Cultural themes in the psychotic symptoms of African American psychiatric patients.

Professional psychologists need to recognize ethnic/racial differences between African Americans and European Americans in psychotic symptom expression to treat individuals with severe mental illness from various cultural backgrounds. Specifically, they need to understand confluent paranoia or the interaction between culture and pathology in psychotic symptom expression. To assist mental health professionals, the present study identified cultural themes in the delusions and hallucinations of a sample of 156 African American psychiatric patients via content analysis. Race-related themes and religious themes were observed in the psychotic symptoms of these patients assessed with the Structured Clinical Interview for DSM IV. Race-related and religious content were manifested in different types of delusions. Race-related themes were more common in persecutory delusions, whereas religious themes occurred more often in other delusions. Race-related themes were associated more with delusions, while religious themes correlated with both delusions and hallucinations. Implications for the treatment of confluent paranoia in African Americans are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance of the Hamilton Depression Rating Scale in depressed patients in the United Arab Emirates

Cross-cultural variation in the frequencies and modes of expression of depressive symptoms may influence the validity of depression rating scales. The most widely used instrument for this purpose, namely Hamilton's Depression Rating Scale (HDRS), has not been systematically evaluated in Arab countries. This study evaluates the face validity of the HDRS-21 by studying symptom frequencies, factor structure and symptom clusters in 100 UAE depressed patients. Concurrent validity is tested by comparing total HDRS scores with global estimates of severity made by clinicians, admission status, impairment of social and occupational functioning, and the endogenicity score of the Newcastle (NC) Diagnostic Index. Total HDRS scores show highly significant agreement with three independent measures of severity of depression. Rank orders of the most and least frequent symptoms are consistent with studies of similar design. Marked differences lie in more retardation and somatization and fewer cognitive components in the present study. Principal-component analysis confirmed the heterogeneous structure of the scale, separating a group of core depressive symptoms, and endogenous, somatization, anxiety and psychotic symptom components. The internal consistency (reliability) of the whole scale is moderate, and improves in the core symptom factor. The main conclusion is that the HDRS is sensitive to severity of depression in the UAE culture. However, it measures heterogeneous aspects, and its internal consistency suffers as a result. High levels of retardation and somatization contribute significantly to the total score in socially developing communities.     

Mislabeling the Black client: A reply to Ridley.

Comments that C. R. Ridley's (see record 1985-26063-001) article on the nondisclosing Black client is welcome and helpful. However, a flaw in nomenclature (i.e., careless use of the diagnostic term paranoia) detracts from the contribution and tends to negate the arguments being made. The mistrust of Whites and White society by some Black clients is based in reality, while paranoia is not. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the continuum of delusional beliefs: An experimental study using virtual reality.

A key problem in studying a hypothesized spectrum of severity of delusional ideation is determining that ideas are unfounded. The first objective was to use virtual reality to validate groups of individuals with low, moderate, and high levels of unfounded persecutory ideation. The second objective was to investigate, drawing upon a cognitive model of persecutory delusions, whether clinical and nonclinical paranoia are associated with similar causal factors. Three groups (low paranoia, high nonclinical paranoia, persecutory delusions) of 30 participants were recruited. Levels of paranoia were tested using virtual reality. The groups were compared on assessments of anxiety, worry, interpersonal sensitivity, depression, anomalous perceptual experiences, reasoning, and history of traumatic events. Virtual reality was found to cause no side effects. Persecutory ideation in virtual reality significantly differed across the groups. For the clear majority of the theoretical factors there were dose–response relationships with levels of paranoia. This is consistent with the idea of a spectrum of paranoia in the general population. Persecutory ideation is clearly present outside of clinical groups and there is consistency across the paranoia spectrum in associations with important theoretical variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mapping the Continuum of Alcohol Problems in College Students: A Rasch Model Analysis.

