Clinical care of gambling disorders: training, experience, and competence among VHA psychologists.

Problem gambling is a common, highly destructive disorder which is often overlooked by clinicians. Levels of clinical training, clinical experience, and professional competence for providing clinical services for problem gambling were examined in a survey of 181 clinical psychologists working in the Veterans Healthcare Administration (VHA). The results suggest that the majority of clinical psychologists have little or no formal training and little or no past or current clinical experience in the treatment of disordered gambling, nor do they see themselves as competent to evaluate or treat patients with disordered gambling. Most have not referred patients for treatment of problem gambling and do not know of a competent provider to whom they can refer. There is an identifiable subgroup, representing 9% of respondents, who do have more training, provide services, and see themselves as competent to provide care for patients with problem gambling. The amount of formal training is positively correlated with care provided and self-ratings of competence. Despite the lack of training and experience, most respondents expressed interest in receiving additional training. These data suggest that to improve rates of diagnosis and treatment of patients with problem gambling in mental health settings, additional training needs to be made available for mental health providers as a group, with specialized training for clinicians interested in specializing in this area.

Effects of disability compensation on participation in and outcomes of vocational rehabilitation.

OBJECTIVE: The authors sought to determine the relationship between receipt of disability compensation and participants' success in a vocational rehabilitation program. METHODS: Administrative data for 22,515 individuals who participated in the Veterans Health Administration compensated work therapy program between 1993 and 1998 were analyzed. Six dependent variables were compared between participants who were receiving disability compensation and those who were not: duration of participation in compensated work therapy, number of hours worked per week, mean hourly earnings, total income from compensated work therapy, dropout rate, and competitive employment status at discharge. Regression equations were determined for each dependent variable to assess associations with the degree of disability, the amount of disability compensation, and the type of compensation program. RESULTS: Participants who were receiving disability benefits worked fewer hours in compensated work therapy each week, earned less income, had a higher dropout rate, and were less likely to be competitively employed at discharge. The amount of compensation and the type of program were modestly but significantly associated with participation in compensated work therapy and with outcome. CONCLUSIONS: Unintended effects of disability compensation programs discourage full participation in vocational rehabilitation and result in poorer rehabilitation outcomes.

Smoking and mental illness.

Patients with mental illness have a higher incidence of smoking than the general population and are the major consumers of tobacco products. This population includes subjects with schizophrenia, manic depression, depression, posttraumatic stress disorder (PTSD), attention-deficit disorder (ADD), and several other less common diseases. Smoking cessation treatment in this group of patients is difficult, often leading to profound depression. Several recent findings suggest that increased smoking in the mentally ill may have an underlying biological etiology. The mental illness schizophrenia has been most thoroughly studied in this regard. Nicotine administration normalizes several sensory-processing deficits seen in this disease. Animal models of sensory deficits have been used to identify specific nicotinic receptor subunits that are involved in these brain pathways, indicating that the alpha 7 nicotinic receptor subunit may play a role. Genetic linkage in schizophrenic families also supports a role for the alpha 7 subunit with linkage at the alpha 7 locus on chromosome 15. Bipolar disorder has some phenotypes in common with schizophrenia and also exhibits genetic linkage to the alpha 7 locus, suggesting that these two disorders may share a gene defect. The alpha 7 receptor is decreased in expression in schizophrenia. [(3)H]-Nicotine binding studies in postmortem brain indicate that high-affinity nicotinic receptors may also be affected in schizophrenia.

Relationship between climate and psychiatric inpatient length of stay in Veterans Health Administration hospitals.

OBJECTIVE: The study examined whether climate has an impact on inpatient psychiatric length of stay in Veterans Health Administration hospitals (VHA). METHOD: Data from the National Weather Service for eight climate variables for the locations of 134 VHA hospitals nationwide were factor analyzed, resulting in two climate factors representing temperature and precipitation. Factor scores were correlated with psychiatric mean lengths of stay from 1994 to 1998 for 99 VHA hospitals with inpatient psychiatric services and for the 22 VHA regional divisions (Veterans Integrated Service Networks). RESULTS: Climate factors correlated modestly but significantly with length of stay, with correlations ranging from -0. 25 to -0.37 at the hospital level and from -0.38 to -0.45 at the VHA regional level; hospitals in warmer and drier climates had shorter lengths of stay. Medical centers in colder climates had the longest lengths of stay in winter and fall. The significant correlation between climate and length of stay was not affected by recent reductions in length of stay in VHA hospitals. CONCLUSIONS: Higher clinical costs associated with longer lengths of stay in colder climates have implications for budget planning. Climate factors must also be recognized for their potential effect on performance monitoring systems focused on hospital utilization. Researchers must continue to consider broader contextual variables such as climate if they are to fully understand the determinants of health care utilization and psychiatric hospitalization costs.

