Behavior therapy as a test of psychoanalytic theory.

The author describes 4 patients in whom radically new symptoms appeared after intensive behavior therapy. He suggests that fresh symptoms are most likely to develop in a small minority of patients who are unable to learn more adaptive psychological defense mechanisms during or after behavior therapy and that psychoanalytic theory may help predict the nature of such symptoms.

Profiles and predictors of assaultiveness for different psychiatric ward populations.

OBJECTIVE: The authors examined associations between patient-related characteristics and assaultiveness on six different psychiatric wards to determine 1) the relative contributions of demographic, disorder-related, and diagnostic variables to prediction of assaultiveness and 2) how ward composition and type of victim affect prediction of assaultiveness. METHOD: Hospital records of 1,025 inpatients residing in psychiatric wards within a 6-month time frame were reviewed for evidence of assaultiveness. Data on all 260 assaultive patients and a sample of 136 of the nonassaultive patients were analyzed with multiple regression to predict assaultiveness scores for each ward and each victim category. RESULTS: The findings indicated high rates of assaultive patients and assaults on fellow patients. Multiple regression results produced different predictors of assaultiveness for different wards but not for different categories of assault victim within each ward. Overall, age and sex consistently failed to predict assaultiveness, whereas greater assaultiveness was significantly associated with a greater proportion of time hospitalized since first admission. The most powerful unique predictors of assaultiveness scores were diagnostic distinctions derived from data on coexistent diagnoses. The most assaults were by acute patients whose diagnoses excluded organic mental disorder but included either bipolar disorder or personality disorder and longer-stay patients whose exclusive diagnosis was organic mental disorder. CONCLUSIONS: This identification, albeit modest, of risk factors for assaultiveness on different wards nevertheless provides information fundamental to the management policies of psychiatric institutions. The findings caution against aggregating different ward populations for research on assaultiveness and endorse the usefulness of coexistent diagnoses for predicting assaultiveness.

Semantic organization of hallucinated "voices" in schizophrenia.

The authors found that the different hallucinated "voices" of four schizophrenic subjects reported over 1-3 weeks expressed semantic content that was at least as persistent as clauses sampled from single 5-7-minute conversational discourses of four comparison speakers. The high degree of semantic recurrence of voices from one day to the next may contribute to the mistaken belief that these experiences derive from a particular nonself agent or speaker.

Behavioral disturbance in dementia.

Fifty-seven subjects with moderate to severe dementia (49 with Alzheimer's disease) were rated twice, 8 weeks apart, using the Mini-Mental State Examination (MMSE), the Blessed Information-Memory-Concentration Test (BIMC), and the Stockton Geriatric Rating Scale (SGRC). Only three subjects lived at home; the rest were in long-stay hospital beds or nursing homes. For 29 subjects, the first rating coincided with their referral to a comprehensive geriatric psychiatry service. The main hypothesis, that the level of behavioral disturbance would correlate positively with the level of cognitive impairment, was strongly confirmed. This finding may reflect the severity of dementia in the study sample. The correlations between MMSE and BIMC scores were .87 at entry and .92 at exit, suggesting that the two measures were broadly equivalent, although both had marked floor effects. Test-retest reliability was high for all three measures. Overall, medication was of limited effectiveness in managing severe behavioral disturbance, highlighting the need for introducing effective behavioral programs.

Psychological status of morbidly obese women before gastric restriction surgery.

One hundred and eighteen of 142 morbidly obese women had gastric restriction surgery after completing self-report questionnaire measures of psychosocial adjustment as part of their preoperative psychiatric assessment. Compared with an age-matched normal population, they scored significantly higher on measures of phobic anxiety, somatization, depression, hostility, and marital dissatisfaction, the last being associated mainly with later onset obesity. Factor analysis of questionnaire and weight data showed that weight was largely independent of psychological adjustment, although associations occurred when analysis was restricted to the data on married women, in which marital and self-assertion abnormalities loaded significantly on the same factor.

Psychological status before and after gastric restriction as predictors of weight loss in the morbidly obese.

Before gastric restriction, 118 morbidly obese women were psychiatrically assessed by clinical interview and self-report questionnaire. One year after surgery, 71 repeated the questionnaires. Weight was assessed at yearly intervals until the four year follow-up (n = 91). The maximum mean weight loss of 35 kg occurred at one year follow-up, when questionnaire respondents reported a slight overall improvement in personal and marital adjustment, and 72% rated themselves as very pleased with the results of surgery. Subsequently, 70% of patients regained weight, although the mean annual increase was only 1.9 kg. Marital dissatisfaction was a significant positive predictor of weight at one year, and generalized anxiety was a significant negative predictor of weight at four years. An increase in phobia scores at one year predicted subsequent maintenance of weight loss, whereas an increase in extrapunitiveness (mainly irritability and criticism of others) predicted subsequent weight gain.