The authors conducted Rasch model (G. Rasch, 1960) analyses of items from the Young Adult Alcohol Problems Screening Test (YAAPST; S. C. Hurlbut & K. J. Sher, 1992) to examine the relative severity and ordering of alcohol problems in 806 college students. Items appeared to measure a single dimension of alcohol problem severity, covering a broad range of the latent continuum. Items fit the Rasch model well, with less severe symptoms reliably preceding more severe symptoms in a potential progression toward increasing levels of problem severity. However, certain items did not index problem severity consistently across demographic subgroups. A shortened, alternative version of the YAAPST is proposed, and a norm table is provided that allows for a linking of total YAAPST scores to expected symptom expression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Entorhinal cortex of aged subjects with Down''s syndrome shows severe neuronal loss caused by neurofibrillary pathology

OBJECTIVE: To examine directly the extent to which ICD-10 hyperkinetic disorder and DSM-IV attention-deficit/hyperactivity disorder (ADHD) identify the same children with the same difficulties. METHOD: Participants were children referred for symptoms of overactivity, inattention, and impulsivity, and a normal control group. Diagnostic criteria for ICD-10 hyperkinetic disorder and DSM-IV ADHD were applied retrospectively. Four groups were identified: hyperkinetic disorder and ADHD (n = 21), ADHD only (n = 22), clinic control (n = 15), and normal control (n = 19). The groups were compared on measures reflecting the central characteristics of ADHD, neurodevelopmental functioning, academic and cognitive functioning, and the presence of conduct problems. RESULTS: There is some evidence of increased symptom severity in the combined diagnostic group. Few differences emerged on measures of neurodevelopmental, academic, and cognitive functioning. Rates of conduct disturbance were similar in both ADHD groups. CONCLUSIONS: DSM-IV criteria identify a broader group of children than those identified by ICD-10. However, there is substantial overlap between the groups formed with these different criteria.     

Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder

OBJECTIVE: A two-part study was conducted to examine the health status of Vietnam veterans with posttraumatic stress disorder (PTSD). In part 1, veterans with and without PTSD were compared on health behaviors and on self-reported and physician-rated health problems. Consistency of self-report with physician rating for health problems across the two groups was compared. In part 2, the association between health status and PTSD symptom severity, depression, somatization, and health behaviors in PTSD patients was evaluated. METHOD: In part 1, 276 combat veterans (225 with PTSD and 51 without PTSD) provided health status information, and medical records were reviewed. In part 2, 225 PTSD patients completed standardized PTSD severity, somatization, and depression measures. RESULTS: When analyses controlled for age, socioeconomic status, minority status, combat exposure, alcohol use, and pack-year history, veterans with PTSD reported and were rated as having a greater number of health problems than veterans without PTSD. Agreement between self-report and physician ratings for both groups ranged from low to moderate. Level of agreement between patient and physician was similar across groups. In the analysis of veterans with PTSD, somatization and PTSD symptom severity were significantly related to self-report of health problems, whereas only PTSD symptom severity was related to physician-rated health. Pack-year history was significantly related to self-reported health status in both groups. CONCLUSIONS: The presence and severity of PTSD in veterans were associated with greater physical health problems and conditions. Psychological variables (e.g., PTSD status, PTSD severity, somatization) and a behavioral variable (pack-year history) were related to health status.     

An analysis of test bias and differential item functioning due to race on the Mattis Dementia Rating Scale

The Mattis Dementia Rating Scale (MDRS) is a commonly used cognitive measure designed to assess the course of decline in progressive dementias. However, little information is available about possible systematic racial bias on the items presented in this test. We investigated race as a potential source of test bias and differential item functioning in 40 pairs of African American and Caucasian dementia patients (N = 80), matched on age, education, and gender. Principal component analysis revealed similar patterns and magnitudes across component loadings for each racial group, indicating no clear evidence of test bias on account of race. Results of an item analysis of the MDRS revealed differential item functioning across groups on only 4 of 36 items, which may potentially be dropped to produce a modified MDRS that may be less sensitive to cultural factors. Given the absence of test bias because of race, the observed racial differences on the total MDRS score are most likely associated with group differences in dementia severity. We conclude that the MDRS shows no appreciable evidence of test bias and minimal differential item functioning (item bias) because of race, suggesting that the MDRS may be used in both African American and Caucasian dementia patients to assess dementia severity.     

