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PubMed2004

Cross-generational effects on gender differences in psychoactive drug abuse and dependence.

BACKGROUND: Studies of patients with cocaine and heroin use disorders have shown gender differences in prevalence, course, and outcome. These differences may be decreasing in successive generations. Less is known about gender differences in course and symptomatology for other illicit drug use disorders, especially in community samples. METHOD: Participants (1323 men and 1384 women) who were biological or step-parents of twins and born in the 1940-1960s, from the Minnesota Twin-Family Study (MTFS) were divided into two cohorts based on the median birth year. A structured interview was used to assess DSM-III-R cannabis, amphetamine, cocaine and hallucinogen use disorders. RESULTS: There was a higher prevalence of each of these drug disorders and earlier onset of cannabis and amphetamine use disorders in later-born participants. For most drug use disorder categories, men and women were similar with respect to age of onset and severity of disorder but women had a shorter course of drug use disorders. Women with amphetamine disorders were atypical with respect to having a higher frequency of use but similar number of lifetime uses compared to men, and more emotional effects of amphetamine intoxication than men. In addition, women with amphetamine disorders were more likely to have anorexia nervosa than those without amphetamine disorders. CONCLUSIONS: These results have several implications for prevention, etiology and treatment.

Adult↗
PubMed2006

Expectations and essentials for the community practice of pathology.

In 3 surveys during the past 10 years, community hospital pathologists were asked what they want, need, or look for when employing a pathologist and, more specifically, what skills and knowledge a newly minted pathologist should have to be successful in the community practice of pathology. The most recent survey, done in spring of 2005, cited surgical pathology diagnosis, frozen section diagnosis, gross dissection, cytology, and fine-needle aspiration as essentials in anatomic pathology. For clinical pathology, knowledge of clinical medicine and test strategies that use the laboratory for clinical problem solving was paramount. New expectations in the latest survey were knowledge of molecular pathology and experience in quality assurance procedures. New pathologists generally meet the expectations of the community hospital workplace; however, there were some deficiencies: they were not proficient in gross pathology or autopsy pathology, they were slow, and many lack the clinical knowledge and experience to be effective consultants. The principal attribute that determines success in the practice of pathology, however, is skill in communication and interpersonal relations, and this remains the major deficiency of the fledgling pathologist.

Clinical Competence↗
PubMed2004

Family carers for older relatives: sources of satisfaction and related factors in Finland.

This study focuses on sources of satisfaction among family carers for older relatives and related factors in Finland. It is part of a major international project concerned with the coping of family carers in four countries. The results reported here are based on questionnaire data collected among 290 family carers from three Finnish towns. The questionnaire included the Carer's Assessment of Satisfaction Index (CASI) developed by Nolan and Grant (1992). The data were processed using SPSS statistical software. The results suggest that carers derived most satisfaction from seeing they could help their relative feel more comfortable, making them feel needed and wanted. Among factors relating to interpersonal dynamics, carers felt that this is one way in which they can show their love for the person they cared for. The family carer's as well as the dependent person's gender, the family carer's age, care burden and general life satisfaction were associated with sources of satisfaction. The results are compared with earlier findings on family carers' sources of satisfaction in Sweden and the UK. Implications for policy and practice are considered.

Adaptation, Psychological↗
PubMed2007

Contribution of divergent thinking to community functioning in schizophrenia.

Fluency deficits have been associated with poor community functioning in patients with schizophrenia. In our previous study we demonstrated that the ability to generate higher-quality responses on tasks of divergent thinking as measured by several fluency tests was impaired in patients with schizophrenia. The purpose of the present study was to investigate the contribution of the deficits in divergent thinking to community dysfunction in schizophrenia. Forty Japanese outpatients with schizophrenia and 32 healthy control subjects were recruited for this study and assessed over a broad spectrum of the neurocognitive domain. Their capacity for divergent thinking was assessed by idea, design, and word fluency tests. Community functioning was assessed by using the Global Assessment of Functioning (GAF), the Life Assessment Scale for the Mentally Ill (LASMI), and the Social Functioning Scale (SFS). The results confirmed the qualitative deficits of divergent thinking in schizophrenia. Stepwise multiple regressions using neurocognitive and demographic/clinical variables as predictors revealed that the higher-quality response scores on the tasks of divergent thinking significantly contributed to community functioning. Moreover, the deficit on the verbal task of divergent thinking significantly contributed to impairment in the area of daily living, and the deficit on the nonverbal task of divergent thinking significantly contributed to impairment in the area of interpersonal relations. The results of this study reveal the importance and the possibility of cognitive remediation and cognitive training with strategies that target capacity for divergent thinking to improve community functioning in patients with schizophrenia.

