Comparison between treatment completers and noncompleters among dually diagnosed substance-abusing adolescents

The psychiatric and demographic characteristics that may distinguish treatment completers from noncompleters among hospitalized adolescents with substance abuse and comorbid psychiatric disorders were examined. Affective and adjustment disorders were more prevalent among treatment completers whereas non-completers were more likely to be assigned a conduct disorder diagnosis. There were no differences between the groups with respect to demographic and legal status, education level and lifetime psychiatric diagnosis in the parents or caretakers, living arrangements, treatment history, and perception of treatment benefits. A higher percentage of treatment completers than noncompleters received psychotropic medications. The factors contributing to treatment termination as well as the clinical and research implications of the findings are discussed.     

Mood and alcohol consumption: An experience sampling test of the self-medication hypothesis.

In this investigation the authors applied the experience sampling method to prospectively test the self-medication hypothesis. In vivo reports gathered in the context of daily life demonstrated that nervousness was the only negative mood state to predict increases in alcohol consumption later in the course of the day. Further examination of this within-person relationship demonstrated that men were more likely to consume alcohol when nervous than were women, but this association was unrelated to family history of alcoholism, problem drinking patterns, or trait anxiety and depression. Consistent with the self-medication hypothesis, cross-sectional analyses also confirmed that alcohol consumption was generally associated with lower levels of nervousness; this effect varied by several demographic and clinical variables. These findings are discussed in terms of the diversity of reasons for alcohol consumption and their potential for explaining problem drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Completeness of reporting of diagnosed HIV-infected hospital inpatients

To assess the completeness of human immunodeficiency virus (HIV) reporting among hospital inpatients whose records listed diagnostic codes for HIV infection but who did not meet the 1987 AIDS case definition, we conducted a statewide hospital study of admissions between January 1, 1986 and December 31, 1990. Of the 396 HIV-infected hospital inpatients identified, 313 (79%) had been reported to the State HIV Registry. HIV reporting was less complete for patients who were older and/or were blood product recipients. Of the 313 reported patients, 189 (60%) had been reported prior to their first hospital admission. Temporal improvements were noted in the completeness of HIV reporting among the hospital patients (1986: 65%; 1987: 81%; 1988: 64%; 1989: 82%; 1990: 86%; Chi square for linear trend 9.6, p < 0.01) and prior to their first hospital admission (1986: 31%; 1987: 34%; 1988: 49%; 1989: 64%; 1990: 72%; Chi square for linear trend 26.6; p < 0.01). Women were more likely than men to be reported prior rather than during or after their first hospital admission (71% vs. 55%; p < 0.01). Of the 155 patients with CD4+ T-lymphocyte test results, 41 had CD4+ counts < 200 mm3 and met the 1993 but not the 1987 AIDS case definition. In South Carolina most (79%) diagnosed, hospitalized, HIV-infected patients had been reported to the State HIV REgistry, with improvements in reporting occurring over time. Findings suggest that the 1993 AIDS case definition will improve our ability to monitor severe morbidity related to HIV.     

Spirituality and the treatment of the dually diagnosed: an investigation of patient and staff attitudes

Spirituality is a neglected area of study and research in the treatment of addictions. The role of spirituality in the treatment of the dually diagnosed has received particularly scant attention. One hundred and one patients on an in-patient dual-diagnosis unit, as well as the 31 members of the nursing staff who treat them were surveyed. Patients and staff were questioned about their spiritual beliefs and what was the role of spirituality in the patients' recovery from addiction. Staff were questioned about their own spirituality and what they think the patients' level of spirituality is. In addition the staff were asked what they think the patients' view of spiritually is. Results indicate that the patients and staff are equally spiritually oriented. The patients view spirituality as essential to their recovery and value spiritual programming in their treatment more than some concrete items. The nursing staff underestimated both the patients' level of spirituality and this importance placed on spiritual issues. The authors suggest that more attention should be given by staff to spirituality in the treatment of this population.     

The self-medication hypothesis of substance use disorders: a reconsideration and recent applications

The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.     

Crack cocaine and schizophrenia as risk factors for PPD reactivity in the dually diagnosed

The authors have investigated the clinical role of the soft tissues and of their influence in the planning phase of the orthognathic surgery, with the purpose to emphasize their capital influence in the face armony. Most of the patients really ask for an aesthetic result, that is in a tight relation with the correct prediction of the morphological changes of the soft tissues. The aesthetics excite nowadays the research, especially in all the surgical fields, and so the orthognatic surgery is more than ever from the soft tissues influenced. Subsequently the authors have investigated the principal indications to the bimaxillary surgery and have suggested a personal diagnostic-therapeutic protocol for a correct and opportune evaluation of the soft tissues relations. Finally the authors have described the whole prediction phase and have shown as the maxillary bones influence the whole facial skelett, and as frequently the chin correction and the rhinoplasty are necessary for a better result in the time.     

