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Biomedical subjects

I Grant

Publications and source records attributed to I Grant.

At least 181 records · Page 10Linked to original sources
PubMed1990

Severity of psychosocial stress and outcome of alcoholism treatment.

We examined the relation between stressful life events and drinking outcome among 129 male alcoholics who had completed an alcohol treatment program. Life events were assessed for the year prior to treatment and for the 3 months after treatment and were rated on the Psychiatric Epidemiology Research Interview and the Contextual Rating System. Approximately 40% of the pretreatment stressors were found to be directly or indirectly related to alcohol use. When stressors related to drinking were excluded from consideration, we found that men who returned to drinking after treatment experienced more severe or highly threatening stress before their relapse than men who remained abstinent during the follow-up period. These data suggest that although less severe stress may not increase risk for relapse, acute severe stressors and highly threatening chronic difficulties may be associated with elevated relapse risk.

Adult↗
PubMed1990

Human immunodeficiency virus-type 1 (HIV-1) and the brain.

Infection with human immunodeficiency virus Type-1 (HIV-1), the causative agent of AIDS, can be associated with central nervous system as well as immune system disease. Advanced AIDS can be complicated by a dementia. Short of frank dementia, many AIDS patients manifest neuropsychological (NP) impairment including disturbance in speeded information processing, abstraction, learning, and recall. Data conflict on whether medically asymptomatic HIV-1 carriers have subtle NP deficits. Variations in tests chosen, criterion specification, and sample selection may all be contributing to disparate results. Longitudinal research is needed, and this should examine representative samples of HIV-1 seropositive individuals for whom approximate date of seroconversion is known and in whom sources of comorbidity (e.g., drug abuse, concurrent infections, CNS injuries) can be specified.

AIDS Dementia Complex↗
PubMed1990

The neuropsychiatry of human immunodeficiency virus.

With the advent of HIV infection, a new causal group of neurobehavioral disorders has emerged. These are the neurogenic and psychogenic neurobehavioral disturbances associated with HIV. Neurogenic disorders are those caused by the direct effects of HIV on the CNS, or by other infectious agents, neoplasms, vascular events, or side effects of biologic treatments in HIV-infected persons. Psychogenic disorders include anxiety, depression, adjustment reactions, and other behavioral disturbances related to knowledge of HIV seropositivity and recognition of being afflicted with a serious illness. In many instances, the psychogenic disorders appear to represent recrudescences of preexisting psychopathology. The comprehensive management of the patient with HIV infection requires early recognition and proper treatment of such complications.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Assessment of AIDS-related cognitive changes: recommendations of the NIMH Workshop on Neuropsychological Assessment Approaches.

This article presents an extended (7-9 hours) and a brief (1-2 hours) battery designed to evaluate early cognitive changes associated with seropositive, asymptomatic persons. The battery was recommended by an NIMH Workgroup which was guided by 10 principles in its development. The domains assessed by the battery are: (1) Indicators of Premorbid Intelligence; (2) Attention; (3) Speed of Processing; (4) Memory; (5) Abstraction; (6) Language; (7) Visuoperception; (8) Constructional Abilities; (9) Motor Abilities; and (10) Psychiatric Assessment. Although the battery assesses a wide range of psychological functioning, specific emphasis has been placed on divided and sustained attention as well as speed of processing and retrieval from working and long-term memory. Descriptions of both the traditional clinical tests and tasks used in cognitive psychology are provided. Although the Workgroup strongly recommends the use of the extended battery in order to ensure the most sensitivity, it recognizes that there may be situations in which this is not possible. In order to increase the likelihood that neuropsychological tests will identify neurologically affected CDC Stage II and III seropositive individuals, the Workshop recommends that each patient's protocol be rated by two trained neuropsychologists using the same clinical criteria. The Workgroup also recommends that a concerted effort be made to incorporate data from the extended and the brief batteries in some central data bank.

AIDS Dementia Complex↗
PubMed1990

Internal vs. external determinants of coping responses to stressful life-events in the elderly.