The risks of risk adjustment

CONTEXT: Risk adjustment is essential before comparing patient outcomes across hospitals. Hospital report cards around the country use different risk adjustment methods. OBJECTIVES: To examine the history and current practices of risk adjusting hospital death rates and consider the implications for using risk-adjusted mortality comparisons to assess quality. DATA SOURCES AND STUDY SELECTION: This article examines severity measures used in states and regions to produce comparisons of risk-adjusted hospital death rates. Detailed results are presented from a study comparing current commercial severity measures using a single database. It included adults admitted for acute myocardial infarction (n=11880), coronary artery bypass graft surgery (n=7765), pneumonia (n=18016), and stroke (n=9407). Logistic regressions within each condition predicted in-hospital death using severity scores. Odds ratios for in-hospital death were compared across pairs of severity measures. For each hospital, z scores compared actual and expected death rates. RESULTS: The severity measure called Disease Staging had the highest c statistic (which measures how well a severity measure discriminates between patients who lived and those who died) for acute myocardial infarction, 0.86; the measure called All Patient Refined Diagnosis Related Groups had the highest for coronary artery bypass graft surgery, 0.83; and the measure, MedisGroups, had the highest for pneumonia, 0.85 and stroke, 0.87. Different severity measures predicted different probabilities of death for many patients. Severity measures frequently disagreed about which hospitals had particularly low or high z scores. Agreement in identifying low- and high-mortality hospitals between severity-adjusted and unadjusted death rates was often better than agreement between severity measures. CONCLUSIONS: Severity does not explain differences in death rates across hospitals. Different severity measures frequently produce different impressions about relative hospital performance. Severity-adjusted mortality rates alone are unlikely to isolate quality differences across hospitals.     

Symptom subtypes in persons institutionalized with schizophrenia: Comparison of demographics, outcome and functional skills.

Using a formula based on the concept by N. C. Andreasen (see record 1982-29376-001) and N. C. Andreasen and S. Olsen (see record 1982-30452-001) of classifying subtypes into positive, negative, and mixed schizophrenia, 312 persons institutionalized with Diagnostic and Statistical Manual of Mental Disorders (DSM-III) schizophrenia were retrospectively examined. 59 Ss were classified into the positive symptom subtype, 33 into the negative symptom subtype, and 220 into the mixed symptom subtype. Symptom subtypes were compared on traditional demographic and outcome indicators, as well as on a dimension critical to rehabilitation (i.e., measures of degree of assistance necessary to perform functional skills). No significant differences were found among the subtypes on demographic items and traditional indicators of outcome such as level of vocational functioning or independent living. However, on measures of degree of assistance necessary to perform functional skills, significant differences were found among the symptom subtypes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child abuse potential and parenting stress: Relationships in maltreating parents.

The relationship between the Child Abuse Potential Inventory (CAP) and the Parenting Stress Index was examined across four groups of maltreating parents. Parents who were self-referred or referred due to high risk obtained significantly higher scores, and neglecting parents obtained significantly lower scores, than either physically abusive parents or spouses of maltreating parents. Significant gender differences were also obtained, with males scoring lower than females. Classification rates for the recommended CAP abuse potential cutoff score were lower than reported in previous research. The two measures appear to be tapping similar constructs but also measuring unique aspects of subjects' functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Severity of cognitive impairment in Alzheimer's disease affects list learning using the California Verbal Learning Test (CVLT)

