Efficacy of two behavioral treatment programs for comorbid geriatric insomnia.

Older adults with comorbid insomnia and medical illness have been excluded from behavioral treatment research, but recent evidence suggested that such treatments would be effective with this population. In this study, 38 older adults with comorbid insomnia were randomized to 1 of 3 conditions: classroom cognitive-behavioral treatment (CBT), home-based audio relaxation treatment (HART), or delayed-treatment control. Compared to the control group, the CBT group had significant changes in 5 of 7 self-report measures of sleep at the 4-month follow-up. The HART group obtained significant outcomes on 3 of 7 measures. Wrist actigraphy measures and secondary-outcome measures did not yield significant findings for either treatment. Clinically significant changes at follow-up were obtained for 54% of patients in CBT, 35% in HART, and 6% in the control group when treatment dropouts were included. Although not as effective as in-person CBT, home interventions may have utility as a first-line, low-cost treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relaxation treatment for insomnia: A component analysis.

Compared 4 relaxation treatments—progressive relaxation, progressive relaxation without tension release, imagery with tension release, and imagery without tension release—for sleep onset insomnia with a waiting-list control (no treatment). Analysis of data from 44 19–71 yr old insomniacs recruited from the community showed all treatment conditions to be superior to no treatment in reducing latency of sleep onset and ratings of fatigue. The presence of muscle-tension release was unrelated to outcome. There was a nonsignificant trend for visual imagery treatments to be superior to somatic-focusing treatments in reducing sleep onset latencies. Treatments using visual focusing were superior to somatic-focusing treatments in reducing the number of nocturnal awakenings. At 6 mo follow-up, only the imagery treatments showed significant improvement over pretreatment levels on latency of sleep onset. Visual-focusing treatments produced significantly greater reductions in sleep onset latency at follow-up than did the somatic-focusing treatments. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new method of treatment for mallet finger. A preliminary report

An infant with a typical Edwards syndrome and a modal chromosome number of 46 is reported. In all cells analyzed one chromosome G was missing and an additional chromosome similar to a pair No. 16 was present. The phenotype of the child indicates that the extra element is a translocation between G and 18 chromosomes as in one case described previously.     

Concept for a behavior therapy treatment program in primary insomnia

Cutaneous recordings of gastric electrical activity (electrogastrography (EGG)) could become a valuable non-invasive tool for recognising gastric electrical abnormalities. Although signals obtained with internally implanted electrodes deliver quantitative information, this technique cannot be used for diagnostic purposes because of its invasive nature. On the other hand, the objectivity of electrogastrography is still in question. The aims of this work are to develop computer techniques for extracting quantitative information from digital electrogastrograms, and to evaluate quantitatively EGG recordings from healthy volunteers. The dynamics of all four EGG parameters are studied: amplitude, frequency, time shift between different channels, and waveform. Four separate two-dimensional computer plots are developed using specially designed digital signal-processing procedures. Each parameter is evaluated in a study of 20 healthy volunteers. Frequency is found to be the only EGG parameter that shows quantitative consistency and merit.     

Computer-assisted attention retraining in head-injured individuals: A controlled efficacy study of an outpatient program.

The efficacy of a computer-assisted attention retraining program was evaluated with 29 outpatients suffering from moderate to severe traumatic brain injury. Ss who were at least 12 mo postinjury were randomly assigned either to the attention training program or a memory training program that served as a control condition. Training lasted 9 wks with 2 2-hr sessions per wk for both groups. The experimental design evaluated outcome by juxtaposing a multiple baseline procedure for a 1st set of measures of attention and memory with a pre- and postgroup comparison that relied on a 2nd set of neuropsychological tests. The experimental group improved significantly in comparison with the control group on measures of attention. The reversed pattern for the memory measures was not observed. None of the treatment effects generalized to the 2nd set of dependent variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Document-based peer review in a psychology training clinic: A preliminary report of a statewide program.

