Empirically derived pain-patient MMPI subgroups: prediction of treatment outcome

Fifty-seven male chronic pain patients admitted to an inpatient multimodal pain treatment program at a Midwestern Veterans Administration hospital completed the MMPI, Profile of Mood States (POMS), Tennessee Self-Concept Scale (TSCS), Rathus Assertiveness Schedule (RAS), activity diaries, and an extensive pain questionnaire. All patients were assessed both before and after treatment, and most also were assessed 2-5 months prior to treatment. No significant changes occurred during the baseline period, but significant improvements were evident at posttreatment on most variables: MMPI, POMS, TSCS, RAS, pain severity, sexual functioning, and activity diaries. MMPI subgroup membership, based on a hierarchical cluster analysis in a larger sample, was not predictive of differential treatment outcome. Possible reasons for comparable treatment gains among these subgroups, which previously have been shown to differ on many psychological and behavioral factors, are discussed.

Automatic external defibrillators: clinical, training, psychological, and public health issues

Automatic external defibrillators (AEDs) will be used by spouses, family members, emergency first-responders, and the citizenry at large. Such use, however, raises a number of clinical, training, psychological, and public health issues. Clinical issues: Is cardiac arrest to be verified by the operator or the AED? Second verification systems, such as breath detectors, produce errors of omission, but greatly expand the pool of potential users. The relative merits of high sensitivity and low specificity in arrest verification must be defined by clinicians relative to the setting and the potential users. AEDs require cessation of basic CPR during their assessment periods; clinicians must determine the tradeoff between long interruption of basic life support and much earlier delivery of countershocks. Training issues: Criteria for those to be trained include consideration of who the patient will be and who the AED operator might be. AEDs pose a familiar adult education problem, that is, acquisition of a new psychomotor skill and retention of that skill for long periods before performance. What are the best teaching techniques? Currently available AEDs have different designs for device-operator interaction. Which design is most likely to assure proper performance during an actual arrest? Psychological issues: What are the psychological effects of learning about, living with, and eventually using an AED? The development of the automatic external defibrillator constitutes the most recent attempt to achieve early defibrillation of patients in cardiac arrest. The potential public health effect of such devices is enormous.

Validation of the Luria-Nebraska Intellectual Processes Scale as a measure of intelligence in male alcoholics

This study investigated the Luria-Nebraska Intellectual Processes Scale (IPS) as a predictor of Wechsler Adult Intelligence Scale (WAIS) IQs among alcoholic inpatients. Strong correlations were found between the IPS and WAIS Verbal IQ and Full Scale IQ; however, the correlation with Performance IQ was only -.41. IQ estimates based on Prifitera and Ryan's (1981) regression equations derived on psychiatric inpatients differed significantly from obtained IQs in the current alcoholic sample. The importance of adequately assessing Performance IQ among patients with alcohol-related problems is discussed.

Arginine vasopressin enhances retention of morphine tolerance

The hot plate method was used to assess tolerance in rats following daily injections of morphine. Following analgesia assessment, or a time equated rest period, rats were injected with either saline or a pituitary peptide. Arginine vasopressin, but not ACTH 4-10, prolonged the retention of morphine tolerance when assessed five weeks after the last injection. Neither the rate nor the degree of tolerance development were influenced by either peptide. These hormones had no effect on retention of tolerance development were influenced by either peptide. These hormones had no effect on retention of tolerance in rats not assessed for analgesia during the period of tolerance development. The effects of pituitary peptides on morphine tolerance are analogous to the effects they have on learning and memory processes, suggesting that similar adaptational processes are occurring in both phenomena.

