Search PubMed⌕ Search

Biomedical subjects

M McCallum

Publications and source records attributed to M McCallum.

At least 19 recordsLinked to original sources
PubMed2004

A prognostic index for operable, node-negative breast cancer.

Clinical data and samples from patients diagnosed, more than 10 years previously, with operable node-negative breast cancer (participants in the Scottish Adjuvant Tamoxifen trial), were revisited. Cases with two distinct categories of outcome were selected; more than 10 years disease-free survival ('good outcome') or distant relapse within 6 years of diagnosis ('poor outcome'). An initial set of cases was analysed for a range of putative prognostic markers and a prognostic index, distinguishing the two outcome categories, was calculated. This index was then validated by testing its predictive power on a second, independent set of cases. A combination of histological grade plus immunochemical staining for BCL-2, p27 and Cyclin D1, generated a useful prognostic index for tamoxifen-treated patients but not for those treated by surgery alone. The value of the index was confirmed in a second set of tamoxifen-treated, early stage breast cancers. Overall, it correctly predicted good and poor outcome in 79 and 74% of cases, respectively (odds ratio 11.0). Other markers assessed added little to prediction of outcome. In the case of molecular assays, sensitivity and reliability were compromised by the age of the tissue specimens and the variability of fixation protocols. In selecting patients for adjuvant systemic chemotherapy, the proposed index improves considerably on current international guidelines and matches the performance reported for 'gene-expression signature' analysis.

Biomarkers, Tumor↗
PubMed2001

Patient personality and time-limited group psychotherapy for complicated grief.

We used a randomized clinical trial to investigate the interaction of two patient personality characteristics (quality of object relations [QOR] and psychological mindedness [PM]) with two forms of time-limited, short-term group therapy (interpretive and supportive) for 139 psychiatric outpatients with complicated grief. Findings differed depending on the outcome variable (e.g., grief symptoms, general symptoms) and the statistical criterion (e.g., statistical significance, clinical significance, magnitude of effect). Patients in both therapies improved. For grief symptoms, a significant interaction effect was found for QOR. High-QOR patients improved more in interpretive therapy and low-QOR patients improved more in supportive therapy. A main effect was found for PM. High-PM patients improved more in both therapies. For general symptoms, clinical significance favored interpretive therapy over supportive therapy. Clinical implications concerning patient-treatment matching are discussed.

Adjustment Disorders↗
PubMed2001

Using DSM axis II information to predict outcome in short-term individual psychotherapy.

The present study considered three methods of using DSM Axis II information to examine the effect of personality disorder on outcome in two forms of short-term, individual psychotherapy (interpretive and supportive). The first method involved examining whether the presence of any personality disorder influenced treatment outcome. The second method involved examining the effect of the number of personality disorders on outcome. The third involved examining outcome for specific personality disorders. The study found that a diagnosis of any personality disorder did not influence the outcome of therapy. In contrast, the number of personality disorders was significantly related to outcome at post-therapy and at 12-month follow-up. The findings indicated that a greater number of personality disorders was associated with less favorable outcome across both forms of therapy. This supports the notion that personality pathology is more severe when it involves a greater number of personality disorders. In an exploratory set of analyses, the study also found some evidence of differences in outcome for specific personality disorders.

Adolescent↗
PubMed2001

Effect of patient gender on outcome in two forms of short-term individual psychotherapy.

This study examined the relationship of patient gender and outcome for two forms (interpretive, supportive) of short-term, individual psychotherapy. Female and male patients (N=89) were randomly assigned to either interpretive or supportive therapy. Outcome was measured in the areas of depression, anxiety, and general symptomatic distress. A significant interaction effect between patient gender and form of therapy was found for measures of depression and general symptomatic distress at post-therapy. Male patients had better outcome in interpretive therapy than in supportive therapy. Female patients had better outcome in supportive therapy than in interpretive therapy. The findings suggest that patient gender may be differentially influential with different forms of short-term therapy.

Adult↗
PubMed2001

Outcome of first contact schizophrenia in Jamaica.

