From Don Giovanni to Magic Johnson: methodological conundrums in the measurement of sexual risk behavior.
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AIDS Vaccines↗
Biomedical subjects
Thomas L Patterson
Publications and source records attributed to Thomas L Patterson.
Predictors of everyday functioning among older Mexican Americans vs. Anglo-Americans with schizophrenia.
OBJECTIVE: We assessed clinical, demographic, and cognitive predictors of everyday functioning in Mexican American and Anglo-American outpatients with schizophrenia. METHOD: Three groups of participants aged 40 years and over with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder were compared: 79 Anglo-Americans, 24 Mexican American patients who chose to be tested in English, and 33 Mexican American patients who preferred Spanish. The study was conducted from October 2001 to July 2004. RESULTS: On demographic, clinical, cognitive, and functional measures, Anglo-American participants were generally similar to Mexican American participants who opted for being tested in English. Mexican American participants who preferred Spanish were significantly different from the other 2 groups on several measures, including everyday functioning performance. To determine the predictors of everyday functioning, separate regression analyses were conducted for each of the 3 groups. Cognitive ability consistently accounted for the greatest proportion of variance in performance regardless of ethnicity, language preference, or education. Among the Mexican American participants, level of acculturation was the second strongest predictor of everyday functioning when the group was examined as a whole; however, acculturation was not a significant predictor when controlling for language preference. CONCLUSION: Cognitive performance and language preference (a proxy for acculturation) may play a particularly important role in predicting ability to perform everyday tasks. Further studies to better understand the potential impact of ethnicity, culture, education, and language on everyday functioning may help develop more specific and culture-sensitive intervention strategies for different ethnic groups.
Acculturation↗
Direct assessment of functional abilities: relevance to persons with schizophrenia.
OBJECTIVE: To review functional outcome assessment strategies specifically focusing on performance-based measures used in patients with schizophrenia. METHOD: In order to identify relevant performance-based measures of functioning we conducted a literature search using key words: functioning, disability, performance, situation, assessment, skills, scale, measurement, instrument, psychosis, and schizophrenia. RESULTS: A description of each of eight measures was provided including assessment protocol, domains of functioning assessed, scoring, basic psychometric properties, appropriateness for clinical trials and likely sensitivity to pharmacologic interventions. Methods for assessment of functioning in patients with schizophrenia are reviewed. CONCLUSIONS: The measurement of functional capacity, through performance-based activities, provides a critical benchmark by which to evaluate the efficacy and effectiveness of medications in clinical trials to improve both cognition and capacity for everyday functioning in seriously mentally ill persons with schizophrenia. In order to comprehensively evaluate functional outcome, a combination of performance-based and other assessment modalities may be required.
Antipsychotic Agents↗
Measuring cognitive insight in middle-aged and older patients with psychotic disorders.
The study examined the psychometric properties, factor structure and validity of a recently developed measure of insight, the Beck Cognitive Insight Scale (BCIS) and tested the relationship between the BCIS and psychiatric symptoms in a sample of middle-aged and older patients with schizophrenia or schizoaffective disorder. The BCIS measures the ability of respondents to observe and question their cognitive processes, whereas other insight scales focus primarily on knowledge about the presence of an illness and need for treatment. Participants were 164 middle-aged and older outpatients with schizophrenia or schizoaffective disorder who completed a battery of measures assessing insight, symptoms of schizophrenia and symptoms of depression. The results of a confirmatory factor analysis (CFA) supported the two-factor structure previously reported for the BCIS, with one factor labeled self-reflectiveness and the other labeled self-certainty. The BCIS showed adequate reliability and a moderate correlation with the Birchwood Insight Scale (IS). The BCIS correlated with some PANSS subscales measuring symptoms of schizophrenia, but did not correlate at a significant level with symptoms of depression. The findings suggest that middle-aged and older outpatients with schizophrenia or schizoaffective disorder respond on the BCIS in a manner similar to a younger inpatient population. This instrument is a promising tool for measuring the role of cognitive change in a broad range of patients experiencing psychosis.
Adult↗
A comparison of injection and non-injection methamphetamine-using HIV positive men who have sex with men.