Adult↗
PubMed2006

An adaptation of the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations.

To adapt the Center for Epidemiologic Studies Depression Scale for use in non-psychiatric Spanish populations, a Spanish translation of the scale was interviewer-administered to 554 subjects aged 18-34 years (65.9% women) and the ratings so obtained were compared with the SCID-CV-based diagnoses of expert clinicians. The internal consistency of the scale was satisfactory (Cronbach's alpha=0.89). Four factors identified by exploratory factor analysis (Depressive/Somatic, Positive Affect, Retarded Activity and Interpersonal Relations) accounted for 55.9% of the variance. A score of 26 was identified as a suitable cut-off for screening purposes, affording a sensitivity of 0.906 and a specificity of 0.918.

Adolescent↗
PubMed1999

A systems approach to resolving OR conflict.

Effective communication and courteous interaction with other hospital departments are essential for a smooth-running OR. To function effectively in a perioperative setting, OR personnel need patience, knowledge, and skill in problem-solving techniques. When health care employees are not taught these techniques and protocols are not in place to manage conflict, friction develops and productivity suffers. In this article, conflict situations between two hospital departments and on OR are presented to characterize successful conflict resolution methods using a systems approach. The results include reduction of surgical procedure delays, efficient ordering of supplies, and improved interpersonal relations.

Conflict, Psychological↗
PubMed1983

Coming on board and staying.

The outcome of a successful orientation is expected to be a fully functioning nurse who provides safe and effective care with minimum supervision and support. Deviation from this outcome focuses disappointment on either the nurse (who may be seen as inadequate or slow) or the orienter (who may be seen as not having done a good job of preparing the nurse). The work share the new employee does not carry must be carried by someone else, putting additional stress on a department that is often short-staffed and expecting the new person to lighten the load. The cost of failure is great to both the hospital and the individual. We believe hospitals can build interpersonal relations into their orientation programs. Even if strategies aren't used throughout the hospital, the operating room can implement them. Tne newcomer who feels capable but remains socially excluded is a likely candidate for turnover.

Inservice Training↗
PubMed1983

Measuring patient attitudes in a comprehensive health care setting.

Systematic patient feedback is important for assessing the impact of existing hospital policy on patients and for providing a base for continuing inservice training of personnel. Health professionals need to have knowledge of patient attitudes about quality of care, interpersonal relations, treatment methods, health status and rights, and the health facility process. A unique combination of the Rosenberg-Fishbein, AID, and psychographic models has considerable promise for objective measurement of patient attitudes over a wide range of health care activities. The model is discussed in terms of a recent patient attitude survey conducted at a major consolidated health care agency in an SMSA of the southeast which provides common management policy and consolidated financial services for two separate hospital facilities.

Adult↗
PubMedDate not supplied

Older people's knowledge and practice about lifestyle behaviors that may prevent vascular dementia.

This study examined the relationship between knowledge and practice of healthy lifestyle behaviors in the prevention of vascular dementia. Data presented here are derived from a convenience sample of 296 participants recruited through senior citizen agencies in Australia. Lifestyle was measured using the Health-promoting Lifestyle Profile (HPLP). Seven knowledge subscales were developed, consistent with the HPLP. Data were analyzed using multiple regression analysis. Correlations among the lifestyle and knowledge indicated statistically significant results. However, the strength of these associations was generally weak. Multivariate analysis found that six variables explained 20% of the variance in the lifestyle score. These included: knowledge of interpersonal relations, knowledge of physical activity, medical knowledge, medical history, self-assessment of general health, and use of alcohol. The results indicate that knowledge, by itself, does not necessarily ensure that people engage in self-practising healthy lifestyle behaviors, and those who experience illness and, perhaps exposure to risk factors, had higher HPLP scores. Recommendations for how older people can be supported to reduce some of the attitudinal barriers that reduce healthy lifestyle behaviors are discussed.

Journal Article↗
PubMed2001

"No strength": sex and old age in a rural town in Ghana.

This article is part of a larger project on social and cultural meanings of growing old in a rural community of Ghana, the fieldwork for which was carried out between 1994 and 2000. It deals with ideas and practices concerning sex among the elderly. Informal conversations were held with individual elders and with groups of people that were, middle-aged and young. Sex was generally regarded as a matter of "strength", which was diminishing at old age. For men the concept of strength specifically referred to sexual potency, whereas for women "strength" was part of a more general feeling of physical power and the ability to perform the many activities expected from being a man's sexual partner. Sex at old age is looked at with a considerable amount of ambivalence. On the one hand, it is something that the elderly should have left behind them. On the other hand, sex confirms the vitality and status of the elder. If sex is practised at old age, it should be orderly and restrained, "respectful".