Clinical assessment of MR of the brain in nonsurgical inpatients

PURPOSE: To evaluate the effect of MR imaging of the brain on four domains of patient care: diagnosis, diagnostic workup, therapy, and prognosis. METHODS: Pre- and post-MR written questionnaires and oral interviews were administered to the referring clinicians of 103 medical and neurologic inpatients at a tertiary care institution. Additional information was obtained from radiologic reports and records. RESULTS: The study population had a diverse array of signs and symptoms and of presumptive clinical diagnoses, reflecting the breadth of disease seen at our institution. The vast majority of physicians (89%) reported that MR imaging added significant diagnostic information, playing an important role in guiding diagnostic workup (24%), planning treatment (34%), and estimating prognosis (47%). MR imaging was significantly more likely to decrease than to increase confidence in the presumptive clinical diagnosis. Thus, MR imaging may be most useful in the setting of diagnostic uncertainty. CONCLUSION: Our results show that MR imaging of the brain has important effects on each of the four domains of care for medical inpatients.     

Validation of the Geriatric Depression Scale--Short Form among inpatients

Little is known about the diagnostic validity of the 15-item Geriatric Depression Scale-Short Form (GDS-SF), especially when compared to the original 30-item version (Geriatric Depression Scale-Long Form; GDS-LF). This study compared the GDS-SF and GDS-LF with a sample of depressed, demented, and thought-disordered inpatients. The GDS-SF and GDS-LF were found to be highly correlated (r = .89) and to have similar high sensitivity rates. The specificity rates for both forms were similar, but lower than desirable. Overall, the GDS-SF was found to be an adequate substitute for the GDS-LF.     

Heterogeneity of cognitive style among depressed inpatients.

An inference from the cognitive theories of depression is that only a subset of depressed individuals should exhibit distinctively negative cognitive styles. Although this inference has been supported by previous research, attempts to characterize these depressives have yielded few identifying variables. This study of psychiatric inpatients and normal control subjects identified several characteristics of depressives with very negative cognitive styles by (a) examining traditional depression subtypes, (b) grouping depressives on the basis of clinical observations, and (c) asking whether sex, developmental events, and history and severity of depression predict cognitive styles. We found that borderline personality disorder, negative family dynamics during childhood, a history of sexual abuse, and severity of depression predict cognitive styles. We speculate that aversive developmental events may contribute to cognitive vulnerability to depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of the University of Rhode Island Change Assessment to measure motivational readiness to change in psychiatric and dually diagnosed individuals.

In this report, the original 4-factor structure of the University of Rhode Island Change Assessment (URICA; C. C. DiClemente & S. O. Hughes, 1990) was replicated, and the scale's internal consistency was found to be acceptable in a sample of 120 psychiatric and dually diagnosed inpatient participants, who had participated in a randomized clinical trial comparing standard treatment (ST) and ST plus motivational interviewing. Contrary to the authors' hypotheses, participants classified as having low motivational readiness to change, based on their URICA scores, demonstrated greater treatment adherence than high-readiness participants, in that they attended a greater proportion of therapy groups while hospitalized (54% vs. 39%; p     

Empirical tests of the absolute sleeper effect predicted from the discounting cue hypothesis.

Two experiments tested the sleeper effect with respect to persuasion research (i.e., the finding that a persuasive message has a greater delayed than initial impact on Ss' attitudes). These experiments included strong tests of the discounting cue hypothesis because they (a) demonstrably created the conditions that the theory indicated were necessary for the effect to occur, (b) demonstrably minimized the impact of a force known to countervail against the effect, and (c) employed statistical tests that had adequate power to detect the effect should it occur. In Exp I, 161 undergraduates read 1 of 2 persuasive messages accompanied by a discounting cue. All the requirements for a strong test were demonstrably met with 1 message, and an absolute sleeper effect was obtained when attitudes were measured again after 5 wks. In Exp II, 493 undergraduates read a persuasive message and 1 of 5 discounting cues. All the requirements for a strong test were demonstrably met in 3 cue conditions, and absolute sleeper effects were found in each of them after 6 wks. Absolute sleeper effects were not observed in the 2 cue conditions in which the necessary conditions for the effect were not met. It is concluded that absolute sleeper effects can be reliably obtained when all the necessary theoretical conditions are met, a known countervailing force is absent, and the statistical tests have adequate power. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirical assessment of handrail diameters.

Fifty-one female clerical employees tried out handrail diameters of four diameters, and were asked for their preference and sense of felt safety. A diameter between 1.75 and 2.00 inches was preferred; the 2.00 inch diameter was felt most safe. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirical test of the "levels" hypothesis with five projective techniques.

Tested the "levels" hypothesis that there is an inverse relationship between the degree of stimulus structure in a test and the level of personality impulse-control system being tapped by the test, for 20 normal and 20 psychiatric Ss. As predicted, an inverse relationship between pathology and stimulus structure over 5 tests (from low-high structure Draw-a-Person, Rorschach, TAT, Rotter Incomplete Sentence Blank, and Bender-Gestalt) was found for normals. Contrary to hypothesis, no such relationship appeared for psychiatric Ss. Other hypotheses that psychiatric Ss manifest more projection and more pathology than normals, and that there is a significant correlation between pathology and projection for every test for each group were confirmed. A new theory of projection of pathology as a function of the stimulus structure of tests is proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A and B undergraduate interviews of schizophrenic and neurotic inpatients: A test of the interaction hypothesis.

