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Biomedical subjects

G Woody

Publications and source records attributed to G Woody.

At least 19 recordsLinked to original sources
PubMed2001

Safety and immunogenicity of a canarypox-vectored human immunodeficiency virus Type 1 vaccine with or without gp120: a phase 2 study in higher- and lower-risk volunteers.

Live attenuated viral vectors that express human immunodeficiency virus (HIV) antigens are being developed as potential vaccines to prevent HIV infection. The first phase 2 trial with a canarypox vector (vCP205, which expresses gp120, p55, and protease) was conducted in 435 volunteers with and without gp120 boosting, to expand the safety database and to compare the immunogenicity of the vector in volunteers who were at higher risk with that in volunteers at lower risk for HIV infection. Neutralizing antibodies to the MN strain were stimulated in 94% of volunteers given vCP205 plus gp120 and in 56% of volunteers given vCP205 alone. CD8(+) cytotoxic T lymphocyte cells developed at some time point in 33% of volunteers given vCP205, with or without gp120. Phase 3 field trials with these or similar vaccines are needed, to determine whether efficacy in preventing HIV infection or in slowing disease progression among vaccinees who become infected is associated with the level and types of immune responses that were induced by the vaccines in this study.

AIDS Vaccines↗
PubMed2001

Are US populations appropriate for trials of human immunodeficiency virus vaccine? The HIVNET Vaccine Preparedness Study.

Questions exist about whether testing of preventive human immunodeficiency virus (HIV)-1 vaccines, which will require rapid recruitment and retention of cohorts with high HIV-1 seroincidence, is feasible in the United States. A prospective cohort study was conducted in 1995-1997 among 4,892 persons at high risk for HIV infection in nine US cities. At 18 months, with an 88% retention rate, 90 incident HIV-1 infections were observed (1.31/100 person-years (PY), 95% confidence interval (CI): 1.06, 1.61). HIV-1 seroincidence rates varied significantly by baseline eligibility criteria--1.55/100 PY among men who had sex with men, 0.38/100 PY among male intravenous drug users, 1.24/100 PY among female intravenous drug users, and 1.13/100 PY among women at heterosexual risk-and by enrollment site, from 0.48/100 PY to 2.18/100 PY. HIV-1 incidence was highest among those men who had sex with men who reported unprotected anal intercourse (2.01/100 PY, 95% CI: 1.54, 2.63), participants who were definitely willing to enroll in an HIV vaccine trial (1.96/100 PY, 95% CI: 1.41, 2.73), and women who used crack cocaine (1.62/100 PY, 95% CI: 0.92, 2.85). Therefore, cohorts with HIV-1 seroincidence rates appropriate for HIV-1 vaccine trials can be recruited, enrolled, and retained.

AIDS Vaccines↗
PubMed2001

Staff beliefs about addiction treatment.

In 1999, the National Institute on Drug Abuse established a researcher/provider partnership designed to test the effectiveness of research-based innovations in community-based treatment settings and facilitate the transfer of those innovations throughout the national treatment system. As a preliminary step in developing their local Clinical Trials Network, researchers and treatment providers within the Delaware Valley Node surveyed 317 staff members concerning their beliefs about addiction treatment. More than 80% of respondents supported increased use of research-based innovations, 12-step/traditional approaches, and spirituality in addiction treatment, while only 39% and 34%, respectively, endorsed the increased use of naltrexone and methadone maintenance. Also, 35% of respondents indicated that confrontation should be used more, and 46% agreed with discharging noncompliant patients. Individuals with more formal training tended to be less supportive of confrontation and more supportive of the increased use of medications. Implications for the clinical trials and technology transfer are discussed.

Alcoholics Anonymous↗
PubMed2001

Prevention of suicide by naltrexone in a recently detoxified heroin addict.