Trends in the content and methodology of Alzheimer caregiving research.

Research into the experience of caregiving for patients with Alzheimer disease continues to grow steadily both in the number of studies and the scope of investigation. A review of the current trends in the content and methodology of research into caregiving is provided as a guide for new investigators entering this field. Whereas most studies continue to focus on the stress and burden associated with caregiving, increased study into topics such as treatment utilization, clinical decision-making, and caregivers and early detection will continue to broaden and enrich the scope of investigation. Positive trends in research methodology, including improved sampling procedures, more frequent inclusion of control groups, the use of improved measurement techniques, and the use of more sophisticated designs and statistics, will all continue. Despite the many contributions of past research into caregiving, future studies promise to make a critical contribution to a number of fields of study.

Processing and recognition of facial affect in schizophrenia.

A deficit in the recognition of facial affect has been well documented in people with schizophrenia. Our 1995 research with normal subjects showed that hemispheric bias for processing facial affect is related to accuracy of recognition of facial affect. We tested whether this relationship holds in a sample of 25 people with schizophrenia who completed tasks of identification of facial affect and chimeric facial affect. Subjects with a left visual-field bias were significantly more accurate in identifying one facial emotion (sad) than were other subjects. Individual differences in hemispheric advantage for processing affect appears to be an important variable related to functional brain capacity within different populations.

Genomic organization and partial duplication of the human alpha7 neuronal nicotinic acetylcholine receptor gene (CHRNA7).

The human alpha7 neuronal nicotinic acetylcholine receptor gene (HGMW-approved symbol CHRNA7) has been characterized from genomic clones. The gene is similar in structure to the chick alpha7 gene with 10 exons and conserved splice junction positions. The size of the human gene is estimated to be larger than 75 kb. A putative promoter 5' of the translation start in exon 1 has been cloned and sequenced. The promoter region lacks a TATA box and has a high GC content (77%). Consensus Sp1, AP-2, Egr-1, and CREB transcription factor binding sites appear to be conserved between bovine and human genes. The alpha7 nAChR gene was found to be partially duplicated, with both loci mapping to the chromosome 15q13 region. A yeast artificial chromosome contig was constructed over a genetic distance of 5 cM that includes both alpha7 loci and the region between them. Four novel exons are described, located in genomic clones containing the partially duplicated gene. The duplicated sequences, including the novel exons, are expressed in human brain.

The long-term impact of child abuse on religious behavior and spirituality in men.

OBJECTIVE: Two hypotheses were tested: (1) In a sample of adult men, past experience of child abuse (sexual, physical, or emotional) will be related to higher levels of reported alienation from religion and God as shown in lower rates of current religious behavior, higher frequency of spiritual "injury," and lower stability of religious behavior and experiences; (2) More "severe" forms of abuse will be associated with higher indicators of alienation. METHOD: Data were collected from 1,207 male veterans, 527 (43.7%) of whom reported being abused as a child. Each subject completed the Spiritual Issues Assessment, a large survey which includes data about: (1) KASL Religiosity Index; (2) The Spiritual Injury Scale; and (3) Religious items from the Westberg Personal Health Inventory. RESULTS: A history of sexual abuse was related to significantly greater spiritual injury and lower stability of spiritual behaviors and experiences, but not to overall rate of current religious behavior. Surprisingly, abuse was related to increased frequency of prayer and of "spiritual experience." Multivariate analyses indicate that the effect size is relatively small and the type of abuse was less important than the presence of any form of abuse. CONCLUSIONS: The findings suggest that the impact of childhood abuse is more complex than initially hypothesized. While abuse seems to be related to continuing spiritual injury and distress, it is also related to higher levels of some spiritual activities and experiences which are usually associated with positive spirituality.

Personality change in head trauma: a validity study of the Neuropsychology Behavior and Affect Profile.

This study represents the first attempt to cross validate and report on the Neuropsychology Behavior and Affect Profile (NBAP) using closed head injury (CHI) participants. The NBAP is designed to measure emotional functioning before and following a brain event. Two CHI samples, differing primarily by method of ascertainment, were compared to a group of normal controls. Results provided support for concurrent and predictive validity of the NBAP across both CHI samples. Significantly higher levels of postinjury emotional functioning in clinic-referred CHI patients compared to CHI individuals not seeking treatment (strictly research participants) was demonstrated. A surprising finding was that pre-injury emotional levels of clinic-referred subjects were rated as less severe than that of controls. Based on this finding, the possibility of a gradient effect was discussed in which raters appeared to place selectively greater weight on current condition, while simultaneously making premorbid levels less severe than they really were. Results were discussed in the context of study limitations and directions for further research.

