Results of electroencephalographic and familial studies in Wilson's disease]

The results of electroencephalographic and familial studies of 31 Wilson's disease patients coming from 26 kindreds are presented. Prior to treatment, 8 patients showed pathological conditions, while 9 and 11 patients showed borderline and normal conditions, respectively, it having not been possible to determine electroencephalographic conditions characteristic of Wilson's disease and find any relationships between the intensity of E.E.G. changes and the clinical picture and stage of development of the disease, respectively. Under penicillamine treatment, there was observed a tendency toward normalization of pathological conditions rather than deterioration of normal E.E.G. findings. So far as familial studies are concerned, the authors report the results obtained for 9 fathers, 19 mothers, and 24 siblings from a total of 21 kindreds; what is remarkable in this connection is the comparatively small percentage of normal E.E.G. findings for healthy siblings. It was only in one single kindred that it was possible to observe similarities between E.E.G. variations of individual family members.     

A biopsychosocial approach to liver transplant evaluation in two patients with Wilson's disease

Wilson's disease (WD) is characterized by hepatic, neurological, and/or psychiatric disturbances. In some cases, liver transplantation is indicated. Because psychologists and other health care workers play an increasing role in the evaluation of individuals presenting for transplant, an understanding of the heterogeneous phenotype of WD is important for mental health professionals working in medical settings. This article reviews two cases of patients with WD (one probable, one confirmed) presenting for liver transplantation and a biopsychosocial assessment approach is demonstrated. Patients are presented in terms of medical, psychiatric, and psychosocial history, neuropsychological examination results, and the subsequent indications for liver transplantation. Both patients exhibited neurocognitive and psychiatric symptoms. One patient was determined to be a marginally suitable candidate for transplantation, whereas the other was considered at high risk for negative outcome post-transplant. This article demonstrates the importance of considering phenotypic presentation, neurocognitive function, psychiatric status, and psychosocial circumstances in assessing transplant readiness in patients with WD. A comprehensive and integrative biopsychosocial assessment approach is appropriate for evaluating patients with WD presenting for liver transplantation.     

Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects

Bright light therapy for seasonal affective disorder (SAD) has been investigated and applied for over 20 years. Physicians and clinicians are increasingly confident that bright light therapy is a potent, specifically active, nonpharmaceutical treatment modality. Indeed, the domain of light treatment is moving beyond SAD, to nonseasonal depression (unipolar and bipolar), seasonal flare-ups of bulimia nervosa, circadian sleep phase disorders, and more. Light therapy is simple to deliver to outpatients and inpatients alike, although the optimum dosing of light and treatment time of day requires individual adjustment. The side-effect profile is favorable in comparison with medications, although the clinician must remain vigilant about emergent hypomania and autonomic hyperactivation, especially during the first few days of treatment. Importantly, light therapy provides a compatible adjunct to antidepressant medication, which can result in accelerated improvement and fewer residual symptoms.     

Handwriting movement analyses for monitoring drug-induced motor side effects in schizophrenia patients treated with risperidone

Epidemiologic studies indicate that nearly 60% of schizophrenia (SZ) patients treated with conventional antipsychotic drugs develop extrapyramidal side effects (EPS) such as parkinsonism and tardive dyskinesia. Although the prevalence of EPS has decreased due to the newer antipsychotics, EPS continue to limit the effectiveness of these medicines. Ongoing monitoring of EPS is likely to improve treatment outcome or compliance and reduce the frequency of re-hospitalization. A quantitative analysis of handwriting kinematics was used to evaluate effects of antipsychotic medication type and dose in schizophrenia patients. Twenty-seven schizophrenia patients treated with risperidone, six schizophrenia patients who received no antipsychotic medication and 47 healthy comparison participants were enrolled. Participants performed a 20-min handwriting task consisting of loops of various sizes and a sentence. Data were captured and analyzed using MovAlyzeR software. Results indicated that risperidone-treated participants exhibited significantly more dysfluent handwriting movements than either healthy or untreated SZ participants. Risperidone-treated participants exhibited lower movement velocities during production of simple loops compared to unmedicated patients. Handwriting dysfluency during sentence writing increased with dose. A 3-factor model consisting of kinematic variables derived from sentence writing accounted for 83% (r = .91) of the variability in medication dose. In contrast, we found no association between observer-based EPS severity ratings and medication dose. These findings support the importance of handwriting-based measures to monitor EPS in medicated schizophrenia patients.     

