Does joint architecture influence the nature of intra-articular fractures?

INTRODUCTION: The architecture of joints has potentially the greatest influence on the nature of intra-articular fractures. We analysed a large number of intra-articular fractures with two aims: (1) to determine if the pattern of injuries observed supports our conjecture that the local skeletal architecture is an important factor and (2) to investigate whether associated dislocations further affect the fracture pattern. METHODS: A retrospective study of intra-articular fractures over a 3.5-year period; 1003 joints met inclusion criteria and were analysed. Three independent investigators determined if fractures affected the convex dome, the concave socket, or if both joint surfaces were involved. Further review determined if a joint dislocation occurred with the initial injury. Statistical analysis was performed using a one-way frequency table, and the χ(2) test was used to compare the frequencies of concave and convex surface fractures. The odds ratios (ORs) were calculated to establish the association between the frequencies of concave and convex surface fractures, as well as between dislocation and either fracture surface involvement. RESULTS: Of the 1003 fractures analysed, 956 (95.3%) involved only the concavity of the joint; in 21 fractures (2.1%) both joint surfaces were involved; and in 26 fractures (2.6%) only the convexity was involved (χ(2)=1654.9, df=2, p<0.0001). As expected, the concavity was 20.8 times more likely to fail than the convexity (11.2-36.6, 95% CI). However, the risk of fracturing the convex surface was 18.6 times higher (9.8-35.2, 95% CI) in association with a simultaneous joint dislocation, compared to those cases without a joint dislocation. CONCLUSIONS: These results very strongly support the study hypotheses: the skeletal architecture of joints clearly plays a highly significant role in determining the nature of intra-articular fractures. Intra-articular fractures involving the convexity are much more likely to be associated with a concurrent joint dislocation.

Use of the Beck Scale for suicide ideation with psychiatric inpatients diagnosed with schizophrenia, schizoaffective, or bipolar disorders.

To ascertain how useful the Beck Scale for Suicide Ideation (BSI; Beck & Steer, Manual for Beck Scale for Suicide Ideation (1991)) would be for assessing the severity of suicidal ideation in patients who were diagnosed with schizophrenia, schizoaffective, or bipolar disorders, 142 inpatients were asked to complete the BSI. Eight (6%) patients refused, and four patients (3%) were unable to complete the BSI because they were unable to concentrate. Of the 130 patients who completed the BSI, 53 (41%) had schizoaffective, 37 (28%) had paranoid schizophrenia, 30 (23%) had manic bipolar, and 10 (8%) had depressed bipolar disorders. The coefficient alpha for the BSI was .96, and its one-week test-retest reliability for a subsample of 15 inpatients was 0.88, p < 0.001. The BSI total scores were positively correlated with having ever attempted suicide, r = 0.46, p < 0.001. According to the BSI, 36 (28%) patients were classified as current suicide ideators. The results were discussed as supporting the use of the BSI with inpatients who are diagnosed with schizophrenia, schizoaffective, or bipolar disorders.

Mean Beck Depression Inventory-II scores by severity of major depressive episode.

The Beck Depression Inventory-II total scores of 35 (14%) outpatients who were diagnosed with a mild DSM-IV Major Depressive Episode (MDE), 144 (55%) outpatients with a moderate MDE, and 81 (31%) outpatients with a severe MDE were compared. The mean BDI-II total scores were, respectively, 18 (SD = 8, 99% CI 12-23), 27 (SD = 10, 99% CI 24-29), and 34 (SD = 10, 99% CI 30-37) (F2.257 = 33.25, p<.001). The mean BDI-II total score of the outpatients with a severe specifier was significantly higher than the mean BDI-II total score of the outpatients with a moderate specifier which was, in turn, significantly higher than the mean BDI-II total score of the outpatients with a mild specifier.

Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers.

The differential efficacies of supportive and cognitive behavioral group therapy models designed for young children (ages 2 to 8) who have experienced sexual abuse and their nonoffending mothers were compared. Forty-four mothers and their respective children participated in either supportive or cognitive behavioral therapy groups with the group format being randomly determined. Repeated measures MANOVAs indicated that compared to mothers who participated in the support groups, the mothers who participated in cognitive behavioral groups reported greater reductions at posttest in (a) their intrusive thoughts and (b) their negative parental emotional reactions regarding the sexual abuse. The children treated with cognitive behavioral therapy demonstrated greater improvement in their knowledge regarding body safety skills at posttest than did the children who received supportive therapy.

