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Biomedical subjects

Barry M Maletzky

Publications and source records attributed to Barry M Maletzky.

5 recordsLinked to original sources

The Oregon depo-Provera program: a five-year follow-up.

In 1999, the Oregon State Legislature, concerned about the risk certain sexual offenders might pose to their communities upon release from prison, enacted House Bill 2500. This bill required selected offenders to be evaluated prior to their release to determine whether medical treatment with medroxyprogesterone acetate (MPA), also known by its trade name of depo-Provera, was indicated to reduce their risk. The present study reviewed the first 275 men to be evaluated under this program from the years 2000 through 2004. Data were collected on diagnoses and outcome on three groups: men judged to need MPA who eventually went on to actually receive it; men recommended to receive MPA who, for a variety of reasons, did not receive the medication; and men deemed not to need MPA. Outcome measures included recidivism data, including reoffenses, parole violations, and reincarcerations, and whether these were sexual in nature. Data were also collected on employment and whether supervising officers believed the men in each group were doing well. Significant differences emerged among these three groups, with men actually receiving depo-Provera committing no new sexual offenses and also committing fewer overall offenses and violations compared to the other two groups. In addition, almost one third of men judged to need medication but who did not receive it committed a new offense and almost 60% of these were sexual in nature. While generalizations from these types of retrospective and partially subjective findings are inherently limited, the present study lends credence to the belief that, in selected offenders, anti-androgenic medication can be a valuable, if time-limited, addition to a cognitive and behavioral treatment program. Suggestions for more practical and far-reaching implementation of this adjunctive approach are offered.

Adult↗

The first-line use of electroconvulsive therapy in major affective disorders.

Although electroconvulsive therapy (ECT) has generally been reserved for patients refractory to other forms of treatment, its use as a first-line treatment, prior to the use of other biologic approaches, has occasionally been mentioned in the literature on the treatment of affective disorders and, when indicated, can prove rapidly effective and even life saving. The present study retrospectively reviewed 27 cases treated over the span of a decade in which ECT was chosen as the first treatment of an affective episode. In none of these cases was antidepressant medication or other biologic approaches used for the current episode. A clinical global rating scale was employed to measure improvement. Although the majority of such patients were treated with ECT first based upon the severity of their depressive illness, 13 received ECT because of their obtunded condition and these patients, initially diagnosed as catatonic on admission, were suspected of having a bipolar condition, as revealed on their discharge diagnosis. In addition, ECT was recommended preferentially in 4 patients because they were pregnant and in another 4 because it had worked well in the past; an additional patient received ECT first because of his fragile medical condition. Almost all patients recovered and none suffered serious adverse effects. Sample case histories are provided along with tentative guidelines for the consideration of first-line use of ECT in clinically difficult cases.

Adult↗

The Abel test.

Explore the source record for details and available documents.

Humans↗

A 25-year follow-up of cognitive/behavioral therapy with 7,275 sexual offenders.

Outcome data are presented, grouped into 5-year cohorts, for 7,275 sexual offenders entering a cognitive/behavioral treatment program. Assessment variables included treatment completion, self-admission of covert and/or overt deviant behaviors, the presence of deviant sexual arousal, or being recharged for any sexual crime (regardless of plea or conviction). It proved possible to follow 62% for the cohort at 5 years after initiating treatment, but follow-up completion rates decreased with time. Outcomes were significantly different based on offender subtype, with child molesters and exhibitionists achieving better overall success than pedophiles or rapists. Prematurely terminating treatment was a strong indicator of committing a new sexual offense. Of interest was the general improvement of success rates over each successive 5-year period for many types of offenders. Unfortunately, failure rates remained comparatively high for rapists (20%) and homosexual pedophiles (16%), regardless of when they were treated over the 25-year period. Implications for clinical practice and future research are drawn.

Cognitive Behavioral Therapy↗