Person-treatment interactions across nonaversive response-deceleration procedures for self-injury: A case study of effects and side effects

Three nominally nonaversive response-deceleration treatment packages, “gentle teaching,” differential reinforcement of incompatible behavior plus interruption, and graduated guidance, were administered to two profoundly retarded men who exhibited topographically similar self-injurious head-hitting maintained under contrasting contingencies identified by functional analysis. Following No Demand and Instructional Demand baseline sessions, the three intervention packages were balanced across 18, 30-minute analog training sessions and three trainers in each subject's prevocational setting, using a simple panel-pressing task as the training objective. There were significant differences between the three packages in rates of target response suppression, effects on collateral behaviors, acquisition of panel pressing, and immediate post-treatment carry-over, both within and between subjects. It is concluded that both functional analysis and within-subject treatment comparison may assist in identification of the least restrictive alternative in applied service settings, and that topographic similarity of self-injury between subjects may not necessarily indicate selection of similar treatment packages.     

Some metrical issues with meta-analysis of therapy effects

Two metrical issues, both concerning the index of effect size used in meta-analyses of therapy effects, are discussed with reference to such analyses. The first issue refers to use of the standard deviation of change scores as a metrical unit, and the conclusion is that the standard deviation of unadjusted post-test scores should be used instead. The second issue concerns measurement errors, and it is argued that the metrical unit—irrespective of which kind of variability metric is chosen—should be corrected for such errors, hence expressing each therapy effect relative to an estimated true rather than observed unit. It is proposed that a set of metrical alternatives should be used in a meta-analysis, so that the analysis is performed for each alternative and the results are compared across the alternatives.     

No blank slates: Pre-existing schemas about pharmaceuticals predict memory for side effects

Objectives: Attribution of symptoms as medication side effects is informed by pre-existing beliefs about medicines and perceptions of personal sensitivity to their effects (pharmaceutical schemas). We tested whether (1) pharmaceutical schemas were associated with memory (recall/recognition) for side effect information (2) memory explained the attribution of a common unrelated symptom as a side effect.

Design: In this analogue study participants saw the patient leaflet of a fictitious asthma drug listing eight side effects.

Main outcome measures: We measured recall and recognition memory for side effects and used a vignette to test whether participants attributed an unlisted common symptom (headache) as a side effect.

Results: Participants who perceived pharmaceuticals as more harmful in general recalled fewer side effects correctly (r_{Correct Recall} = ?.273), were less able to differentiate between listed and unlisted side effects (r_{Recognition Sensitivity} = ?.256) and were more likely to attribute the unlisted headache symptom as a side effect (r_{side effect attribution} = .381, ps < .01). The effect of harm beliefs on side effect attribution was partially mediated by correct recall of side effects.

Conclusion: Pharmaceutical schemas are associated with memory for side effect information. Memory may explain part of the association between pharmaceutical schemas and the attribution of unrelated symptoms as side effects.     

Enrichment and Stress in Families Caring for a Child with a Serious Emotional Disorder

We examined enrichment and stress in 214 families who had children with severe emotional disorders. Caregivers' ratings of enrichment and stress were obtained through a newly developed instrument, the Effects of the Situation Questionnaire, which used parallel items covering 17 life areas. While ratings of stress were generally higher than enrichment, caregivers reported some enrichment in areas encompassing self concept and family relationships, Bivariate and multivariate analyses using various child, family, and service-system variables revealed that stress was notably associated with severity of the child's disorder, low empowerment, and a lack of coordination among service providers. Enrichment was unrelated to severity but associated with high empowerment and spiritual support. Our findings suggest that families' experiences of caregiving can have both positive and negative aspects and that a comprehensive approach to serving and studying families should take both into account.     

Short-term effects of telephone therapy for breast cancer patients.

The authors report the short-term effects of a clinical trial testing 2 telephone therapies for breast cancer patients. Women (N = 222) with breast cancer were recruited and randomly assigned to cancer education, emotional expression, or standard care. Oncology nurses conducted 6 individual 30-min-therapy phone sessions. Women in the cancer education condition reported greater perceived control than women in the standard care condition. No treatment effects were obtained for mood or quality of life. These are the 1st data from a large-scale study testing telephone therapy, and they suggest that such therapies may be ineffective. Explanations for the results include therapy type and delivery, participant characteristics, short- versus long-term results, therapy conent, and whether therapy is necessary for breast cancer patients.     

