Depressive manifestations and differential patterns of treatment outcome in an intensive partial hospitalization treatment program.

Patients with personality disorder demonstrate heterogeneity in symptom presentation and treatment needs. Methods of subtyping patient presentations may illuminate important patient-treatment matches. Previous studies of an intensive partial hospitalization approach for patients with affective and personality disorders had demonstrated significant treatment effects. The current study aimed at identifying differential patterns of treatment engagement and outcome within this context of substantial aggregate benefit. Our sample was comprised of 107 outpatients, all of whom presented with Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) Axis II traits or full disorders. In a prior cluster analysis, measures of depressive symptom manifestation were employed to identify four distinct patient subgroups. The cluster designation was tested as an independent factor influencing in-treatment ratings (well-being, anxiety, depression) and pre- to posttreatment ratings of outcome. The patient clusters showed significantly different patterns of change in anxiety (slopes) over the course of treatment. Significant differences between clusters were also evident in the proportion of patients achieving clinically significant change on 3 central outcome indexes. Results are considered in terms of the match between the patient’s clinical presentation (e.g., anaclitic depression) and the treatment approach, with attention to implications for patient selection and preparation for the partial hospital program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Process and outcome in a hostel outreach program for homeless clients with severe mental illness

A longitudinal study followed 55 homeless and severely mentally ill clients of a hostel outreach program to assess outcomes and their relationship to program elements. Results at 18-month follow-up indicated that, despite chronic histories of transiency and shelter use, housing stability had been achieved, and that initial gains in social functioning and symptom reduction had been increased. Development of a strong working alliance proved a key program element in the findings.     

Cocaine use early in treatment predicts outcome in a behavioral treatment program.

In this evaluation of baseline drug use as a predictor of treatment outcome, cocaine use during a 5-week baseline was compared in methadone maintenance patients who had n?=?10) versus ≥5 (n?=?9) weeks of abstinence during an experimental cocaine abstinence reinforcement treatment. Cocaine use was evaluated at the 1st and last visit and the 1st and last week of baseline and as a mean across the 5-week baseline treatment; response was calculated as a mean across 12 weeks of experimental treatment. Those who had successful outcomes (abstainers) used significantly less cocaine in the 5-week baseline than those with less successful outcomes (nonabstainers). Differences in cocaine use were not evident in the 1st baseline visit or week, but the abstainers used significantly less cocaine in the last visit and week of baseline compared with the nonabstainers. Cocaine use during baseline provided critical predictors of response to the experimental treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Leukocyte differentials predict short-term clinical outcome following antipsychotic treatment in schizophrenia

PURPOSE: The purpose of the test-retest phase of the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study was to determine the repeatability of the various parts of the CLEK Study protocol. This paper presents the test-retest parameters of the refraction protocol. METHODS: We examined 138 CLEK Study-eligible patients on two occasions (median, 90 days; range, 22 to 268 days). All patients underwent subjective refraction on two occasions, and contact lens over-refractions were performed either over the patient's habitual rigid contact lenses or over a trial rigid contact lens equal in base curve to the steep keratometric reading in nonrigid contact lens wearers. RESULTS: Mean interoccasion differences +/- SD were -0.32 +/- 2.91 D and -0.17 +/- 1.39 D for subjective refraction sphere and cylinder power, respectively, and the mean absolute difference for subjective refraction cylinder axis was 18.1 +/- 20.2 degrees. The mean interoccasion difference +/- SD for high-contrast visual acuity with subjective refraction was 0.38 +/- 10.9 letters correct. Mean interoccasion differences +/- SD were -0.11 +/- 0.81 D and 0.02 +/- 0.67 D for contact lens over-refraction sphere and cylinder power, respectively, and the mean absolute difference for contact lens over-refraction cylinder axis was 11.6 +/- 9.9 degrees. The mean interoccasion difference +/- SD for visual acuity with contact lens over-refraction was 0.50 +/- 5.2 letters correct and 0.71 +/- 6.9 letters correct for high- and low-contrast visual acuity, respectively. CONCLUSIONS: The repeatability of subjective refraction in keratoconus patients is good but somewhat lower than that found in nondiseased eyes. Only 36% of our repeat measures of sphere power from subjective refraction fell within 0.50 D of each other, compared with more than 90% in studies of normal eyes.     

