Antihypertensive treatment,compliance, and quality of life: Review of a little-understood relation

If patients notoriously violate treatment regimens known to effectively control hypertension, then there must be some subjective costs associated with adherence to these regimens. Generally speaking, there must be some reduction in quality of life associated with antihypertensive medication. Unfortunately the concept of quality of life, due to its lack of specificity, is of little help in further investigating the nature of these subjective costs. We developed a simple neuropsychophysiological model based on fundamental psychological and physiological processes: corticoinhibitory effects of phasic blood pressure elevation reduce the aversive or painful qualities of many stressors. This negative reinforcement increases the rate of the reinforced physiological behavior, i.e., phasic analgesic blood pressure increases. Such negatively reinforced operant behavior is known to be extremely resistant to extinction. Counter actions such as taking antihypertensive medication not only lead to reduced quality of life due to their cancellation of the analgesic effect of conditioned blood pressure increase, but also lead to some form of reluctance to comply with treatment. The model not only provides an innovative etiological path to the emergence of neurogenic essential hypertension, but also yields a highly specific and lean concept of quality of life. Furthermore, it supplies the health care community with a concise explanation for the well-known low compliance of patients with their antihypertensive regimens. In addition to its parsimony, the model fits well with various experimental findings and has been operationalized and tested empirically. Specific therapeutic implications can be derived.     

Predicting interpersonal competence in young adulthood: The roles of family,self, and peer systems during adolescence

The present investigation examines the impact of family, self, and peer systems, evaluated during early adolescence, on the development of interpersonal competence in young adulthood. The participants were 110 Caucasian individuals, their mothers, and one of their teachers. At the first assessment, the participants ranged in age from 11.5 to 15.1 years old. Approximately six years later, the participants completed a second evaluation involving assessment of interpersonal competence. Increased interparental conflict and parental divorce predicted decreased self-esteem. Decreased self-esteem predicted poorer peer-adolescent relationships, which, in turn, forecasted poorer adult interpersonal competence. The results suggest that living in a distressed family leads to diminished self-esteem which can influence the quality of peer relationships and place an adolescent on a trejectory toward difficulties in interpersonal competence during adulthood.     

Role of maternal functioning and parenting skills in adolescent functioning following parental divorce

While divorce has been associated with impaired child functioning, the mechanisms within the divorce process leading to such an outcome have rarely been examined. The following hypothesis was examined: Divorce is associated with poor parental adjustment or disrupts parenting behavior, or both, which leads to poor adolescent functioning. Subjects were 121 and 93 young adolescents from intact and recently divorced families, respectively, and their mothers and teachers. Mothers completed measures assessing parental conflict and depression, observers coded parenting skills during a mother-adolescent interaction, and teachers completed measures assessing adolescent functioning. Although the magnitude of differences was not large, analyses of variance indicated that the divorced sample was functioning poorer than the married sample on all measures except interparental conflict. Path analysis suggested that parental functioning and parenting skills play a role in adolescent functioning following divorce.     

Dysfunctional isolation in the elderly: Increasing marital and family closeness through improved communication

Unique developmental crises in old age may lead to social withdrawal that negatively affects the individual and his/her marital and family relationships. Without an awareness of these aging dynamics, the therapist can inadvertently perpetuate these distancing behaviors which can exacerbate marital and family conflict. This paper discusses certain developmental crises which can result in increased isolation for the older adult, and suggests therapeutic interventions to facilitate increased closeness among family members.     

Recent Suicidal Ideation Among Patients in an Inner City Emergency Department

The rates and associated features of suicidal ideation among 5,641 patients seeking routine, nonsuicide related care in an inner‐city emergency department were examined. Approximately 8% of patients seeking routine care in the emergency department reported some form of suicidal ideation within the past 2 weeks. Suicidal ideation was common in individuals who were single with poorer mental health, had higher depression, and had received some drug or alcohol treatment in the past 3 months or had used cocaine or marijuana in the past 30 days. Improved screening procedures could help to identify routine care patients who are at risk for suicide.