Showing papers in "Journal of Nervous and Mental Disease in 1987"

Validity and reliability of the Experience-Sampling Method.

Abstract: To understand the dynamics of mental health, it is essential to develop measures for the frequency and the patterning of mental processes in every-day-life situations. The Experience-Sampling Method (ESM) is an attempt to provide a valid instrument to describe variations in self-reports of mental processes. It can be used to obtain empirical data on the following types of variables: (a) frequency and patterning of daily activity, social interaction, and changes in location; (b) frequency, intensity, and patterning of psychological states, i.e., emotional, cognitive, and conative dimensions of experience; (c) frequency and patterning of thoughts, including quality and intensity of thought disturbance. The article reviews practical and methodological issues of the ESM and presents evidence for its short-and long-term reliability when used as an instrument for assessing the variables outlined above.

A review of psychoactive substance use and abuse in schizophrenia. Patterns of drug choice.

Abstract: We reviewed studies measuring unsupervised use of psychoactive substances in schizophrenic and control populations and organized the results by substance class. Despite much variation in their methodologies, these studies broadly agreed that schizophrenic groups' use of amphetamines and cocaine, cannabis, hallucinogens, inhalants, caffeine, and tobacco was significantly greater than or equal to use by control groups consisting of other psychiatric patients or normal subjects. Schizophrenic groups' use of alcohol, opiates, and sedative-hypnotics was significantly less than or equal to use by control groups. We discuss the implications of this nonrandom pattern of drug choice for the hypothesis of substance abuse as a form of self-medication in schizophrenia.

Taking the measure of anxiety and depression. Validity of the reconstructed Hamilton scales.

Abstract: The ability of the Hamilton Psychiatric Rating Scale for Depression (HRSD) and the Hamilton Anxiety Rating Scale (HARS) to discriminate major depressive disorder (MDD) from generalized anxiety disorder (GAD) was studied in 120 psychiatric outpatients and cross-validated with another 71 outpatients. Factor and discriminant analyses were used to develop revised anxiety and depression scales that were less positively correlated with each other, showed greater internal consistency, and differentiated MDD and GAD better than the original scales. The recombined scales also displayed higher rates of correctly assigning the samples to these disorders than did the original scales.

Comorbidity among childhood anxiety disorders.

Abstract: This paper reports on 73 consecutive admissions to an outpatient anxiety disorder clinic for children and adolescents. Patients were evaluated with a structured diagnostic interview for primary and secondary disorders with DSM-III criteria in order to examine patterns of comorbidity. The most common primary diagnoses for the sample included separation anxiety disorder (33%), overanxious disorder (15%), social phobia of school (15%), and major depression (15%). Children with a primary diagnosis of separation anxiety disorders were most likely to receive a concurrent diagnosis of overanxious disorder. Alternatively, children with a primary diagnosis of overanxious disorder were most likely to receive an additional diagnosis indicative of a social anxiety problem, either social phobia or avoidant disorder. Children with a primary major depression most often exhibited social phobia and/or overanxious disorder. No clear-cut pattern of comorbidity emerged for the social phobic (school) group. These findings are discussed in terms of their comparability with results recently obtained from an adult anxiety clinic population.

Fears, beliefs, and attitudes in DSM-III hypochondriasis.

Abstract: In order to explore fears, beliefs, and attitudes of patients with DSM-III hypochondriasis, the authors administered the self-rated Illness Attitude Scales to 21 patients with hypochondriasis, matched family practice patients, nonpatient employees, and nonhypochondriacal psychiatric patients. Hypochondriacal patients reported more fears of and false beliefs about disease; they attended more to bodily sensations, had more fears about death, and distrusted physicians' judgments more, yet sought more medical care than other subjects. They did not take better precautions about their health. The self-report of overt attitudes suggests a characteristic syndrome, consistent with the DSM-III description of hypochondriasis. Two of the subscales of the Illness Attitude Scales yielded characteristic responses in hypochondriasis.

Acute posttraumatic stress disorder in victims of a natural disaster.

