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PubMed1983

Is there a characteristic pattern to the treatment history of clinic outpatients with borderline personality?

The prior psychiatric histories, dispositions, and treatment plans for a group of patients with borderline personality, evaluated in an outpatient clinic, were compared to those of evaluated patients diagnosed as having neurotic and/or other personality disorders or schizophrenia. Variables that were found to discriminate patients diagnosed as borderline from the other two groups included a history of past hospitalizations and their duration, frequency of prior outpatient treatment, previous use of psychotropic medications, rates of dropout and referral-out of the clinic, and number of treatment sessions received during a 2-year follow-up period. Patients with borderline personality who had the most previous treatment and the most severe symptoms received the least treatment. The histories of extensive previous treatment are consistent with the frequently brief and unsatisfactory nature of the index clinic contacts.

Adult↗
PubMed1992

Day hospital therapeutic community treatment for patients with personality disorders. An empirical evaluation of the containment function.

Does a day hospital format represent an adequate level of treatment for decompensated patients with personality disorders? The study concerns 97 consecutive patients, 50 of whom belonged to cluster A and B personality disorders. The patients were referred partly from an acute admission ward and partly from outpatient departments. The mean treatment time was approximately 6 months. The dropout rate for schizotypal and borderline patients was 38%. No patient committed suicide. Two patients made suicidal attempts during treatment. The level of medication was moderate, and 58% of the patients were drug-free at discharge. Treatment results at discharge, measured by SCL-90 and Health Sickness Rating Scale, were very good for patients with axis I disorders only, good for cluster C personality disorders, modest for borderline patients, and very modest for schizotypal patients. In general, the results indicate that the containing capacity of a day hospital therapeutic community is substantial and that it may reduce the need for long-term inpatient treatment.

Adult↗
PubMed1992

The outpatient treatment of depression. Implications of outcome research for clinical practice.

Multiple studies have demonstrated that individual psychotherapy, pharmacotherapy, and the two in combination are all effective treatments for depressed outpatients. However, the implications of these data for clinical practice have been incompletely considered, and the often drawn mistaken conclusion is that they support routine treatment with psychotherapy and pharmacotherapy together. Analyses of treatment success rates, treatment failure rates, and treatment dropout rates indicate that combined treatment offers no advantage over treatment with psychotherapy alone and only modest advantage over treatment with pharmacotherapy alone. Routine use of combined treatment, therefore, exposes patients to unnecessary costs and side effects. The data suggest that psychotherapy alone should usually be the initial treatment.

Ambulatory Care↗
PubMed1994

Pretreatment variables that predict completion of an adolescent substance abuse treatment program.

The present study was designed to determine the utility of pretreatment data in predicting completion and dropout from adolescent substance abuse treatment. One hundred thirty-two consecutively admitted adolescents (mean age = 16.4 years; 93 male subjects, 39 female subjects) with significant substance abuse were administered a battery of standardized substance abuse, psychopathology, and social questionnaires immediately after admission to an intensive, set-length substance abuse treatment program. Seventy-four adolescents completed the program. Using discriminant function analyses, five pretreatment measures were found to predict treatment completion in male subjects, including: greater severity of problems with alcohol; greater use of drugs other than alcohol, cannabis, and tobacco; higher degree of internalizing problems; and lower self-esteem. Significant predictors for completion by female subjects were not found. The role of treatment readiness and motivation for male subjects is examined, and the lack of significant findings for female subjects is discussed.

Adolescent↗
PubMed1997

Underreporting of cocaine use at posttreatment follow-up and the measurement of treatment effectiveness.