To clarify the personological basis of the differential compatability of A and B therapists with schizophrenic and neurotic patients, A and B (determined by the Personality Research Form and the A-B Scale) undergraduate volunteers (20 males, 20 females) conducted 20-min interviews with male state hospital inpatients (40 schizophrenics, 40 neurotics) in a 2 (interviewer A–B status) by 2 (interviewer sex) by 2 (patient type) factorial design. As expected from studies of the personality correlates of A–B status, many more B than A interviewers "looked forward" to conducting the interviews. Once in the interview situation, however, A-type interviewers elicited better self-disclosure from schizophrenic patients than did Bs, whereas the latter outperformed As with neurotic patients. Results are discussed in terms of a personological formulation that considers interviewer effectiveness to be a joint function of interviewer personality characteristics and the situational context. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinician assessment of psychiatric comorbidity and alcoholism severity in adult alcoholic inpatients

Although psychiatric comorbidity and alcoholism severity are risk factors for poor outcomes in treating alcoholism, little is known about whether clinicians assess these conditions accurately. In this study we evaluated four clinicians' assessments of two indicators of alcoholism severity and three psychiatric co-morbidities in 78 inpatients in their third to seventh day of hospitalization in alcohol treatment programs. Clinicians overestimated the number of days drinking in 28% of subjects, and the number of drinks per drinking day in 37% of subjects. Clinicians underestimated alcohol consumption for patients with higher incomes. Clinicians correctly diagnosed 67% of 18 subjects with antisocial personality disorder, 65% of 26 with major depression, and 89% of 28 with drug abuse. These preliminary results need to be replicated in larger samples of clinicians to determine whether interventions are needed to improve the recognition of important prognostic factors in the treatment of alcoholic patients.     

Frequency of dissociative disorders among psychiatric inpatients in a Turkish University Clinic

BACKGROUND: Intravenous gammaglobulin (i.v.IG) contains anti-idiotypic antibodies that are potent inhibitors of HLA-specific alloantibodies in vitro and in vivo. In addition, highly HLA-allosensitized patients awaiting transplantation can have HLA alloantibody levels reduced dramatically by i.v.IG infusions, and subsequent transplantation can be accomplished successfully with a crossmatch-negative, histoincompatible organ. METHODS: In this study, we investigated the possible use of i.v.IG to reduce donor-specific anti-HLA alloantibodies arising after transplantation and its efficacy in treating antibody-mediated allograft rejection (AR) episodes. We present data on 10 patients with severe allograft rejection, four of whom developed AR episodes associated with high levels of donor-specific anti-HLA alloantibodies. RESULTS: Most patients showed rapid improvements in AR episodes, with resolution noted within 2-5 days after i.v.IG infusions in all patients. i.v.IG treatment also rapidly reduced donor-specific anti-HLA alloantibody levels after i.v.IG infusion. All AR episodes were reversed. Freedom from recurrent rejection episodes was seen in 9 of 10 patients, some with up to 5 years of follow-up. Results of protein G column fractionation studies from two patients suggest that the potential mechanism by which i.v.IG induces in vivo suppression is a sequence of events leading from initial inhibition due to passive transfer of IgG to eventual active induction of an IgM or IgG blocking antibody in the recipient. CONCLUSION: I.v.IG appears to be an effective therapy to control posttransplant AR episodes in heart and kidney transplant recipients, including patients who have had no success with conventional therapies. Vascular rejection episodes associated with development of donor-specific cytotoxic antibodies appears to be particularly responsive to i.v.IG therapy.     

Perfectionism and depression: Longitudinal assessment of a specific vulnerability hypothesis.

The authors tested whether perfectionism dimensions interact with specific stress to predict depression over time. A sample of 103 current and former patients completed measures of perfectionism and depression at Time 1 and measures of stress and depression 4 months later. After controlling for Time 1 depression, self-oriented perfectionism interacted only with achievement stress to predict Time 2 depression. Socially prescribed perfectionism did not interact with achievement or social stress to predict Time 2 depression, but it did predict Time 2 depression as a main effect. The results provide support for the contention that perfectionism dimensions are involved in vulnerability to depression over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of alcohol typologies using HIV risk behaviors among alcoholic inpatients.

Evaluated the strength of associations for HIV risk behavior and 5 typologies of alcoholism (gender, comorbid psychopathology, gamma–delta, family history, and drug abuse) among 802 inpatients (481 men and 321 women; mean age 34.4 yrs) at alcohol treatment centers. Findings suggest that some of the alcohol typologies describe subtypes with significant differences on rates and levels of HIV risk behaviors. Specifically, gender, depression, and anxiety subtypes were not consistently associated with HIV risk; however, the antisocial personality disorder and drug abuse subtypes had the strongest average effect size across a number of indicators of HIV risk behaviors (e.g., condom nonuse, multiple sex partners, and injection drug use). The gamma–delta and family history subtypes also resulted in elevated HIV risk behaviors, although with smaller effect sizes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)