Affect identification bias demonstrated with individual chimeric faces.

The current study extends previous findings of a left visual-field bias in chimeric face tasks, by using a new procedure which incorporates chimeric stimuli depicting both positive and negative target affects and requires the identification of affect in individually presented faces. This new procedure is more representative of the types of judgements made in daily social interaction. Results with this new procedure are consistent with previous findings, indicating a significant left visual-field bias for both positive and negative affects in the majority of subjects. Handedness was significantly related to lateralization scores, with dextrals showing greater left visual-field biases than sinistrals. Among sinistrals, a left visual-field bias was noted only for happy chimera.

Comparison of the regional expression of nicotinic acetylcholine receptor alpha7 mRNA and [125I]-alpha-bungarotoxin binding in human postmortem brain.

Neuronal nicotinic acetylcholine receptors are expressed in the human central nervous system. A specific subtype of this receptor family, the alpha7 nicotinic acetylcholine receptor, is thought to be the principal alpha-bungarotoxin (alphaBTX)-binding protein in mammalian brain. Although the expression of this receptor subtype has been characterized in rat, no study has specifically compared the expression of both the alpha7 gene and the localization of BTX binding sites in human brain. Expression of alpha7 mRNA and receptor protein in human postmortem brain tissue was examined by in situ hybridization and [125I]-alpha-bungarotoxin autoradiography, respectively, with particular emphasis on regions associated with sensory processing. Regions with high levels of both alpha7 gene expression and [125I]-alphaBTX binding include the nucleus reticularis of the thalamus, the lateral and medial geniculate bodies, the basilar pontine nucleus, the horizontal limb of the diagonal band of Broca, the nucleus basalis of Meynert, and the inferior olivary nucleus. High-to-moderate levels of alpha7 probe hybridization were also seen in the hippocampus and the cerebral cortex; however, there was a reduced or variable degree of [125I]-alphaBTX binding in these regions compared with the level of probe hybridization. In most brain regions, [125I]-alphaBTX binding was localized to neuronal cell bodies similar in morphology to those that exhibited alpha7 hybridization, suggesting that the high-affinity [125I]-alphaBTX binding sites in the human brain are likely to be principally composed of alpha7 receptor subtypes.

The dream in midlife women: its impact on mental health.

The current study examines the Dream in midlife women and its impact on mental health functioning. Ninety midlife women filled out a questionnaire examining Dream Status, Dream Success, Dream Content, and Dream Support, as well as mental health factors of depression, anxiety, and purpose-in-life. Neither early nor current Dream Status was not found to be significantly related to mental health factors. Partial support was found for the hypothesis that Dream Success is related to mental health factors. Early Dream Content related to career and current Dream Content related to both marriage/intimacy and career are related to positive performance on mental health factors. Dream Support is positively related both to Dream Success and to mental health factors while resistance to the Dream is not. The results are discussed in light of gender differences in the developmental function and impact of the Dream.

WAIS-R intersubtest scatter in patients with dementia of Alzheimer's type.

This study explored the relationship between three indices of intersubtest scatter and level of cognitive deterioration in a sample of 104 patients with dementia of Alzheimer's type, who ranged in age between 52 and 84 years. Scatter was highly related to education and premorbid level of functioning. Advancement of dementia was shown to be associated with decrease in scatter, which suggests caution in interpretation of high magnitude of inter-subtest scatter as an indication of brain dysfunction. Easy-to-calculate range of scatter proved to be adequate measure of scatter. Calculation of more complex indices, such as PVI, provides only minimal incremental gain.

The pattern of deficit in different memory components in normal aging and dementia of Alzheimer's type.

The study explored differential patterns of deficits in different memory components as a function of dementia severity. Three groups of 58 subjects each were used: (1) highly functioning elderly who are free of neurological or psychiatric symptoms; (2) individuals with early signs of memory disturbance, whose MMSE scores were > or = 24; and (3) individuals with MMSE scores below 24, who meet criteria for DAT. Performance on the tests that assess different memory components was compared for the three groups. Results suggest pronounced change in acquisition component of memory at the onset of dementia, whereas retrieval from remote memory discriminates well between the mild and the more advanced phases of the disease. Retrieval from recent memory deteriorates more gradually. Based on these results, efficiency of different memory mechanisms was discussed.