There is a paucity of research on the psychosocial and behavioral characteristics of individuals who inject methamphetamine (meth). The present study compared injection and non-injection users of meth in terms of background characteristics, drug use patterns, health and social problems, sexual risk behavior, and psychosocial factors. The sample consisted of 194 HIV+Men who have Sex with Men (MSM) who were enrolled in a sexual risk reduction intervention for meth users. Men who injected meth were significantly more likely to be Caucasian, bisexual, homeless, divorced/separated, with lower educational attainment as compared to non-injectors. Injectors also reported more years of meth use, greater frequency and amount of meth use, more social and health problems, including higher prevalence of STDs and Hepatitis C, and more sexual risk behaviors. In terms of psychosocial factors, injection users of meth scored significantly higher on measures of impulsivity and experiences of rejection, and lower on a measure of emotional support. A multivariate logistic regression revealed that educational attainment and experiences of rejection were the factors that best discriminated between injection and non-injection users of meth. The unique characteristics of injection meth users are discussed in relation to the development of effective HIV prevention programs for the target population.
Adult↗
Psychosocial functioning on the Independent Living Skills Survey in older outpatients with schizophrenia.
Improving real-life community functioning in patients with severe mental illness has been an important recent focus of treatment outcome research. Few studies, however, have examined psychosocial functioning in older psychotic patients. The Independent Living Skills Survey (ILSS) is a measure of the basic functional living skills of individuals with severe and persistent mental illness. The self-report version of the ILSS was administered to 57 middle-aged and older community dwelling outpatients with schizophrenia and 40 age-comparable nonpsychiatric participants. Regardless of whether patients resided in assisted living or independent settings, they showed significantly impaired functioning on a majority of the functional areas assessed by the ILSS. No consistent relationship was found between symptom severity and functioning. With certain modifications, the ILSS appears to be a sensitive indicator of functional impairment in this older sample of community-dwelling outpatients with schizophrenia. Information provided by the instrument might be useful to guide rehabilitation efforts and measure functioning changes in response to treatment in this population.
Activities of Daily Living↗
Effects of depressive symptoms and anxiety on hemostatic responses to acute mental stress and recovery in the elderly.
Depression and anxiety are prospectively associated with cardiac morbidity and mortality. Increased clotting diathesis may mediate this link. We hypothesized that there would be an association between mood and hemostatic changes that occur during and following recovery from acute mental stress. Forty-eight community-dwelling elderly subjects underwent a laboratory speech stressor task. Plasma von Willebrand factor (vWF), thrombin/antithrombin III (TAT) complexes, D-dimer, tissue-type plasminogen activator (t-PA), and type I plasminogen activator inhibitor (PAI-1) were measured at rest, after conclusion of the speech, and 14 min afterwards (recovery). Mood was assessed with the Hamilton Rating Scales for Depression (Ham-D) and Anxiety (Ham-A). Mental stress elicited a hypercoagulable state as evidenced by increases in TAT and D-dimer, and by a decrease in t-PA. Overall, hypercoagulability had increased after recovery. Ham-D scores and Ham-A scores correlated with increases in D-dimer over the testing interval (i.e. area under the curve). Ham-A (but not Ham-D) uniquely explained 8% and 17% of the variance in resting D-dimer and D-dimer area under the curve, respectively. The independent association of anxiety symptoms with resting and stress-induced fibrin formation (D-dimer) may be a mechanism linking mood with cardiovascular disease risk in the elderly.
Acute Disease↗
HIV, psychosis and aging: past, present and future.
OBJECTIVE: To review the clinical features, treatment issues, and research needs surrounding HIV infection in older adults with psychotic disorders and new-onset psychosis in HIV-infected individuals, while focusing on the implications of the highly active antiretroviral therapy (HAART) era and the use of atypical antipsychotic agents. DESIGN: We searched the Medline/HealthStar database for articles that had examined new-onset psychosis in HIV disease and existing HIV infection in adults with psychotic disorders. RESULTS: Individuals with psychotic disorders have an elevated risk of HIV infection. The risk factors for, prognosis for, and treatment of HIV disease may all be affected by older age. New-onset psychosis in HIV-infected individuals presents with a range of clinical features and is likely to remain a problem encountered in the near future, despite the treatment advances associated with HAART. Antipsychotic agents are the treatment of choice for psychosis in HIV-infected individuals. Research has demonstrated the sensitivity of HIV-infected individuals to the extrapyramidal side-effects of conventional antipsychotic agents, adverse effects that are reduced with the use of atypical antipsychotic agents. CONCLUSION: HIV, psychosis, and aging represent a trio with important clinical implications. HIV-infected older adults, a growing portion of the HIV population, face challenges in terms of concomitant illness, treatment sensitivity, and the potential for increased morbidity and premature mortality. Atypical antipsychotic agents in low doses represent an advance over conventional antipsychotic agents, although they do have their own side-effects.