Several previous studies have identified high incidence rates, high relapse rates and poor short-term outcome for schizophrenia in African-Caribbeans in the United Kingdom (UK). Studies in the Caribbean have found the incidence of schizophrenia to be within worldwide levels, and one-year outcome to be much lower than that reported for African Caribbean patients in the UK. First contact patients with schizophrenia identified prospectively by the Present Status Examination were followed prospectively for one year. The main outcome measures which were collected from case notes included: clinical status and medication usage at contact with clinical service, employment status, outpatient clinic compliance, relapse rate and in-patient hospital status, after 12 months. Three hundred and seventeen patients between ages 15 and 55 years who had made first contact with the psychiatric service in Jamaica in 1992 received a computer diagnostic programme for the present status examination (CATEGO) diagnosis of schizophrenia. The majority 197 (62%) were treated at home, and 120 (38%) were admitted to hospital for treatment. Two hundred and sixty-four (83%) were still being seen after one year. The relapse rate was 13% (41 patients), higher for admissions (24, 20%) than for those treated at home (17, 9%; p < 0.001). The relapse rate was higher for patients brought into care by the police and mental health officers (p < 0.005). One hundred and thirty-five (43%) were in gainful employment within the 12-month period of follow-up, contrasted with the 40% unemployment rate for the 2.4 million population of the island (chi square = 39.322, p < 0.001). There was a self-reported use of medication in 213 (67%) patients, with 142 (45%) on monthly intramuscular depot medication. The low relapse rates and good outcome measures after 12 months of first service contact with schizophrenia are related to high levels of gainful employment and good intramuscular medication compliance. The favourable short-term outcome in Jamaica does not correspond to the high relapse rate for this condition found in African Caribbeans in the UK.

Adolescent↗
PubMed2000

Treatment of acute schizophrenia in open general medical wards in Jamaica.

OBJECTIVE: The study assessed the efficacy of treating acute psychotic illness in open medical wards of general hospitals. METHODS: The sample consisted of 120 patients with schizophrenia whose first contact with a psychiatric service in Jamaica was in 1992 and who were treated as inpatients during the acute phase of their illness. Based on the geographic catchment area where they lived, patients were admitted to open medical wards in general hospitals, to psychiatric units in general hospitals, or to acute care wards in a custodial mental hospital. At first contact, patients' severity of illness was assessed, and sociodemographic variables, pathways to care, and legal status were determined. At discharge and for the subsequent 12 months, patients' outcomes were assessed by blinded observers using variables that included relapse, length of stay, employment status after discharge, and clinical status. RESULTS: More than half (53 percent) of the patients were admitted to the mental hospital, 28 percent to general hospital medical wards, and 19 percent to psychiatric units in general hospitals. The three groups did not differ significantly in geographic incidence rates, patterns of symptoms, and severity of psychosis. The mean length of stay was 90.9 days for patients in the mental hospital, 27.9 days in the general hospital psychiatric units, and 17.3 days in the general hospital medical wards. Clinical outcome variables were significantly better for patients treated in the general hospital medical wards than for those treated in the mental hospital, as were outpatient compliance and gainful employment. CONCLUSIONS: While allowing for possible differences in the three patient groups and the clinical settings, it appears that treatment in general hospital medical wards results in outcome that is at least equivalent to, and for some patients superior to, the outcome of treatment in conventional psychiatric facilities.

Acute Disease↗
PubMed2000

Different perspectives of the therapeutic alliance and therapist technique in 2 forms of dynamically oriented psychotherapy.

OBJECTIVE: This study addresses several issues concerning patients' and therapists' perceptions of key therapy process variables. This includes examining whether patients and therapists differ in their perceptions of the therapeutic alliance and therapist technique, what the relation is between perceptions of the alliance and technique, and whether these perceptions are predictive of treatment outcome. METHOD: Patient and therapist perceptions of the therapy process were provided in a comparative trial of 2 forms of short-term individual dynamic psychotherapy. Patients (n = 144) were randomly assigned to each condition. Treatment outcome was assessed using a large, comprehensive battery of reliable measures. RESULTS: The findings revealed several differences in the patients' and therapists' ratings of the alliance and technique in the 2 forms of therapy. Patient ratings of the alliance and technique were predictive of treatment outcome. CONCLUSION: The findings contribute to understanding the extent to which therapy participants share views of therapy processes and highlight the importance of the therapist's attending to the patient's perception of therapy.