The differential pattern of memory deficit in normal aging and dementias of different etiology.

The study explored encoding, storage, and retrieval components of memory functioning in four groups of subjects: (1) normal elderly; (2) elderly subjects in the early prestages of DAT; (3) elderly subjects with a more advanced DAT; (4) younger subjects in the early prestages of AIDS dementia. Each group consisted of 26 subjects, who were administered the Rey Auditory-Verbal Learning Test. The results suggest impaired encoding and retrieval in the DAT groups. The AIDS group demonstrated deficient storage and retrieval. Their pattern of memory deficits was similar to that seen in normal aging. The results speak in favor of the hypothesis of subcortical nature of neurological changes in normal aging.

Confounding factors in the measurement of depression in HIV.

Our study investigates the nature of elevated depression scores on the MMPI-168 in human-immunodeficiency-virus- (HIV-)infected individuals. Comparison of MMPI scales, factor scores, and individual depression item endorsement rates were made between three groups of homosexual/bisexual men: asymptomatic HIV-1 seropositives (n = 156), symptomatic HIV-1 seropositives (n = 156), and a comparison group of HIV-1 seronegatives (n = 117). Elevated scores were found on the MMPI depression scale for all three groups, with HIV infection and the presence of symptoms being associated with significant elevations in depression. Analyses of these elevated scores through the use of factor scores and individual item analyses strongly suggest that endorsement of items related to physical symptoms and neuropsychological complaints accounted for much of the difference in overall depression scores between samples. Implications are discussed for measurement and diagnosis of depression in HIV populations.

Auditory sensory gating and catecholamine metabolism in schizophrenic and normal subjects.

Diminished neuronal response to repeated sensory input is a sensory-gating phenomenon that has been found to be deficient in schizophrenic patients. For example, schizophrenic patients fail to decrease the amplitude of the P50 wave of the auditory evoked potential to the second of paired click stimuli. In some studies, however, normal subjects have also failed to decrease their P50 responses. The aim of this study was to determine if accommodation to the recording situation over time would affect the gating of the P50 response. The gating of the P50 wave is measured as the ratio of the amplitude of the second response to the amplitude of the first. Three successive auditory evoked potentials were compiled, each from trains of 32 pairs of stimuli. Twelve normal subjects and 12 schizophrenic patients were studied. Unconjugated catecholamine metabolites were measured from venous samples drawn before and after the electrophysiological recording. Between the first and third trials, the normal subjects significantly increased their gating of P50. This increase in gating of P50 was related to decreased levels of the noradrenergic metabolite 3-methoxy-4-hydroxyphenylglycol. No similar phenomenon was observed in the schizophrenic patients, a number of whom had a further decrease in P50 gating over the three trials. Transient failure to observe gating of P50 in normal subjects may be related to increased state-dependent noradrenergic activity, which is known to disrupt sensory gating. This mechanism does not seem to account for the more persistent failure of sensory gating in schizophrenia.

The impact of the dream on mental health functioning in the male midlife transition.

In the area of adult development, Levinson's notion of the personal Dream is important in understanding the male midlife transition. Levinson suggests that during this period in the life cycle the status of the Dream becomes a prominent issue, as men become increasingly aware of the limits of their achievements. Sixty-four midlife men filled out questionnaires examining whether they had a Dream, and whether they experienced or anticipated experiencing success or failure of that Dream. The Beck Depression Inventory, the IPAT Anxiety Scale, and the Purpose-In-Life Test were included to assess the mental health status of the respondents. The results support the conclusion that whether a man has a Dream, and the degree to which he experiences success in achieving it are significantly related to his mental health status (i.e., depression, anxiety, and purpose-in-life) during the midlife transition.

Re-examination of CPM performance and neglect in lateralized brain injury.

The current study examines the effects of lateralized brain injury on Raven's Coloured Progressive Matrices (CPM) performance. Archival data on 106 unilateral brain-damage patients, 59 with right hemisphere damage and 47 with left, was utilized to examine four aspects of differential performance. Right brain-damaged subjects performed significantly lower than left brain-damaged subjects overall on the CPM. They also showed evidence of a higher incidence of and greater severity of hemi-neglect. After partialling out the effects of hemi-neglect, the subject groups were no longer significantly different on overall CPM performance. Evidence supporting the presence of heterogeneous subtests was not found. The results support the emerging pattern in research findings indicating that hemi-neglect plays a central role in differential performance. The CPM appears limited in its application and interpretation for patients with hemi-neglect.