Psychosocial characteristics of "double depression".

Thirty-nine patients with "double depression" (major depression and dysthymia) were compared to 38 patients with recurrent major depression without dysthymia on a number of severity of illness, psychosocial, and biological variables. No significant differences were found on any psychosocial or biological measure.

Attributional, perceptual, and affective responses to depressed and nondepressed marital partners.

Husbands of wives with (n = 22) or without (n = 23) a history of a depressive disorder indicated their attributions about and affective reactions to real and hypothetical positive and negative events occurring to their wives, rated their wives on personality traits categorized as depression-related and depression-neutral, and reported their own marital satisfaction. Husbands of depressed, relative to nondepressed, wives made more dispositional attributions, reported more negative affect in reaction to negative events, and indicated less marital satisfaction. Depressed wives were rated more negatively on both depression-related and depression-neutral personality traits. Results are interpreted as suggesting that spouses of depressed wives have a generalized negative view of their wives, which may also be operating within distressed marriages.

Mental health care providers: the need for AIDS education.

Mental health care providers completed a set of measures assessing their attitudes, knowledge, and beliefs concerning AIDS. Those surveyed were aware of the main transmission routes but were excessively concerned about casual contact. Most indicated that they are not competent to deal with AIDS patients and would prefer not to care for them. The majority favored client testing and segregated programs for HIV-infected persons. Additional AIDS-related education and staff support are needed to overcome irrational beliefs and prejudice.

A controlled study of combined hormonal and psychological treatment for sexual unresponsiveness in women.

Thirty couples, whose presenting complaint was general sexual unresponsiveness in the female partner, were randomly allocated to one of three treatment groups: testosterone plus sexual counselling; placebo plus the same form of counselling; or testosterone alone. Therapy was time-limited to 16 weeks, and assessments were conducted pre-treatment, at the end of treatment and at a four-month follow-up. There were no notable differences in outcome between the two counselling groups, both of which showed significantly greater improvement on a number of measures of sexual and general interpersonal adjustment and attitude change than the group that received testosterone alone. Although a significant improvement with testosterone alone was found on ratings of vaginal lubrication, frequency of sexual interest and coital pleasure, significant changes on the same variables were also apparent in the other two groups. On no measure was testosterone alone shown to be significantly superior to either of the other two treatments. These results, in accordance with those of other recent related research, therefore indicate no significant advantages in using testosterone with an otherwise unselected sample of sexually unresponsive women.

Risk adjustment of Florida mental health outcomes data: concepts, methods, and results.

This article discusses outcome evaluation systems for mental health programs. It reviews and critically evaluates design and analysis methods for strengthening the validity of such uncontrolled comparisons. The article examines methods for statistically adjusting preexisting groups, now referred to as risk adjustment or case-mix adjustment, and offers guidelines for determining when this procedure is appropriate. Then, analyses on two dependent variables--a global rating of functioning and a consumer satisfaction measure--available from an outcomes evaluation system currently underway in Florida are used to demonstrate the proposed method of risk adjustment. Results for 24 providers of mental health services showed that while risk adjustment only made a small difference in the overall provider rankings, the ranking of some specific providers changed considerably. The article concludes with a discussion of the implications of this research.

Training psychiatric patients to discuss medication issues. Effects on patient communication and knowledge of medications.

Psychiatric inpatients were randomly assigned to a medication-related communication skills program or to a control condition that consisted of a medication education program. The medication communication program emphasized learning to ask physicians questions about medications, to describe current problems, and to make relevant requests. Although patients in both groups improved their knowledge of medications, the medication communication skills program had the added impact of teaching patients to ask more questions of a doctor and to engage in longer conversations. Moreover, patients who completed the medication communication program were rated as more assertive, as having acquired more information about a new medication that was prescribed, as having greater social skill, as being more likely to be compliant with medication, and as having greater eye contact. These results suggest that the use of a medication-related communication skills program may be a somewhat novel and effective way to increase patient involvement in treatment and to facilitate the elicitation of information about the prescribed medication regimen.

Neurological features of HIV-related disease in Glasgow.

The neurological features of 10 patients with HIV-related disease seen in Glasgow between July 1984 and May 1988 are described. Two of these patients presented with ARC and eight with AIDS. Six patients showed features consistent with a diagnosis of AIDS-dementia complex, one had cerebral toxoplasmosis, one had CNS lymphoma, one had a probable drug-induced encephalopathy and one patient had a meningoencephalitis of undetermined cause. Seven of these patients have now died. The implications of these findings are discussed.

Retarded ejaculation as a function of non-aversive conditioning and discrimination: a hypothesis.

Learning theory formulations of the development of retarded ejaculation have, so far, been confined to the conditioning of anxiety as the principal aetiological factor. A preliminary study of nine patients with ejaculatory failure suggests that positive reinforcement associated with self-masturbation may play a more central role. Some preliminary clinical observations consistent with this hypothesis, and the implications for treatment are discussed.

Assisting clients of community mental health centers to secure SSI benefits: a controlled evaluation.

