Biomedical subjects

A Blaszczynski

Publications and source records attributed to A Blaszczynski.

At least 19 recordsLinked to original sources

PubMed1999

Sex offending as a psychosocial sequela of traumatic brain injury.

OBJECTIVE: To describe the nature and extent of sexual offending after traumatic brain injury (TBI). DESIGN: Retrospective file review. SETTING: A brain injury unit providing inpatient and outpatient rehabilitation services. PARTICIPANTS: A review of five years of admissions to the Brain Injury Rehabilitation Unit (N = 477) identified a sample of 29 males who committed 128 incidents of sex offending. MAIN OUTCOME MEASURES: A protocol to record data on demographic, injury, radiological, and psychosocial variables and offending behaviors. RESULTS: Of the total population of 445 clients with TBI, 6.5% (n = 29) were identified as having committed some form of sexual offense. Alcohol was a factor in only three (2.3%) of the incidents, and only two clients had a preinjury history of sexual offending. The most common offenses were the "touching" offenses, followed by exhibitionism and overt sexual aggression. Staff members were the most common targets of the offenses, followed by members of the general public, other people with TBI, and family members. CONCLUSIONS: Sex offending is a significant clinical problem among a small minority of men after TBI. The absence of alcohol and preinjury histories of sexual offending suggest that the brain injury and contingent sequelae were a significant etiological factor underlying the offenses. A number of implications for the clinical management of clients with sexually aberrant behaviors is identified and discussed.

Adolescent↗

PubMed1999

Pathological gambling and obsessive-compulsive spectrum disorders.

To test the hypothesis that pathological gambling can be classified as an Obsessive-Compulsive Spectrum Disorder, the Padua Inventory was administered to 40 diagnosed pathological gamblers and a control group of 40 normal subjects. Analysis showed that the pathological gamblers obtained a significantly higher mean total score on obsessionality than controls. Elevated scores on two factors reflecting impaired control of mental activities and loss of motor control contributed to the over-all difference. In the context of other research suggesting pathological gamblers would score high on psychometric measures of impulsivity, this study provides preliminary support for a Spectrum Disorder Model, suggesting that pathological gamblers are characterised by elevated scores on traits of 'impulsivity' and 'obsessionality.'

Adult↗

PubMed1998

Impulsivity, personality disorders and pathological gambling severity.

AIMS: The present study seeks to replicate and expand findings from earlier studies that pathological gamblers manifest elevated traits of impulsivity. Secondly, the study aims to elucidate the relationship between impulsivity, indices reflecting severity of pathological gambling and other measures of psychopathology and personality dysfunction. DESIGN: Case series. PARTICIPANTS: Eighty-two consecutive gamblers, seeking treatment for problem gambling. SETTING: Impulse Disorders Research Unit, School of Psychiatry, University of New South Wales, Australia. MEASUREMENTS: Semi-structured interview designed to obtain demographic information and gambling history, the South Oaks gambling Screen, the Eysenck Impulsivity Scale, the Personality Disorder Questionnaire-Revised, the Beck Depression Inventory and the Beck Anxiety Inventory. FINDINGS: Results show elevated traits of impulsivity among clinic samples of pathological gamblers compared to normative data and show that impulsivity is related to the severity of gambling behaviour as measured by the South Oaks Gambling Questionnaire. A principal component analysis of the Eysenck Impulsivity Scale and the personality Disorder Questionnaire-Revised, demonstrated that the concept of the "antisocial-impulivist" identified to Blaszczynski, Steel & McConaghy (1997) is not only characterized by impulsivity and antisocial personality disorder but also by high loadings from other cluster B and cluster C personality disorders. CONCLUSION. This research supports the role of the construct of impulsivity in mediating the severity of gambling behaviour and associated behavioural and psychological disturbance among pathological gamblers presenting for treatment. Impulsivity is best understood as part of a general personality disorder structure characterized primarily by DSM-III-R Axis II cluster B and some cluster C personality disorder.

Adult↗

PubMed1997

Satisfaction of Vietnamese patients and their families with refugee and mainstream mental health services.

