Informing clients about the limits to confidentiality, risks, and their rights: Is self-disclosure inhibited?

Investigated the effects of providing varying amounts of detail regarding the limits to confidentiality in a psychotherapy analog. 24 mildly depressed undergraduates (as determined on the Beck Depression Inventory) were offered an interview to explore their depression and were told it would be much like single-session therapy. Before the interview, Ss were randomly assigned to read and sign 1 of 3 consent forms. Little evidence emerged of significant inhibition of disclosure when detailed information was provided; straightforward encouragement for disclosure eliminated the small inhibitory effect. A 2nd study, with 40 Ss, demonstrated the concurrent validity and sensitivity to change of the major dependent variable. The results of the 2 studies are encouraging not only to psychologists concerned about the moral rights of their clients but also to psychologists who have avoided informing clients about the limits to confidentiality, risks of therapy, and clients' rights because they feared it would necessarily discourage disclosure. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of hemorrhagic lupus pneumonitis with plasmapheresis

Pulmonary hemorrhage is a rare and often fatal complication of systemic lupus erythematosus (SLE). Treatment with high-dose steroids and cyclophosphamide has been of only modest value, with a reported mortality of up to 92%. We have recently seen three patients with active SLE who developed acute life-threatening pulmonary hemorrhage. Diagnostic evaluation of these patients showed negative sputum and blood cultures, negative glomerular basement membrane antibodies, and negative antineutrophilic cytoplasmic antibodies. In two patients, an open-lung biopsy was performed, and histological examination showed granular alveolar immunofluorescence staining for immunoglobulin and complement components. Treatment with plasmapheresis was initiated with prompt resolution of symptoms and clearing of chest radiograph. Two patients had recurrent bleeds despite treatment with cyclophosphamide and high-dose steroids and required repeated intubation. Plasmapheresis resulted in rapid radiographic and clinical improvement on each occasion. Two patients survived long-term and are presently without pulmonary problems; one patient died of sepsis after initial response to plasmapheresis. The dramatic improvement of the pulmonary disease in these patients leads us to conclude that rapid initiation of plasmapheresis should be strongly considered in SLE patients with severe, life-threatening pulmonary hemorrhage.     

Intake of high-fat food is selectively enhanced by mu opioid receptor stimulation within the nucleus accumbens

The present study was designed to further investigate the nature of feeding induced by opioid stimulation of the nucleus accumbens through an examination of the effects of intra-accumbens (ACB) opioids on macronutrient selection. In 3-hr tests of free-feeding (satiated) rats, intra-ACB administration of the mu receptor agonist D-Ala2,N,Me-Phe4, Gly-ol5-enkephalin (DAMGO; 0, 0.025, 0.25 and 2.5 micrograms bilaterally) markedly enhanced the intake of fat or carbohydrate when the diets were presented individually (although the effect on fat intake was much greater in magnitude). Intra-ACB injections of DAMGO, however, produced potent preferential stimulatory effects on fat ingestion with no effect on carbohydrate ingestion when both fat and carbohydrate diets were present simultaneously. Moreover, this selective stimulation of fat intake was independent of base-line diet preference and could be blocked by systemic injection of naltrexone (5 mg/kg). We also examined the effect of 24-hr food deprivation on the pattern of macronutrient intake in rats with access to both carbohydrate and fat. In contrast to the DAMGO-induced selective enhancement of fat intake, food deprivation significantly increased the intake of both diets to the same extent; however, in this case, only the stimulated fat intake was blocked by systemic naltrexone. Intra-ACB administration of DAMGO in hungry rats produced an effect similar to that observed in free-feeding rats; preference was strongly shifted to fat intake. Similarly, the opioid antagonist naltrexone (20 micrograms) infused directly into ACB preferentially decreased fat intake in hungry rats. These findings suggest that endogenous opioids within the ventral striatum may participate in the mechanisms governing preferences for highly palatable foods, especially those rich in fat.     

Acute and long-term outcomes of extremely injured blunt trauma victims

Long-term outcomes after blunt trauma remain poorly defined. The purpose of this study was to document such outcomes in extremely injured adults (Injury Severity Score > or = 50). From April 1990 to June 1993, 76 patients (5% of all trauma victims) had an ISS > or = 50 at a single trauma center. Thirty-five (46%) survived to hospital discharge. The mean duration of hospital stay was longer for survivors than for nonsurvivors (92 days versus 16 days, p < 0.001). Of the 35 survivors, 26% were discharged directly home, 60% to a rehabilitation hospital, 8% to a chronic care facility, and 6% to an acute care hospital. After a mean follow-up of 27 months, 6% had died, 9% refused participation, and the remaining 30 patients (91% of long-term survivors) demonstrated significant residual disabilities in physical, emotional, and mental health status. We suggest that extremely injured patients comprise a small proportion of blunt trauma victims, consume substantial acute care hospital resources, often survive, and yet frequently have residual disability. A reduction in this long-term disability may represent the greatest challenge in modern trauma care.     

Bioelectric Potentials?Their Source, Recording, and Significance

The progress in the understanding, recording, and clinical utilization of bioelectric potentials is very briefly covered, from their discovery by Galvani in the 18th century to the present. Emphasis is placed on neurophysiological aspects and the author's involvement therein.     

Resting EEG in first-episode and chronic schizophrenia

Prostatic acid phosphatase, prostate-specific antigen, and zinc as markers of prostate, and fructose as marker of seminal vesicles were investigated in the seminal plasma of 35 idiopathic asthenozoospermic and 20 normal subjects to evaluate their relationship with sperm motility. Total seminal plasma levels of the three prostatic markers and, to a lesser extent, total fructose levels were lower in asthenozoospermic patients, and in all the pooled subjects, the same levels were directly correlated with the motility of ejaculated spermatozoa. When the levels of the biochemical markers were expressed as concentrations in seminal plasma, only prostatic acid phosphatase levels remained lower in asthenozoospermic patients and they maintained a direct correlation with sperm motility in all the pooled subjects. The PAP/Zn/Fr (representing the ratio between PAP concentration and free Zn available for spermatozoan uptake) was lower in asthenozoospermic patients and it was also directly related to sperm motility in all the pooled subjects. These data suggest that altered sperm motility is associated with a probable impairment of sex accessory gland function in subjects with idiopathic asthenozoospermia, while prostatic acid phosphatase seems mainly related to sperm motility.     

Exposure workups

Exposure workups are an important responsibility for infection control personnel. A well-designed plan for investigating exposures, which includes appropriate algorithms, will enable infection control personnel to evaluate exposures rapidly and consistently so that nosocomial transmission is minimized. Infection control personnel should use their own data to develop policies and procedures that suit the needs of their facility. After they have implemented the plan, infection control personnel should continue to collect data on exposures so they can continuously improve their performance.