Adolescent↗
PubMed2000

Role behavior expectancies and alliance change in short-term individual psychotherapy.

Patients and therapists participating in a clinical trial of short-term, time-limited individual (STI) psychotherapy were asked to rate expectancies regarding their own and their counterpart's role behaviors during sessions. Significant relationships differed according to the index of alliance used (patient, therapist) and as a function of scores on a global patient personality measure known as Quality of Object Relations (QOR). Among high-QOR (or mature) cases, the patient's expectancy of being able to contribute to the treatment process was inversely associated with change in the patient-rated alliance. For those with low QOR (more primitive object relations), congruence of expectancies regarding a supportive therapist role was directly associated with change in the therapist-rated alliance. Results are discussed in terms of evaluating and preparing patients for psychotherapy and the appropriate therapeutic strategies for patients of different QOR.

Adult↗
PubMed1999

Follow-up findings for interpretive and supportive forms of psychotherapy and patient personality variables.

Follow-up findings at 6 and 12 months are reported for a clinical trial that investigated the efficacy of interpretive and supportive forms of short-term individual psychotherapy and the interaction of each form with the patient's quality of object relations (QOR) and psychological mindedness (PM). Patients in both forms maintained their posttherapy improvements at 6- and 12-month follow-up assessments. They did not differ significantly from each other. At 6 and 12 months, there was evidence for a direct relation between QOR and favorable outcome. At 12 months, there was also evidence for an interaction effect, which indicated a direct relation between QOR and favorable outcome for interpretive therapy and almost no relation for supportive therapy. Thus, QOR continued to be an important predictor of outcome at 6 and 12 months, with some evidence for persistence of an interaction effect. In contrast, no follow-up effects were found for PM.

Adult↗
PubMed1999

Borderline functioning, work, and outcome in intensive evening group treatment.

Cluster analysis was used to identify subgroups of a sample of 40 patients with borderline personality disorder (BPD). The BPD patients were part of a larger sample that had participated in an intensive, group-oriented Evening Treatment Program. A set of pretherapy outcome measures was used to represent patient "attributes" for the cluster analysis. Eight clusters were identified. Two, each defined by a single patient with pronounced pathology, were deleted from further analyses. In a discriminant-function analysis, four dimensions emerged that differentiated the six remaining clusters. Significant relationships among the four dimensions and measures of therapeutic work and treatment outcome were identified. The relationships reflected the impact of behavioral characteristics associated with BPD on participation in and benefit from intensive group-oriented evening treatment. Implications of these exploratory findings for the understanding and treatment of BPD are discussed.

Adult↗
PubMed1999

Transference interpretations in short-term dynamic psychotherapy.

Transference interpretations are one of the distinguishing features of dynamically oriented psychotherapy. Previous studies have suggested that too many transference interpretations may be detrimental, in particular for certain kinds of patients. Given the potential for negative effects, attempts to validate (replicate) the previous findings are worthwhile. The relationships between the frequency and proportion of transference interpretations and both the therapeutic alliance and treatment outcome were examined in a sample of 40 patients who received time-limited, 20-session, individual psychotherapy. Inverse relationships were found between the frequency of transference interpretations and both patient-rated therapeutic alliance and favorable outcome. The relationships differed as a function of the patient personality characteristic known as quality of object relations (QOR). These results extend previous findings regarding transference technique in short-term dynamic therapy with low-QOR and high-QOR patients.

Adult↗
PubMed1998

Interpretive and supportive forms of psychotherapy and patient personality variables.

A randomized clinical trial investigated the efficacy of interpretive and supportive forms of short-term individual psychotherapy and the interaction of each form with the patient's quality of object relations (QOR) and psychological mindedness (PM). The psychiatric outpatient sample included 144 therapy completers and 27 dropouts. Eight experienced therapists provided distinct forms of manual-guided therapy. Outcome was assessed by a comprehensive battery. The dropout rate was higher for interpretive therapy than for supportive therapy. Patients in both forms improved, but they did not differ on outcome from each other. A multivariate interaction effect indicated a direct relation between QOR and outcome for interpretive therapy and almost no relation for supportive therapy. A multivariate main effect indicated a direct relation between PM and outcome for both forms. The relevance of patient personality to outcome in different forms of therapy is addressed.

