Racial differences in the frequency of depressive symptoms among community dwelling elders: the role of socioeconomic factors.

In a biracial sample of community dwelling elders (n=4162, the Duke EPESE), African-Americans endorsed more items than Whites on a standardized depression scale, the CES-D, in unadjusted, cross-sectional analyses. However, indices of socioeconomic status (e.g., education and problems meeting needs) were found to mediate the relationship between race and depression. When these socioeconomic variables were included in cross-sectional analyses, the association between depressive symptoms and race reversed such that Whites were significantly more likely to endorse depressive symptoms than African-Americans. Further, whereas in unadjusted, longitudinal analyses, race was unrelated to changes in depressive symptoms over time, with the inclusion of the socioeconomic variables Whites were found to endorse more depressive symptoms than African-Americans. We conclude that socioeconomic variables influence the size and direction of racial differences in the endorsement of depressive symptoms in community dwelling elders.

Territoriality and obsessive-compulsive symptoms.

We proposed a relationship between territoriality and obsessive-compulsive (OC) symptoms and derived and tested several hypotheses. We predicted that territoriality could be adequately assessed by a new self-report measure, that a nonspurious and significant relationship exists between territoriality and OC symptoms and disorder, that territoriality would serve as a risk for the future increase of OC symptoms, and that OC disorder (OCD) patients would manifest their territoriality needs by choosing to sit farther from their therapists than non-OCD patients. Results from four studies on nonpatient and patient samples were consistent with our preliminary conceptualization, which deserves continued development and research attention.

Family-focused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy.

BACKGROUND: Few studies have examined the combined effects of psychosocial treatment and pharmacotherapy for bipolar disorder. This study used a randomized, controlled design to examine a 9-month, manual-based program of family-focused psychoeducational treatment (FFT). METHODS: Bipolar patients (N = 101) were recruited shortly after an illness episode and randomly assigned to 21 sessions of FFT (n = 31) or to a comparison treatment involving two family education sessions and follow-up crisis management (CM; n = 70). Both treatments were delivered over 9 months; patients were simultaneously maintained on mood stabilizing medications. Patients were evaluated every 3 months for 1 year as to relapse status, symptom severity, and medication compliance. RESULTS: Patients assigned to FFT had fewer relapses and longer delays before relapses during the study year than did patients in CM. Patients in FFT also showed greater improvements in depressive (but not manic) symptoms. The most dramatic improvements were among FFT patients whose families were high in expressed emotion. The efficacy of FFT could not be explained by differences among patients in medication regimes or compliance. CONCLUSIONS: Family-focused psychoeducational treatment appears to be an efficacious adjunct to pharmacotherapy for bipolar disorder. Future studies should evaluate family treatment against other forms of psychotherapy matched in amount of therapist-patient contact.

Health problems and service utilization in the homeless.

This study examined the health problems and utilization patterns of homeless individuals (n = 292) seeking medical services in a small, southern community. Results showed that the medical problems for which the homeless sought treatment were often (72.6 percent) a reoccurring problem for which treatment had been previously received. The most prevalent medical problem was upper respiratory infection (47 percent), likely exacerbated by the high rate (73 percent) of cigarette smoking found among the sample. More than half (51.4 percent) of the participants had used other medical services in the past month. Despite these high rates of utilization, the homeless may, in fact, be underutilizing appropriate preventive medical services, waiting until the medical problem becomes serious before seeking treatment, and overutilizing emergency rooms for nonemergency care. Community-based services sensitive to the needs of the homeless are likely to cost communities less money while providing better services to the homeless.

Harman (1-methyl-beta-carboline) in blood plasma and erythrocytes of nonalcoholics following ethanol loading.

Eleven subjects having no history of substance abuse or dependence who agreed to abstain from alcohol for one week prior to the investigation were selected to participate in the present study. On two occasions, separated by four to six weeks, blood was drawn over an 8-hour period (0, 0.5, 1, 2, 4 and 8 hours). On the first occasion, subjects were given an oral dose of ethanol (1 g/kg) after the first blood sample was drawn (ethanol-loading condition). On the second occasion no ethanol was administered (control condition). On both occasions no detectable harman was found in the plasma of subjects. In the control condition harman was detected in the erythrocytes of 7 subjects which remained relatively stable over time. In the ethanol-loading condition, however, a time-dependent increase of harman in the erythrocytes was observed. The concentration of ethanol, acetaldehyde, and erythrocyte-harman showed a parallel trend over time. These findings demonstrate an increased level of harman following ethanol loading in humans.

Benzodiazepine prescriptions and therapist non-compliance.

In an investigation of benzodiazepine (BDZ) prescription patterns, psychiatrists in private practice were found to exhibit "therapist non-compliance" with regard to general medical recommendations for BDZ use. The findings indicate that BDZ prescriptions in general (53% among patients treated with psychotropics) as well as long-term treatment of patients (37%) are quite common among private practice psychiatrists. BDZ treatment is not restricted to "minor psychiatric disorders", and contrary to the guidelines, even patients with substance dependence are not excluded. A positive association was found for BDZ use and patients' self-reported symptoms and health complaints, the number of other medications prescribed and age. In a discussion of therapist non-compliance it is proposed that this may be a consequence of a symptom-based treatment model, individual health concepts, the doctor-patient relationship and physician's cost-benefit analysis. Thus, psychiatrists' non-compliance may reflect to some extent a case-oriented treatment rationale.