Coping appears to function in the relationship between stressful life-events and health. Factors that may influence an individual's use of a particular coping strategy, however, are not well understood. Coping consistency within individuals and across situations was examined in a longitudinal study of 74 independently living elderly persons, as were the effects of the type of event experienced, appraisal of its degree of threat, and demographic variables on coping behaviour. Correlational analyses indicated that coping responses were more a function of event type than of an individual's consistent style. A number of distinct life-events were associated with particular types of coping responses. The degree of threat, one's expectation of the changeability of an event, and one's appraisal of possible courses of action were also correlated with specific coping behaviours. Age was negatively correlated with problem-focused coping and total number of coping responses. This study suggests that the type of stressful event an individual experiences may be a more important general determinant of one's coping response than is one's overriding propensity to cope in a particular way.

Adaptation, Psychological↗
PubMed1990

Neurogenic and psychogenic behavioral correlates of HIV infection.

In this chapter, we have suggested that neurobehavioral phenomena in HIV-infected individuals can be usefully grouped according to underlying pathogenesis. Neurogenic phenomena are those that result from direct involvement of the brain either by HIV-1 (primary neurogenic disorder) or from opportunistic infection, neoplasia, or side effects of treatment (secondary neurogenic disorder). These phenomena should be distinguished from disturbances resulting from a second pathogenetic mechanism--the psychogenic disorders. We define psychogenic disorders as those that reflect primarily psychological responses to knowledge of HIV infection and/or progression of disease, and resultant of social ramifications. In proposing the neurogenic and psychogenic groupings, we do not intend to harken back to antique "mind-body" distinctions. We recognize fully that diseases of the brain can and do cause disturbances in mood, thought, and behavior, and that preexisting psychogenic disturbances might, in fact, be substantially worsened by onset of such neuropathology. Nevertheless, for the sake of clarity and also of determining appropriate treatment, we feel that the distinction we propose is a heuristically useful one. Challenges that lie ahead include defining more precisely the incidence and natural course of HIV-associated neurogenic disorder. Although there is little doubt that CDC IV individuals have higher prevalence of both subclinical and clinical "organic mental" symptomatology, the time of onset and rate of progression of such changes are not understood. At present, it seems likely that early in the course of HIV infection, the CNS is spared; at some point, however, rate of neuropsychiatric abnormality probably increases, and this may not be directly related to progression of the immunological aspect of the disease. In regard to psychogenic phenomena, it is clear that anxiety syndrome can occur as a direct product of knowledge of HIV serostatus and may be exacerbated by progression of disease. It is possible also that some subgroups of HIV + individuals (e.g., military samples) may be at heightened risk for suicide. These observations pose challenges for focused intervention with these groups. Accumulating data both on neurogenic and psychogenic phenomenology underscore also the importance of conceptualizing HIV infection in neurobehavioral as well as immunologic-virologic terms.

AIDS Dementia Complex↗
PubMed1990

Quality of life in a placebo-controlled trial of zidovudine in patients with AIDS and AIDS-related complex.

We measured quality of life using the Karnofsky Performance Status and Quality of Well-Being scale (QWB) for 31 patients with AIDS and AIDS-related complex in a placebo-controlled trial of zidovudine. Sixteen patients were randomized to zidovudine and 15 to placebo. We recorded nine scores for each patient during 1 year. During the blinded trial, 3 patients receiving placebo died; at 1 year, one had died in the zidovudine group and 10 in the placebo group. Repeated-measures analysis of variance demonstrated that mean scores declined less for the zidovudine group than for the placebo group during the blinded trial (p less than 0.03) and during 1 year (p less than 0.002). However, because the QWB incorporates death into its score, these results largely reflected differences in mortality. When data from those who died were excluded, Karnofsky scores were higher for the zidovudine group at the end of the blinded trial (p less than 0.02), but at 1 year no significant differences were observed between groups. The QWB and other quality-of-life measures may contribute to more comprehensive evaluation of AIDS treatments, and may detect treatment effects earlier. Whether existing measures can detect real differences among survivors will require testing in patients with less advanced disease.

AIDS-Related Complex↗
PubMed1990

Avoidant coping predicts psychological disturbance in the elderly.

In a prospective study of 81 independently living elderly persons, information on coping strategy in response to a stressful life event was used in a canonical analysis to examine the relationship between coping factors and health status measures. A canonical correlation of .53 (28% of variance) indicated that those who responded to stressful life events with self-blame, wishful thinking, and avoidance tended to be more symptomatic 4 months later. In a regression analysis, avoidant coping significantly contributed to the prediction of psychological disturbance at the time of the second interview (R2 = .22, p less than .05). Coping strategy, however, did not significantly contribute to the prediction of physical health status during the interval examined. These results are generally consistent with the notion that coping strategies modulate the influence of life events on health and well-being but underscore the possibility that such relationships may differ depending on whether physical or psychological health status is being predicted.