14 licensed psychologists evaluated 20 5-session treatment reports completed by graduate students at a psychology training clinic. The review report ratings indicate that psychologists were impressed with the services provided and proposed at the training clinic. The review program is seen as supplementing the clinic's educational and quality assurance activities. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dacryocystantrostomy. A preliminary report

A new operative technique is described in which the lacrimal sac is drained into the maxillary sinus. The advantages of the procedure, especially of avoiding a facial incision, are emphasized. Five patients suffering from long-standing epiphora underwent surgery. Two patients had chronic dacryocystitis. Two other patients presented with a mucocele of the lacrimal sac. In the fifth patient, there was obstruction in the nasolacrimal duct. Short term follow-up results suggest its usefulness as a first line of surgical treatment in cases of epiphora due to obstruction in the lacrimal sac or the naso-lacrimal duct.     

Imagery as an aid in working through unconscious conflicts: A preliminary report.

Considers a technique designed to aid the working-through process in psychoanalytic treatment. It consists of an analysand, either during or after treatment, imploding psychodynamic themes that have come to be understood as crucially involved in his/her psychology and psychopathology. This process refers to the person conjuring up affect-laden images in which warded-off libidinal and aggressive impulses are expressed and then met with punishment (e.g., abandonment, castration). Clinical material is cited that suggests that the use of implosive imagery as a psychoanalytic treatment adjunct can lead to the mastery of unconscious conflict, the emergence of new insights, and the retrieval of repressed memories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postdoctoral training in clinical psychology: A preliminary report by an interest group.

3 purposes of this paper are: "to bring to those concerned with the education of psychologists some information about postdoctoral training in clinical psychology and some thinking of an interest group actively concerned with this problem, to call to the attention of potential candidates postdoctoral training opportunities which now exist, and to invite correspondence and future participation from interested institutions and individuals." 19 centers offering postdoctoral fellowships and their training directors are listed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonpharmacological interventions for insomnia in older adults: A meta-analysis of treatment efficacy.

The benefit of nonpharmacological interventions for insomnia in old age was investigated. A total of 13 single-outcome studies from 1966–1998 involving 388 patients (mean age exceeding 60 years, minimum age in sample, 50 years) were included in a meta-analysis of treatment efficacy. This analysis demonstrated that behavioral interventions produce improvements in sleep parameters of older insomniacs, measured in terms of sleep-onset latency, number of nocturnal awakenings, time awake after sleep onset, and total sleep time. Clinical improvements seen at posttreatment were maintained at followups (averaging 6 months). It is concluded that behavioral treatments produce significant and long-lasting improvements in the sleep pattern of older insomniacs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of ten hours of implosive therapy in the treatment of outpatients: A preliminary report.

The present report, investigating the effectiveness of implosive therapy (IT) with outpatients, mainly was designed as an exploratory study to determine the feasibility and value of more effective evaluations of this new behavioral therapy. 40 patients were divided into 1 experimental and 3 control groups. Only the IT group showed a consistent trend to shift away from psychopathology as measured by the MMPI. Some evidence is presented that the changes in this group are not due to the number of therapy sessions, to the skills and personal qualities of the therapists independent of the treatment technique, to the termination of treatment, or to effects resulting from the commitment to and expectation of professional treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Comprehensive Object Relations Profile: A preliminary report.

This article reports a study of a newly created instrument designed specifically for the measurement of object relations concepts. The Comprehensive Object Relations Profile (CORP) is a semistructured projective test that asks the subject to respond to specific questions regarding interpersonal vignettes. Each question is designed to tap a particular dimension of object relationships. Three dimensions are measured: object constancy, object integration, and empathy. Validity was assessed by a comparison of three diagnostic groups: schizophrenics, borderlines, and neurotics. Reliability was measured by the interjudge method. The results indicated that the CORP significantly differentiated the three diagnostic groups in the expected direction and that the CORP is a highly reliable instrument. The implications of these results were drawn for both the usefulness of the CORP and the validity of object relations concepts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Radioisotope choroid plexography. A preliminary report

Radioisotope plexography seems as easy and innocuous as routine brain scanning. An introductory method is given which could be improved. The choroid plexuses of the four ventricles were well visualized in 15 patients. Consideration is given to the possible labeling process. Besides its morphological value, the test could give interesting clues in the dynamic study of hydrocephalus.     

Hospitalization needs during an outpatient rehabilitation program for severe chronic airway obstruction

The number of days of hospitalization for respiratory disease following entry into an outpatient pulmonary rehabilitation program was reviewed for 44 patients with chronic airway obstruction whose hospitalization records were available for the year prior to entry into the program. A significant reduction in the number of days of hospitalization occurred in patients for each of the four years following entry into the program, compared to the year prior to therapy.     

