The Synergistic Effect of Class II HLA Epitope-Mismatch and Nonadherence on Acute Rejection and Graft Survival.

Predicting long-term outcomes in renal transplant recipients is essential to optimize medical therapy and determine the frequency of posttransplant histologic and serologic monitoring. Nonadherence and human leukocyte antigen (HLA) mismatch are risk factors that have been associated with poor long-term outcomes and may help individualize care. In the present study, class II HLA mismatches were determined at the HLA epitope level in 195 renal transplant recipients in whom medication adherence was prospectively measured using electronic monitors in medication vial caps. Recipients were grouped by medication adherence and high (≥10 HLA-DR, ≥17 HLA-DQ) or low epitope-mismatch load. We found that the combination of higher epitope mismatch and poor adherence acted synergistically to determine the risk of rejection or graft loss. Nonadherent recipients with HLA-DR epitope mismatch ≥10 had increased graft loss (35% vs. 8%, p < 0.01) compared to adherent recipients with low epitope mismatch. At the HLA-DQ locus nonadherent recipients with HLA-DQ epitope mismatch ≥17 had increased graft loss (33% vs. 10%, p < 0.01) compared to adherent recipients with low epitope mismatch. Subclinical nonadherence early posttransplant combined with HLA class II epitope mismatch may help identify recipients that could benefit from increased clinical, histologic, and serologic monitoring.

Periodic tallies by regulatory boards: a vital tool for tracking supply in the psychology workforce.

Regulatory boards in psychology and other mental health professions are in key positions to address workforce supply issues. Board data provide real time estimates of the growth within the health professions they regulate. The authors recommend that periodic tallies of the psychology workforce be undertaken through surveys of psychology boards. This will require that boards adopt efficient and standard methods for tracking licensees. Better data from boards would provide longitudinal and cross-jurisdictional comparisons that may enhance efforts to balance supply and demand in the professional workforce and the distribution of psychologists.

Psychological effects of participation and nonparticipation in a placebo-controlled zidovudine clinical trial with asymptomatic human immunodeficiency virus-infected individuals.

Psychological effects of participation in Protocol 019, a zidovudine placebo-controlled clinical trial, were investigated. Forty-six Protocol 019 subjects and 27 control asymptomatic human immunodeficiency virus-seropositive subjects were assessed at entry, 2 months, 6 months, and after trial modification. At baseline there were no psychological differences. Most Protocol 019 and control subjects were depressed on at least one psychological measure; fewer were anxious. Both groups had improvement over time. By 6 months, Protocol 019 subjects had decreased Beck Depression Inventory (BDI) scores, state anxiety, stress reaction, and symptoms of depression and anxiety. Controls had decreased scores on only the BDI. Over time, the percentage meeting modified DSM III-R criteria for anxiety decreased in both groups and the proportion of Protocol 019 subjects meeting DSM III-R depression criteria decreased. After protocol modification, study subjects were less depressed and distressed than controls. Protocol 019 subjects reduced depression symptoms but controls did not. Clinical trial participation was not deleterious and may have yielded some relative psychological benefit.

Depression in Alzheimer patients: discrepancies between patient and caregiver reports.

Estimates of the prevalence of depression in dementia patients vary widely. One problem in accurate identification of such depression is determining whether to rely on demented patients' reports or second-party caregivers' reports of symptoms. To further explore this problem, 31 outpatients with probable Alzheimer disease and their 31 caregivers were interviewed separately with depressive symptom questionnaires. Caregivers reported more depressive symptoms in dementia patients than patients reported for themselves. Correlations between caregivers' and patients' reports of individual symptoms ranged between -0.23 to 0.76, with lowest correlations found for intrapsychic distress, cognitive impairment, and hallucinations. Patients' responses were not necessarily affected by stereotypic responding or severity of impairment, but patients appeared to under-report symptomatology. Caregivers' responses were associated with the extent of contact with the patients, familial relationship, and sources of information used to determine patients' mood but were not correlated with caregivers' depression or ratings of how they would feel if they were "in the patient's shoes."

Psychological and physical reactions to whirlpool baths.

Physical and psychological reactions to whirlpool baths were studied in a group of 40 healthy adult volunteers. Responses were measured after 10-min immersions in whirlpools under on and off conditions. Whirlpools and warm baths both induce increases in pulse and finger temperature, although a greater increase in finger temperature is associated with whirlpools. Both conditions produced increased feelings of well-being and decreased state anxiety. Whirlpool immersion resulted in a slight decrease in DSM III symptoms of anxiety. Immersion did not produce consistent significant changes in blood pressure, respiration rate, muscle tension, or pupil size. No changes emerged in anxiety, hostility, or depression on the Multiple Affect Adjective Checklist. Although whirlpools appear to be a popular form of recreation, this study reveals limited significant incremental relaxation beyond the effects due to warm water alone.

Differences between patient and family assessments of depression in Alzheimer's disease.

A structured interview covering the DSM-III criteria for major depression was adapted for separate use with Alzheimer's disease patients and with their families. Data from 36 patients yielded a depression rate of 13.9%, whereas information from their families indicated that the rate was 50.0%. This disagreement reflected greater family endorsement of patients' loss of interest or pleasure, irritability, fatigue, and feelings of worthlessness. Use of DSM-III-R criteria narrowed but did not eliminate the discrepancy between patients' and families' assessments of the patients' depression. Uniform procedures for gathering and integrating data from the family that are relevant to diagnosis in this group are indicated.

An experimental inquiry into transference roles and age.

In this psychotherapy analogue investigation, the effects of client age and therapist age on transference-like projections onto therapists were examined. Young (25-35) and older (60-70) pseudoclients compared paraprofessional therapists to significant figures in their own lives after a dyadic "helping" interview. The results provide empirical support for the phenomenon of reverse transference in therapy with older patients. Older clients were more inclined than young clients to view therapists, particularly younger therapists, as similar to their children. Young clients more willingly attributed parental qualities to older therapists. Both old and young clients may see therapists more as peers or friends than as family members.