Acquired Immunodeficiency Syndrome↗
Determinants of condom use stage of change among heterosexually-identified methamphetamine users.
There is a paucity of research on the association between methamphetamine use (meth) and sexual risk behavior among heterosexual meth users. This study used a multiple theories approach to identify factors associated with stage of change for condom use in a sample of 181 HIV-negative, heterosexually identified meth users. Background characteristics, drug use variables, and theoretical mechanism of change variables were examined in relation to Prochaska's contemplative and preparation stages of change. Sexual risk behavior was highest among those in the contemplation stage of change. When compared with those in the preparation stage of change, contemplators were more likely to be never married, more likely to have an STD, consumed larger amounts of meth and other illicit drugs, had lower scores on self-efficacy and outcome expectancies for condom use and negotiation of safer sex practices, and had less positive social norms in relation to AIDS preventive behaviors. A multivariate logistic regression revealed that the preparation stage of change was associated with increased self-efficacy for condom use, stronger social norms regarding condom use, and reduced occurrence of sexually transmitted diseases. The findings are discussed in relation to the development of sexual risk reduction interventions for heterosexual meth users.
Adult↗
The context of sexual risk behavior among heterosexual methamphetamine users.
Relatively little is known about the relationship between methamphetamine (meth) use and sexual risk behavior among heterosexual adults. This descriptive study explores the context of sexual risk behavior among HIV-negative, heterosexual meth-using men and women. Drug use history, motivations for meth use, relationship types, and the social-sexual context of meth use were examined as factors that relate to sexual risk behavior and meth use. The majority of participants were white males with an average age of 38.6 years. Primary motivations for current meth use were to get high, to get more energy, and to party. Participants used meth an average of 14 days per month and consumed an average of 7.9 g during this period. The average number of unprotected vaginal, anal, and oral sex acts over a 2-month period were 21.5, 6.3, and 41.7, respectively. Participants reported an average of 9.4 sex partners over 2 months. The findings are discussed in relation to HIV prevention messages and the development of sexual risk reduction interventions for HIV-negative, heterosexual meth users.
Adult↗
A qualitative exploration of female sex work in Tijuana, Mexico.
Previous research has documented high rates of STDs and increased risk of HIV infection among female sex workers (FSWs) in Mexico; however, little is known about the sexual risk behaviors of this population. The purpose of this study was to explore work history, context of sex work, sexual risk practices, client characteristics, attitudes toward condoms, and potential barriers to condom use in a sample of FSWs in Tijuana, Mexico. Analysis of qualitative data from 25 FSWs revealed that most women entered the sex trade at a young age ( M = 23 years), primarily as a result of financial need. Forty percent were single mothers supporting children. Women worked an average of 6-7 days per week; work shifts ranged from 4 to 13 hr per day. Clients were both Mexican and foreign (mostly American and Asian), and ranged in age from 18 to 80 years. Positive aspects of the job included flexible work hours and good income. Negative aspects of sex work included risks associated with physical assault, diseases, and unwanted pregnancies. Most clients did not want to use a condom and many offered additional money for unprotected sex. FSWs did not like to use condoms because they were perceived as uncomfortable. Most FSWs did not negotiate the use of condoms, had a low knowledge regarding the proper use of condoms, and were reticent to report their own unsafe sex practices. These results suggest the need to develop culturally appropriate safer sex interventions for FSWs in Mexican border cities.
Adult↗
Assessing disability in older patients with schizophrenia: results from the WHODAS-II.
