The prediction of psycho-social adjustment subsequent to cardiac insult.

Cardiovascular patients comprise a sizable proportion of the national population of the disabled. The relevant literature emphasized the importance of developing predictors of outcome in the recovery process. Evidence suggests that a matrix comprised of psychological, physiological, and sociodemographic factors is associated both with the development of and subsequent reaction to cardiac insult. In a cardiovascular patient sample, a series of predictive equations was derived that relates concurrent physiological, psychological and sociodemographic variables to a measure of later adjustment. The multiple regression equation was derived from data obtained from a sample (N = 20) of patients seen by the Cardiac Work Evaluation Unit of a large University medical center. Cross-validation indicated that the equation accounted for a large proportion of the predictable variation.

A comparison of the toxicity effects of the anticonvulsant eterobarb (antilon, DMMP) and phenobarbital in normal human volunteers.

Renewed corporate interest in the anticonvulsant drug eterobarb justified renewed clinical and experimental interest in this drug. The unique and clinically intriguing feature of eterobarb is that while sharing the anticonvulsant properties of other barbiturates, the hypnotic side effects usually associated with barbiturates appear to be absent in animal studies and greatly reduced in clinical trials. This study was designed to compare the hypnotic effects of eterobarb with those of phenobarbital in healthy normal human volunteers using a double-blind, placebo-controlled design. Both clinical and neuropsychological parameters of toxicity were measured, while blood barbiturate levels were monitored to correlate neurobehavioral changes with total barbiturate level. As expected, there is a linear relationship between the degree of toxicity and the barbiturate level, but much higher barbiturate levels were tolerated without toxicity by subjects taking eterobarb. For ethical reasons, subjects were not maintained at high levels of toxicity over the 14-week trial. However, both eterobarb and phenobarbital recipients failed to show significant improved performance on Digits Total, a test of mental flexibility (Digit Symbol Substitution). In addition, phenobarbital recipients showed the only significant decrement of performance on Digits Total, and they failed to improve significantly on Trails-Part A, in which all other groups improved. This study confirms that eterobarb has less hypnotic side effects and less neurotoxicity than does phenobarbital.

Neuropsychological effects of electroconvulsive therapy.

Although ECT as the treatment of choice for psychotic depression has been in use for many years, little is known about the neocortical residual of such treatments inferred from behavioral measures. The major portion of the literature has been concerned with inferred or observed changes in affective state. The present study compared pre- and posttreatment performances on the Halstead-Reitan neuropsychological battery of 20 patients who were receiving ECT from two different machines. Most Ss gave indicators of cerebral impairment prior to treatment when performance of one side of the body was contrasted with performance of the other side. After treatment, there was an increased number of Ss who evidenced signs consistent with damage to the right cerebral hemisphere. Some concern was raised that a large number of patients who eventually are subject ot ECT because of depression behave in this way because of an undiagnosed neocortical dysfunction. There is some suggestion that the effect of the procedure is to either create or intensify a right hemisphere focus as inferred from behavioral measures.

Assessing ADHD and comorbid disorders in children: the Child Behavior Checklist and the Devereux Scales of Mental Disorders.

Evaluated discriminant validity and clinical utility of selected subscales of the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) and the Child Behavior Checklist (CBCL; Achenbach, 1991a) in 228 children referred to a clinic for the evaluation and treatment of attention deficit hyperactivity disorder (ADHD). The DSMD is a multiaxial behavior rating scale that measures symptomatology for a broad range of child psychopathology as described in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-R-III] and 4th ed. [DSM-IV]; American Psychiatric Association, 1987, 1994). Discriminant function analyses as well as sensitivity, specificity, and predictive power analyses were computed to evaluate the discriminant validity and clinical utility of selected DSMD and CBCL subscales for assessing ADHD, oppositional defiant disorder (ODD), and anxiety disorders. Results indicated that the DSMD compared very favorably with the CBCL in the ability to discriminate between children with ADHD and those without ADHD and between children with comorbid ODD and anxiety disorders and children who did not meet criteria for these disorders. The DSMD Attention subscale may be somewhat better at ruling in ADHD combined subtype (ADHD-C) and ADHD inattentive subtype (ADHD-I) than the CBCL Attention Problems subscale, but the CBCL Attention Problems subscale may have slightly better utility than the DSMD Attention subscale in ruling out these subtypes. Both the CBCL and DSMD were more useful for ruling out than for ruling in ODD and anxiety disorders.