Arthroscopic treatment of partial rotator cuff tears in young athletes. A preliminary report

A cluster of four cases of haemolytic uraemic syndrome in children occurred in Northern Bohemia, Czech Republic, between 15 June and 7 July, 1995. All the cases had significantly elevated titres of anti-O157 lipopolysaccharide (LPS) antibodies as detected by the indirect haemagglutination assay. All but one of them had drunk unpasteurized goat's milk from the same farm within the week before the disease. Evidence of E. coli O157 infection was subsequently found in 5 of 15 regular drinkers of the farm's raw goat's milk; four of them were asymptomatic, 1 had mild diarrhoea at the end of June. Verocytotoxin 2-producing E. coli O157:H7 strains of phage type 2 and of identical pulsed-field gel electrophoresis patterns were isolated from 1 of 2 farm goats and from 1 of the asymptomatic goat's milk drinkers. The frequency of anti-O157 LPS antibodies found among regular drinkers of the farm's raw goat's milk (33%; 5 of 15) was significantly higher than that found in control population (0%; none of 45) (P = 0.0005; Fisher's exact test). Our findings indicate that goats may be a reservoir of E. coli O157:H7 and a source of the infection for humans; raw goat's milk may serve as a vehicle of the pathogen transmission.     

A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months

AIM: In this study, the effects of a 12-week hospital-based outpatient pulmonary rehabilitation program (HRP) are compared with those of a 12-week home-care rehabilitation program (HCRP) in COPD patients. A control group received no rehabilitation therapy. METHODS: After randomization and stratification, effects on lung function, exercise performance (4-min walking test and cycle ergometer test), dyspnea, and leg effort during exercise, and well-being were assessed in 45 COPD patients with moderate to severe airflow limitation (mean [SD] FEV1 percent predicted, 42.8 [8.4]). RESULTS: After HRP and HCRP, at 3 to 6 months after the start of the study, equal improvements were detected in exercise capacity and in Borg dyspnea and leg effort scores at similar work levels during the cycle test. However, whereas after HRP at longer term values tended to return to baseline outcome, after HCRP a further ongoing significant improvement in exercise capacity was observed, while Borg dyspnea scores remained significantly improved over 18 months. Improvements in cycle workload and dyspnea score were significantly better maintained after HCRP as compared with HRP. Lung function, arterial oxygen saturation, and heart frequency during exercise did not change. A significant improvement in well-being was maintained over 18 months in both rehabilitation groups. CONCLUSION: Beneficial effects are achieved both after a HRP and a HCRP in COPD patients with moderate to severe airflow limitation. Yet we recommend to initiate HCRPs as improvements are maintained longer and are even further strengthened in this setting.     

Psychological treatment of secondary insomnia.

Psychological treatment of insomnia has focused on primary insomnia (i.e., having a psychological origin). Secondary insomnia, sleep disturbance caused by a psychiatric or medical disorder, although it is more common than primary insomnia, has received very little attention as a result of the belief that it would be refractory to treatment. The present study randomly assigned older adults with secondary insomnia to a treatment group, 4 sessions composed of relaxation and stimulus control, or a no-treatment control group. Self-report assessments conducted at pretreatment, posttreatment, and a 3-month follow-up revealed that treated participants showed significantly greater improvement on wake time during the night, sleep efficiency percentage, and sleep quality rating. The authors hypothesize that treatment success was probably due in part to difficulty in diagnostic discrimination between primary and secondary insomnia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of paradoxical intention in a behavioral program for sleep onset insomnia.

Sleep onset insomnia seems often to be based on performance anxiety associated with a client's fears of being able to fall asleep; in some cases, a therapeutic program might actually exacerbate this performance anxiety by focusing on the client's efforts to voluntarily control the sleep onset process. Five Ss aged 23–41 yrs and experiencing sleep onset difficulty unusually resistant to a conventional behavioral program for this problem (i.e., deep muscle relaxation and systematic desensitization), were exposed to paradoxical intention suggestions requiring that they try to remain awake as long as possible, rather than attempt to fall asleep. A rapid reduction of sleep onset latency occurred following the shift from the conventional program to the paradoxical intention instructions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)