Impairment in list learning is considered a primary symptom of Alzheimer's disease (AD), yet there are no published reports examining the relationship between list learning and severity of cognitive impairment. We gave nine-item and 16-item versions of the California Verbal Learning Test (CVLT; Delis et al., 1987), a standardized shopping list assessment of memory, to 24 AD patients (mean age = 76.2 +/- 8.1; mean years of education = 13.8 +/- 2.4), who were stratified into four groups based on MMSE scores (mean = 16.0 +/- 5.6). ANOVAs revealed severity effects for total list learning (p < 0.001), the first trial (p < 0.001), the last trial (p < 0.001) and short- and long-delay recall measures. Most of these differences seemed due to floor effects. For example, the modal number of words recalled after a delay was 0 by subjects with MMSE scores below 21. Severity of cognitive impairment was associated with the proportion of intrusions such that the most severely demented subjects gave almost entirely intrusion responses. Surprisingly, list length did not significantly affect any of the free recall measures. Our results suggest that list learning and recall seem to be lost relatively early in AD. Measures of list recall like the CVLT may not be useful in tracking severity of cognitive impairment over time.     

Role of gender, sex role identity, and Type A behavior in anger expression and mental health functioning.

This study, including 407 female and 222 male college students, investigated the relationship of gender, sex role identity, and Type A behavior to multiple dimensions of anger expression and mental health functioning. Significant multivariate effects were found for sex role and behavior pattern type for anger expression. Significant gender differences were not observed. Univariate analyses revealed consistent relationships between sex role identity and anger proneness, suppression, and control and the tendency to express anger outwardly. Consistent relationships were found between behavior pattern type and both anger proneness and suppression. Significant multivariate effects were found for gender, sex role, and behavior pattern type for mental health functioning. Gender differences were not observed in depression. Women obtained higher scores on indirect hostility, irritability, and dependency, and men obtained higher scores on assault and aggressiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative priming in patients with Parkinson's disease: Evidence for a role of the striatum in inhibitory attentional processes.

Patients with Parkinson's disease (PD) and normal controls (NCs) performed a negative priming task. NCs displayed the normal pattern of negative priming in that relative to a control condition they were slower to identify a target within a stimulus array when it had been a distractor in the previous array. PD patients did not display any evidence of negative priming. In contrast, both PD patients and NCs displayed statistically the same level of spatial priming and response repetition cost. Regression analyses indicated that although symptom severity, symptom characteristics, and global cognitive functioning were not reliable predictors of negative priming or spatial priming in PD patients, greater symptom severity and poorer global cognitive functioning were associated with less response repetition cost. The possible role of the striatum in negative priming, spatial priming, and response repetition cost is discussed (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical significance of the National Institute of Mental Health Treatment of Depression Collaborative Research Program data.

The clinical significance of research findings is an important issue that, until recently, was often neglected. Statistical methods are available, however, to evaluate the meaningfulness of pre- to posttreatment change. The clinical significance of the National Institute of Mental Health Treatment of Depression Collaborative Research Program Data was evaluated. A substantial number of clients receiving treatment for depression made reliable improvements and had posttreatment scores that fell within a functional distribution. A small number of clients reliably deteriorated despite undergoing 12 sessions of treatment. No differences in clinical significance rates among treatment groups existed for measures of depressive symptoms. Treatments differed in terms of clinical significance on a measure of general symptom severity. There was substantial agreement among diverse methods of measurement regarding the identification of individuals making clinically significant change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Estimated number of patients with chronic renal failure but not with end-stage renal disease in Japan: comparisons between two estimation methods

BACKGROUND: A significant number of American women of childbearing age are troubled by premenstrual symptoms, but the underlying cause is not understood, resulting in inadequate therapy. OBJECTIVES: To use basal levels of cortisol to differentiate women with low symptom (LS) patterns of turmoil-type premenstrual symptoms from women with premenstrual symptom (PMS) patterns and from women with premenstrual magnification (PMM) patterns of turmoil-type premenstrual symptoms. METHOD: Symptom and cortisol patterns of women were monitored for three consecutive menstrual cycles. Three distinct groups of women were identified based on symptom patterns and types. RESULTS: Significant differences in symptom severity among groups were observed during the follicular (F = 203; df= 2, 24; p < .0001) and luteal phases (F= 51.3; df= 2, 24; p< .0001) of the cycle. There were no statistically significant differences in cortisol among groups for the follicular phase, but there were during the luteal phase (F= 4.0; df= 2, 24; p= .03). CONCLUSIONS: Altered regulation of the stress axis may be involved in mediating turmoil-type PMS.     