Aged↗
PubMed2005

[Frequency of psychotic-like symptoms among adults consulting general practitioners].

OBJECTIVES: To assess the frequency of the most frequently observed psychotic-like symptoms in adults consulting general practitioners and to describe their principal characteristics and management. METHODS: Observational epidemiologic survey of 1200 randomly selected general practitioners, distributed throughout France. The symptoms considered were those modified from the BPRS (Brief Psychiatric Rating Scale). During the two-week survey, practitioners recorded the total number of children and adults consulting them and the number with psychotic-like symptoms. They described the characteristics and management of the first three adults with these symptoms (chronological selection). RESULTS: The mean rate of adults with psychotic-like symptoms was 4.9 +/- 8.1% (95% confidence interval: 4.4, 5.4%) during the 12 618 consultation days assessed. The mean age of these patients was 52 years, with equal numbers of men and women. At the consultation, 18.6% were disabled or on short-term sick-leave from work because of the psychiatric disorder; 35.3% of the patients had no known history of psychiatric disorders. Nearly all these patients (95.2%) had more than one psychotic-like symptom. The principal such symptoms were: "changes in behavior, presentation, or interpersonal relations" (62.0%), "bizarre behavior" (48.2%), "depression" and "anxiety" (49.7 and 42.2%), "unusual thought content" or "conceptual disorganization" (29.3 and 26.9%). Most patients received outpatient pharmaceutical management. CONCLUSION: We observed a greater frequency of psychotic-like symptoms in adults consulting general practitioners than expected.

Adult↗
PubMed1998

Depressive symptom reversal for women in a primary care setting: a pilot study.

Cognizant that only 20% of depressed individuals seek treatment, Healthy People 2000 has recommended a goal of increasing this figure to 45%. This flows from a recognition of depression as a serious and costly problem, with women carrying twice the risk of men. Primary care settings are the first contact a depressed woman may make with the health care system. This study piloted a collaborative model in which a Psychiatric Mental Health Advanced Practice Nurse (PMH-APN) was available on site to assist providers to recognize women with depressive symptoms and to provide intervention. Thirty three women were identified by primary care providers and referred for screening to the PMH-APN. Assessment and intervention based on the interpersonal theory of Peplau were accomplished in an average of eight sessions with the PMH-APN. Pre and postintervention descriptive data on the primary outcome (depressive symptoms) and three theoretically congruent mediating variables (performance and social self-esteem and satisfaction with interpersonal relations) were consistent with the expected outcomes of the intervention.

Adolescent↗
PubMed1997

Recovering from alcoholism in communal-living settings: exploring the characteristics of African American men and women.

African American men (n = 33) and women (n = 32) residing in a self-governed, communal-living aftercare program known as Oxford House were surveyed on socio-demographic, personality, recovery, and setting attribute variables. Women, compared to men, were more likely to report sexual abuse as an adult, be diagnosed with an eating disorder, engage in writing bad checks prior to recovery, and claim a stronger perception that Oxford House provided a structured and safe setting. Men, in contrast to women, were more likely to have engaged in drug sales and residential theft prior to recovery, claim less self-doubt about controlling their future life, and report greater attempts at rebuilding interpersonal relations and working 12-step programs. Men and women did not differ significantly in self-reports of co-dependency. Results indicate that gender specific and culturally sensitive characteristics upon both entry and in the course of recovery should be considered in communal facilities such as Oxford House.

Adult↗
PubMed1999

The impact of dementia on the detection of depression in elderly subjects from the general population.

BACKGROUND: The performance of the CES-D in a sample of elderly community residents was assessed. The influence of dementia on test performance and the necessity for the use of four factor scores instead of a single summary score of the CES-D were studied. METHOD: Two hundred and eighty-seven subjects out of the general population aged 60-99 years were personally interviewed with standardized diagnostic tools and completed the CES-D. Best-estimate diagnoses served as 'gold standards' for receiver operating characteristics (ROC) analysis. RESULTS: The CES-D discriminated well between depressive and non-depressive subjects. Exclusion of demented subjects from the sample did not markedly increase test performance. Current depressive illness and dementia led to high scores on the CES-D. Unlike the factors 'depressive affect', 'somatic/vegetative complaints', and 'interpersonal relations', the factor' positive affect' of the CES-D discriminated well between demented and non-demented participants. CONCLUSIONS: The CES-D is a valid instrument for screening for depression in a community sample of elderly subjects. Its use can be recommended even if the presence of dementia is likely. The use of factor scores of the CES-D does not substantially contribute to an improvement of overall test performance, but, nevertheless, allows a more detailed insight and better interpretation of test results.

