Exploring direction of causation between social support and clinical outcome for HIV-positive adults in the context of highly active antiretroviral therapy.

Social support and its associations with virological outcome were assessed over a 4-year period for 34 adult outpatients living with HIV/AIDS and consistently on highly active antiretroviral therapy (HAART). Clinical variables and perceived availability of social support were measured in three waves (T1, 1997; T2, 1999; T3, 2001). Cross-lagged logistic regression analyses were employed to evaluate the direction of potential causal pathways between social support and clinical status in terms of 'undetectable' viral load. Social support ratings declined moderately overall, with a more pronounced reduction that was of clinical (effect size, 0.82) and statistical significance (p = 0.000) for the subgroup (n = 11; 32%) with final 'detectable' viral load. Evidence suggested causal directionality in which cross-sectional social support and/or improvements in social support over time predicted virological outcome, with better social support associated with greater likelihood of viral load suppression to 'undetectable' level, an outcome achieved for 68% (n = 23) of the sample. In contrast, cross-sectional virological status reflected immunological outcomes but did not predict subsequent ratings of social support or changes in social support ratings. HIV-positive adults consistently taking HAART appeared to experience better clinical benefit if they perceived interpersonal, informational and emotional support to be available, a finding that underscores the importance of social support in relation to treatment outcome for this population.

Quality of life among urban Canadian HIV/AIDS clinic outpatients.

Perceived health-related quality of life (QOL) of 113 adult people living with HIV/AIDS (PHA) attending an outpatient hospital clinic was assessed upon initial registration using the Medical Outcomes Study SF-36. QOL ratings on both physical functioning and psychological well-being aspects of the SF-36 were lower than for the general population, especially among PHA in the sample who were symptomatic or for whom AIDS had developed. Although not compromised in terms of physical functioning, asymptomatic PHA had well-being QOL scores comparable to other chronic medical conditions. In general, demographic, social, and many of the health and immune status variables examined were not significantly related to QOL. Number of symptoms was negatively associated with both physical status and emotional well-being dimensions of QOL. PHA in the asymptomatic stage of HIV infection reported better QOL than symptomatic/AIDS patients on few QOL dimensions. Mean QOL ratings did not significantly differ between AIDS patients and those with symptomatic (non-AIDS) infection. These findings suggest that although becoming symptomatic has a significant impact on a majority of dimensions of QOL, being diagnosed with HIV affects well-being dimensions the most. An emphasis on support for both adjusting to diagnosis and symptom management is as important as viral suppression in maximizing QOL for PHA.

Help-seeking patterns in HIV/AIDS outpatients.

This study investigates factors associated with requests for professional services, made by newly registered HIV/AIDS Clinic outpatients, referred by general practice physicians to a large urban hospital serving a broad metropolitan/rural area in Canada. Professional service requests were divided into two primary help-seeking categories: practical support (assistance with financial aid, housing, medication costs, etc.) and emotional support (i.e., psychological counselling). Slightly more than half of the sample (51%) of people living with HIV/AIDS (PHA) requested professional services. Service requesters are indistinguishable from non-requesters on a large number of variables, including age, gender, family awareness of HIV/AIDS diagnosis, time elapsed since diagnosis, employment status, spousal status, overall support network size, physical health indicators (Karnofsky Performance Status, CD4 count, symptoms, opportunistic infections) and receipt of community support services elsewhere. Similarly, requesters and non-requesters report comparable levels of overall perceived social support and quality of life. However, requesters of practical support services report significantly fewer friends, lower emotional-informational social support and poorer quality of life due to body pain than non-requesters. Requesters of emotional support services report experiencing significantly lower positive social interaction compared to non-requesters. Implications for the provision of practical and emotional support services for PHA are discussed.

The relationship assessment measure for same-sex couples (RAM-SSC): a standardized instrument for evaluating gay couple functioning.

The utility of a standardized relationship assessment tool for same-sex couples is evaluated in this preliminary study. The RAM-SSC, adapted from the Waring Intimacy Questionnaire (WIQ, Waring & Reddon, 1983; Waring, 1984), was administered to a clinical sample of 32 gay male couples beginning conjoint therapy and to a nonclinical comparison group of similar size from the gay community. Clinical sample couples reported significantly lower mean scores (less positive perceptions of functioning) in most dimensions of the RAM-SSC, compared to the nonclinical group, whose scores were found to resemble those of WIQ reference values for nongay male partners in heterosexual marriages. The RAM-SSC, therefore, can be considered as a potentially viable relationship measure for use in clinical work with gay male couples, for assessment and treatment outcome evaluation purposes. Further investigation into the psychometric properties of the RAM-SSC in terms of reliability and validity is recommended.

Perceived support in newly registered HIV/AIDS clinic outpatients.

This study compares levels of perceived social support in newly registered outpatients attending an HIV/AIDS clinic to those reported in a reference sample of other ambulatory medical populations. Perceived availability of four types of functional support is assessed: tangible, affectionate, positive social interaction and emotional-informational. Other elements of patients' support networks that might be associated with perceived support are also examined. In general, functional support levels in the outpatient PHA population were found to be similar to those of the MOS-SSS reference sample. Patient factors including age, gender, family awareness of HIV/AIDS diagnosis, time elapsed since diagnosis, employment status, physical health indicators, antiretroviral treatment history and support network size showed no relationship to functional support. Network composition factors significantly associated with higher social support ratings included the presence of a partner (all dimensions of functional support) and a greater proportion of close friends as opposed to close family members (emotional-informational support). Requesters of clinic support services tended to exhibit lower emotional-informational support scores compared to non-requesters. Implications for the provision of support services to people living with HIV/AIDS are discussed.

Telephone prompting to increase attendance at a Psychiatric Outpatient Clinic.