Abstract: Five months after a tornado devastated a rural community in eastern North Carolina, the authors surveyed the mental health status of 116 disaster victims, using the Hopkins Symptom Checklist (HSCL) expanded to include most of DSM-III criteria for posttraumatic stress disorder (PTSD). A total of 69 (59%) victims met the criteria for acute PTSD, 19 of whom had a severe form. Although an inadequate degree of social support was more often noted in victims with severe PTSD, other demographic factors and degree of injury or property damage did not appear to be related to the presence of PTSD. Severity or presence of PTSD was supported by high scores on all HSCL subscale factors. These findings suggest a high incidence of acute PTSD in victims of natural disasters and the potential value of HSCL in screening for PTSD in large populations.

Panic Attacks in the Natural Environment

Abstract: Despite much recent research, there is still little systematic information about the phenomenology of panic attacks, and their possible causes remain obscure. We investigated panic attacks in the natural environment using an event sampling approach. Twenty-seven panic attack patients and 19 matched normal controls kept panic attack and self-exposure diaries for 6 days and wore an ambulatory heart rate/physical activity recorder for 3 days. Patients reported 175 attacks, generally of moderate severity. The most frequent symptoms were palpitations, dizziness/lightheadedness, dyspnea, nausea, sweating, and chest pain/discomfort. The results did not support the classification of panic attacks recently proposed by Sheehan and Sheehan, which requires three symptoms as a cutoff for panic attacks. Panic attacks classified by the patients as situational (i.e., occurring in feared situations) were more severe and occurred in situational contexts different from spontaneous attacks, but were otherwise phenomenologically similar. Heart rates did not change during spontaneous attacks and were only mildly elevated during situational attacks or during the 15 minutes preceding these attacks. These heart rate changes were interpretable as effects of anxiety, although physical activity showed a similar pattern of changes. Some normal control subjects reported on the panic diary primarily situational anxiety episodes that were phenomenologically similar to, albeit less severe than, the patients' episodes. Panic patients may sometimes fail to perceive environmental triggers for their attacks because many attacks classified as spontaneous occurred in classical "phobic" situations. Furthermore, the comparison of concurrent diary and retrospective interview and questionnaire descriptions showed that panic patients have a tendency toward retrospective exaggeration. Implications for the assessment, definition, and classification of panic attacks are discussed.

Temporal and Social Contexts of Heroin-Using Populations. An Illustration of the Snowball Sampling Technique

Abstract: Snowball sampling is a method that has been used in the social sciences to study sensitive topics, rare traits, personal networks, and social relationships. The method involves the selection of samples utilizing “insider” knowledge and referral chains among subjects who possess common traits that ar

Expressed emotion and schizophrenic outcome among Mexican-American families

Abstract: This study has demonstrated that among low-income, relatively unacculturated Mexican-American households, a high level of expressed emotion on the part of key relatives significantly increases the risk of relapse for remitted schizophrenics who return home to live with their families after hospital discharge. This cross-cultural replication of earlier research findings in London and southern California suggests that critical, hostile, or emotionally overinvolved attitudes and behaviors may be general major stressors that adversely influence the fragile adaptation of schizophrenic individuals in diverse cultural settings. The finding of a lower prevalence of high levels of expressed emotion among Mexican-American compared to Anglo-American and British households lends support to the hypothesis that intrafamilial behaviors may account for different schizophrenic outcomes in different cultures.

Posttraumatic stress disorder. The stressor criterion.

Abstract: Posttraumatic stress disorder (PTSD) was officially introduced into psychiatric nomenclature in 1980, when it was incorporated into DSM-III. There is as yet little empirical research on the validity of the diagnosis/Literature on disasters, civilian and wartime, and on more ordinary stressful life e

The monitoring of optimal experience. A tool for psychiatric rehabilitation.

Abstract: This article illustrates the use of quantitative time-sampling data in developing a psychology of “optimal experience” to help in the psychiatric development of adequate rehabilitation approaches. The Experience-Sampling Method was used on a sample of 47 Italian adolescent students to measure fluctu

Recovery style from mental illness and long-term outcome.