Adolescent↗
PubMed1997

Predicting patient benefit from a group-oriented, evening treatment program.

Patients with coexisting mood and personality disorders are a challenge to service care providers who offer treatment. The response of 190 patients with one or both disorders to an intensive group-oriented evening treatment program was investigated. Benefit was assessed using factors derived from pre-post outcome measures and from general impressions of program usefulness. A predictive model consisting of patient levels of psychological mindedness and psychodynamic work was applied. Results indicated that psychological mindedness was significantly related to psychodynamic work in the program, and work was related to general impressions of program usefulness. These results cross-validated findings from a previous study of a day-treatment program. Restricted range may have prevented finding significant results for the pre-post outcome factors. Clinical implications of the findings are discussed.

Cognition↗
PubMed1996

Psychological mindedness.

THERE is a consensus in the psychotherapy literature that the patient dimension of psychological mindedness is important to working within all forms of psychoanalytically oriented therapy. Silver (1983) offered a comprehensive definition of psychological mindedness stating that the capacity includes: The patient's desire to learn the possible meanings and causes of his internal and external experiences as well as the patient's ability to look inwards to psychical factors rather than only outwards to environmental factors....[and] to potentially conceptualize the relationship between thoughts, feelings, and actions. (p. 516).

Adolescent↗
PubMed1993

Concentration and correspondence of transference interpretations in short-term psychotherapy.

This article provides a review of research on the relationship between aspects of transference interpretation and outcome in dynamic psychotherapy. It also presents the results of a recently completed study that focused on 2 aspects of transference interpretations, concentration and correspondence. Significant relationships between each of these 2 aspects and both therapeutic alliance and outcome were found, as well as an interaction effect for outcome. The relationships differed as a function of the patient personality characteristic known as quality of object relations. The results concerning correspondence were consistent with those of previous studies that investigated the correctness of interpretations. The overall findings suggest that (a) variation in technique may make a difference in brief dynamic therapy and (b) variation and impact of technique may have been masked in some previous studies and reviews.

Adult↗
PubMed1993

Affect and outcome in short-term group therapy for loss.

Affect and work variables were monitored for 12 of 16 groups involved in a controlled outcome study of psychoanalytically oriented short-term group therapy. Groups were conducted by experienced therapists for outpatients who experienced difficulties adapting to personal losses through death, separation, or both. Postsessional ratings of positive and negative affect were provided by individual patients, therapists, and other patients. Psychodynamic work was rated independently using a content analysis system. Patients who had experienced separation were more inhibited in their affective expression. Rating sources agreed that positive affect increased over time. Direct relationships were found between positive affect and favorable outcome. Concerning negative affect, the strongest predictors of favorable outcome involved the interaction of affect and work. Implications of these findings are discussed in terms of the cathartic hypothesis.

Adult↗
PubMed1993

Understanding the relationship between transference interpretation and outcome in the context of other variables.

Transference interpretation has traditionally been regarded as a powerful distinguishing feature of dynamically oriented psychotherapy. The failure of early studies to demonstrate its impact on outcome may, in part, have been due to limitations in methodology and conceptual models. A recently completed clinical trial of short-term individual psychotherapy has provided evidence of associations between two aspects of transference interpretation and outcome. The two aspects were concentration (frequency expressed as a proportion of interventions) and correspondence (congruence with a patient formulation). The nature of the associations varied as a function of the patient characteristic known as quality of object relations. Also important was the therapeutic alliance. When the variables were considered together in a multivariate model and their relationships examined by means of multiple regression, substantial amounts of outcome variance were accounted for. The evidence from previous and recent studies suggests that technique can have an important impact on outcome in short-term individual psychotherapy. It also indicates that the impact of technique should be viewed in relation to patient and relationship variables.

Humans↗