Adaptation, Psychological↗
PubMed1989

A shortened MMPI useful for psychiatric screening of the non-institutionalized elderly.

We compared the reliability of the Faschingbauer Abbreviated MMPI (the FAM) to the standard MMPI with a sample of non-institutionalized, independently living elderly individuals. FAM items were extracted from the standard MMPIs of 83 middle-class men and women with a mean age of 74 years. Results indicate that the FAM is correlated highly with the MMPI. Although statistically significant differences were found between the FAM and MMPI forms on some scales, 77% of the profile pairs were judged to satisfy interpretive reliability criteria, and for the profiles that were rejected the FAM was not found to overestimate or underestimate any MMPI scale systematically. The potential value of the FAM as a screening device for elderly individuals who are living in the community is addressed.

Adaptation, Psychological↗
PubMed1989

Cross-cultural studies of dementia: use of a Chinese version of the Blessed-Roth Information-Memory-Concentration test in a Shanghai dementia survey.

A culturally adapted Chinese version of the Blessed-Roth Information-Memory-Concentration test (CIMC) was used in a dementia screening survey of a probability sample of 5,055 elderly Shanghai residents. The individual items on the CIMC that best predicted the overall score were similar to the best predictor of an American version of the IMC. Performance on the CIMC was markedly affected by the level of education or lack thereof. In a subsample for whom clinical diagnoses were obtained, it was possible to establish cutoff values on the CIMC by stratifying the sample according to education.

Aged↗
PubMed1989

Recognition memory span in mildly and moderately demented patients with Alzheimer's disease.

An abbreviated form of Moss et al.'s (1986) Recognition Span Test (RST) was administered to patients with mild or moderate dementia of the Alzheimer type (DAT) and to intact control (NC) subjects. Memory spans for verbal (i.e., words), spatial and configurational (i.e., faces) information were assessed. Delayed recall (15 s and 2 min) of the words used on the verbal recognition span was also determined. The results showed that both DAT patient groups were impaired on the three recognition tasks and that the spatial and verbal forms differentiated the mildly from the moderately demented patients. The mean overall recognition span scores (spatial + verbal + facial) differentiated between DAT patients and intact controls, with 37 of the 39 patients falling beyond the 95% confidence limits derived from the control subjects' scores. On verbal recall, both the mildly and moderately demented patients were severely impaired and evidenced a very rapid rate of forgetting between the 15-s and 2-min recall attempts. These findings suggest that the RST is not only highly sensitive to memory disorders in the early stages of DAT but also effective in discriminating among various stages of this disorder.

Aged↗
PubMed1989

A comparison of the WAIS and WAIS-R using T-score conversions that correct for age, education, and sex.

A newly developed T score conversion system that corrects Wechsler Adult Intelligence Scale (WAIS) and Wechsler Adult Intelligence Scale-Revised (WAIS-R) subtest and IQ scores for appropriate demographic variables was used to compare subjects' performance on the two versions of the instrument. Using 428 pairs of subjects matched on age, education, and sex, with one person in each pair having taken the WAIS and the other the WAIS-R, we found no significant differences in level or pattern of performance when analyses were performed on the T scores. This was in contrast to highly significant differences when uncorrected scaled scores and IQ values were compared. Therefore, the T score system appears to provide a tool which may help clinicians make more direct comparisons between the results obtained on the WAIS and WAIS-R.

Adult↗
PubMed1989

Graded neuropsychological impairment and elevated gamma-glutamyl transferase in chronic alcoholic men.

This study hypothesizes that distinct biochemical and metabolic disturbances associated with liver injury may be related to specific cognitive changes in alcoholics. In 132 alcoholic men admitted to an alcohol treatment program, increases in gamma-glutamyl transferase (GGT) values were correlated with impairment in several measures of visuoperceptual and visuoconceptual functioning. The association between plasma levels of GGT and neuropsychological performance was independent of the relative contribution of other laboratory measures of liver injury and of alcohol consumption histories. These observations support the hypothesis that elevated levels of GGT are distinctly associated with neuropsychological deficits and suggest that possible mechanisms beyond severe hepatic dysfunction and alcohol consumption underlie cognitive deficits in alcoholics.

Adult↗