Abstract: Integration and sealing over have been identified as clinically distinct recovery styles from schizophrenia. Specific definitions and scales of these styles were applied reliably to 231 patients from the Chestnut Lodge follow-up study at long-term outcome (15 year average). Data were analyzed for the entire sample and for diagnostic subgroups: schizophrenia, schizoaffective and unipolar affective disorders, and schizotypal and borderline personality disorders. Results find that integration and sealing over are strongly correlated with functional outcome. While linked somewhat to type of psychopathology, these styles are best conceived as enduring personality trait characteristics in the nature of predictors.

Use of the Mini-mental State Examination in a Probability Sample of a Hispanic Population

Abstract: The Spanish DIS was applied to a community probability sample in an island-wide survey of the prevalence of psychiatric disorders in Puerto Rico. The prevalence of “severe cognitive impairment” as measured by the DIS Mini-mental State Examination (DIS/ MMSE) is significantly higher than that reporte

Depression, parkinsonian symptoms, and negative symptoms in schizophrenics treated with neuroleptics.

Abstract: To determine whether depression and neuroleptic-induced parkinsonism confound the clinical assessment of negative symptoms in schizophrenics, we evaluated 45 outpatient schizophrenics for depression, parkinsonian symptoms, and negative symptoms using standard clinical rating scales. Neuroleptic and

An approach to the delineation of adult attachment: Scale development and reliability.

Abstract: The authors present the results of a project to develop scales to measure the features of adult attachment using a construct-oriented approach. Adult attachment is defined in terms of eight features: proximity seeking, secure base effect, separation protest, feared loss of the attachment figure, reciprocity, availability, responsiveness of the attachment figure, and use of the attachment figure. Each feature was defined and a large item pool to tap all dimensions was derived from item nominations by clinicians, researchers, and lay subjects. The resultant scales were administered to a small sample for preliminary empirical testing. Analyses of internal reliability for each scale resulted in the elimination of items that detracted from reliability. After editing, all scales had satisfactory internal consistency. A discriminant-functions analysis provided suggestive evidence that this method of defining and measuring adult attachment would have relevance for identifying psychopathology.

The role of brief instructions and suggestibility in the elicitation of auditory and visual hallucinations in normal and psychiatric subjects

Abstract: The present study is an investigation of the elicitation of auditory and visual hallucinations by brief instructions and the relationship of the report of hallucinatory-type experiences to standard measures of suggestibility. Two experiments were carried out. The first used normal subjects predisposed or not predisposed to hallucinate, as assessed by the Launay-Slade Hallucination Scale (LSHS-A). The second used hallucinating and nonhallucinating psychiatric patients. The high LSHS-A scorers and the hallucinating psychiatric patients were significantly more likely to hear suggested sounds than were their respective controls. High LSHS-A scorers were also significantly more likely to see suggested objects than were their respective controls, although this finding was not replicated in the psychiatric subjects. No significant differences on measures of suggestibility were found between the groups, although in the psychiatric group Barber Test Suggestion and Subjective Involvement scores correlated positively with LSHS-A scores.

Treatment of chronic closed head injury with psychostimulant drugs: a controlled case study and an appropriate evaluation procedure.

Abstract: The psychostimulant drugs methylphenidate (MPH) and dextroamphetamine (DEA) have proven efficacy in clinical populations whose primary symptoms include disorders of attention, impulse control, and locomotor hyperactivity. These medications have also been shown to influence in a positive manner cognitive functioning, particularly in the areas of sustained attention and memory. In light of these facts, the psychostimulants MPH and DEA were administered in separate trials to a young man who suffered from similar symptoms secondary to a chronic closed head injury. The medication trials were double-blind, placebo-controlled, dose-response studies. Cognitive functions, particularly memory and attention, improved in the active drug conditions. In addition, there was a consistent, positive drug effect across behavioral assessments. This case study emphasizes the importance of studying psychostimulant effects in patients with neuropsychological and behavioral sequelae of closed head injury; it also presents an appropriate methodology for evaluating psychostimulant effects in a clinical research setting.

Prototypicality ratings of DSM-III criteria for personality disorders.