Substance abusers, especially cocaine abusers, may underreport their substance use in outcome interviews. Follow-up interviews were conducted and urine specimens were obtained on 633 persons 9 months after admission to a 3-month cocaine treatment program. Although 422 (67%) reported no use of cocaine in the past 30 days, 134 of these (32%) had cocaine-positive urines. This group did not differ on most characteristics at intake or follow-up from the 288 with cocaine-negative urines. The amount of treatment received did affect willingness to admit drug use. Of 132 treatment completers who reported no cocaine use at follow-up, 21 (16%) had positive urines. Of 91 early dropouts who also reported no cocaine use, 36 (40%) had positive urines. This differential rate of underreporting had the effect of seriously underrepresenting the effectiveness of treatment completion as compared with little or no treatment.

Adult↗
PubMed2000

Self-injurious behavior in anorexia nervosa.

Recent reports have postulated the existence of two different types of self-injurious behavior: impulsive and compulsive. The aim of the present study is to analyze the dimensionality of self-injurious behavior and to study the link between self-injurious behavior and clinical features in anorexia nervosa. The study involved 236 consecutive patients with anorexia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-reported questionnaires, such as the Eating Disorders Inventory and Hopkins Symptom Checklist. A principal component analysis was used to study the dimensionality of different types of self-injurious behavior, including purging. Our findings confirm the distinction between impulsive and compulsive self-injurious behavior. The dimensions appear to be represented as a continuum in both the anorexia nervosa diagnostic subgroups. A third distinct dimension emerged that included self-induced vomiting and laxative/diuretics abuse. Childhood sexual abuse and anxiety significantly predict the presence of impulsive self-injury, whereas obsessionality and age predict compulsive self-injury. The coexistence of a positive score on both dimensions of self-injurious behavior was the strongest predictor of treatment dropout. The present study highlights the importance of self-injurious behavior; it should be given due consideration in future outcome studies on anorexia nervosa

Adolescent↗
PubMed1977

A population-based assessment of the continuity of ambulatory care.

A strategy is described in which explicit patient care criteria are used to measure the continuity of the health problem solving process. Prevalent diseases are selected to represent the work load of the health system. Continuity is defined in terms of rates of transition between the major clinical elements: screening, the definitive diagnostic evaluation, treatment, and follow-up evaluation. Results define critical dropout patterns and promote constructive assessment of the health care system. Sample data from the Indian Health Service are presented and discussed.

Ambulatory Care↗
PubMed1983

The determinants of dropping out of care among hypertensive patients receiving a behavioral intervention.

Predictors of dropping out of care were examined for 171 treated hypertensive patients enrolled in a randomized trial of social support strategies designed to improve compliance and blood pressure control. Control patients who continued to receive routine care were more than twice as likely to drop out as patients who received routine care and periodic home visits by nurses or pharmacists (odds ratio [OR] = 2.7). The combination of home visits and a second intervention, having family members monitor patients' blood pressure and compliance behavior, was no more effective than home visits alone (OR = 1.1). The home visits intervention was one of six variables identified by a stepwise regression as significant predictors of dropping out. Patients with four or more high-risk characteristics constituted 15% of the sample but contributed almost half (46%) of the dropouts. Targeting support strategies at high-risk patients may be a cost-effective means of reducing uncontrolled hypertension.

Adult↗
PubMedDate not supplied

Midlife women's adherence to home-based walking during maintenance.

BACKGROUND: Despite the many known benefits of physical activity, some women (27%) report no leisure-time physical activity in the prior month. Of those women who began an exercise program, the dropout rate was as high as 50% in the first 3-6 months. The challenge for researchers and clinicians is to identify those factors that influence not only adoption, but also maintenance, of physical activity. OBJECTIVE: The purpose of this study was (a) to describe midlife women's maintenance of walking following the intervention phase of a 24-week, home-based walking program, and (b) to identify the effects of background characteristics, self-efficacy for overcoming barriers to exercise, and adherence to walking during the intervention phase on retention and adherence to walking. METHODS: There were Black and White women participants (N = 90) aged 40-65 years who completed a 24-week, home-based walking program. Self-efficacy for overcoming barriers to exercise, maximal aerobic fitness, and percentage of body fat were measured at baseline, 24 weeks, and 48 weeks. Adherence was measured with heart-rate monitors and an exercise log. RESULTS: Retention was 80% during maintenance. On average, the women who reported walking during maintenance adhered to 64% of the expected walks during that phase. Examination of the total number of walks and the number and sequence of weeks without a walk revealed dynamic patterns. The multiple regression model explained 40% of the variance in adherence during the maintenance phase. DISCUSSION: These results suggest that both self-efficacy for overcoming barriers and adherence during the intervention phase play a role in women's walking adherence. The findings reflect dynamic patterns of adopting and maintaining new behavior.