The World Health Organization has recently published an instrument to evaluate disability, entitled the World Health Organization Disability Assessment Schedule-Second Version (WHODAS-II). We sought to evaluate its reliability and validity in older patients with schizophrenia. We studied 54 outpatients with schizophrenia and 22 normal comparison subjects. Besides WHODAS-II, we used standardized rating scales to assess positive and negative symptoms, depressive symptoms, cognitive functioning, everyday functioning, and quality of well-being. There was high internal consistency in WHODAS-II item scores and significant test-retest reliability. Patients reported greater disability than normal comparison subjects. Among the patients, disability scores were significantly associated with severity of depressive symptoms and quality of well-being, but not with cognitive performance and everyday functioning. The findings offer strong evidence for reliability and some evidence for validity of the WHODAS-II in older patients with schizophrenia.
Activities of Daily Living↗
Female methamphetamine users: social characteristics and sexual risk behavior.
The primary objective of this research was to expand our knowledge regarding the personal and social characteristics of female methamphetamine (meth) users, their motivations for using meth, patterns of meth use, medical and social problems associated with meth use, and the relationship between meth use and sexual risk behaviors. The sample consisted of 98 HIV-negative, heterosexually-identified, meth-using females residing in San Diego, California. Female meth users were characterized by personal and social disadvantage, high rates of psychiatric symptomatology, and high levels of sexual risk behavior, including multiple partners, risky partner types (e.g., anonymous sex partners), and high rates of unprotected vaginal and oral sex. Meth use was also associated with the subjective positive experience of sex. These finding suggest that behavioral interventions should be tailored to the social characteristics of female meth users, and program content should reflect the intertwining of women's sexual experience and meth use.
Adult↗
Cognitive predictors of medication adherence among middle-aged and older outpatients with schizophrenia.
OBJECTIVE: Medication nonadherence presents a considerable problem in patients with schizophrenia. There are limited and conflicting data on the association of cognitive impairment with antipsychotic nonadherence. In this study, we evaluated the correlation of patients' scores on Mattis' Dementia Rating Scale (DRS; total and subscale scores) with scores on the Medication Management Ability Assessment (MMAA), a performance-based measure of medication management. METHODS: Participants included 110 outpatients with schizophrenia or schizoaffective disorder. Each was evaluated using the MMAA role-play tasks and the DRS. Patients also completed the Drug Attitude Inventory (DAI), and the PANSS (Positive And Negative Syndrome Scale). RESULTS: Age, DAI score, and DRS scores were all correlated with MMAA performance. In a stepwise regression analysis, only DRS scores were predictive of MMAA performance. Among the DRS subscales, conceptualization and memory were the best statistical predictors of MMAA performance. CONCLUSION: Cognitive functions, especially conceptualization and memory, were the strongest patient-related predictors of his or her ability to manage medications, over and above the effects of age, gender, education level, symptom severity, and attitudes toward medications. These results suggest a need for intervention studies focused on improving, or at least compensating for, specific cognitive deficits such as those in memory and conceptualization among patients with schizophrenia in order to improve their ability to manage medications.
Affect↗
Emotional expressiveness, hostility and blood pressure in a longitudinal cohort of Alzheimer caregivers.
OBJECTIVE: To assess the interactive effect of chronic stress and emotional expressiveness (EE) on blood pressure (BP) in older adults. METHOD: Among spousal caregivers (n=111) of Alzheimer's disease (AD) patients, BP was assessed at home by a visiting nurse every 6 months for 7 years. Caregiving demands, EE, social desirability and hostility were also assessed. RESULTS: State hostility was more prevalent among newer caregivers and those encountering more dementia problem behaviors and ADL limitations but unrelated to BP or BP change (P>.05). In a cross-sectional analysis, higher diastolic BP was associated with more spousal problem behaviors and being less emotionally expressive (P<.05). Longitudinal (growth curve analysis) increases in diastolic BP were predicted by providing more spousal ADL assistance (P<.05) but not by EE. CONCLUSION: Both caregiving stress and low EE may contribute independently to hypertension risk in the elderly.
Activities of Daily Living↗
Sexual risk reduction among HIV-positive drug-using men who have sex with men.
