Don't Step on the Tiger's Tail: A Mixed Methods Study of the Relationship Between Adult Impact of Childhood Adversity and Use of Coping Strategies.

A mixed methods study examined the relationship between childhood adversity (ACE) and coping among individuals grouped by perceived impact of ACE in adulthood. Groups did not differ on mean total ACE scores and total ACE score was not associated with any coping strategy. Differences between groups were found in 6 of 14 coping strategies. Planning and active coping were endorsed the most by both groups, despite their being used in significantly different amounts and in different ways. How individuals with ACE rate its impact in their current lives is a significant factor in the use and meaning of coping strategies.

Negative affect predicts adults' ratings of the current, but not childhood, impact of adverse childhood events.

Adverse childhood events (ACE's) have been empirically related to a wide range of negative health and mental health outcomes. However, not all individuals who experience ACE's follow a trajectory of poor outcomes, and not all individuals perceive the impact of ACE's as necessarily negative. The purpose of this study was to investigate positive and negative affect as predictors of adults' ratings of both the childhood and adult impact of their childhood adversity. Self-report data on ACE experiences, including number, severity, and 'impact' were collected from 158 community members recruited on the basis of having adverse childhood experiences. Results indicated that, regardless of event severity and number of different types of adverse events experienced, high levels of negative affect were the strongest predictor of whether the adult impact of the adverse childhood events was rated as negative. All individuals rated the childhood impact of events the same. Implications are discussed.

Direct and indirect effects of childhood adversity on adult depression.

Exposure to adverse events in childhood is a predictor of subsequent exposure to adverse events in adulthood, and both are predictors of depression in adults. The degree to which adult depression has a direct effect of childhood adversity versus an indirect effect mediated by adult adversity has not previously been reported. We report data collected from 210 adult participants regarding childhood and adult adversity and current symptoms of depression. Mediation of the relationship between childhood adversity and adult depression by adult adversity was statistically assessed to evaluate the relative direct and indirect effects of childhood adversity on current depression levels in adults. Both the direct effect of childhood adversity on adult depression and the indirect effect, mediated by adulthood events, were significant. Therefore, partial mediation of the relationship between childhood adversity and adult symptoms of depression by adult adverse events was found in the sample. Implications for treatment are presented.

Effectiveness and cost of olanzapine and haloperidol in the treatment of schizophrenia: a randomized controlled trial.

CONTEXT: Although olanzapine has been widely adopted as a treatment of choice for schizophrenia, its long-term effectiveness and costs have not been evaluated in a controlled trial in comparison with a standard antipsychotic drug. OBJECTIVE: To evaluate the effectiveness and cost impact of olanzapine compared with haloperidol in the treatment of schizophrenia. DESIGN AND SETTING: Double-blind, randomized controlled trial with randomization conducted between June 1998 and June 2000 at 17 US Department of Veterans Affairs medical centers. PARTICIPANTS: Three hundred nine patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of schizophrenia or schizoaffective disorder, serious symptoms, and serious dysfunction for the previous 2 years. Fifty-nine percent fully completed and 36% partially completed follow-up assessments. INTERVENTIONS: Patients were randomly assigned to receive flexibly dosed olanzapine, 5 to 20 mg/d, with prophylactic benztropine, 1 to 4 mg/d (n = 159); or haloperidol, 5 to 20 mg/d (n = 150), for 12 months. MAIN OUTCOME MEASURES: Standardized measures of symptoms, quality of life, neurocognitive status, and adverse effects of medication. Veterans Affairs administrative data and interviews concerning non-VA service use were used to estimate costs from the perspective of the VA health care system and society as a whole (ie, consumption of all resources on behalf of these patients). RESULTS: There were no significant differences between groups in study retention; positive, negative, or total symptoms of schizophrenia; quality of life; or extrapyramidal symptoms. Olanzapine was associated with reduced akathisia in the intention-to-treat analysis (P<.001) and with lower symptoms of tardive dyskinesia in a secondary analysis including only observations during blinded treatment with study drug. Small but significant advantages were also observed on measures of memory and motor function. Olanzapine was also associated with more frequent reports of weight gain and significantly greater VA costs, ranging from 3000 dollars to 9000 dollars annually. Differences in societal costs were somewhat smaller and were not significant. CONCLUSION: Olanzapine does not demonstrate advantages compared with haloperidol (in combination with prophylactic benztropine) in compliance, symptoms, extrapyramidal symptoms, or overall quality of life, and its benefits in reducing akathisia and improving cognition must be balanced with the problems of weight gain and higher cost.

A pilot study comparing motivational interviewing and an educational intervention in patients with schizophrenia and alcohol use disorders.

Thirty subjects with comorbid schizophrenia and alcohol use disorders were randomly assigned to receive either a Motivational Interviewing (MI) or Educational Treatment (ET) intervention with treatment goals of abstinence and/or decreased alcohol use. Subjects were followed up at 4, 8 and 24-weeks upon completion of the interventions. Outcome measures included number of drinking days, abstinence rates, average blood alcohol concentration and standard ethanol content per drinking day. Subjects randomized to the MI intervention had a significant reduction in drinking days and an increase in abstinence rates when compared to subjects receiving ET. Motivational Interviewing may be a useful treatment intervention for individuals with schizophrenia and alcoholism.