Evaluating geriatric medical outpatients with the Beck Depression Inventory-Fastscreen for medical patients.

To ascertain how effective the seven-item Beck Depression Inventory-FastScreen for medical patients (BDI-FS) was in screening geriatric (> 55 years old) patients for depression, the BDI-FS and the 15-item Geriatric Depression Scale (GDS-S) were administered to 33 (44%) male and 42 (56%) female outpatients who were scheduled for routine office visits by physicians specializing in geriatric medicine. The internal consistency of the BDI-FS was high (coefficient alpha = 0.83), and it was positively correlated with the GDS-S, r = 0.81, p < 0.001. The BDI-FS scores were not related to sex, age, ethnicity, or type of medical diagnosis, but were positively correlated with a diagnosis of depression (r = 0.49, p < 0.001) and being prescribed an antidepressant (r = 0.55, p < 0.001). A BDI-FS cut-off score of four and above had 100% sensitivity and 84% specificity rates, respectively, for identifying patients who were and were not diagnosed with depression.

Hopelessness depression as a distinct dimension of depressive symptoms among clinical and non-clinical samples.

Subtyping depression has been an interest of theorists and clinicians for at least four centuries. In this paper, we examined the validity of the symptom cluster component of the hopelessness theory of depression. We used structural equation modeling analyses on large samples of psychiatric outpatients (N=1604, 844, and 680) and Air Force cadets (N=1404) who completed the items of the Beck Depression Inventory (BDI). Findings were supportive of the hopelessness depression cluster as a distinct depressive syndrome. Implications for the nosology of depression and for depression theory were discussed.

A survey of use of a durable power of attorney to admit geropsychiatric patients.

Medical directors from 198 inpatient psychiatric facilities in 46 states completed a survey on the use of a durable power of attorney for health care to compel admission of unwilling patients with dementia. About half the facilities had a policy allowing use of a power of attorney for this purpose. Thirty-four percent believed that it was optional to use either a durable power of attorney or an involuntary commitment to force admission of demented patients, whereas 47 percent believed that such patients could be admitted against their will only through involuntary commitment.

Evidence for the construct validities of the Beck Youth Inventories with child psychiatric outpatients.

To provide further information about the construct validities of the Beck Youth Inventories of Emotional and Social Impairment, these inventories were administered to 35 female and 65 male outpatients whose ages ranged from 7 to 12 years and who were diagnosed with various psychiatric disorders. The Children's Depression Inventory was also administered, and the children were rated by a parent with the Conners' Parent Rating Scale-Revised: Short Form. The scores on the former inventory were more positively correlated with the scores on the Beck Youth Depression Inventory (r =.81, p<.001) than with scores on the four other Beck Youth Inventories, and those on the Conners Oppositional scale were comparably correlated with the scores on the Beck Youth Disruptive Behavior (r=.49, p<.001) and Anger (r=.41, p<.001) Inventories. These latter correlations were higher than those for scores on the Oppositional scale with the scores on the three other Beck scales.

Screening for major depressive disorders in adolescent psychiatric inpatients with the mood modules from the Primary Care Evaluation of Mental Disorders and the Patient Health Questionnaire.

The mood modules from the Primary Care Evaluation of Mental Disorders (PRIME-MD) and the Patient Health Questionnaire (PHQ) were administered to 17 (52%) female and 16 (48%) male adolescent (13-17 years old) psychiatric inpatients. The internal consistencies of both were good (KR-20 for PRIME-MD=.80, Cronbach coefficient alpha for Patient Health Questionnaire=.85). The correlation between the PRIME-MD and Patient Health Questionnaire total scores was .87 (p<.001), and the point-biserial correlation of both questionnaires' total scores with being diagnosed with a Major Depressive Disorder was .54 (p<.001). Both mood modules appeared to be equally effective in screening for a Major Depressive Disorder.

Psychometric properties of the Beck Self-Esteem Scales.

The psychometric characteristics of the Beck Self-Esteem Scales (BSE) are described for 360 psychiatric outpatients. Patients rated their evaluative beliefs about themselves (Self Scale) and their beliefs about how others evaluate them (Other Scale). Both measures consist of 18 pairs of adjectives, e.g., lovable-unlovable, that are rated using a 10-point scale. The coefficient alphas for the Self Scale (0.94) and the Other Scale (0.95) indicated high internal consistency. Both scales were positively associated with other measures of self-esteem and negatively associated with measures of anxiety and depression. As predicted by the cognitive theory of depression, patients with a principal mood disorder scored significantly lower on the BSE than patients with a principal anxiety disorder. In addition, the mean scores for patients with major depression and dysthymia on the Self Scale were significantly lower than the mean scores for the Other Scale.