Aged↗
PubMedDate not supplied

Progress in the psychotherapy of mood disorders: studies from the Western Psychiatric Institute and Clinic.

UNLABELLED: During the last three decades, we have witnessed dramatic improvements in both the psychosocial and pharmacological treatments of affective disorders. Administered in concert with the new medications advances in pharmacology have produced, disorder-specific psychosocial treatments have further improved the prognosis and course of bipolar and unipolar disorder. METHODS: We review our research on unipolar and bipolar disorder and their treatment, in particular interpersonal psychotherapy (IPT) and modifications thereof. RESULTS: We provide empirical evidence that IPT is an efficacious acute and maintenance treatment for affective disorders. Our cumulative research and clinical experience suggest that interpersonal relations and circadian and social rhythms influence affective illnesses and that psychotherapy may aid in normalizing problems in these areas for patients with affective illnesses. CONCLUSIONS: Despite the excitement generated by the recent progress in research on mental disorders and their treatment, we are yet to fulfill the promise that the explosion of knowledge about targeted pharmacotherapies or psychotherapies would seem to offer. To move our field forward, we must continue to apply scientific rigor and thought to understanding the suitability of current nomenclatures, the impact of comorbid psychiatric and medical illnesses and symptoms on the manifestation and treatment of affective disorders, and the practicality of widespread utilization of new treatments.

Aged↗
PubMed1999

Olanzapine versus haloperidol in the treatment of schizophrenia and other psychotic disorders: quality of life and clinical outcomes of a randomized clinical trial.

BACKGROUND: Little information is available on the impact of the atypical antipsychotic olanzapine on quality of life (QOL). A 6-week, double-blind randomized multicenter trial, with a long-term extension, was conducted to evaluate the clinical efficacy and QOL of olanzapine and haloperidol in treating schizophrenia and other psychotic disorders. METHODS: A total of 828 outpatients provided QOL data. Study patients were aged greater than 18 years with a DSM-III-R diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder and baseline BPRS (items scored on 0-6 scale) total scores, > or = 18 were randomized to 6 weeks of treatment with olanzapine 5 to 20 mg/day or haloperidol 5 to 20 mg/day. Patients entered a 46-week double-blind extension if they demonstrated minimal clinical response and were tolerant to study medication. The Quality of Life Scale (QLS) and SF-36 Health Survey were used to evaluate QOL. RESULTS: During the 6-week acute phase, olanzapine treatment significantly improved BPRS total (p = 0.004), PANSS total scores (p = 0.043), QLS total (p = 0.005), intrapsychic foundations (p < 0.001) and interpersonal relations scores (p = 0.036), and SF-36 mental component summary scores (p < 0.001) compared with haloperidol. During the extension phase, olanzapine treatment significantly improved PANSS negative scores (p = 0.035) and improved QLS total (p = 0.001), intrapsychic foundations (p < 0.001), and instrumental role category scores (p = 0.015) versus haloperidol treatment. Significantly more haloperidol patients discontinued treatment due to adverse events during the acute and extension phases (p = 0.041 and p = 0.014, respectively). Changes in QLS total and MCS scores were associated with changes in clinical symptoms, depression scores and extrapyramidal symptoms. CONCLUSIONS: Olanzapine was more effective than haloperidol in reducing severity of psychopathology and in improving QOL in patients with schizophrenia and other psychotic disorders. The QOL benefits of olanzapine, although modest, may be important for long-term treatment.

Adult↗
PubMed2001

Genetics and culture: the geneticization thesis.

The concept of 'geneticization' has been introduced in the scholarly literature to describe the various interlocking and imperceptible mechanisms of interaction between medicine, genetics, society and culture. It is argued that Western culture currently is deeply involved in a process of geneticization. This process implies a redefinition of individuals in terms of DNA codes, a new language to describe and interpret human life and behavior in a genomic vocabulary of codes, blueprints, traits, dispositions, genetic mapping, and a gentechnological approach to disease, health and the body. This article analyses the thesis of 'geneticization'. Explaining the implications of the thesis, and discussing the critical refutations, it is argued that 'geneticization' primarily is a heuristic tool that can help to re-focus the moral debate on the implications of new genetic knowledge towards interpersonal relations, the power of medicine, the cultural context and social constraints, rather than emphasizing issues as personal autonomy and individual rights.

Bioethics↗