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Biomedical subjects

S I Miller

Publications and source records attributed to S I Miller.

At least 109 records · Page 6Linked to original sources
PubMed1982

Replicable abstinence rates in an alcoholism treatment program.

Treatment outcome studies of alcoholism have historically had innumerable difficulties and controversy. Few investigators ever have reported a replication of their initial study results, let alone the crossvalidation of such initial results. This article provides results of a four-year replication study of a medical behavioral treatment approach. Comparisons of patients receiving a uniform treatment were made at yearly intervals. A few variables are identified to clarify who will or will not achieve and maintain follow-up sobriety, although it is admitted that our knowledge in this area is still rudimentary. These results affirm for the practitioner today that the alcoholic patient is treatable with a high probability of success. When the outcome of treatment is positive, the diagnosis and referral become crucial for alcoholism just as for other treatable diseases.

Adult↗
PubMed1982

A framework for relating alcoholism and depression.

A diagnosis of primary, as opposed to secondary, depression in alcoholics is not easy to make and not always a helpful clinical guide when it is made. A useful framework for understanding alcoholism and depression clinically is to distinguish between alcoholics who are actively drinking, newly sober, or in recovery. Medication for depression should never be given to an actively drinking alcoholic. Newly sober alcoholics and those in various stages of recovery are expected to be depressed. Medication is generally not needed to deal with depression due either to withdrawal or to life problems associated with recovery from alcoholism. The use of antidepressant medication may be appropriate only when depression continues after all other avenues of therapy have been exhausted.

Alcoholism↗
PubMed1981

Zinc status of pregnant alcoholic women: a determinant of fetal outcome.

The zinc status of 25 alcoholic and 25 non-alcoholic pregnant women was measured and correlated with fetal outcome. The volume index of alcohol consumption and the Michigan Alcoholic Screening Test were used to define alcoholic women. The alcoholic women had significantly lower plasma-zinc levels that the non-alcoholic women (50.7 versus 72.2 micrograms/dl). Fetal cord-plasma zinc levels were also lower in the offspring of alcoholic women (65.5 versus 81.3 micrograms/dl). Manifestation of fetal dysmorphogenesis appears to relate to zinc status.

Alcoholism↗
PubMed1981

Social class and perceived improvement in therapy: the effects of therapist discipline and therapy type.

The present study approached the question of differential perception of improvement across social classes by various disciplines and therapeutic orientations. Records of 4,257 psychiatric patients were examined for type of therapy, discipline of therapist, rated improvement, and social class. For variables "type of therapy" and "discipline of therapist," the interaction term of analysis of variance was significant, indicating that some therapists (i.e., with a given therapeutic orientation) show greater differential among the social classes with regard to perceived improvement than others. Psychiatrists were found more reluctant to rate patients as improved, and responded less differentially among the classes than social workers and psychologists. With regard to therapeutic orientation used, therapists using family therapy or medication rated a higher percentage of patients improved in Class IV than in Class III. The results suggest that therapists with differential training backgrounds (either discipline or therapeutic orientation) have different perceptions of change in psychiatric patients, which may be due to their differential training.

Humans↗
PubMed1981

The Cleveland NIAAA prospective alcohol-in-pregnancy study: the first year.

Data from 2,913 antepartum gravidas screened for alcohol problems during the first year of a large prospective study designed to relate antenatal drinking behavior to infant outcome have been analyzed. The Michigan Alcoholism Screening Test (MAST) appears to separate two populations of pregnant patients. Differences between positive and negative MAST responders indicate variables, such as ethnicity, previous pregnancies, nutrition and cigarette smoking, which will require control when infant outcome data are evaluated. Positive MAST responders were found to be more likely to drink alcohol, to drink greater volumes and to drink more frequently than matched negative responders. They obtained a smaller proportion of their alcohol intake from wine and were more likely to drink a combination of beer, wine and/or liquor than the negative responders. The positive responders significantly decreased their alcohol intake as pregnancy progressed, while negative responders did not, suggesting the possibility that abstinence oriented therapy may be helpful. Problems with quantitating alcohol intake by humans and strategies for separating chronic and acute alcohol effects are discussed.

Adult↗
PubMed1980

Elevated superoxide dismutase in black alcoholics.