Parental criticism and treatment outcome in adolescents hospitalized for severe, chronic asthma

This pilot study investigated the relationship between parental criticism and medical treatment outcome across an inpatient hospitalization in 19 adolescents with severe, chronic asthma. Parental criticism toward their asthmatic adolescent was assessed using the Five Minute Speech Sample technique (FMSS) at the beginning of the adolescent's inpatient stay at a national asthma referral center. Those adolescents whose parents were rated as high in criticism on the FMSS were found to have greater improvement in their overall asthma severity, greater reduction in their steroid medication dose, and shorter lengths of stay in the hospital than those whose parents were rated as low in criticism. The adolescents whose parents were rated as high in criticism also showed lower compliance with their prescribed theophylline and oral steroid medication at admission than the low criticism group. These findings do not appear to be due to misdiagnosis secondary to the presence of vocal cord dysfunction or to the allergy status of the children. Clinical implications and possible causal mechanisms underlying these findings are discussed.     

Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness

OBJECTIVES: This study evaluated the hypothesis that greater integration and coordination between agencies within service systems is associated with greater accessibility of services and improved client housing outcomes. METHODS: As part of the Access to Community Care and Effective Services and Supports program, data were obtained on baseline client characteristics, service use, and 3-month and 12-month outcomes from 1832 clients seen at 18 sites during the first year of program operation. Data on interorganizational relationships were obtained from structured interviews with key informants from relevant organizations in each community (n = 32-82 at each site). RESULTS: Complete follow-up data were obtained from 1340 clients (73%). After control for baseline characteristics, service system integration was associated with superior housing outcomes at 12 months, and this relationship was mediated through greater access to housing agencies. CONCLUSIONS: Service system integration is related to improved access to housing services and better housing outcomes among homeless people with mental illness.     

Factors associated with participation, attrition, and outcome in a smoking cessation program at the workplace.

Of 66 24–58 yr old smokers in 2 worksites, 67% participated in a smoking cessation program. 55% completed the program. Of those, 29% had quit smoking by posttest, and 17% were abstinent at the 6-mo follow-up. Different variables predicted participation, attrition, and outcome. Significant predictors of smokers who participated were length of cessation in previous abstinence attempts, number of years they smoked, and belief regarding personal vulnerability in contracting a smoking-related disease. Levels of pretest carbon monoxide and attitudes regarding adoption of smoking restrictions in the worksite predicted attrition. Posttest cessation was related to nicotine levels of cigarette brand smoked at pretest and pretest beliefs regarding postcessation weight gain. Abstinence at the 6-mo follow-up was predicted by number of co-workers who smoked and pretest concerns related to postcessation weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Can sonography predict the outcome in patients with achillodynia?

PURPOSE: We evaluated whether the grade assigned to the Achilles tendon's appearance on sonograms can be used to predict the outcome of achillodynia. METHODS: A retrospective evaluation was done of a case series of patients with Achilles tendon pain seen at a sports medicine clinic. The study consisted of chart reviews, telephone follow-up interviews, and grading of ultrasound images of the tendon obtained during the initial visit. The grading scheme was as follows: grade 1, normal tendon; grade 2, enlarged tendon; and grade 3, tendon containing a hypoechoic area, regardless of size. The time needed to recover from symptoms was compared between grades using survival analysis. RESULTS: The group consisted of 33 patients, with a mean age of 35.8 years and a mean follow-up time of 24.3 months. There was a statistically significant difference in the time to full recovery between grades (p = 0.02). Patients with grade 1 tendons had a prompter resolution of symptoms than did patients with grade 2 or 3 tendons. CONCLUSIONS: This retrospective study of the outcome of achillodynia demonstrates the possible use of tendon sonography as a prognostic tool to supplement physical examination.     

Variables associated with participation and outcome in a worksite smoking control program.

This prospective study investigated variables potentially related to participation and success in a worksite smoking modification program. Variables assessed included demographic factors (gender, age, years smoked), smoking habit and pattern variables (nicotine dependence, number of cigarettes per day) and measures of stress and social support. Older subjects who were heavier smokers were more likely to participate in the program. However, strength of habit and age were inversely associated with success at quitting smoking (at posttreatment) and with smoking reduction among nonabstinent subjects (at the 6-month follow-up). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contractile patterns in patients with severe chronic dyspepsia

The Shaker superfamily encodes voltage-gated potassium (Kv) channels. The amino (N) terminus is important for channel assembly and mediates fast inactivation. We recently isolated a Kv channel from rabbit kidney, denoted rabKv1.3 (Yao et al., J. Clin. Invest. 97, 2525-2533, 1996) and found that deleting a region (T0 domain, amino acids 3-39) proximal to the T1 recognition domain (a.a 42-185) leads to a 13-fold amplification of Kv current as compared to wild type channels (Yao et al., BBRC 249, 492-498). Here we show that deleting the T0 domain affects neither single channel conductance nor channel open probability. Instead, it increases the absolute number of channel proteins present in the membrane. We conclude that the T0 domain is a previously unrecognized Shaker Kv1.3, N-terminal regulatory region that modulates steady state channel protein density in the plasma membrane.     