Abstract: Although DSM-III personality disorder criteria have demonstrated acceptable reliability, the question of validity has not been adequately addressed. A first step in establishing the validity of diagnoses is to establish the validity of the criteria used to assess each diagnosis. The content validity of diagnostic criteria was investigated in relation to the larger set of potential criteria culled from the psychiatric literature. For each DSM-III axis II diagnosis, a panel of clinicians rated how prototypical each potential criterion was of the diagnosis in question. The results reveal problems with the organization and content of the criteria for most diagnoses. Many DSM-III criteria are composed of several statements linked by conjunctions or disjunctions. These component statements often received markedly different ratings, suggesting that criteria should be single statements. For most diagnoses, traits not included in DSM-III received higher ratings than did some DSM-III criteria. Suggestions are made to improve the distinctiveness and content validity of paranoid, schizoid, antisocial, borderline, avoidant, dependent, and compulsive personality disorders. The results for schizotypal personality disorder suggest that many clinicians are uncertain about this diagnosis. These findings provide a systematic way to modify definitions that contrasts with the more arbitrary ways in which diagnoses have previously been defined and redefined.

Typifications. The first step for clinical diagnosis in psychiatry.

Abstract: Reigning views on psychiatric nosology regard as "too subjective" certain features of diagnosis which respected psychiatrists have reported and several empirical studies have confirmed. We describe two of these persistent "mysteries" of psychiatric nosology: rapid diagnoses and the praecox feeling. We then demystify these mysteries by explicating the workings of "typification" in the diagnostic process. The criteria of disorders which are provided by classification manuals, such as DSM-III, are shown to presuppose such typifications. Psychiatric typification, although a preconceptual skill, can be rendered fully scientific and objective.

The daily life of ambulatory chronic mental patients.

Abstract: The purpose of this research is to describe in greater detail than is typically done the daily life experiences of 11 ambulatory chronic mental patients and 11 nonpsychiatric controls. The subjects, although diagnostically heterogeneous, were representative of Dutch chronic mental patients. The Experience-Sampling Method was used to signal subjects randomly 10 times a day for 6 consecutive days to fill out self-rating forms assessing mental state and contextual information at the moment of the signal. Compliance was good. In time-allocation comparisons with nonpsychiatric subjects the patients were found to live relatively "normal" lives. As expected, their psychopathology was influenced by social environments such as being alone, at home, or in society at large. Contrary to other studies that stress the social isolation of such individuals, the chronic subjects reported feeling better away from home and among people than normal subjects. When alone, chronic patients reported daydreaming more and noted a tendency to drift away from thoughts about current activities. Mental state fluctuations and daily interactions, characteristic of this group, are examined in relation to theories of vulnerability and coping style of chronic mental patients, with an eye to individualized treatment applications.

Physiological responses of college students to a pet.

Abstract: The effect of a pet on cardiovascular responses of college students was examined under three test conditions (i.e., reading aloud, reading quietly, and interacting with an unknown dog). A repeated-measures analysis with three covariates was used to examine the effect of the treatment on each of six dependent variables (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and State and Trait Anxiety). Reading aloud differed from baseline measures under all treatment conditions (p less than .001) Reading quietly and interacting with a pet were slightly below baseline for all dependent variables with a slightly greater effect by reading quietly than interacting with a pet. Examination of interactions between variables revealed no significant differences. Effects on State anxiety level mirrored cardiovascular responses (p less than .001). Trait anxiety levels remained relatively constant throughout the treatments. Results indicated that interacting with a pet does affect physiological and psychological responses by lowering response levels. A parallel effect was also demonstrated by reading quietly. Given the effect of pet interaction upon selected indicators of health in well college students, these data suggest the relevance of examining this treatment with an "at-risk" group.

Outcome predictors in acute schizophrenia. Prospective significance of background and clinical dimensions.