OBJECTIVE: The study examined levels of satisfaction with mainstream mental health services and specialized mental health services for refugees among Vietnamese psychiatric patients and their relatives. Demographic, diagnostic, symptomatic, and service-related issues that might influence satisfaction were investigated. METHODS: Eighty-six Vietnamese patients were identified from case notes of mainstream inpatient services (N = 31), mainstream community services (N = 7), and a specialized refugee treatment unit (N = 48). During an interview, a scale measuring satisfaction with treatment as well as measures of anxiety, depression, and posttraumatic stress disorder was administered to them. A modified satisfaction scale was administered to 56 relatives. RESULTS: Patients and relatives were, on average, moderately satisfied with treatment. Patients expressed greater satisfaction with the specialized treatment unit for refugees than with mainstream services, a finding that was not influenced by diagnostic differences or symptom levels at the time patients responded. Further analyses controlling for multiple comparisons revealed that the extent of the information provided and the ease of negotiating changes in treatment were the most salient variables in distinguishing satisfaction levels across the two types of treatment centers. Patients' fluency in English and their relatives' level of education were inversely associated with satisfaction scores, tentatively suggesting that the greater the ability of patients and their families to evaluate services, the less likely they were to express satisfaction with treatment. CONCLUSIONS: Specialized mental health services for refugees may be more acceptable to refugee populations than their mainstream counterparts, perhaps because better communication with patients and their families is possible in the specialized services. Patients and families who are in a position to evaluate services fully are more likely to be critical of treatments offered.

Acculturation↗

PubMed1997

Impulsivity in pathological gambling: the antisocial impulsivist.

The construct of impulsivity has to date remained relatively unexplored in the pathological gambling literature. This is in spite of recent claims suggesting that impulsivity may be an important feature characterizing a subgroup of pathological gamblers who are claimed to suffer from a Multi-Impulse Personality Disorder. The present study examined the potential role of impulsivity using the Eysenck Impulsivity Scale among 115 pathological gamblers. Results indicate that heightened impulsivity is associated with the degree of severity of psychological and behavioural change in pathological gamblers. However, the findings also indicate that impulsivity closely mirrors components contained in Eysenck Personality Questionnaire Psychoticism Scale, the California Personality Inventory Socialization Scale and DSM-III Antisocial Personality Disorder. This is manifest both in terms of high intercorrelations between the measures of psychopathy and impulsivity and in their predictive relationship to the level of psychological distress suggesting a uniform impulsivity/psychopathy construct. Thus, the research supports a model of pathological gambling in which the severity of associated behavioural and psychological disturbance is mediated by a impulsivity/ psychopathy construct.

Adolescent↗

PubMed1996

Pathological gambling: forensic issues.

OBJECTIVE: The aim of this paper is to review the literature describing the hypothesised link between crime and pathological gambling and its relevance to arguments of diminished responsibility. METHOD: An attempt was made to include all publications in the psychiatry and psychology literature which made reference to pathological gambling and criminal behaviours. Given the limited research in this field, specific unpublished conference papers were also included in the review. RESULTS: Evidence supports the contention that pathological gamblers are at high risk for committing criminal offences in order to maintain their habitual gambling behaviours. An antisocial personality disorder while acting to increase the risk factor is in itself an insufficient explanation for the observed link. As a result of the acceptance of pathological gambling as a psychiatric disorder, the judicial system is being increasingly confronted with an argument of diminished responsibility for gambling-related offences committed by pathological gamblers. CONCLUSION: A diagnosis of pathological gambling does not diminish legal responsibility but is a factor that should be considered in sentencing. Referral to psychiatric services reduces the risk of recidivism.

Adolescent↗

PubMed1993

The development of the Separation Anxiety Symptom Inventory (SASI).

Separation anxiety continues to be implicated as an early risk factor to adult emotional disorder but recent research findings are somewhat contradictory. Inconsistencies in approaches to measuring memories of early separation anxiety may have contributed to this lack of clarity. We report the development of a brief self-report instrument, the Separation Anxiety Symptom Inventory (SASI), which was designed to overcome some of these deficiencies in measurement. The SASI was shown to have a coherent factorial structure, high internal consistency (Cronbach's Alpha > .80) and test-retest reliability over an average of 24 months (Intraclass Correlation Coefficient = .89), with serial scores not being affected by changes in contemporaneous anxiety levels. Some index of the validity of the measure was achieved by (a) comparing SASI scores of index twins with descriptors of their "insecure" behaviours in early life provided by corresponding co-twins; (b) comparing SASI scores with retrospective DSM III-R diagnoses of early anxiety disorders obtained by structured interviews; and (c) examining SASI scores in subjects with histories of school refusal. The SASI provides a useful standardised measure which will aid in the further testing of the separation anxiety hypothesis of adult emotional disorder.

Adolescent↗

PubMed1993

Reported early separation anxiety symptoms in patients with panic and generalised anxiety disorders.