Superoxide dismutase concentrations in lysates of erythrocytes from black alcoholics were higher than those of white alcoholics and of nonalcoholics of both races. Higher concentrations of enzyme protein, as determined by competition radioimmunoassay, correspond to proportionately higher enzyme activity. Elevated superoxide dismutase levels were not related to any other clinical, historical, or demographic variables. Increased superoxide dismutase levels may delay or prevent some of the pathological sequelae of alcoholism and may be a useful biological marker for alcohol abuse.

Alcoholism↗
PubMed1980

Hypoglycemia as a manifestation of sepsis.

Hypoglycemia has rarely been described as a clinical sign of severe bacterial sepsis. We recently encountered nine patients in whom hypoglycemia (mean serum glucose of 22 mg/dl) was associated with overwhelming sepsis. Clinical disease in these patients included pneumonia and cellulitis; in three patients, no focus of infection was apparent. Altered mental status, metabolic acidosis, leukopenia, abnormal clotting studies and bacteremia were common features in these cases. In four patients, no cause for hypoglycemia other than sepsis was present. In five patients, another possible metabolic cause for hypoglycemia was present (alcoholism in four and chronic renal insufficiency in one) although none had been observed to be hypoglycemic on previous hospitalizations. Streptococcus pneumoniae (three cases) and Hemophilus influenzae, type b, (two cases) were the most common pathogens, and the over-all mortality was 67 per cent. The mechanism(s) for hypoglycemia with sepsis is not well defined. Depleted glycogen stores, impaired gluconeogenesis and increased peripheral glucose utilization may all be contributing factors. Incubation of bacteria in fresh blood at room temperature does not increase the normal rate of breakdown of glucose suggesting that the hypoglycemia occurs in vivo. Hypoglycemia is an important sign of overwhelming sepsis that may be more common than has previously been recognized.

Acidosis↗
PubMed1979

Cupro-zinc superoxide dismutase: a possible biologic marker for alcoholism (studies in black patients).

Cupro-zinc superoxide dismutase (SOD-1) was measured by competition radioimmune assay of erythrocyte lysates of alcoholic and control subjects. Normal amounts of SOD-1 were found in the extract from control subjects (815 ng/mg Hb) and from white alcoholics (874 ng/mg Hb). However, the level of SOD-1 in lysates from black alcoholics (1033 ng/mg Hb) was significantly increased (p = 0.0001, rank sum test) compared with black and white controls. This increase was not related to any other observed hematologic disorder or to any historical, demographic, or laboratory value examined.

Adult↗
PubMed1978

Are divided doses of tricyclic antidepressants necessary?

A double blind control comparison on the effects of 50 mg of clomipramine given three times a day and 150 mg of clomipramine in a single bedtime dosage revealed no significant differences in therapeutic efficacy. Patients reported more lightheadedness and dizziness but no differences on other side effects. The theoretical basis was the long biological half-life of such tricyclic antidepressants. Advantages included ease of administration, patient compliance, and timing of sedative effect.

Adjustment Disorders↗
PubMed1978

Social class and psychiatric diagnosis: differential findings in a lower-class sample.

Social class and the American Psychiatric Association Diagnostic and Statistical Manual II Diagnosis were examined for all patients contracting the Department of Psychiatry over a year at a large county hospital. This sample was primarily lower class -50 per cent Class V and 33 per cent in Class IV. All diagnoses showed average class between IV and V. Organic brain syndrome, both psychiatric and non-psychotic, and mental retardation had lower average social class than other diagnoses. A small sample of the diagnosis behaviour disorder of childhood and adolescence was also lower than other diagnoses. Class V patients with mental malfunction may present differently than patients from other social classes. The absence of differences on neurosis and functional psychosis may have been due to the predominance of lower class patients, diagnosticians more familiar with lower class patients, or the allowable choice of diagnoses.

Adolescent↗
PubMed1977

Logic as a tool for clinical training in social work.

The paper is an attempt to illustrate the usefulness of logic as a technique in the clinical training of mental health professionals. The specific concepts that are examined include the nature of deductive and inductive reasoning, hypothesis testing, necessary and sufficient conditions, "if-then" propositions, and the nature of clinical evidence. Knowledge and use of these concepts was tested in a tutorial program directed toward students who were beginning graduate studies in the field of social work. Some of the difficulties encountered by these students, especially in the clinical aspects of their training, were directly related to an inadequate understanding of these logical forms of reasoning. It is suggested that a portion of the clinical training in mental health fields be directed towards a deeper understanding and utilization of these basic concepts.

Curriculum↗