Adult↗
PubMed1989

Psychosocioeconomic predictors of treatment success/failure in chronic low-back pain patients.

The present study evaluated various psychosocioeconomic variables in chronic low-back pain (CLBP) patients being treated in a functional restoration rehabilitation program. The purpose of the study was to identify those factors that may have predictive value with respect to treatment outcome. Three groups of patients (Success, Failure, Dropout) were examined based on outcome and follow-up data 1 and 2 years after program completion. Once group assignment was made based on outcome, a variety of psychologic, socioeconomic, and demographic data obtained at the time of program admission was analyzed to determine if there were differences among the groups. Several factors were found to distinguish among the groups, including Minnesota Multiphasic Personality Inventory (MMPI) and Millon Behavioral Health Inventory (MBHI) scale scores, prior surgical history, level of worker compensation, and pain intensity ratings. These results confirm the presence of psychosocioeconomic differences among CLBP patients and suggest the need for continued research in this area to improve treatment efficacy in these patients.

Adult↗
PubMed2000

Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study.

STUDY DESIGN: A cohort of 100 patients with symptomatic lumbar spinal stenosis, characterized in a previous article, were given surgical or conservative treatment and followed for 10 years. OBJECTIVES: To identify the short- and long-term results after surgical and conservative treatment, and to determine whether clinical or radiologic predictors for the treatment result can be defined. SUMMARY OF BACKGROUND DATA: Surgical decompression has been considered the rational treatment. However, clinical experience indicates that many patients do well with conservative treatment. METHODS: In this study, 19 patients with severe symptoms were selected for surgical treatment and 50 patients with moderate symptoms for conservative treatment, whereas 31 patients were randomized between the conservative (n = 18) and surgical (n = 13) treatment groups. Pain was decisive for the choice of treatment group. All patients were observed for 10 years by clinical evaluation and questionnaires. The results, evaluated by patient and physician, were rated as excellent, fair, unchanged, or worse. RESULTS: After a period of 3 months, relief of pain had occurred in most patients. Some had relief earlier, whereas for others it took 1 year. After a period of 4 years, excellent or fair results were found in half of the patients selected for conservative treatment, and in four fifths of the patients selected for surgery. Patients with an unsatisfactory result from conservative treatment were offered delayed surgery after 3 to 27 months (median, 3.5 months). The treatment result of delayed surgery was essentially similar to that of the initial group. The treatment result for the patients randomized for surgical treatment was considerably better than for the patients randomized for conservative treatment. Clinically significant deterioration of symptoms during the final 6 years of the follow-up period was not observed. Patients with multilevel afflictions, surgically treated or not, did not have a poorer outcome than those with single-level afflictions. Clinical or radiologic predictors for the final outcome were not found. There were no dropouts, except for 14 deaths. CONCLUSIONS: The outcome was most favorable for surgical treatment. However, an initial conservative approach seems advisable for many patients because those with an unsatisfactory result can be treated surgically later with a good outcome.

Activities of Daily Living↗
PubMedDate not supplied

Five-year changes in North Carolina outpatient cardiac rehabilitation.