Increased prevalence of sensing types in men with cluster headaches.

To ascertain whether the percentage of men who suffer with cluster headaches and are classified as sensing types according to Jung's theory of psychological types was comparable to the percentage (74%) of Sensing types that was found by Gallagher, et al. among women who experience migraine headaches, the Myers-Briggs Type Indicator was administered to 25 male cluster-headache patients. There were 19 (76%) male Sensing types, and this was comparable to the percentage of Sensing types for migrainous women. The results are discussed as supporting previous contentions that Sensing types may be prone to developing psychosomatic symptoms related to stress.

Risk factors for suicide in psychiatric outpatients: a 20-year prospective study.

To determine the risk factors for suicide, 6,891 psychiatric outpatients were evaluated in a prospective study. Subsequent deaths for the sample were identified through the National Death Index. Forty-nine (1%) suicides were determined from death certificates obtained from state vital statistics offices. Specific psychological variables that could be modified by clinical intervention were measured using standardized scales. Univariate survival analyses revealed that the severity of depression, hopelessness, and suicide ideation were significant risk factors for eventual suicide. A multivariate survival analysis indicated that several modifiable variables were significant and unique risk factors for suicide, including suicide ideation, major depressive disorder, bipolar disorder, and unemployment status.

Use of the Beck Depression Inventory-II with depressed geriatric inpatients.

To provide information about the clinical utility of the Beck Depression Inventory-II (BDI-II) [Beck, A.T., Steer, R.A., & Brown, G.K. (1996b). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation] with geriatric inpatients, the BDI-II was administered to 130 psychiatric inpatients who were 55 years old or above and who were diagnosed with principal DSM-IV major depressive disorders (MDD) (N = 85, 65%) or adjustment disorders with depressed mood (N = 45, 35%). The internal consistency of the BDI-II was high (coefficient alpha = 0.90), and its total score was not significantly related to sex, age, or ethnicity. An iterated maximum-likelihood factor analysis found the Cognitive and Noncognitive dimensions which have been reported for the BDI-II by Steer and co-workers (Steer R.A., Ball R., Ranieri W.F., & Beck A.T. (1999). Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients. Journal of Psychopathology and Behavioral Assessment, 55, 117-128) in a younger sample of clinically depressed psychiatric outpatients. The mean BDI-II total score of the 85 geriatric inpatients with MDD was also comparable to that of 42 younger (< or = 54 years old) inpatients with MDD. The results were discussed as supporting the use of the BDI-II with clinically depressed geriatric inpatients.

Screening for major depression disorders in adolescent medical outpatients with the Beck Depression Inventory for Primary Care.

PURPOSE: To ascertain the psychometric characteristics of the Beck Depression Inventory for Primary Care (BDI-PC) among adolescents (12-17 years old) scheduled for health maintenance examinations, and to determine the effectiveness of the BDI-PC in screening the adolescents for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, major depression disorders (MDD). METHODS: The BDI-PC was administered to 50 male and 50 female adolescents who received pediatric health maintenance examinations. The diagnosis of MDD was established with the Mood Module from the Primary Care Evaluation of Mental Disorders. RESULTS: The internal consistency of the BDI-PC was high (Cronbach alpha = .88), and it was not significantly associated with gender, ethnicity, age, or having a medical disorder. A cutoff score of > or = 4 had both 91% sensitivity and specificity rates for identifying adolescents with and without MDD. CONCLUSIONS: The BDI-PC is a useful instrument for screening for clinical depression in adolescents receiving routine medical examinations.

Prevalence of malingering in suicidal psychiatric inpatients: a replication.

The MMPI-2, L, F, and K validity scales were administered to 21 (42%) suicide attempters and 29 (58%) ideators who had been hospitalized as being at risk for committing suicide. These inpatients were also asked to rate anonymously how much they had "exaggerated on purpose or lied about being suicidal to a staff member" during their current hospitalizations. The three MMPI-2 validity scores of the inpatients were not associated with self-reported malingering, and 6 (12%) of the inpatients reported malingering. This rate was comparable to the 10% rate which had previously been found by Rissmiller, et al. in 1998.

Physiological hyperarousal: construct validity of a central aspect of the tripartite model of depression and anxiety.