An analysis of onsite versus offsite dental care for an institutionalized population

The Job Corps is a program for disadvantaged youths between the ages of 16 and 22 in need of general education and vocational training. During fiscal 1978, 61 residential centers had a total enrollment of 33,732. Despite differences in size, location, and organizational structure of the centers, uniform requirements for health services have been established. The administration at each center must ensure emergency dental care, arrange for examination of all corps members, and make routine treatment available on a priority basis. Because of uniqueness of local situations, various mechanisms are used to accomplish these goals. The most fundamental difference is the provision of care by means of onsite clinics with salaried dentists as opposed to offsite arrangements with fee-for-service in private dental offices. An analysis of cost and utilization data for the 1978 FY indicated that onsite care ($96.19/CMY) was significantly more expensive than offsite care ($72.24/CMY). The difference in the mean number of visits, however, was also statistically significant. Onsite care resulted in 4.78 visits/CMY; corps members made 2.24 visits/CMY when offsite care was provided. Furthermore, even taking into consideration the initial expenses involved in establishing clinical facilities, the cost of an onsite visit, $22.30, was less than an offsite visit, $33.62. The cost and utilization patterns were the same at small centers as large centers.

Pain-patient MMPI subgroups: the psychological dimensions of pain

Two-hundred-forty male pain patients were given the MMPI and an extensive pain history questionnaire. A hierarchical clustering procedure was used, and three distinct profiles emerged. One profile was essentially "normal," while a second profile revealed the "hypochondriasis" configuration, and a third was highly elevated on scales which reflect a "psychopathological" type of profile. A discriminant analysis yielded functions correctly classifying over 90% of the subjects in each group. Although the three groups did not significantly differ on age, education, income, IQ, assertiveness, type of pain, or years of pain duration, they did differ on the pain history questions relating to pain severity and pain impact on their lives. The psychopathological group reported significantly more distress than the hypochondriasis group, and the hypochondriasis group reported significantly more distress than the normal group. The implications for pain treatment are discussed.

On-center vs off-center dental care for Job Corps members: cost and utilization

While Job Corps Centers vary in size, location, and administrative structure, they are subject to uniform requirements for health services, established by federal regulation and must make individual decisions about whether to furnish dental care on-site or by some alternative arrangement in the community. Analysis of cost and utilization data indicated that expenditures for on-site dental care are greater than for off-center care. However, on-center care results in more dental visits and a lower cost/visit. These observations hold even for the smallest size centers.

Pretty patient - healthy patient? A study of physical attractiveness and psychopathology

Recent research has shown that physically attractive persons are viewed by others, and by themselves, as "better" in many ways than less attractive persons. The trend in research findings is pervasive, and a stereotype has been proposed: "what is beautiful is good." This study explored the relationship between physical attractiveness and emotional adjustment of hospitalized schizophrenic patients. It was hypothesized (1) that judges would consider attractive patients better adjusted than unattractive patients; and (2) that attractive patients would appear healthier or better adjusted than unattractive patients on standard diagnostic measures. The results of multivariate analyses supported the first hypothesis, but consistently failed to support the second. Limitations of the present findings and of the "beautiful is good" stereotype are discussed.

Therapists' expectations for in-therapy roles of hospitalized patients

Therapists' expectations with regard to in-therapy behavior of hospitalized patients were measured and factor analyzed. Five interpretable factors emerged and supported the conclusion that therapists' role expectations for patients complement patients' role expectations for therapists. Mean scores on the factors were independent of therapists' experience and professional training.

Patients' expectancies and improvement in treatment: the shape of the link

It has been hypothesized (a) that patients' expectancies for therapeutic gain are linked to the clinical improvement that the patients realize in treatment; and (b) that patients' expectancies may play a causative role in such improvement. The first hypothesis has received empirical support, but the second has not. This study tested the causativeinterpretation of patients' expectancies and a second interpretation, which states that patients' expectancies predict, but do not cause clinical improvement. The shape of thelink between expectancy and improvement for hospitalized schizophrenics was explored. Based on motivation research it was reasoned that a curvilinear relationship between expectancy and improvement would support a causative interpretation and that a linear relationship would support a predictive interpretation of the nature of expectancy. Multiple regression analyses found a linear relationship between expectancies and objective measures of improvement for the patients, but no evidence of a curvilinear relationship between these measures. The results were interpreted as supporting a predictive interpretation of the expectancies of hospitalized schizophrenic patients.