Attachment theory has proposed that early separation anxiety is a risk factor for adult anxiety disorder, with the recent focus being particularly on panic disorder. The results of empirical studies examining this link are, however, contradictory, possibly because of inconsistencies across studies in measuring memories of early separation anxiety. In the present study, a psychometrically sound measure, the Separation Anxiety Symptom Inventory (SASI) was used to compare memories of such early symptoms in panic disorder (including those with mild phobic-avoidance), generalised anxiety disorder and control subjects. Anxiety patients as a group returned higher SASI scores (p < 0.001) with a non-significant trend for panic disorder patients to score higher than those with generalised anxiety. These results suggest that early separation anxiety may be a harbinger of adult anxiety and that risk of panic disorder may be higher in the most severely affected youngsters. As a risk factor, early separation anxiety does not however appear to be uniquely related to adult panic disorder.

Adult↗

PubMed1992

The relationship between relative's Expressed Emotion and schizophrenic relapse: an Australian replication.

We report a predictive study, carried out in Sydney Australia, investigating the association between the Expressed Emotion (EE) status of the household to which the patient is discharged and schizophrenic relapse. Expressed Emotion was not related to illness severity either at admission or discharge, but was related to variables reflecting chronicity and employment history. There was a significant association between returning to a high EE household and both re-hospitalisation and relapse. The significant association between EE and relapse held only for: patients not on medication, males, and those patients in high contact with their relatives. A discriminant function analysis found that decline in occupational status and the number of critical comments expressed by the relative were the strongest predictors of relapse. The results presented here are consistent with the majority of published reports on EE and relapse and contradict the negative findings of a recently published but smaller study also carried out in Sydney.

Adult↗

PubMed1992

The Sydney intervention trial: a controlled trial of relatives' counselling to reduce schizophrenic relapse.

The result of a psychosocial intervention which aimed to reduce schizophrenic relapse through relatives' counselling is presented. Thirty-six schizophrenic patients living in high Expressed Emotion (EE) parental households were randomly allocated to an intervention or control group. The parents of patients allocated to the intervention were offered ten weekly sessions of counselling. The patient was not included in these sessions. Patients in both groups received standard after-care of medication and support. Relapses in the intervention group, although fewer, were not significantly different from the control group. Given the impressive evidence in favour of family interventions in reducing relapse rates in schizophrenic patients possible reasons for this result are discussed. Aspects of the intervention described here, exclusion of the patient, no control over the patients' medication or involvement with their management, short duration of intervention and lack of individual assessment, could explain this finding. This negative result is important in indicating what factors should be included in an effective psychosocial intervention.

Adult↗

PubMed1992

The emergence of clinical psychology departments in Australian teaching hospitals.

Over recent years, clinical psychological services have diversified within the health sector, leading to a breakdown in the traditional nexus between clinical psychology and psychiatry, and to the emergence of the interdisciplinary field of behavioral medicine. From their earlier limited role as providers of psychometric assessments in educational and psychiatric hospital settings, clinical psychologists now provide a wide range of therapeutic services and research skills to general hospitals, universities, community health centres, and the private sector. This evolving trend has significant implications for the future structure and direction of clinical practices in clinical psychology, psychiatry and medicine.

Adaptation, Psychological↗

PubMed1991

A comparison of relapsed and non-relapsed abstinent pathological gamblers following behavioural treatment.

Eighteen pathological gamblers reporting abstinence at a 2-9-year follow-up period were classified into two samples; those reporting complete abstinence, or those abstinent with intermittent relapse episodes. Results indicated that both samples improved significantly on post-treatment psychological and demographic measures, and did not differ from each other. It was concluded that a subgroup of gamblers may experience intermittent brief relapses that are not invariably associated with a continued return to addictive gambling habits. Complete abstinence as a criterion for successful treatment outcome may be too stringent in that it fails to acknowledge the possibility of continued abstinence following brief episodes of relapse.

Adult↗

PubMed1991

Control versus abstinence in the treatment of pathological gambling: a two to nine year follow-up.

A structured gambling interview schedule, the Eysenck Personality Questionnaire, Spielberger's State-Trait Anxiety Inventory, Zuckerman's Sensation Seeking Scale and Beck Depression Inventory were administered to 63 out of 120 pathological gamblers who had 5 years previously completed a behavioural treatment for uncontrollable gambling behaviour. Results indicated that both abstinence and controlled gambling outcomes were associated with continued improvement in self-report and psychological indices of social functioning and psychopathology. Response to treatment was associated with a reduction in arousal levels, anxiety and depression. Uncontrolled gamblers failed to show post-treatment changes on parameters of improvement. It was concluded that abstinence is not the only possible therapeutic outcome in behavioural treatment and further, that controlled gambling is not a temporary response which is followed by a return to continued uncontrollable gambling.