Physiological hyperarousal (PH) is an understudied component of the tripartite model of depression and anxiety. This study contributes to the literature on PH, the tripartite model, and anxiety and its disorders, using data from psychotherapy outpatients (n = 2,448), air force cadets (n = 1,335), and undergraduates (n = 284). Psychometrics and exploratory and confirmatory factor analyses showed that PH is a reliable, cohesive, discriminable, and valid construct. Compared with subjective anxiety, PH was more associated to panic versus mood disordered status, and to panic versus generalized anxiety disordered status. As hypothesized, an aspect of anxiety sensitivity (i.e., fear of body sensations) was particularly related to subjective anxiety in the presence of PH. Results support the PH construct as replicable, valid, and clinically important and support the utility of the tripartite and related models for understanding the relation of depressive and anxious syndromes.

Suicide ideation at its worst point: a predictor of eventual suicide in psychiatric outpatients.

Scales for measuring current suicide ideation (SSI-C), suicide ideation at its worst point in the patient's life (SSI-W), and hopelessness (BHS) were administered to 3,701 outpatients seeking psychiatric treatment. Thirty patients from this sample eventually committed suicide, within a mean of 4 years from the initial assessment. Based on cut-off scores derived from receiver operating characteristic (ROC) analyses, the SSI-W had an odds ratio of 13.84 for predicting suicide, whereas the SSI-C and the BHS had odds ratios of 5.42 and 6.43, respectively. The assessment of suicide ideation at its worst point identifies a subgroup of patients at relatively high risk for eventual suicide. Robust interventions and periodic monitoring for suicide ideation and hopelessness are recommended to reduce long-term suicide risk.

Use of the Beck Depression Inventory for Primary Care to screen for major depression disorders.

To ascertain how effective the Beck Depression Inventory for Primary Care (BDI-PC) was in screening for DSM-IV major depression disorders (MDD) in outpatients who were scheduled for routine office visits with physicians specializing in internal medicine, the BDI-PC was administered to 60 male and 60 female outpatients. The internal consistency of the BDI-PC was high (alpha 0.85), and the Mood Module from the Primary Care Evaluation of Mental Disorders was used to diagnose MDD. The BDI-PC scores were not significantly correlated with sex, age, ethnicity, or total number of medical diagnoses. A BDI-PC cutoff score of 4 and above yielded 98% maximum clinical efficiency with 97% (95% CI 82%-99%) sensitivity and 99% (95% CI 94%-99%) specificity rates, respectively, for identifying patients with and without MDD. The BDI-PC is discussed as an effective case-finding instrument for screening primary care patients for MDD.

Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients.

To ascertain the dimensions of the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) in clinically depressed outpatients, exploratory factor analyses were performed with the BDI-II responses of 210 adult (> or =18 years) outpatients who were diagnosed with DSM-IV depressive disorders. Two factors representing Somatic-Affective and Cognitive dimensions were found whose compositions were comparable to those previously reported by Beck, Steer, and Brown (1996) for psychiatric outpatients in general. A subsequent confirmatory factor analysis supported a model in which the BDI-II reflected one underlying second-order dimension of self-reported depression composed of two first-order factors representing cognitive and noncognitive symptoms. The clinical utility of using subscales based on these two latter first-order symptom dimensions was discussed.

Common and specific dimensions of self-reported anxiety and depression: the BDI-II versus the BDI-IA.

The Beck Depression Inventory-II (BDI-II) [Beck, A. T., Steer, R. A. & Brown, G. K. (1996). Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.] and Anxiety Inventory (BAI) [Beck, A. T. & Steer, R. A. (1993a). Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation.] were administered to 840 outpatients who were diagnosed with various types of psychiatric disorders to determine whether the general symptom compositions and relative amounts of variance of the common and specific dimensions of self-reported anxiety and depression for these instruments would be comparable to those that had been found by Steer et al. [Steer, R. A., Clark, D. A., Beck, A. T. & Ranieri, W. F. (1995). Common and specific dimensions of self-reported anxiety and depression: A replication. Journal of Abnormal Psychology, 104, 542-545.] with the BAI and amended Beck Depression Inventory (BDI-IA) [Beck, A. T. & Steer, R. A. (1993b). Manual for the Beck Depression Inventory. San Antonio, TX: Psychological Corporation.]. A Schmid-Leiman transformation was used with the iterated-principal-factor pattern matrix of the BAI and the BDI-II loadings and indicated that the overall symptom compositions and relative amounts of variance that were explained by the one common and two specific anxiety and depression dimensions were comparable to those previously found with the BDI-IA.