This case describes a heroin addict who was participating in a placebo-controlled randomized trial of naltrexone as an aid to relapse prevention. The patient tried to commit suicide by taking a heroin overdose after learning that he was HIV-positive. He was on naltrexone at the time and, as a result, survived what would probably have been a fatal overdose. This case demonstrates that naltrexone can have immediate as well as long-term positive effects in persons who are attempting to recover from heroin addiction.

Adult↗
PubMed2001

The Penn Psychoanalytic Treatment Collection: a set of complete and recorded psychoanalyses as a research resource.

From a set of seventeen complete and tape-recorded psychoanalyses, a sample of findings is presented: (a) the level of agreement of two clinical judges on the psychological health of these patients is adequate for the late sessions, but not for the early sessions; (b) the amount of change during psychoanalysis appears to be similar to that in the Menninger Foundation Psychotherapy Research Project; (c) psychiatric severity measures from the early sessions can yield a significant level of prediction of the later benefits from psychoanalysis. Finally, further research uses of this collection of psychoanalyses are suggested.

Adult↗
PubMed1999

Cocaine-induced mood disorder: prevalence rates and psychiatric symptoms in an outpatient cocaine-dependent sample.

This paper attempts to examine and compare prevalence rates and symptom patterns of DSM substance-induced and other mood disorders. 243 cocaine-dependent outpatients with cocaine-induced mood disorder (CIMD), other mood disorders, or no mood disorder were compared on measures of psychiatric symptoms. The prevalence rate for CIMD was 12% at baseline. Introduction of the DSM-IV diagnosis of CIMD did not substantially affect rates of the other depressive disorders. Patients with CIMD had symptom severity levels between those of patients with and without a mood disorder. These findings suggest some validity for the new DSM-IV diagnosis of CIMD, but also suggest that it requires further specification and replication.

Adult↗
PubMed1998

Imipramine treatment of opiate-dependent patients with depressive disorders. A placebo-controlled trial.

BACKGROUND: The literature is inconclusive on the role of antidepressant medications in treating drug dependence. Studies have either not focused on depressed patients or have selected patients with depressive disorders based on cross-sectional symptoms rather than a syndromal diagnosis. A clinical trial of an antidepressant was, therefore, conducted on drug-dependent patients with syndromal depression. METHODS: Patients receiving methadone hydrochloride maintenance treatment were selected if they met the criteria for a DSM-III-R depressive disorder that was chronologically primary, had persisted during a past abstinent period or was long-standing, and persisted during at least 1 month of stable methadone treatment. Subjects were randomized to a 12-week, double-blind, placebo-controlled trial of imipramine hydrochloride. A favorable response was defined as a Clinical Global Impression scale score for depression of 2 ("much improved") or 1 ("very much improved") and at least a 75% reduction in self-reported drug or alcohol use or abstinence. RESULTS: One hundred thirty-seven patients were randomized, and 84 completed a minimum adequate trial of at least 6 weeks. Among the 84 adequately treated patients, 57% (24/42) receiving imipramine were rated as responders compared with 7% (3/42) receiving placebo (P < .001). On measures of mood, there was a robust effect of imipramine. Imipramine was superior to placebo on some self-reported measures of substance use and craving, and mood improvement was associated with improvement in self-reported substance use. However, few patients achieved urine-confirmed abstinence. CONCLUSIONS: Imipramine was an effective antidepressant in patients receiving methadone who were selected via syndromal criteria for depressive illness. Imipramine may reduce substance abuse among patients whose mood improves; however, this effect was less robust.

Adult↗
PubMed1998

Training in cognitive, supportive-expressive, and drug counseling therapies for cocaine dependence.

This study assessed the effects of training on the performance of 65 therapists in delivering manual-guided therapies to 202 cocaine-dependent patients. Changes in ratings of therapists' adherence and competence was assessed in 3 treatment modalities: supportive-expressive dynamic therapy (SE), cognitive therapy (CT), and individual drug counseling. Effects of manual-guided training on the therapeutic alliance were also assessed. Training effects were examined through a hierarchical linear modeling approach that examined changes both within cases and across training cases. A large effect across cases was detected for training in CT. Supportive-expressive therapists and individual drug counselors demonstrated statistically significant learning trends over sessions but not over training cases. Training in SE and CT did not have a negative impact on the therapeutic alliance, although alliance scores for trainees in drug counseling initially decreased but then rebounded to initial levels.