According to the US Centers for Disease Control, the majority of new HIV infections are the direct result of unprotected sexual relations between serodiscordant individuals. Thus, the development of behavioral interventions to increase the safer sex practices of HIV-positive individuals has the potential to reduce the number of new infections. Currently, less than 1% of the total US population is infected with HIV. Targeting behavioral interventions to this smaller group of HIV-positive individuals has the potential for making cost-effective reductions in the number of new infections. Despite reports that some HIV-positive individuals continue to engage in high-risk behaviors, interventions designed to prevent secondary transmission of HIV are rare. In this era of highly active antiretroviral therapy (HAART), interventions for HIV-positive individuals are more critical than ever to address the unique challenges and issues they face regarding disclosure and partner notification, use of HAART and sexual risk behavior, and HIV-related stigma. Although a growing number of reports document the efficacy of sexual risk reduction interventions for HIV-positive individuals, to date none of these studies have focused on drug-using populations. This article focuses on sexual risk reduction interventions for HIV-positive men who have sex with men (MSM), the largest group of HIV-positive individuals in the United States. It reviews factors associated with high-risk behaviors and discusses some findings from research with HIV-positive methamphetamine users, including (1) data from a small qualitative study and its implications for the development of new interventions, and (2) baseline data from an ongoing large-scale study of the efficacy of a theory-based sexual risk reduction intervention for HIV-positive methamphetamine-using MSM. The article concludes with a discussion of future research issues, including, for example: Can sexual risks be reduced in the context of active drug use? Are different patterns of drug use, or specific drugs, associated with increased risk behavior? How do gender, race, and culture relate to the efficacy of specific interventions?
Amphetamine-Related Disorders↗
Effects of alcoholism and gender on brain metabolism.
OBJECTIVE: Proton magnetic resonance spectroscopy was used to evaluate gender influences on alcohol-associated changes in brain metabolism. METHOD: Concentrations of N-acetylaspartate, choline-containing compounds, myo-inositol, and creatine plus phosphocreatine in frontal lobe gray matter and white matter were estimated in eight women and 17 men who were recently detoxified from long-term alcoholism. Twelve women and 13 men with no history of alcoholism were used as a comparison group. RESULTS: In male and female alcoholics, frontal lobe white matter concentrations of N-acetylaspartate were significantly lower (-8.8%) than those seen in nonalcoholic comparison subjects. In the frontal lobe gray matter region, a significant alcoholism status-by-gender interaction and follow-up analyses revealed that female alcoholics had significantly lower N-acetylaspartate concentrations (-10.73%) relative to female comparison subjects, while male alcoholics and male comparison subjects had similar levels of this metabolite (<1% difference). CONCLUSIONS: Lower concentrations of white matter N-acetylaspartate, which may indicate neuronal loss or dysfunction, is equally severe in men and women with comparable alcohol abuse histories. However, female alcoholics exhibited significantly less N-acetylaspartate in frontal gray matter relative to female nonalcoholic comparison subjects, which could mean that female alcoholics are more susceptible to gray matter injury than their male counterparts. However, this finding could also be explained by higher-than-expected levels of N-acetylaspartate in the healthy female comparison group.
Adult↗
Reducing the sexual risk behaviors of HIV+ individuals: outcome of a randomized controlled trial.
Testing behavioral interventions to increase safer sex practices of HIV+ individuals has the potential to significantly reduce the number of new infections. This study evaluated a behavioral intervention designed to reduce the sexual risk behaviors of HIV+individuals. HIV+individuals (N = 387) who reported engaging in unprotected sex with HIV- or partners of unknown serostatus were randomly assigned to (a) a single counseling session targeting problem areas identified by the participant in 3 possible intervention domains (i.e., condom use, negotiation, disclosure); (b) a single-session comprehensive intervention that covered all 3 intervention domains; (c) the same comprehensive intervention, plus 2 monthly booster sessions; or (d) a 3-session diet and exercise attention-control condition. The median number of unprotected sex acts decreased from 14 at baseline to 6, 6, and 4 at 4-, 8-, and 12-month follow-ups, respectively. A repeated measures analysis of variance revealed a significant decrease in unprotected sex acts across all groups across time. A significant Group x Time interaction revealed that the comprehensive-with-boosters group had the most unprotected sex at 8-month follow-up as compared to the other 3 groups. These findings suggest that a brief intervention can result in large reductions in HIV transmission risks among HIV+individuals, but the relative benefit of one intervention approach over another remains unclear.
Adult↗