Development and psychometric validation of the HIV Treatment Knowledge Scale.

Accurate treatment knowledge is required for patients to successfully manage complex medical conditions. Existing HIV knowledge scales focus on disease transmission and risk factors. This is the first study to develop and validate a scale to measure HIV treatment knowledge about complex treatment issues such as adherence, side-effects and drug resistance. A total of 346 participants were recruited into this cross-sectional study. Participants included HIV-positive patients (n=130), HIV-hepatitis C co-infected patients (n=22), hepatitis C patients, (n=78), community healthcare providers (n=35) and college students (n=81). Participants completed the proposed HIV Treatment Knowledge Scale and a validated measure of general knowledge about HIV transmission and risk factors. Two-week test-retest data were collected. Results demonstrated that the HIV Treatment Knowledge Scale was significantly correlated with general HIV knowledge across all samples. Among HIV-positive patients, the HIV Treatment Knowledge Scale was positively associated with time since HIV diagnosis. HAART-experienced patients had significantly higher treatment knowledge than HAART-naïve patients. HIV-positive patients scored significantly higher than hepatitis C patients and college students on HIV treatment knowledge. Test-retest reliability (r=0.83) and internal consistency (reliability coefficient=0.90) were both satisfactory. The HIV Treatment Knowledge Scale is a novel, easy-to-administer measure demonstrating high levels of validity and reliability. It has important applications as a clinical teaching tool with patients and healthcare workers and it could be used as an outcome indicator in HIV educational intervention studies.

A randomized controlled psycho-education intervention trial: Improving psychological readiness for successful HIV medication adherence and reducing depression before initiating HAART.

The purpose of this study was to evaluate a novel psycho-educational intervention intended to increase patients' medication preparedness and treatment adherence skills before initiating highly active antiretroviral therapy (HAART). Sixty-three HIV-positive patients not currently on antiretroviral therapy participated in a randomized controlled trial of a standardized, four-session psycho-educational intervention (Supportive Therapy for Adherence to Antiretroviral Treatment; STAART). Session topics included learning techniques to increase medication adherence and learning effective strategies to cope with stress and depression. Patients completed psychological questionnaires assessing psychological readiness to initiate HAART and depressed mood. They completed both measures at study baseline and at four-weeks post-baseline. After controlling for baseline medication readiness scores, intervention patients (n = 30) reported significantly higher mean medication readiness following the STAART intervention (four-weeks post-baseline) (27.3+/-6.9) compared to controls (n = 33; 24.6+/-9.9; p < 0.05). Among depressed patients (n = 27), those receiving the intervention (n = 15) reported significantly lower mean depression scores at four-weeks post-baseline (22.5+/-12.9) compared to controls (n = 12; 27+/-9.9; p < 0.05). The STAART intervention enhanced HIV treatment readiness by better preparing patients prior to initiating HAART. It was also beneficial for reducing depressive symptoms in depressed, HIV-positive patients.

Binge eating disorder versus overeating: a failure to replicate and common factors in severely obese treatment seeking women.

The disordered eating symptoms, general psychopathology and dieting history among obese women diagnosed with Binge Eating Disorder (BED) and obese women who overeat (OE) are examined. One hundred and thirty women (n=83 with BED and n=47 who overeat) seeking treatment for an eating disorder were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria and the Eating Disorders Examination (EDE). They also completed a battery of psychometric tests. Despite adequate statistical power to detect differences, MANOVAs revealed very few significant differences between the groups. Loss of control of eating does not adequately differentiate these two groups within an eating disorders treatment-seeking context. It is likely that only the most acutely distressed from each group is seeking treatment, so that differences found in a community sample would not be found. Using a principal components analysis, factors within each group that may underlie the common psychopathology of both groups (i.e. disordered eating symptoms, general psychopathology and dieting history) were found.

Characteristics of patients who choose between two types of group psychotherapy.

Patient selection or matching to group psychotherapy is usually done by therapists. An alternative is to allow patients to "sample" and then select from different group therapies. In the current study characteristics of patients (N = 20) who selected from two types of group psychotherapy in a day-treatment program were examined. Patients were assessed on measures of current psychiatric symptomatology (Symptom Checklist 90-Revised [SCL-90R]; Derogatis, Rickles & Rock, 1976), psychological mindedness (McCallum & Piper, 1990) and psychological defenses Mechanisms Inventory (Ihilevich & Gleser, 1986). The two groups did not differ with regard to symptomatology or psychological mindedness. It was found that patients who chose a verbal and process-oriented psychotherapy tended to have externalizing defenses (turning anger against others and projection), however. These defenses appear to be congruent with this more emotionally expressive therapy. Patients who chose a structured and activity-oriented group psychotherapy tended to have internalizing defenses (repression/denial and intellectualization). These defenses seem consistent with this group therapy, which emphasized less emotional expressiveness. The implications of patient choice for group therapy and patient selection practices are discussed.