenhagen in the period 1900-94. Data on employment were obtained from company files. Information on cancer was obtained from the Danish Cancer Registry. RESULTS: Findings showed that bus drivers or tramway employees had an increased risk of all malignant neoplasms (standardised incidence ratio (SIR) 1.24, 95% confidence interval (95% CI) 1.19 to 1.30). The relative risk was significantly increased for both men and women (SIR 1.24, 95% CI 1.19 to 1.30 and 1.28, 1.06 to 1.53, respectively). People employed for < 3 months had no increased risk of cancer (1.04, 0.81 to 1.31). For men who were employed for > 3 months the risk of lung cancer (1.6, 1.5 to 1.8), laryngeal cancer (1.4, 1.0 to 1.9), kidney cancer (1.6, 1.3 to 2.0), bladder cancer (1.4, 1.2 to 1.6), skin cancer (1.1, 1.0 to 1.2), pharyngeal cancer (1.9, 1.2 to 2.8), rectal cancer (1.2, 1.0 to 1.5) and liver cancer (1.6, 1.2 to 2.2) was significantly increased. For women employed for > 3 months the risk of lung cancer was significantly increased (2.6, 1.5 to 4.3). CONCLUSION: This cohort study shows that bus drivers and tramway employees are at an increased risk of developing several types of cancer. This might be due to the exposure to air pollution during working hours or to other risk factors, primarily smoking.     

Self-administered cocaine causes long-lasting increases in impulsive choice in a delay discounting task.

Cocaine use is associated with high levels of impulsive choice (preference for immediate over delayed rewards), but it is not clear whether cocaine use causes elevated impulsive choice, or whether elevated impulsive choice is solely a predisposing factor for cocaine use. This study examined the effects of prior cocaine self-administration on rats performing a delay discounting task commonly used to measure impulsive choice. Male Long-Evans rats were implanted with intravenous catheters, and following recovery, were trained to self-administer 30 mg/kg/day cocaine HCl (approx. 0.5 mg/kg/infusion) for 14 consecutive days (a control group received yoked intravenous saline infusions). Following three weeks of withdrawal, all rats were food-restricted and began training on the delay discounting task in standard operant chambers. On each trial, rats were given a choice between two levers. A press on one lever delivered a small food reward immediately, and a press on the other delivered a large food reward after a variable delay period. Rats that self-administered cocaine displayed greater impulsive choice (enhanced preference for the small immediate over the large delayed reward, as reflected by shorter indifference points) compared to controls, but were no different from controls on a “probabilistic discounting” task in which they chose between small certain and large uncertain rewards. These data suggest that self-administered cocaine can cause lasting elevations in impulsive choice, and that the high levels of impulsive choice observed in human cocaine users may be due in part to long-term effects of cocaine on brain function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A-B therapist status, patient diagnosis, and psychotherapy outcome in a psychiatric outpatient population.

Previous research generally has supported the hypothesis that A therapists obtain better therapy outcomes with schizophrenics, while B therapists do better with neurotics. Based on recent evidence, a 2nd hypothesis (super A) has been advanced which predicts that A therapists do at least as well with neurotic patients as do B therapists and that As obtain significantly more positive outcomes with schizophrenics. To examine these hypotheses, the therapy outcomes of 7 A and 4 B therapists, differentiated by their scores on the 23-item Whitehorn and Betz (1957) A-B scale, with their 18 schizophrenic and 18 neurotic patients were examined. A multivariate ANOVA computed for the 2 outcome measures, therapists' ratings of patient improvement and number of therapy sessions, clearly supported the super-A hypothesis. Separate ANOVAs demonstrated further support for the super-A hypothesis with therapists' ratings as the dependent variable, whereas the interaction hypothesis received support with number of sessions attended as the dependent measure. Of considerable importance was the fact that the addition of ataractic medication to the treatment of schizophrenics did not attenuate the effect of the A-B therapist distinction on therapeutic outcome. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MCMI-III as a treatment outcome measure for psychiatric inpatients

The Million Clinical Multiaxial Inventory-III (MCMI-III) recently was introduced to replace and update the MCMI-II. A sample of 97 psychiatric inpatients were administered the MCMI-III shortly following admission, and again 7-10 days later. Changes in the personality and symptom scales generally paralleled those found in previous work with the MCMI-II, although the mean retest interval was considerably shorter than in the earlier study. However, some differences between the two instruments were observed, confirming the need for ongoing cross-validation work on the MCMI-III as an instrument that is distinct from the MCMI-II.     