The entire caseloads of three Community Mental Health Centers were screened on variables normally assessed in the SSI application process. These data were then used to classify each individual as Possibly Eligible for SSI benefits, or as Probably Not Eligible. The Possibly Eligible subjects were randomly assigned to either the Experimental condition, in which subjects were helped to apply for SSI, or the Control condition, in which no intervention was provided. Results showed that the Experimental subjects were almost twice as likely to secure SSI benefits as the Control subjects. The usefulness of the screening form was supported in that control subjects were almost five times more likely to be awarded SSI, compared with subjects who had been classified as Probably Not Eligible.

Mental health and substance abuse staff: HIV/AIDS knowledge and attitudes.

Mental health and substance abuse treatment staff completed a set of measures assessing their attitudes, knowledge, and beliefs concerning AIDS. Results indicated that while most staff were aware of basic information about the disease, approximately one-third were not aware of the neuropsychological and psycho-behavioural concomitants of the disorder. Those surveyed were aware of the main transmission routes, but overgeneralized their concern to casual contact. Most staff indicated willingness to work with HIV-infected individuals, although 29% stated they would try to avoid working with them. Interestingly, mental health staff expressed greater hesitancy than substance abuse staff. These and other results are interpreted to suggest that some desensitization of concern may have already occurred among those who have worked with HIV-positive clients. Individuals who had worked with an HIV-positive client had greater knowledge, less discomfort, and were less likely to want to avoid those who are HIV-positive. Questions attempting to identify sources of discomfort in working with AIDS or HIV-positive clients suggested that fear of contagion may be the primary concern, followed by discomfort of working with the terminally ill, and then discomfort with IV drug users and homosexuals. The implications of these results for continuing education activities and staff readiness are discussed.

Knowledge of AIDS and HIV among various groups.

To date, no cure has been found for HIV/AIDS. Prevention has therefore been the immediate principal aim and a didactic approach has been given a primary role. Studies from the USA indicate that knowledge level may be dictated by membership of particular subcultural groups and the perceived relevance of HIV/AIDS to these groups. This study investigates knowledge among four groups: homosexual; single heterosexual; IV drug users; and a 'married' group. Results indicate some gaps in knowledge and a greater knowledge base among one of the high risk groups, the homosexual group.

Administrative challenges to working with HIV-positive clients: experiences of mental health and substance abuse program directors in Florida.

Administrators of publicly-funded mental health and substance abuse programs described their agencies' activities, policy development, the administrative impediments, and training needs related to caring for HIV-infected clients. Almost all have served HIV-infected clients and admit clients to their programs regardless of HIV status. The administrators reported little staff opposition to working with this clientele. Liability and confidentiality concerning testing and client/staff safety were major concerns. The difficulty of providing needed medical care and the expense of treating such clients were also viewed as major impediments to service delivery. The most critical training needs were for mental health interventions related to death and dying, grief counseling, and neuropsychological complications, as well as for policy and procedure development concerning legal and ethical issues.

Hormonal treatments of sexual unresponsiveness in postmenopausal women: a comparative study.

Forty postmenopausal women, referred for hormone replacement therapy and all of whom reported a significant concern about a decline in their sexual interest, were randomly allocated to one of two hormone implant treatment groups: either oestradiol (50 mg) alone, or oestradiol (50 mg) and testosterone (100 mg). Comparison between the two groups as a whole revealed no significant differences on any measure, both treatments being associated with a significant reduction in the severity of psychological, somatic and vasomotor symptoms, and with a significant improvement in sexual interest and responsiveness. Similar effects were also observed in patients who denied, pretreatment, any concurrent dyspareunia. Although it is not possible to identify the reasons for change, the results indicate no advantages of supplementary testosterone administration over oestradiol alone for sexually unresponsive postmenopausal women.

HIV risk factors for persons with serious mental illness.

HIV risk factors were assessed among 120 persons in treatment for serious mental illness. Although subjects had good general knowledge regarding HIV, many engaged in high risk behaviors. Condom use was infrequent among those who had multiple sexual partners, and sharing needles was common for those who used i.v. drugs. Clearly, factual knowledge about HIV was not sufficient to prevent risky behavior. Nearly half of the sample was categorized as at medium to high risk, and almost half of the participants, especially those at medium risk, underestimated their own level of risk. The results suggest that education and intervention strategies should focus on increasing the accuracy of the individual's risk assessment as well as changing attitudes towards condoms and improving skills in using condoms. Assessing personal risk and adopting risk-reduction strategies are the keys to successful AIDS prevention for persons with serious mental illness.

The usefulness of the semantic differential with "mild grade' mental defectives.

Although the semantic differential has been quite widely used with mental defectives, its usefulness (in its traditional form) with such a population has not been conclusively demonstrated. The semantic differential was developed and shown to be valid as an index of representational mediation processes. However, there is also evidence of a mediational deficiency among retardates which, therefore, ought to be reflected in retardates' responses to the semantic differential. Thus, the present study was designed to test two hypotheses: (a) that mild grade retardates, in comparison with subjects of average intelligence, would show less discrimination in the use of the semantic differential, and (b) that such discriminative deficiencies would in turn predispose toward a polarized response bias among the retarded. The results, which support both hypotheses, are discussed in terms of their implications for the usefulness of an unmodified semantic differential with the mentally subnormal.