Impact of comorbid oppositional or conduct problems on attention-deficit hyperactivity disorder

OBJECTIVE: To investigate whether the presence of comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) alters the correlates of attention-deficit hyperactivity disorder (ADHD). METHOD: Three groups of children (33 "pure" ADHD, 46 ADHD + ODD, and 12 ADHD + CD) were compared on measures of ADHD, aggression, anxiety, parental psychopathology, self-esteem, school, and social-emotional functioning. RESULTS: Findings indicated that the presence of comorbid oppositional or conduct problems in children with ADHD altered the correlates of ADHD across a number of areas, including greater ADHD symptom severity and social dysfunction. Nevertheless, some correlates were more closely linked with the comorbid condition of ADHD + CD (e.g., higher aggression, anxiety, and maternal pathology, as well as decreased self-esteem), while others appeared more closely linked with ADHD + ODD (e.g., social withdrawal, elevated academic achievement paired with higher perceived scholastic competence). CONCLUSIONS: Findings support the distinctive profiles of the disruptive behavior disorder groups and emphasize the deleterious effects on the quality of life experienced by the comorbid conditions. The need for syndrome-specific interventions is stressed.     

Common measures of asthma severity lack association for describing its clinical course

BACKGROUND AND OBJECTIVE: To address the problems of increasing asthma morbidity and mortality rates, reliable severity measures must be identified. Accordingly, we compared three measures and their relationship to beclomethasone compliance. METHODS: Three clinical measures (symptom scores, morning peak expiratory flow rates, and number of as needed albuterol inhalations with Nebulizer Chronologs [Forefront Technologies, Inc., Lakewood, Colo.]) were assessed daily in 13 adults with asthma for 8.9 +/- 2.1 weeks. The relationships among these three variables were analyzed in terms of Pearson correlation coefficients. These were evaluated for each of the three possible pairs of the three clinical measures for each of the 13 patients. The relationship between inhaled beclomethasone compliance and the pairwise correlations was studied with the use of nonparametric statistical procedures. RESULTS: In four of the 13 patients, no pairwise correlations between any of the three severity measures were observed. The peak expiratory flow rate-symptom score relationship was observed in eight patients, whereas peak expiratory flow rate-albuterol use and albuterol use-symptom score correlations were each seen in four patients. Mean beclomethasone compliance was 64% and was greatest in those patients whose albuterol use increased concurrently with symptom scores (94% vs 50%, p = 0.02). CONCLUSIONS: The commonly used measures of asthma severity, symptom scores, peak flow rate, and beta-agonist use may not be interchangeable in describing the clinical course. Patients whose beta-agonist use is driven by symptoms tend to be more compliant with use of inhaled corticosteroids.     

Rorschach images of symbiosis and separation in eating-disordered and in borderline and nonborderline subjects.

The Rorschach protocols of 62 eating-disordered women were analyzed for content expressing symbiotic, separation, and counter-symbiotic strivings. Subjects were grouped into three symptom pattern groups and into borderline and nonborderline groups as measured by Gunderson's Diagnostic Interview for Borderlines (DIB). Very few differences in this content were found among the three symptom-based groups. Consistent and significant differences were found among these groups in the relation between overall Rorschach response productivity and the production of responses with this content. This suggests that the symptom patterns may reflect differing modes of self-regulation. Consistent and significant differences in the production of this content were also found between borderline and nonborderline groups, supporting clinically based claims that symbiotic Rorschach responses are diagnostic of borderline functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)