Validity of the Wonderlic Personnel Test as a brief IQ measure in psychiatric patients.

100 male psychiatric inpatient referrals (mean age 41.18 yrs) for psychological testing were administered the Wonderlic Personnel Test and the Wechsler Adult Intelligence Scale—Revised (WAIS—R) in a counterbalanced order. In this clinical context, the Wonderlic proved not to be an acceptable alternative to the WAIS—R. The tests correlated only moderately (.75), differed in mean IQ level, and agreed in IQ classification in only 40% of the cases. Efforts to improve these results by devising new IQ correction factors resulted in only slight improvements. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prognostic indexes in a military psychiatric population.

Used biographical variables, available at the time of admission to a Navy psychiatric service, to predict the posthospital adjustment of 827 male patients (Navy and Marine Corps personnel) to military life. Predictor variables were combined, using a multiple-regression technique and a simple item-analyzed scale. The latter proved to be slightly, but not significantly, more efficient than the multiple-regression procedure as judged from cross-validity correlations. Variables which were reliable prognostic indicators included (a) occupational specialty, (b) number of children, (c) wife's attitude, (d) solitariness of work, (e) length of service, (f) diagnosis, and (g) recognition for inservice achievements. While improvement on base-rate prediction was not possible, an increase in effectiveness rate for expsychiatric patients could be effected by selecting a high prognosis score as a requirement for returning a patient to duty. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aggressive behavior of psychiatric patients among geriatric population

The effects of protein supplements and culture dish type on in vitro fertilization (IVF) and embryo development in culture were examined in the domestic cat. In Experiment I, follicular oocytes were fertilized and cultured in either 1) modified Earle's balanced salt solution, designated MK-1, supplemented with one of the following: 10% human serum (HS), 10% FCS or 0.4% BSA, or 2) Medium 199 (M-199) supplemented with 10% FCS. Fertilization rates were lower (P < 0.01) in MK-1 + BSA (74.4%), MK-1 + FCS (56.1%), and M-199 + FCS (51.4%) than in MK-1 + HS (94.7%). A greater (P < 0.01) percentage of blastocysts was obtained in MK-1 + HS (50.0%) than in other treatment groups (range, 4.3-17.2%). In Experiment II, the effect of dish type (tissue culture dish, TCD, versus suspension culture dish, SCD) on embryo development was evaluated in MK-1 supplemented with either HS or BSA. Significantly higher proportions of IVF-derived embryos developed to blastocysts at 120 and 144 hr post-insemination, respectively, when cultured in HS/SCD (47.2 and 71.7%) than in BSA/SCD (11.4 and 27.3%) or BSA/TCD (10.4 and 25.0%). At 120 hr post-insemination, there was a lower (P < 0.01) percentage of blastocysts in HS/TCD (22.2%) than in HS/SCD. In Experiment III, six embryos per cat were transferred to the uterine horns of 17 recipients at 144 hr after hCG treatment. Five of 7 recipients which received late morulae cultured in MK-1 + BSA (SCD) for 120 hr became pregnant (71.4%). Eight of 10 recipients which received early blastocysts cultured in MK-1 + HS (SCD) for 120 hr became pregnant (80.0%). We conclude that MK-1 containing HS is highly beneficial for overcoming the in vitro developmental block of IVF-derived feline embryos and increasing the success rate of IVF/ET.     

Correlates of competence in a child psychiatric population.