Knowing, liking, and judged problem severity in relation to referral and outcome measures in a school-based intervention program.

Teachers, as referral agents, and nonprofessional child aides, as interventionists, rated 709 kindergartners-6th graders seen in a school-based mental health program for how well they were known by teachers and child aides, how much they were liked by them, and how serious their problems were. All evaluation measures derived from 3 instruments--the AML (which measures Acting Out, Moodiness and Withdrawal, and Learning Problems), the Teacher Referral Form, and the Aide Status Evaluation Form. Several interconnected studies describe the ratings' properties and stability, how they differed across demographic groups, and how they related to indexes of referral status, termination status, and improvement. Better liked children and those seen initially as having less severe problems had healthier referral and termination profiles and were judged to have improved more in the program by both rater groups. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative affect combines with smoking outcome expectancies to predict smoking behavior over time.

The present study examined whether the tendency to experience negative affective states combines with smoking outcome expectancies to predict smoking behavior over time. Participants were 121 young adults and resource people recruited from 3 alcohol and drug treatment programs and through community advertisements. Each participant completed 3 interviews over a 4-year period. Results indicated that dispositional negative affect and positive smoking expectancies were significantly correlated with smoking behavior both within and across time. Expectations of positive and negative reinforcement partially mediated negative affect's relation with smoking across time. Positive expectancies did not function as a moderator of negative affect's relation with smoking behavior. These results represent an important step in incorporating smoking outcome expectancies into multivariate models of smoking risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Landau-Kleffner syndrome (acquired aphasia with epilepsy). Etiopathology and response to treatment with anticonvulsants

The Landau-Kleffner syndrome consists in the association of an aphasia acquired during childhood or adolescence after a period of normal development, accompanied by epileptic fits and, sometimes, psychological disturbances. The appearance of the symptoms may not be simultaneous. The nature of this syndrome has been widely discussed and even the possibility of being a non-unitary syndrome has been considered. It may be possibly due to diverse etiologies, genetic or acquired (infectious). The relation between the aphasic, the psychologic and the convulsive symptoms has also raised controversies. A case of a female is described in which the psychological symptomatology was so severe, she had to be admitted in a psychiatric unit. The symptoms consisted in agitation during the night and severe persistent insomnia so as difficulties for relationship during day. No abnormalities were detected in a TAC nor in a RM but electroencephalographic and neuropsychological abnormalities were detected. The epileptic fits disappeared with a carbamacepine treatment but the rest of symptoms remained even more accentuated. After her admission, a treatment with valproate achieved to control her fits and the aphasic symptoms and neuropsychological deficits were compensated in the course of several months. After a year of treatment the patient's life was normalized, she resumed her studies, the EEG abnormalities disappeared so as the psychological disturbances and the behavior problems with the exception of phobic symptoms, similar to the ones of other family members. The patient has a history of epilepsy on its mother's side. The evolution and treatment response suggests that at least in some cases of the Landau-Kleffner syndrome, the etiology of the aphasia and other neuropsychological deficits and of the behavior disorders are related with some subclinical epileptic discharges and with a "functional inhibition" of some areas of the nervous system.     

Responses to hypothetical high risk situations: Do they predict weight loss in a behavioral treatment program or the context of dietary lapses?

Before starting a behavioral weight control program and after 6 months of treatment, 93 participants were asked to listen to 4 scenarios describing typical high risk situations for dieters (family celebration, watching TV, tension at work, argument). The number of coping responses generated, latency of responses, and perceived risk of lapsing were assessed; participants also identified which situation would be most difficult for them. Telephone interviews were conducted during the weight loss program to assess situations surrounding actual dietary lapses. Participants who rated the negative affect situations as most difficult were more likely to lapse in situations involving negative affect; 87% of these participants lapsed in association with negative affect. Moreover, participants who generated coping responses to more of the situations subsequently lost more weight. Thus, baseline performance on a hypothetical high risk task predicts subsequent performances in a behavioral weight loss program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Termination, appointment use, and outcome patterns associated with intake therapist discontinuity.

