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Biomedical subjects

J Mintz

Publications and source records attributed to J Mintz.

At least 19 recordsLinked to original sources
PubMed1992

Treatments of depression and the functional capacity to work.

This study evaluated the effects of antidepressants and psychotherapy on work impairment in depressed patients. Original databases from 10 published treatment studies were compiled and analyzed (N = 827). Functional work impairment was common at baseline, manifested by unemployment (11%) or on-the-job performance problems (absenteeism, decreased productivity, interpersonal problems, 44%). Generally, work outcomes were good when treatment was symptomatically effective, but the trajectories of work restoration and symptom remission were different, with work recovery appearing to take considerably longer. Relapse was an important determinant of long-term occupational outcome, particularly for seriously ill patients for whom relapse meant rehospitalization or other profound social disruption. Affective impairment was distinguished from functional impairment, with the former characterizing milder depression and the latter characterizing moderate to severe depression. Some methodological recommendations are discussed.

Absenteeism↗
PubMed1992

Prodromal symptoms and signs of bipolar relapse: a report based on prospectively collected data.

Prospectively collected data on 19 recently hospitalized patients with bipolar disorder were examined for prodromal changes preceding relapse. The 4-month periods before six manic and six depressive relapses were compared with each other and with a comparable period for seven patients who did not relapse. The Brief Psychiatric Rating Scale was used to assess symptoms. Significant elevations in unusual thought content were found 1 month before manic relapse. Depressive relapsers evidenced higher levels of conceptual disorganization throughout the prerelapse period. Nonrelapsers showed very stable symptom profiles.

Adult↗
PubMed1992

Concurrent and predictive electrodermal correlates of symptomatology in recent-onset schizophrenic patients.

Electrodermal activity and symptomatology were interrelated in a group of 56 male and 13 female recent-onset schizophrenic patients. Electrodermal activity was indexed by the frequency of nonspecific skin conductances responses and the number of trials to habituation of the skin conductance orienting response. Symptomatology was assessed by the Brief Psychiatric Rating Scale (BPRS) on two separate test occasions. The first test occasion was during the inpatient period when psychotic symptoms were prevalent and medications were variable. The second test occasion was several months later during an outpatient period when symptoms were stabilized and medications held constant. Electrodermal activity was positively and significantly related to a number of symptoms in male patients, most reliably the BPRS factors Activation and Hostility/Suspiciousness. These relationships were most consistent during the outpatient period. Of particular theoretical interest, greater electrodermal activity during the inpatient period was associated with greater outpatient psychopathology. The results suggest that heightened inpatient electrodermal activity is predictive of poor short-term symptomatic recovery in recent-onset, acute, male schizophrenic patients.

Adolescent↗
PubMed1992

Developmental Processes in Schizophrenic Disorders: longitudinal studies of vulnerability and stress.

The Developmental Processes in Schizophrenic Disorders project is a longitudinal study of schizophrenic patients who have recently had a first episode of psychosis. The project focuses on discriminating characteristics of schizophrenic patients that are "stable vulnerability indicators," "mediating vulnerability factors," and "episode indicators" by comparing normal subjects to schizophrenic patients assessed in clinically remitted and psychotic states. A parallel project goal is to identify predictors of relapse, social and work impairment, and illness course among potential psychobiological vulnerability factors and environmental potentiating factors. Hypothesized vulnerability factors and potential environmental stressors are examined first under standardized maintenance antipsychotic medication conditions for at least 1 year. Patients showing stable remission of psychosis after 1 year of maintenance antipsychotic medication are invited to enter drug crossover and withdrawal protocols to determine the need for continuous antipsychotic medication. Vulnerability and stress factors are again assessed. A summary of results to date is presented. Deficits in early components of processing visual arrays and in sustained discrimination of successive ambiguous perceptual inputs are relatively stable across psychotic and clinically remitted states in the schizophrenic patients. Performance on a vigilance task demanding active, working memory also remains abnormal during clinical remission but covaries significantly with psychotic state and is a candidate for a mediating vulnerability factor. Autonomic activation level does not appear to be an enduring vulnerability factor, but it predicts the extent of short-term symptomatic recovery and may mediate the impact of stressors. Under conditions of standardized, injectable antipsychotic medication, independent stressful life events and highly critical attitudes toward the patient in the social environment predict relapse risk. Prospective data suggest that signs and symptoms prodromal to psychotic relapse may be present in about 60 percent of patients.