Adult↗
PubMed1997

The National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Rationale and methods.

The National Institute on Drug Abuse Collaborative Cocaine Treatment Study is a large, multisite psychotherapy clinical trial for outpatients who meet the DSM-IV criteria for cocaine dependence. For 480 randomized patients, the outcomes of 4 treatments are compared for an 18-month period. All treatments include group drug counseling. One treatment also adds cognitive therapy, one adds supportive-expressive psychodynamic therapy, and one adds individual drug counseling; one consists of group drug counseling alone. In addition, 2 specific interaction hypotheses, one involving psychiatric severity and the other involving degree of antisocial personality characteristics, are being tested. This article describes the main aims of the project, the background and rationale for the study design, the rationale for the choice of treatments and patient population, and a brief description of the research plan.

Ambulatory Care↗
PubMed1997

Evaluation of a video-supplement to informed consent: injection drug users and preventive HIV vaccine efficacy trials.

We evaluate the impact of a videotape specially produced to supplement written information about preventive HIV vaccine trials. One hundred eighty-six injection drug users were randomly assigned to an education session in which either: (a) a pamphlet was reviewed before a brief discussion period or (b) the videotape was watched prior to reviewing the pamphlet and participating in the discussion. The relationship among retention of information, trust in government, and willingness to participate in a vaccine trial was tested before the presentation of information, immediately after, and 1 month later. Results indicate that both methods produced significant increases in knowledge immediately after information presentation, but only the video-supplemented group retained the information 1 month later. Subjects receiving the video supplement also showed a significant increase in trust at the first posttest period, but this increase was not maintained 1 month later. Regardless of group assignment or evaluation point, willingness to participate was not associated with knowledge but was associated with trust in government.

AIDS Vaccines↗
PubMed1996

DSM-IV antisocial personality disorder field trial.

The development of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) included 12 field trials to assess proposed revisions. This article provides results from the antisocial personality disorder (APD) field trial that was conducted to obtain data of relevance to the proposals for simplification and for the inclusion of more traditional traits of psychopathy. Provided herein are the results from 4 sites that had sampled from populations of particular relevance to the diagnosis of APD (i.e., prison inmates, psychiatric inpatients, outpatients with substance use disorders, and homeless persons). The results indicated that some items from the 3rd revised Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) could be deleted without affecting the diagnosis. The field trial provided mixed support for the proposal to include more traditional traits of psychopathy.

Adolescent↗
PubMed1996

Psychiatric comorbidity: prevalence in methadone maintenance treatment.

This study examines prevalence rates for DSM-III-R anxiety and affective disorders in three follow-up samples of opioid addicts who were treated with methadone maintenance. At least one anxiety disorder was diagnosed in 55% of the total sample. Affective disorders were found in 58%. At least one anxiety disorder coexisted with at least one affective disorder in 36% of the sample. The research demonstrates that opiate addiction in this sample is most often associated with other comorbid psychopathology. It suggests a need for thorough assessment for general psychopathology in opioid addicts entering addiction treatment, especially assessment for anxiety and affective disorders. It also suggests the need for treatment that focuses on diagnosed mental disorders in addition to drug counseling for the substance abuse disorder.

Adult↗
PubMed1994

Methadone maintenance outcome as a function of detoxification phobia.