Psychotherapy clients often experience intake therapist discontinuity: meeting first with an intake therapist, then entering therapy with a different treating therapist. The authors compared such discontinuity clients at a university’s counseling center (55.6% of 15,137 clients) with continuity clients, who continued therapy with their intake therapists. Discontinuity clients were twice as likely as continuity clients to terminate by missing the appointment after intake. Improvement among discontinuity clients lagged behind improvement among continuity clients at Sessions 2 and 3. Though more likely to terminate by missing Session 2, discontinuity clients attended 2 sessions more than continuity clients, on average, making treatment of discontinuity clients 19% more expensive than treatment of continuity clients in terms of sessions attended. The extra sessions attended by discontinuity clients did not yield overall better outcomes. Intake therapist discontinuity appeared to disrupt the beginning of psychotherapy, dissuading some clients from returning after intake, slowing early improvement among those who did return, and unproductively lengthening their treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Melanoma of unknown primary site: presentation, treatment, and prognosis--a single institution study. University of Pennsylvania Pigmented Lesion Study Group

BACKGROUND: A retrospective analysis of 40 patients diagnosed with melanoma of unknown primary site (MUP) was undertaken to analyze the etiology and clinical behavior of this presentation. METHODS: The patient records were located by a computer search of the Pigmented Lesion Clinic data base at the University of Pennsylvania. With the Cox proportional hazards model, the survival of the MUP patients with lymph node presentation was compared with that of patients with lymph node disease and a known concurrent primary melanoma. RESULTS: Sixty-five percent of the patients presented with lymph node metastasis only, 28% presented with visceral lesions, and 8% presented with subcutaneous nodules. The prevalence of dysplastic nevi was 22.5%. The overall 4-year survival rate for the 40 MUP patients was 55% +/- 9%. The 4-year survival (57% +/- 12%) of patients with lymph node presentation was compared with that of patients presenting with lymph node disease and a known concurrent primary melanoma (19 +/- 6%). Survival was significantly different between the groups (P = 0.008). This survival difference remained significant (P = 0.02) even after adjustments for number of positive lymph nodes, year of diagnosis, and age at diagnosis. CONCLUSIONS: This analysis revealed that MUP patients with lymph node metastasis survived significantly longer than patients diagnosed with lymph node metastasis concurrent with a known cutaneous primary melanoma. The prevalence of dysplastic nevi in the MUP patient series was intermediate between that reported among primary melanoma patients and that reported among population controls, suggesting the likelihood of a primary cutaneous origin for the metastatic melanoma.     

Obstetric outcome in 100 women with severe anxiety over childbirth

BACKGROUND: Extreme fear of delivery with request of cesarean section is a problem. The obstetric outcome in women given psychological and obstetric support is described. METHODS: Women, consecutively referred to the Psychosomatic outpatient clinic because of fear of delivery (n = 100), were compared to a matched reference group (n = 100). RESULTS: The women in the study group had higher frequency of psychic problems than the references. The majority, 68 of the women (68%) initially requested cesarean section (CS). After individualized psychological and obstetrical support, 38 of these women agreed to vaginal delivery (38%) and 30 had an elective CS (30%). In the end another 13 (13%) women had a CS for obstetric or mixed reasons. Complication rate was low and similar in the groups. The 57 women who eventually had a vaginal delivery (57%) showed an obstetric outcome similar to the reference group. They had a higher frequency of induction of labor (p = 0.02). and of epidural and pudendal blocks for pain relief (p = 0.002 and 0.05 respectively). They had shorter labor time (p = 0.05). The cost of the psychological therapy was well compensated for by the savings due to the reduction in the number of CS. CONCLUSIONS: Psychosomatic support for women with severe fear of delivery resulted in a 50% reduction of CS for psychosocial indications and vaginal deliveries similar to a reference group. The cost of psychosomatic support was less than savings due to fewer cesarean sections.     

Children with encopresis: a study of treatment outcome

A pediatric treatment program for encopresis was established in a large medical center. This consisted of counseling and education, initial bowel catharsis, a supportive maintenance program to potentiate optimum evacuation, retraining, and careful monitoring and follow-up. A group of 127 children received care for this problem. At the end of one year, outcome data were obtained on 110 patients. Of these, 51% had not had "accidents" for more than six months. Another 27% showed marked improvement and were having only rare episodes of incontinence. 14% of these children showed some improvement, but continued to have incontinence, while 8% showed no improvement whatsoever during the treatment year. These four outcome groups were compared with respect to a large number of demographic, developmental, psychosocial, and clinical variables.