Adult↗

PubMed1991

Comparison of imaginal desensitisation with other behavioural treatments of pathological gambling. A two- to nine-year follow-up.

Of 120 pathological gamblers randomly allocated to imaginal desensitisation (ID) or to other behavioural procedures (60 to each group, all procedures administered over one week) 63 subjects were contacted two to nine years later. Twenty-six of the 33 who received ID reported control or cessation of gambling compared with 16 of 30 who received other behavioural procedures. This difference was significant, indicating ID had a specific effect additional to that of the other behavioural procedures. It is suggested the other procedures could be regarded as placebos. As the response at a mean of over five years to one week of ID is comparable with that reported to more intensive therapies, after briefer follow-up, it is suggested ID is a cost-effective therapy for pathological gambling, and is worth considering when resources are limited.

Aversive Therapy↗

PubMed1991

Parental representations of patients with panic disorder and generalised anxiety disorder.

Previous studies using the Parental Bonding Instrument have shown a general trend for neurotic subjects to score their parents as less caring and more protective. Such a finding was broadly replicated in a study of 80 clinically anxious subjects and age- and sex-matched controls. Although direct comparisons of PBI scores failed to reveal clear-cut differences between generalised anxiety (GA) and panic disorder (PD) subgroups, logistic regression analyses revealed higher odds ratios for parental assignment to aberrant categories in the GA group, with PD patients reporting a more limited pattern of overprotective parenting only. Our findings suggest that adverse parental behaviour may be relevant to the pathogenesis of GA, while parental 'affectionate constraint' may be a parental response to early manifestations of PD.

Adult↗

PubMed1990

Boredom proneness in pathological gambling.

To test the hypothesis that pathological gamblers seek stimulation as a means of reducing aversive under-aroused states of boredom and/or depression, the Beck Depression Inventory, Zuckerman's Sensation Seeking Scale and a Boredom Proneness Scale were administered to 48 diagnosed pathological gamblers and a control group of 40 family physician patients. Analyses of variance showed pathological gamblers obtained significantly higher boredom proneness and depression scores than those of controls. That the Boredom Proneness Scale failed to correlate with the Zuckerman Boredom Susceptibility subscale suggested the two measure differing dimensions. Results indicated the possible existence of three subtypes of pathological gamblers, one group characterized by boredom, another by depression, and a third by a mixture of both depression and boredom.

Adult↗

PubMed1989

Resistance to treatment of adolescent sex offenders.

Little information is available concerning adolescent sexual offenders and their response to treatment. Of 45 sex offenders treated in two studies, 6 were adolescents and 21 of the 39 adults reported that their deviant behavior had commenced before or during adolescence. All 6 adolescents presented for treatment only following detection of their offenses, which in 3 led to legal charges. Of the 39 adults, 12 sought treatment voluntarily. Subjects were randomly allocated to receive covert sensitization, imaginal desensitization, medroxyprogesterone, or imaginal desensitization plus medroxyprogesterone. The response of the adults was equivalent to the best reported in the literature. Seven of the 39 required additional treatment, 3 being charged for further sexual offenses. Four of the 6 adolescents required additional treatment, 3 being charged with further sexual offenses. These differences were statistically significant. Adolescent sexual offenders may be more resistant to treatment because their sexual urges are under more direct hormonal control whereas in adults sexual urges are in part under the control of behavior completion mechanisms. Sexual offenses in adolescence need to be considered as at least as significant as those of adults, and more intensive follow-up treatment appears indicated in their management.

Adult↗

PubMed1989

Anxiety and/or depression in the pathogenesis of addictive gambling.

The Spielberger State-Trait Anxiety Inventory and the Beck Depression Inventory were administered to 75 pathological gamblers seeking behavioral treatment, to investigate the hypothesis that anxiety and depression were important determinants in the maintenance of gambling behavior. Further, subgroups of "pure" poker-machine and "pure" horse-race gamblers were isolated and compared to determine whether differences existed between groups of individuals who selected different forms of gambling. Although the desire to win money was given as the main reason for participation, need for money played a less significant role in precipitating further gambling. Rather, the concept that pathological gambling is a behavioral stress reaction received some support. As a group pathological gamblers had moderate levels of depression. State or trait anxiety scores were no different from Spielberger's normative sample of neuropsychiatric patients, but were higher than those of college students. No significant differences were found between the poker-machine and horse-race gambling subgroups on age, years gambling, years of uncontrolled gambling, state and trait anxiety, or depression. It was suggested that environmental factors are of importance in determining the form of gambling selected, but differences between these subgroups on other psychological dimensions could not be excluded on the basis of the present study.

Adolescent↗