This study examined the relation between individual and composite measures of child competence with family background and adult ratings of psychopathology. A battery of psychological tests, generally considered to reflect competent functioning, was administered to 180 children, aged 6–12 years, who were consecutively referred to a psychiatric outpatient clinic. Generally, children who scored high on a composite competence index were rated by parents and teachers as showing fewer problems, which is consistent with observations in nonclinical samples. Moreover, analysis of the composite competence index supported the view that children with even a moderate degree of competence have an advantage. Two findings of this study differed from those observed in nonclinical samples. First, a composite measure of child competence was more likely than single measures to be related to parent and teacher ratings of competence and problems. Second, girls were generally less competent than boys. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for posttraumatic stress disorder in a general psychiatric outpatient setting.

Posttraumatic stress disorder (PTSD) may affect survivors of a number of accidents and illnesses, in addition to violence victims and combat veterans. Prior research suggests that PTSD may be underdiagnosed when trauma is not the presenting problem. Thus, a PTSD screening scale might have utility in routine clinical settings. The authors evaluated the screening performance of the Posttraumatic Diagnostic Scale (PDS) in a general psychiatric setting. Results indicated that the PDS performed as well in this setting as it did in the original trauma-focused validation studies, independent of PTSD status as a primary, versus secondary, reason for presenting. A simple cutoff score was adequate for case identification. There were no gender effects, and the scale performed equally well among patients with, versus without, a depressive diagnosis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacotherapy in outpatient psychiatric practice

Calcium metabolism was studied in 47 patients with borderline or lepromatous leprosy. Total and ionized calcium, phosphorus, creatinine, total alkaline phosphatase, parathyroid hormone (PTH), 25-hydroxy vitamin D [25(OH)D], and 1,25-dihydroxy vitamin D [1,25(OH)2D] were measured in serum; calcium and total hydroxyproline were determined in urine. Total subperiosteal diameter and medullar cavity diameter were measured on an X-ray of the hand of all patients. Average values were within normal ranges for all of the biochemical determinations. Total serum calcium was moderately below the normal range in eight patients but ionized calcium levels were within the normal ranges in all of the patients. Four patients, all of them with lepromatous leprosy, had levels of 1,25(OH)2D higher than normal but none of them was hypercalcemic and PTH levels were within normal range. Although all values were within the normal ranges, lepromatous leprosy patients had lower total calcium, higher alkaline phosphatase, and higher urinary hydroxyproline than borderline leprosy patients (9.1 +/- 0.4 vs 9.4 +/- 0.3 mg%, p < 0.001; 10.3 +/- 2.9 vs 7.4 +/- 2.3 King-Armstrong units, p < 0.02 and 27.2 +/- 12 vs 19.4 +/- 5.6 mg/24 hr, p < 0.02, respectively). No differences were found between patients and controls in the average micrometric measurements of the second metacarpal bone but significant osteopenia was found in 19% of the patients. The main finding of the present study in a representative sample of leprosy patients is that the average total serum calcium was in the lowest limit of the normal range, but the ionized serum calcium was in the middle of the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)     

Drugs of abuse testing in a psychiatric outpatient service

Drug testing of patients in a psychiatric outpatient service is an effective way to identify patients who relapse into renewed use of drugs of abuse and in monitoring the effectiveness of ongoing medical and psychological therapy. Most of this testing involves the analysis of urine specimens with immunoassays. Hair testing affords an alternative specimen matrix that is easy to obtain and not readily adulterated and offers the advantage of a wider surveillance window. Hair analysis is technically demanding, and the possibility of false-positives caused by environmental contamination renders it a controversial alternative. Sweat and saliva are potentially useful testing matrices, but their usefulness in clinical practice must await validation by additional clinical and laboratory experience. The correct interpretation of drug test results is predicated on knowing the performance characteristics of the analytical method, route of administration, and pharmacokinetics of the drug. All questionable positive results need confirmation testing to verify true positivity.     

Personality test correlates of psychiatric outpatient status.