Adolescent↗
PubMed1992

Technique for training schizophrenic patients in illness self-management: a controlled trial.

OBJECTIVE: To determine whether schizophrenic outpatients receiving low-dose neuroleptic therapy could learn and retain complex information and skills related to self-management of their illness, a novel technique of teaching, using cognitive and behavioral methods, was designed to compensate for the patients' learning disabilities. METHOD: The subjects were 41 patients with DSM-III-R schizophrenia who were receiving constant maintenance neuroleptic drug therapy. They were randomly assigned to structured, modularized skills training or to supportive group psychotherapy. RESULTS: The patients who received skills training made significant gains in each of the areas taught, while those participating in group therapy did not. The skills learned during training were retained without significant erosion over a 1-year follow-up period. CONCLUSIONS: The effectiveness of modularized teaching of illness self-management skills to schizophrenic patients appears to be largely independent of baseline psychology and symptom improvement. Such an approach is useful for overcoming or compensating for the enduring cognitive and information processing deficits commonly found in schizophrenia.

Activities of Daily Living↗
PubMed1992

Haloperidol plasma levels and clinical response: a therapeutic window relationship.

OBJECTIVE: The purpose of the study was to assess the relationship between plasma haloperidol and clinical response. METHOD: Sixty-nine newly admitted drug-free schizophrenic men were randomly assigned to receive haloperidol, 5, 10, or 20 mg daily for 4 weeks, and clinical response was measured at the end of the fixed-dose period. Haloperidol was assayed by a sensitive and specific radioimmunoassay. RESULTS: The authors found a curvilinear relationship between clinical response and plasma haloperidol during fixed-dose treatment, with an apparent optimum between 5 and 12 ng/ml. When plasma levels above 12 ng/ml were lowered to the 5-12 ng/ml range, all patients improved to varying degrees and no patient deteriorated. When plasma levels of nonresponders within this therapeutic window were raised above 12 ng/ml (as in routine practice), they, on balance, deteriorated in that they became more dysphoric. With the 20-mg dose, half the patients had plasma levels above 12 ng/ml. CONCLUSIONS: In this sample of newly admitted schizophrenic men, optimal clinical response occurred with a plasma haloperidol range of 5-12 ng/ml.

Adult↗
PubMed1992

Acquisition and retention of skills training methods in chronic schizophrenic outpatients.

Forty-one DSM-III-R schizophrenic subjects on constant, low-dose maintenance neuroleptic drug therapy (5-10 mg of fluphenazine decanoate intramuscularly every 2 weeks) were randomly assigned to structured and modularized skills training or to supportive group psychotherapy. The skills training was designed by using cognitive and behavioral methods to compensate for the learning disabilities that plague many schizophrenic patients. Skill acquisition was assessed by using quantified performance on standardized role-play tests. Subjects who received skills training made significant gains in each of the areas taught, whereas those who participated in the control psychotherapy group did not. The knowledge and skills learned during training were retained without significant erosion over a 1-year followup period. These results suggest that the use of structured principles of learning and cognitive therapy can effectively train schizophrenics in skill areas pertinent to the self-management of their illness.

Adult↗
PubMed1991

T2 hyperintense foci on magnetic resonance images of schizophrenic patients and controls.