OBJECTIVE: Methadone maintenance outcome as a function of detoxification phobia was examined. METHOD: Opiate addicts (N = 271) in a 1983 random sample of methadone maintenance patients from three diverse populations were studied. Subjects from an individually assessed follow-up sample (N = 102) were compared on detoxification phobia. Logistic regression analysis yielded best predictors of the phobia. RESULTS: Phobic patients were more likely to be white, female, and abstinent; to have had fewer detoxification attempts and longer periods on maintenance; to show persistence of the phobia; to meet diagnostic criteria for depressive or anxiety disorders; and to have Addiction Severity Index scores above the 75th percentile for psychological problems. CONCLUSIONS: Detoxification phobia has a complex relationship to methadone maintenance outcome. It is associated with greater abstinence for patients in methadone maintenance treatment. However, for rehabilitated phobic patients it presents a barrier to successful detoxification and a drug-free adjustment that is often associated with other psychopathology but could be ameliorated by targeted assessment and treatment.

Adult↗
PubMed1993

Determinants of condom use among intravenous drug users.

OBJECTIVE: To examine the factors associated with condom use among a cohort of sexually active intravenous drug users (IVDU). DESIGN: Data were collected via personal interview at the fourth-month assessment point of a longitudinal study monitoring HIV infection and risk behaviors among IVDU. SETTING: A community-based methadone clinic. PARTICIPANTS: A total of 158 sexually active heterosexual male and female IVDU, including both methadone patients and out-of-treatment individuals with a history of opiate abuse. MAIN OUTCOME MEASURES: We describe a new approach to identify the determinants of condom use. Previous studies have described subjects as either 'condom users' or 'condom non-users', using an individual's overall behavior as the unit of analysis. By analyzing condom use during the most recent sexual encounter, we avoided the problem of interpreting inconsistent condom use. Data were analyzed using forward stepwise logistic regression. RESULTS: Thirty-four per cent of the heterosexual subjects (n = 160) reported using a condom during their last sexual encounter. Being HIV-positive and having either a causal or commercial partner were each associated with increased probability of using a condom (odds ratio, 10.6, 4.4 and 12.1, respectively). No interactions with sex were found. CONCLUSIONS: Our results suggest that knowing that one is HIV-positive is an important determinant of condom use; HIV testing may therefore increase the use of condoms. In addition, interventions to change sexual behaviors may need to focus on the type of sexual partner.

Adult↗
PubMed1993

Psychological health-sickness (PHS) as a predictor of outcomes in dynamic and other psychotherapies.

This is the first dedicated review of quantitative studies on Sigmund Freud's proposition that the poorer the psychological health, the more limited are the benefits from treatment. Since observer-rated scales for psychological health-sickness were developed in 1949, many studies have applied them, and the majority show significant prediction of outcomes of psychotherapy, with correlations between .2 and .35. This article reviews (a) the main methods of measurement, (b) the record of predictive success, (c) validity studies, (d) the relation to psychiatric diagnosis, (e) prediction in forms of treatment other than psychotherapy, and (e) theories of why psychological health predicts outcomes of psychotherapy.

Humans↗
PubMed1993

A review of the substance use disorders section of the DSM-IV.

The DSM-IV work groups are the first to be given the opportunity to document carefully all stages of deliberations and make decisions based on carefully constructed and data-based criteria. The 5-year process has encouraged the use of detailed literature reviews and allowed members of the working groups to generate data from both MacArthur analyses and field trials to make the most appropriate decisions possible. The Substance Use Disorders Work Group was faced with a potentially infinite number of questions that could be asked. The guidelines presented at the beginning of this article, especially the focus on areas in which data are already available or might potentially be generated from a field trial, allowed our Work Group to focus on a limited number of questions. With rare exceptions, each of these areas was evaluated by the thorough literature reviews that have formed the chapters that make up this section of the Sourcebook. Our goals are relatively straightforward. It is important that clinicians, researchers, administrators, and those who will work the DSM-IV process have full access to the state of the literature that existed in the late 1980s and early 1990s, and the decision-making process that was used to address the issues that affected the DSM-IV. It is hoped that this article will not only help readers to understand both how and why the DSM-IV Substance Use Disorders Work Group made the relevant decisions, but will also encourage active research to answer more fully the potentially important questions raised in these reviews.

Humans↗