Although it has been commonly taught and has been reported elsewhere that telephone prompting increases the rate at which patients keep their first outpatient clinic appointment, this study indicated that the increased rate at which patients kept their first appointment was more likely related to socioeconomic factors (such as having a telephone) than to telephone prompting. The authors conclude that measures to improve services to patients need to be carefully scrutinized before one can assume that results following initiation of a new procedure are in fact due to that procedure.

The urban epidemic of phencyclidine (PCP) use: clinical and laboratory evidence from a public psychiatric hospital emergency service.

Routine blood samples of 145 consecutive patients seen in the Los Angeles County Psychiatric Hospital Emergency Room during a 48-hour weekday period in June 1979 were examined for phencyclidine (PCP) using a sensitive and specific gas capillary gas chromatographic nitrogen detector (GC2-N) method. Of these 145 samples 63 (43.4%) were positive and PCP levels ranged 0.34 to 142.9 nanograms/ml (mean 14.6 ng/ml +/- 3.4 S.E.M.). An analysis of the records of these 63 patients revealed a wide variety of psychotic clinical pictures resembling mania, depression or schizophrenia with relatively few of the supposedly characteristic manifestations of PCP intoxication. Each of the 63 patients had at least one manifestation of toxic psychosis and/or acute delirium, in addition to the florid symptoms characteristic of functional states. PCP measurement, pharmacokinetics and the possible relationships of this intoxication to the psychiatric manifestations are discussed.

A prospective psychological study of 50 female face-lift patients.

Fifty female face-lift patients were evaluated preoperatively with psychological tests and psychiatric interviews. Their postoperative psychological courses were studied for up to 6 months. Approximately 30% had postoperative depressive reactions. These reactions were primarily correlated with a preexisting, clinically detectable depression, high depressive Beck scores, or a depression-prone personality pattern. There was no statistical correlation between postoperative depressive reactions and magical expectations, post-operative complications, marital status, recent bereavement, relationships with spouse and family, or concerns about death. Preoperative depression scores were often transiently intensified postoperatively, but usually eventually stabilized at a level lower than the preoperative scores. Many women showed postoperative psychological improvement. Twenty-eight percent had an increase in self-esteem, 8% felt better able to cope with life, and 8% were more assertive and confident in their work. The desire to improve self-image and to advance in a career were reasonably reliable predictors of psychological improvement.

Patients' requests of an outpatient clinic.

Three-hundred-twenty-five consecutive predominantly lower-class new patients at a psychiatric outpatient clinic rated the importance they attached to each of 14 categories of treatment needs or requests. Psychiatric residents subsequently rated the importance of each request for each patient at the conclusion of their initial assessment interview. Requests reflecting needs for intrapsychic therapy, clarification, and control of feelings were considered very important by approximately two thirds of the patients; needs for institutionalized contact, advice, and community triage by one half; and other requests for medication, reality contact, succorance, ventilation, confession, social intervention, administrative requests by a minority (one fourth to one third). Residents significantly underestimated the importance their patients attached to 10 of 14 requests. Factor analyses confirmed several systematic sources of disparity between patient and therapist perception of lower-class patient needs.

A comparison of videotaped and live patient interview examinations and written examination in psychiatry.

The authors scored the examination performance of 28 psychiatrists who were tested after conducting an interview with a real patient and after seeing a videotaped interview with an actor playing the role of either a psychotic or a neurotic patient. The also scored the performance of 15 of the same examinees who completed a written examination. Eighty-five percent of the examinees reported that the videotaped interview examination was a useful learning experience, and 81% said that it was a useful testing experience. The examiners' feelings varied regarding the use of the standardized videotaped format for certification and recertification of psychiatrists.

Which patients respond to a mental health consumer survey.

Characteristics of patients at the Los Angeles County - University of Southern California Medical Center, Adult Psychiatric Outpatient Clinic who responded to a Los Angeles County voluntary "Client Satisfaction Survey" were compared with those who did not. Three significant differences consistently emerged. If an individual was a member of a minority group (black of Spanish surname), had less than a high school education, and was taking antispsychotic medication, his chance of returning a questionnaire to a waiting-room collection box was 79% as compared to the 30% chance of returning if he had none of these three characteristics. Younger patients had "Anglos" more often used the U.S. mail than the collection box to return the questionnaires. It is important that both methods be used to minimize bias. Most of the many patient-characteristics studied did not influence return rate. These findings are discussed in relation to the return method, ethnicity, medication, chronic mental illness, diminished freedom, and consumer voice in voluntary questionnaires.

Who gets supervised? An extension of patient selection inequity.

A study of 89 individual psychotherapy patients followed by 17 residents in a teaching clinic demonstrated that those presented for supervision significantly differed from the others in being younger, better educated, and better liked by residents and in having higher incomes and longer term treatment. The authors discuss the implications of these findings in relation to the inequity in service time and teaching emphasis that this selection allows.

Effect of drug ritual changes on schizophrenic patients.

The author evaluated the charts of 115 chronic schizophrenic patients who regularly attended a follow-up group to determine whether changes in long-standing medication regimens produced an increased dropout rate, decreased attendance, or psychotic decompensation. He found that although there were nonsignificant trends showing a relationship between medication change and group attendance for individual patients, there were no significant difference between group attendance and change or no change in medication routine for the group of patients as a whole. He concludes that necessary changes in medication routines for chronic schizophrenic patients are safe.

Teaching dynamic psychotherapy by observation.

Experience with a seminar demonstrating psychotherapy, interviews with 12 of the treated patients, and a survey of 23 residents have shown the value of this teaching method and its effect on the participants. Generally the patients felt helped and residents were enthusiastic. The teaching format has many valuable features--most important being the inclusion of a faculty-observer.