High resolution magnetic resonance imaging (MRI) of the brain was performed on 18 male schizophrenic patients and 15 male normal control subjects using an identical imaging protocol. The number and size of T2 hyperintense foci were clinically quantified by an academic radiologist. Large foci (greater than or equal to 3 mm in diameter) were observed more frequently on patient images (7/18) than on control images (1/15). The imaging protocol detected high rates of focal hyperintensities, but no differences between patients and controls were noted in the total affected brain area (sum of focal areas) or in the presence or absence of foci.

Adult↗
PubMed1991

Serum prolactin as a correlate of clinical response to haloperidol.

The rise in serum prolactin concentration in patients treated with neuroleptic drugs is well documented, but attempts to relate this rise to clinical response have yielded conflicting results. These conflicting results could be explained by design flaws in those studies attempting to relate prolactin to clinical response. Seventy-three newly (re)admitted drug-free schizophrenic men were randomly assigned to receive haloperidol either 5, 10, or 20 mg daily for 4 weeks. Prolactin levels post-treatment were significantly (p less than 0.02) related to global outcome by logistic regression. A serum prolactin level may be a useful guide to the lowest effective dose of haloperidol in newly treated schizophrenic men. Above a plasma prolactin level of approximately 30 ng/ml there was very little increase in response. Patients on the 5, 10, and 20 mg daily haloperidol doses had mean prolactin levels of 16, 32, and 34 ng/ml, respectively.

Adult↗
PubMed1979

The impact of Vietnam service on heroin-addicted veterans.

Age-matched samples of Vietnam veterans and veterans who did not serve in Vietnam were surveyed at the time that they applied for treatment of heroin addiction. Vietnam veterans were more likely to have begun using heroin during their military service, and they were more likely to say that their service experiences had affected their use of drugs, usually citing relief of fear and tensions of war. Veterans who had not been in Vietnam were somewhat more likely to have begun using drugs after service, and generally indicated that their military experiences had not affected their drug use. When they did cite an effect of service, the factors usually indicated were boredom and a lack of meaningful activity. Attitudes toward narcotic use were negative in both groups, but significantly less so among Vietnam veterans. However, these attitudes did not relate to patterns of current or past drug use. Groups did not differ in the extent of or reasons for current illicit drug use, but non-Vietnam veterans reported more alcohol use. The Vietnam war was mentioned by one Vietnam veteran and by no non-Vietnam veterans as a reason for continuing narcotic use. Few other differences were found. Notably, typical treatment course over a 5-year follow-up period was similar in the two study groups.

Adult↗
PubMed1979

Depression in treated narcotic addicts, ex-addicts, nonaddicts, and suicide attempters: validation of a very Brief Depression Scale.

Samples of heroin-addicted veterans in treatment at a VA drug clinic, ex-addict and nonaddict Vietnam veterans followed-up after return to the United States, and male suicide attempters who were not drug abusers completed a very short (five item) form of the Beck Depression Inventory developed for screening and research purposes. Results confirmed prior findings of high rates of depression among narcotic addicts in treatment. Two samples of patients assessed at intake to treatment did not differ significantly from the suicide patients in BDI-5 scores. Methadone maintenance patients and ex-addicts scored below those groups, but higher than nonaddicts. Relief of inner tensions or worries was chosen most frequently as the reason for continuing use of narcotics by patients in treatment, suggesting that self-medication for psychiatric problems may be common. The BDI-5 proved to be an efficient method for screening for depression in these samples, and thus might be useful in clinical or research settings when a very brief method is needed.

Depression↗
PubMed1977

Depression in veterans two years after Viet Nam.

The authors evaluated the incidence of depression in a sample of 202 Viet Nam veterans an average of 28 months after their return from Viet Nam. Approximately one-third of the sample fell within the clinically depressed range of the Beck Depression Inventory. Comparison of the depressed and nondepressed groups indicated that the former had higher frequencies of drug abuse (particularly while in Viet Nam), more marital difficulties, a higher unemployment rate, and more current legal problems. This high incidence of depression, coupled with the finding that few of these men were being treated for the illness, indicates the need for an outreach approach to this population.

Adult↗