Abstract: In a prospective 2-year follow-up of 37 young acute schizophrenics, we examined the predictive significance and relative contribution of historical, genealogical, course, and clinical dimensions. Patients were evaluated multidimensionally at index admission and after 21 to 33 months, at which time 19 cooperated in follow-up involving clinical, functional, psychometric, and objective outcome measures. Multiple regression analysis found that combinations of 3 to 4 index variables significantly predicted 13 of 14 outcome measures, yielding multiple R values between.63 and.93 (X =.78). In total, a set of eight parameters contributed in explaining the outcome variance. The strongest overall predictor of favorable outcome was baseline negative syndrome. Other significant predictors were good premorbid school functioning, favorable prior disposition, sudden onset of illness, nonparanoid subdiagnosis, family history of alcoholism, psychomotor retardation, and depression. Accordingly, a patient's premorbid adjustment, course of illness, and presenting clinical profile provided nonoverlapping sources of outcome prediction. Of these three dimensions, it was proposed that the prognostic significance of the clinical profile may be phase specific, carrying different implications when assessed in the acute vs. chronic stage of illness. Language: en

Impact of mental illness in families of mental health professionals.

Abstract: Family burden and coping strategies were investigated in 84 experienced mental health professionals with family members suffering from chronic major mental illnesses. The sample was nationally recruited from ads in professional journals. Personal reactions of respondents involved cognitive and attitudinal changes in conceptions of psychotic disorders and guarded relations with colleagues with respect to self-disclosure and case involvement. Financial and emotional burdens were substantial, with ongoing stressful life events, aversive patient behaviors, and poor treatment histories. In rating family coping strategies, mental health professionals showed a high degree of concordance with nonprofessional family members in assigning priority to education on symptoms, medications, and patient management techniques. Involvement with self-help groups and physical separation from patients were rated higher than individual or family therapy as aids in coping for families of the mentally ill.

Short-term retest reliability of the Halstead-Reitan Battery in a normal sample.

Abstract: Very few studies have examined short-term retest reliability of the Halstead-Reitan Battery in patient samples or normal subjects. The present study examined 3-week retest reliability in a sample of normal healthy subjects. Both psychometric and clinical reliability issues were addressed. On most of

Panic disorder. Spectrum of severity and somatization.

Abstract: One hundred++ ninety-five primary care patients were screened for panic disorder utilizing the National Institute of Mental Health Diagnostic Interview Schedule (DIS) as well as four additional questions that screened for core autonomic symptoms of panic disorder. A spectrum of severity of panic disorder was found. A subgroup of patients, labeled in the study as having simple panic, was found to have anxiety attacks associated with four or more autonomic symptoms, but they did not meet DSM-III recurrence criteria (three anxiety attacks within a 3-week period). Compared to primary care patients without panic attacks, patients with both simple panic and panic disorder exhibited multiple phobias, avoidance behavior, a high lifetime risk of major depression, and elevated scores on self-rating scales of anxiety and depression. The four autonomic screening questions that the authors added to the DIS interview increased the sensitivity of the DIS in identifying patients with panic disorder. Patients with panic disorder who selectively focus on their frightening autonomic symptoms may not be identified by screen questions that only focus on the cognitive awareness of anxiety.

Stigma perceived by patients attending modern treatment settings. Some unanticipated effects of community psychiatry reforms

Abstract: In recent years reforms were instituted in the Federal Republic of Germany that were designed to facilitate the integration of psychiatric services and psychiatric patients into community life. One goal of this reform was to reduce patients' feelings of stigmatization. Because such feelings were thought to arise through patients' tenure at large, isolated state hospitals, we hypothesized that patients sent to such hospitals would feel more stigmatized than would patients assigned to a modern, integrated university hospital. Further, we hypothesized that patients in the two settings would adopt different strategies to cope with the stigma they perceived and that staff members in the two settings would share patients' views concerning these matters. Although we found that the staff in both hospitals shared our prediction that state hospital patients would perceive more stigmatization, our findings showed just the opposite. State hospital patients were significantly less likely than university hospital patients to believe that most people would devalue and discriminate against mental patients. Nor did we find strong evidence of different styles of coping with stigma among patients in the two settings. Taken together, our results suggest that in the realm of stigmatization well-intentioned efforts of reforms may have had undesirable unanticipated consequences. Given this, we suggest approaches for intervening more directly with patients in the form of "Daily Living Groups," which are designed to explicitly discuss actual and feared stigmatization.