Relaxation therapy for insomnia: nighttime and day time effects

We compared day time functioning in college students with and without insomnia and explored changes in day time functioning after progressive relaxation (PR) treatment for insomnia. Students with insomnia (SWI; n = 57) were compared to a control group of students not complaining of insomnia (SNI; n = 61) on self-reported sleep variables and five questionnaires: Insomnia Impact Scale (IIS), Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Penn State Worry Questionnaire (PSWQ). SWI demonstrated significant impairment on all day time functioning and sleep measures compared to SNI. To investigate treatment effects on day time functioning, 28 SWI were randomly assigned to PR. Treated SWI were compared to untreated SWI and SNI at posttreatment. Treated participants improved sleep in comparison to untreated SWI, but failed to show significant improvements in day time functioning. Insomnia treatments focused on improving sleep may not improve day time functioning, or day time gains may emerge more slowly than sleep gains. This study documents the wide range of day time functioning complaints in young adults with insomnia and suggests that the goal of insomnia treatment should be to not only improve sleep but also to improve the subjective experience of day time functioning.     

Description and Formative Evaluation of the Kentucky IMPACT Program for Children with Serious Emotional Disturbance

The Kentucky IMPACT Program is described and formative evaluation results are reported. This information suggests that the Program has value for children and youth with serious emotional and behavioral disorders.     

The effects of behavioral activation therapy with inpatient geriatric psychiatry patients

This study examined the effects of Behavioral Activation (BA) treatment on depressive symptoms and quality of life among older adult patients in a geriatric psychiatry facility. There were 50 participants with mild to moderate cognitive impairment, each being 65 years of age or older. A 2 (between) × 3 (time of measurement) design was used in this study comparing control (treatment-as-usual) and experimental (BA) conditions at pre-, mid-, and posttreatment. BA consisted of eight 30- to 60-minute sessions across 4 weeks. Intent-to-treat analyses indicated a significant Group × Time interaction on depressive symptoms, with this effect remaining when only completer data were included. Further analyses indicated that this effect was due to significant change early in treatment in both the full and completer samples. There was no evidence of a significant effect on the quality-of-life measure. Cognitive status was not related to change in depressive symptoms, suggesting that BA may be useful across a range of older adults.     

Predicting the effects on husbands of behaviour therapy for wives' agoraphobia

The husbands of 33 agoraphobic women were studied systematically before and for 1 yr after their wives received intensive exposure in vivo mainly in small, cohesive groups. Although most husbands reported improved personal adjustment 1 yr after their wives' therapy, many had experienced transitory negative reactions such as anxiety and depressive symptoms. These were most likely to occur after large, rapid improvements in the phobic and general symptoms of severely-disabled patients. Such improvements challenged the husbands' capacity to adapt to their wives' changed attitudes and behaviour, particularly regarding sex roles. These findings explain why reports of negative effects on husbands are found infrequently in behavioural studies of agoraphobia, which generally exclude patients with major additional symptoms, have relatively high drop-out rates and generate improvements comparatively slowly. In contrast, group exposure in the present study generated rapid improvements and inhibited dropping-out, even in patients with severe additional symptoms and problems, who were included in the study. Thus, the likelihood of repercussions on the husband was maximized. Negative effects were most likely in husbands who had adapted to their wives' disability as part of a sex-role stereotyped view of marriage, and in husbands who were persistently critical and unsupportive of their wives.     

Long-term stability of cognitive behavioral therapy effects for panic disorder with agoraphobia: A two-year follow-up study

Objective

Cognitive-behavioral therapy (CBT) aims to help patients establish new behaviors that will be maintained and adapted to the demands of new situations. The long-term outcomes are therefore crucial in testing the durability of CBT.

Method

A two-year follow-up assessment was undertaken on a subsample of n = 146 PD/AG patients from a multicenter randomized controlled trial. Treatment consisted of two variations of CBT: exposure in situ in the presence of the therapist (T+) or on their own following therapist preparation (T−).

Results

Both variations of CBT had high response rates and, overall, maintained the level of symptomatology observed at post-treatment with high levels of clinical significance. Effect sizes 24 months following treatment were somewhat lower than at the 6-month follow up. Once patients reached responder status, they generally tended to remain responders at subsequent assessments. Differences were observed for patients that obtained additional treatment during the follow-up period. Expert opinion and subjective appraisal of treatment outcome differed. No robust baseline predictors of 2-year outcome were observed.

Conclusion

Most patients maintain clinically meaningful changes two years following treatment across multiple outcome measures. Approximately 1/3 of patients continued to experience meaningful residual problems.