摘要:

Multiple studies have demonstrated that individual psychotherapy, pharmacotherapy, and the two in combination are all effective treatments for depressed outpatients. However, the implications of these data for clinical practice have been incompletely considered, and the often drawn mistaken conclusion is that they support routine treatment with psychotherapy and pharmacotherapy together. Analyses of treatment success rates, treatment failure rates, and treatment dropout rates indicate that combined treatment offers no advantage over treatment with psychotherapy alone and only modest advantage over treatment with pharmacotherapy alone. Routine use of combined treatment, therefore, exposes patients to unnecessary costs and side effects. The data suggest that psychotherapy alone should usually be the initial treatment.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This study assessed levels of depressive symptomatology in a household probability sample of Alaskan Native (N= 188) and Euro-American (N= 371) residents of 13 communities in Alaska. Our objective was to examine ethnic differences in both the association between depressive symptomatology and exposure to the ExxonValdezoil spill and subsequent cleanup efforts, and in the role of family support as a moderator of exposure to this technological disaster. Level of exposure was significantly associated with mean Center for Epidemiological Studies-Depression Scale scores in both Natives (p<.05) and Euro-Americans (p<.01). Both ethnic groups also reported significant declines in traditional relations with increasing levels of exposure (p<.001). However, Natives had a significantly higher mean Exposure Index score than Euro-Americans and were more likely to report working on cleanup activities, damage to commercial fisheries, and effects of the spill on subsistence activities. Depressive symptomatology was associated with reported participation in cleanup activities and other forms of contact with the oil in Natives, and reported damage to commercial fisheries, use of affected areas, and residence in a community in geographic proximity to the spill in Euro-Americans. Perceived family support was not directly associated with depressive symptoms in either ethnic group, but did serve to buffer the effects of exposure on depressive symptoms in Euro-Americans. The results suggest that cultural differences play an important role in determining the psychosocial impacts of a technological disaster, particularly with respect to exposure, appraisal of an event as stressful, perceived family support as a moderator of stress, and expression of depressive symptomatology.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The purpose of this study was to determine the relationship of ethnic identity to psychiatric diagnosis in white, black, Latino, and Asian clients of the Los Angeles County mental health system. The sample (N= 26,400) consisted of adult inpatient and outpatient clients seen in county mental health facilities between January 1983 and August 1988. Logistic regression analysis was used to determine the relationship of ethnicity to diagnosis in both outpatient and inpatient samples. The covariates included in the analysis were age, gender, socioeconomic status, and primary language. Ethnicity had a significant and consistent relationship to diagnosis in both outpatient and inpatient samples, with black and Asian clients having a greater proportion of psychotic diagnoses than whites, and Latinos a lesser proportion than whites. None of the covariates included in the analysis had a consistent relationship to diagnosis. Whites and Asians received more diagnoses of major affective disorders than blacks or Latinos; blacks and Asians received more diagnoses of schizophrenia and other psychoses than whites, and Latinos received fewer of these diagnoses than whites. Substance abuse was lower for Asians than for the other three groups. Based on the findings, it was concluded that there continues to be a difference in psychiatric diagnosis that is related to ethnicity. Clinical practice issues and recommendations for further research are considered in relationship to these findings.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The present study was designed to examine the relationship between electrodermal activity and the levels of the dopamine metabolite homovanillic acid (HVA) and the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in cerebrospinal fluid. Lumbar cerebrospinal fluid from 36 unmedicated and six medicated schizophrenic patients and 23 controls was analyzed by gas chromatograph-mass spectrometer. The schizophrenic patients and a group of 14 normal controls were presented with a series of orienting tones (1000 Hz, 80 db, 2-second duration) while electrodermal activity was monitored. For the patients, this occurred during an acute episode of schizophrenia. The results suggest an inverse relation between electrodermal activity and the CSF-level of HVA. Although the picture is not entirely consistent, electrodermal nonresponders appear to have normal HVA levels, while electrodermal responders have decreased levels compared with normal controls. There is also a relation between electrodermal activity and 5-HIAA, but this association is not as clear-cut as the one between electrodermal activity and HVA.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This paper explores how symptoms of mental health problems influence acquired immune deficiency syndrome-related risk behaviors, and how changes in those symptoms relate to risk behaviors engaged in by young adults. Repeated interviews with 602 youths since 1984 provide a history of change in behaviors. Mental health symptoms during adolescence (alcohol/drug [r=.28]; conduct disorder [r=.27]; depression [r=.16]; suicide [r=.14]; anxiety [r=16]; and posttraumatic stress [r=.09]) are associated with higher numbers of risk behaviors (specifically, prostitution, use of intravenous drugs, and choice of a highrisk sex partner) during young adulthood. Changes in mental health symptoms between adolescence and young adulthood are related to the number of risk behaviors engaged in by young adulthood (total number of symptoms [B =.10], alcohol/drug abuse or dependence [B =.34], depression [B =.20], suicidality [B =.35], anxiety [B =.13], and posttraumatic stress [B =.14]). Changes in symptoms of mental health problems are associated specifically with those risk behaviors that are initiated primarily in young adulthood: intravenous drug use, prostitution, and choice of risky partners. The findings show that prevention and treatment of mental health problems are important components of preventive interventions for human immunodeficiency virus infection in high-risk teens and young adults.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

In the present study, we replicated and extended our previous findings of increased 24- hour urinary catecholamine excretion in posttraumatic stress disorder (PTSD). Dopamine, norepinephrine, and epinephrine concentrations were measured in 22 male patients with PTSD (14 inpatients and eight outpatients) and in 16 nonpsychiatric normal males. The PTSD inpatients showed significantly higher excretion of all three catecholamines compared with both outpatients with PTSD and normal controls. Dopamine and norepinephrine, but not epinephrine, levels were significantly correlated with severity of PTSD symptoms in the PTSD group as a whole. In particular, these catecholamines seemed related to intrusive symptoms. None of the catecholamines were correlated with severity of depression. The findings support the hypothesis of an enhanced sympathetic nervous system activation in PTSD, and suggest that increased sympathetic arousal may be closely linked to severity of certain PTSD symptom clusters.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This study investigates the similarity between patients' relationships with their therapists and patients' relationships with others in their life. We examined the in-session narratives about the therapist and compared them with the patient's general relationship pattern as determined by a previously tested method, the Core Conflictual Relationship Theme (CCRT) method. The source for both narratives and CCRT patterns were transcripts of therapy sessions from 35 consenting outpatients in a university clinic. We found significant similarity between the patterns of relationship with the therapist and with others. One aspect of the relationship pattern, the patient's response to the therapist and to others, was consistently similar. We offer objective evidence in support of an age-old and central tenet of psychodynamic therapy, the transference concept.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

To clarify the relationship between dissociative symptoms and obsessive-compulsive disorder (OCD), 100 patients with OCD were assessed with standardized instruments measuring symptoms of OCD, dissociation, and depression. Diagnoses of personality disorders and dissociative disorders were made using structured interviews. Compared with a previous study, OCD patients had dissociation scores slightly higher than normal controls and comparable to patients with other anxiety disorders. Patients with elevated dissociation scores had more severe OCD symptoms, were more depressed, and were more likely to have a personality disorder than patients with low dissociation scores. Although dissociative symptoms were frequently reported by OCD patients, symptoms of OCD may also mimic dissociation in some patients.

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:1992

数据来源: OVID