PURPOSE: The purpose of this study was to describe cardiac rehabilitation programming, barriers to participation, and reasons for dropout in North Carolina from a program director's perspective and to compare those results with those of a similar statewide survey conducted 5 years earlier. METHODS: In 1999 and 2004, a survey was mailed to all North Carolina program directors of outpatient cardiac rehabilitation programs. The response rate was 85% (61/72) in 1999 and 79% (61/77) in 2004. RESULTS: More than 85% of North Carolinians older than 40 years lived within a 15-mile buffer of an outpatient cardiac rehabilitation program in 2004. Most programs were staffed with personnel trained in nursing, exercise physiology, and nutrition in 1999 and 2004. Women and African Americans remained disproportionately underrepresented as participants in the program for both years. In 2004, approximately one third of cardiac rehabilitation programs reported having a referral to rehabilitation on the hospital discharge plan for myocardial infarction and coronary artery bypass surgery. In 1999 and 2004, the most frequently reported barrier to participation remained financial, followed by lack of interest or motivation and workplace conflicts. Work conflicts, lack of interest, and comorbidities were the most frequently reported reasons for dropping out from cardiac rehabilitation programs in both 1999 and 2004. CONCLUSIONS: Increasing participation in cardiac rehabilitation programs by addressing barriers at multiple levels may facilitate greater patient participation. This statewide survey could be used in other states as a surveillance tool, to track changes in rehabilitation over time from a program director's perspective.

Ambulatory Care Facilities↗
PubMedDate not supplied

Indicators of success in distance education.

Distance education offers many advantages to students, faculty, and educational institutions. Despite these advantages, distance education classes historically have higher dropout rates than do the courses taught in the traditional, face-to-face setting. Current research includes information related to technology, teaching tips, and resources for these extended learning opportunities. However, information related to student success in distance education is limited and success indicators are poorly defined. Current studies on success indicators often lack a defining framework that provides an opportunity for study replication and strengthens the credibility of study findings. An empirical model developed by Powell et al divides potential determinants of success into three categories. This literature review identifies indicators in each category and indicates a need to revise the current framework to include technology as a fourth category. The revised framework should provide a basis for additional research in this rapidly growing area.

Attitude of Health Personnel↗
PubMedDate not supplied

What do patients expect from their first visit to a pain clinic?

OBJECTIVE: To examine patients' expectations of their first outpatient visit to a pain clinic. We asked patients what would be the most satisfying and the most disappointing outcomes of their visit and whether they expected changes in medication and further investigations to result from their consultation. DESIGN: Patients completed questionnaires and a structured interview to assess expectations before their clinic appointment. METHODS: Seventy-seven patients with chronic pain who were first time referrals to a regional pain clinic participated in the study. Patient expectations and questionnaires measuring depression and pain-related disability were completed prior to the pain clinic appointment. RESULTS: Most patients expected an explanation or an improved understanding of their pain problem. The most common satisfying outcome was relief or control of pain, and the most common disappointing outcome was being told nothing could be done. The majority of patients expected further medical investigations and changes to the prescribed medication. Depression and pain-related disability strongly influenced patient expectations. CONCLUSIONS: For patients attending pain clinics, the explanation of their pain problem is rated as important as the cure or relief of their pain. Improved understanding of patient expectations by pain clinic clinicians may lead to greater patient satisfaction and reduced treatment dropout.

Analgesics↗
PubMed2003

Maternal psychological distress: adult sons' and daughters' mental health and educational attainment.

BACKGROUND: Offspring of depressed women have high rates of depressive symptoms and other psychopathology. The authors examined the relationship of mothers' symptoms of depression and anxiety reported during their offspring's childhood and adolescence on depressive disorder and educational achievement of their adult children. METHOD: The data come from a longitudinal cohort study of first graders from Woodlawn, a neighborhood in Chicago, followed from age 6 to 32 years (N = 879). Adult children's depression and educational attainment are regressed on earlier self-reports of mothers' psychological distress. Using multiple logistic regression, the authors controlled for the relationships of poverty, mothers' education, mobility, family structure, mothers' illness, and children's first grade classroom behavior and psychological symptoms. RESULTS: Daughters of mothers with persistent maternal psychological distress had two and a half times the risk of lifetime depressive disorder, but no increased risk of high school dropout. For sons, mothers' psychological distress was not related to depression but was related to poorer educational attainment. CONCLUSIONS: Mothers' depressed feelings during the childrearing years relate to their children's depression and educational attainment as measured in adulthood. The patterns differ for sons and daughters.