Frequencies of stanine scores for 10 Comrey Personality Scales (CPS) were compared separately by sex for 394 psychiatric outpatients (mean age 31 yrs) and 748 normals from the original CPS normative group (A. L. Comrey, 1970). In both sexes, outpatients had significantly more high scores on Response Bias, Orderliness vs Lack of Compulsion, and Social Conformity vs Rebelliousness and more low scores on Activity vs Lack of Energy, Emotional Stability vs Neuroticism, and Extraversion vs Introversion. Female outpatients also had more low scores on Trust vs Defensiveness and male outpatients had more low scores on Masculinity vs Femininity. Outpatients had more extreme scores over all CPS scales than normals. It is concluded that tests of normal personality traits have considerable potential utility for screening, diagnosis, and design of clinical interventions. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

WAIS—R validation of the Wonderlic Personnel Test as a brief intelligence measure in a psychiatric sample.

Although there have been several reports of high correlations between Wonderlic Personnel Test scores and Wechsler Adult Intelligence Scale (WAIS) Full Scale IQ, findings have been inconsistent in psychiatric samples. Sample differences and differences between the WAIS and the revised WAIS (WAIS—R) were considered likely reasons. In this study of relatively nonagitated but chronically ill psychiatric patients (N?=?18), Wonderlic IQ estimation accuracy and Wonderlic/WAIS—R correlations were consistent with data previously reported for the WAIS, and generally support the value of the Wonderlic as a highly economical measure of general intelligence. However, the inability of 1 subject to manage the Wonderlic format suggests that severe visuospatial impairment can invalidate this test. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a measure of unemployability among restored psychiatric patients.

Examined the tenability of supplementing subjective clinical information concerning a patient's employability with more objective data for formulating specific placement procedures. Analysis revealed that 15 behavioral items differentiated placed successes, placed failures, and nonplaced patients on initial and replication studies of 87 and 129 psychiatric patients. Results indicate that the final items comprise an effective instrument for distinguishing the mentally restored individual who will experience failure in employment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of the standard MMPI and the Mini-Mult in a psychiatric outpatient clinic.

Obtained comparisons between the standard MMPI and the Mini-Mult for a sample of 39 male and 39 female patients in an outpatient psychiatric service of a large urban hospital. Findings indicate that while the Mini-Mult is sensitive to psychopathology, it underestimates extreme scores and is not an accurate substitute for the MMPI in predicting clinical types. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A delay discounting measure of great expectations and the effectiveness of psychotherapy.

Many clients prematurely terminate therapy before they have recovered. One possible explanation for treatment dropout is unmet expectations. Although the effects of unmet role expectations have received much attention in the literature, little is known about unmet outcome expectations. Two studies were designed to look at duration and effectiveness outcome expectations held by individuals within a primary referral base for a training clinic setting--a setting with a slower rate of recovery than other outpatient settings. Study 1 (N = 110) used a delay discounting method to find rate-of-recovery expectations associated with differing treatment lengths. Results indicated expectations much higher than the demonstrated effectiveness of therapy associated with training clinics. Study 2 (N = 307) replicated Study 1 and examined the possibility of altering outcome expectations through education. Study 2 results indicated that outcome expectations may be altered through client education. Both studies' results are discussed in terms of reducing premature termination and overall treatment outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the MMPI-168 in a psychiatric population.

Administered the 1st 168 items of the MMPI to 505 psychiatric patients. Factor analysis of the resulting data identified factors of Somatization, Depression, Psychotic Distortion, Low Morale, and Acting Out, plus a separate Masculinity-Femininity factor. Results compare favorably with those from the technically best of the item-level analyses of the complete MMPI that have been reported by others. Factor scoring keys that can be used with an abbreviated short-form administration are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the SCL-90 in a psychiatric population.

Administered the SCL-90, a 90-item revision of Hopkins Symptom Check List, to 358 unselected psychiatric outpatients. Responses were factor analyzed using a principal components procedure, and varimax rotation yielded 5 interpretable factors for which factor scores were derived—Depression, Somatization, Phobic Anxiety, Functional Impairment, and Hostile Suspiciousness. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)