Characteristics of police referrals to a psychiatric emergency unit in Australia.

The study examined characteristics of patients referred by police to a psychiatric emergency unit on the campus of a 400-bed psychiatric hospital in Adelaide, South Australia. Of all police referrals (N = 634) during a 21-month period, 437 cases were admitted to the hospital. Most police referrals were young, single, unemployed men. In a subsample of 61 patients, 72 percent had previous psychiatric admissions and 39 percent had been previously referred by police. Compared with nonpsychotic subjects, psychotic subjects used more mental health resources, had a longer index admission, and after the index discharge relapsed more rapidly and spent more days in the hospital.

Obsessive-compulsive disorder: a questionnaire survey of a self-help group.

Ninety-three of 217 members of a self-help group for sufferers from obsessive-compulsive disorder (OCD) completed a detailed questionnaire concerning psychological symptoms, biographical data, and the family and social context of their disorder. Eighty-one respondents (49 women) met DSM-III-R criteria for OCD, and the data are based on these. The mean duration of OCD was 18 years, and 74% of respondents rated their symptoms as extremely, very, or fairly severe for at least 50% of the time since onset. Respondents had received a great deal of psychiatric and psychological treatment, and rated behaviour therapy and individual psychotherapy as the most effective. Women employed outside the home reported significantly less obsessional symptoms than those who were not. Significantly raised scores on a measure of perceived parental protection, and significant correlations between parental overprotection and the amount of psychiatric treatment, suggest avenues for new research in the area.

Student nurses' specialty choice: the influence of personality and education.

Before and after a nine week psychiatric-mental health (PMH) nursing program of their Diploma course, 51 second year student nurses completed a questionnaire on which they rated their interest in 14 nursing specialties. They also completed measures of personality and attitudes to psychiatric treatment. Factor analysis showed that students' initial specialty interests fell into three groups that were termed 'procedural', 'child/infant orientated', and 'action orientated'. After the PMH program, the popularity and interrelationships of specialty choice changed substantially. Community and psychiatric nursing became more popular, whereas some of the 'procedural' specialties became less so. Correlations showed that the more conservative nurses initially selected the more traditional nursing specialties, and there were statistically significant relationships between psychological defence style and specialty choice. These findings have implications for nursing specialty choice and recruitment.

Morbid obesity: effects on the marital system of weight loss after gastric restriction.

Eighty morbidly obese married women and 69 of their husbands completed a self-report measure of personal and marital adjustment before the women proceeded to gastric restriction surgery. Fifty-five women and 41 husbands repeated the measure 12 months after surgery, at which time the women had lost a mean of 35.4 kg. Women rated themselves as significantly more attractive and sociable, and rated their husbands as significantly less sociable and interesting, than before surgery. Husbands rated their wives as excessively sociable after surgery, the reverse of their previous view. The data offered some support for a family systems view of morbid obesity, but the systemic effect appeared weak, and is probably not a major contributor to wives' morbid obesity in most cases.

Psychological treatment of essential hypertension: a controlled comparison of meditation and meditation plus biofeedback.

Twenty-one patients with essential hypertension were randomly allocated to eight 1-hour sessions of meditation training, meditation plus biofeedback-aided relaxation, or a no-treatment control group. Statistically significant falls in systolic and diastolic blood pressure occurred after both training programs, although overall reductions in blood pressure were not significantly greater in either program than in the control group. Meditation plus biofeedback-aided relaxation produced falls in diastolic blood pressure earlier in the training program than did meditation alone. All patients practiced mediation regularly between training sessions: The amount of practice did not correlate with the amount of blood pressure reduction after training. On questionnaire measures of psychological symptoms and personality, sex differences emerged, with females showing significant abnormalities in hostility scores and males showing significantly raised levels of somatopsychic symptoms. In females, outward-directed hostility fell significantly and assertiveness increased after training, but in males, somatopsychic symptoms were unchanged.

Agoraphobic women married to abnormally jealous men.

Of 36 married female agoraphobics treated by the author over a period of 3 years, seven were married to men who displayed abnormal jealousy. In all these cases the husbands' jealousy adversely influenced their wives' response to treatment, and improvement in wives was associated with increased morbidity in their husbands.