Adolescent↗
PubMed2006

Differential rates of treatment discontinuation in clinical trials as a measure of treatment effectiveness for olanzapine and comparator atypical antipsychotics for schizophrenia.

Antipsychotic treatment discontinuation can be used to measure overall treatment effectiveness. Our goal was to investigate differential treatment discontinuation comparing olanzapine with other atypical antipsychotics. A post hoc pooled analysis of 4 randomized, double-blind, 24- to 28-week schizophrenia clinical trials included 822 olanzapine-treated and 805 risperidone-, quetiapine-, or ziprasidone-treated patients. A checklist was used to record the reason for discontinuation. Treatment differences were assessed between olanzapine and the other 3 antipsychotics combined. Poor response/symptom worsening was the primary reason for discontinuation, regardless of medication. The rate of discontinuation due to poor response/symptom worsening significantly varied by treatment (olanzapine, 14.23%, vs. other atypical antipsychotics, 24.60%; P < 0.0001). The rate of discontinuation due to intolerability of medication did not significantly vary by treatment (olanzapine, 5.60%, vs. other atypical antipsychotics, 7.45%; P = 0.13). Consequent to the differential rates of discontinuation due to poor response/symptom worsening, the olanzapine-treated patients experienced a significantly greater likelihood of overall treatment completion (53.9% vs. 39.3%; P < 0.001) and a significantly longer duration of treatment (19.1 vs. 16.1 weeks; P < 0.0001) than other atypical-treated patients. The predominant reason for the significantly lower discontinuation rate of treatment for patients taking olanzapine compared with that of patients taking other atypical antipsychotics was the significantly higher dropout rates in other atypical antipsychotics because of poor response/symptom worsening.

Adult↗
PubMed2005

The capacity for dynamic process scale (CDPS) and patient engagement in opiate addiction treatment.

This study examined the relationship between continuation in an opiate treatment program and patient characteristics such as affect regulation, insight, and capacity for interpersonal relations. Participants consisted of 63 patients randomly selected from those completing an initial interview at a short-term heroin detoxification program. Patient characteristics were assessed using the Capacity for Dynamic Process Scale (CDPS). Results of this study indicated that the CDPS total score for each patient was related to the subsequent number of treatment sessions attended by that patient and significantly differentiated dropouts from completers. These findings support previous use of the CDPS in psychotherapy research. In addition, this study extends use of the CDPS to research on brief pharmacotherapy treatment of opiate addiction.

Adult↗
PubMed2006

Attrition bias in longitudinal research involving adolescent psychiatric outpatients.

This study investigated whether the degree of difficulty contacting participants at follow-up in a longitudinal study of adolescent psychiatric outpatients is associated with baseline and/or follow-up Axis I and II psychopathology and sociodemographic variables. At baseline, 101 participants 15 to 18 years old were assessed using standardized diagnostic instruments, and 97 were reinterviewed, face-to-face, at 2-year follow-up. A hierarchical tracking strategy and meticulous follow-up contact log were used. More than one quarter of the sample required multiple tracking efforts to be located and interviewed. The presence and number of Axis I and II disorders at 2-year follow-up was significantly associated with follow-up contact difficulty. Baseline psychopathology and sociodemographic variables were not associated with follow-up contact difficulty. The findings indicate that longitudinal studies of adolescent outpatients that compare dropouts with completers utilizing baseline characteristics are likely to underestimate the extent of psychopathology at follow-up.

Adolescent↗