Therapists prophesy

Therapists' expectancies for therapeutic gain in patients reputedly are linked to the actual outcome of treatment for their patients. Theoretical papers have suggested that therapists' expectancies may cause or facilitate patient therapeutic response to treatment. Unfortunately, empirical data related to these notions are greatly lacking. The present study tested the relationship between therapist expectancy and treatment outcome for hospitalized schizophrenic patients. It also tested two opposing hypotheses re the nature of the link between therapist expectancy and outcome (causative vs. predictive). Multiple regression analyses revealed that therapists' expectancies are multi-dimensional, formed partly on the basis of therapists' knowledge of psychopathology in general and partly on their perception of their patients' pretreatment adjustment. The analyses also revealed that therapists' expectancies were associated significantly with treatment outcome; the data supported a predictive, not causative, interpretation of the nature of therapists' expectancies.

Patients' expectancies and hospital outcome

Although it is widely held that patients' expectancies for therapeutic gain are related causally to treatment outcome, a recent review of expectancy research found scant evidence for the hypothesized expectancy-outcome relationship. Supportive findings were reported only in studies with serious methodological weaknesses. This study tested the relationship between the prognostic expectancies of hospitalized schizophrenic patients and several objective measures of hospital outcome. It also tested the hypothesis that expectancies may bear primarily a predictive, not causal, relationship to outcome. Multiple regression analyses found patients' expectancies to be correlated significantly with 8 of 15 measures of posthospital adjustment and with 14 of 15 measures of prehospital adjustment. The findings supported the expectancy-outcome relationship and also were consistent with a predictive interpretation of patients' expectancies.

The schizophrenic as soothsayer

It is generally believed that patients' prognostic expectancies are linked to the outcome of treatment. It is also generally believed that the nature of the expectancy-outcome relationship is causative: patients' expectancies are viewed as causing or facilirating patients' responses to treatment. The study reported here tested both notions. The expectancies of hospitalized schizophrenic patients were tested by multiple regression for association with objective measures of the patients' pre- and post-treatment adjustment. Expectancy measures were closely correlated with patients' pre-treatment adjustment at hospital admission, were moderately correlated with patients' post-treatment adjustment at discharge, and were almost completely independent of post-treatment adjustment at 9-mo. follow-up. It is speculated that patients may base their prognostic expectancies partly on their pre-treatment adjustment, that patients' expectancies are associated with short-term measures of outcome, and that patients' expectancies predict but do not primarily cause or facilitate a therapeutic response to treatment for hospitalized schizophrenic patients. Finally, limitations of the findings and their generalizability are discussed.

Therapists' expectancies and treatment outcome: some overlooked factors

A recent study found factored measures of therapists' expectancies significantly correlated with 8 of 15 objective measures of treatment outcome for hospitalized patients. A subsequent study of the same relationships using unfactored expectancy measures with a diagnostically homogeneous sample of patients showed therapists' expectancies significantly correlated with 14 of 15 measures. This study reexamined the initial expectancy-outcome data using unfactored expectancy measures. The over-all results showed that characteristics of samples of subjects and the adequacy of expectancy measures both significantly influenced the results of tests of the expectancy-outcome relationship.

Fermentation tubes for in vitro digestion of forages

During in vitro digestion of forages by rumen microorganisms in polycarbonate centrifuge tubes, forage particles formed dense mats which were raised above the level of media by entrapped gas. This did not occur with polyethylene centrifuge tubes. In vitro organic matter digestion was higher in polyethylene than in poly-carbonate tubes. Vacuum infiltration of water into samples prior to inoculation increased in vitro digestion with both types of tubes but to a greater extent with samples of high than of low digestion. Regression analysis of in vivo digestibility on in vitro digestion showed that the lowest residual standard deviation was with polyethylene tubes and vacuum infiltration, but omission of vacuum infiltration gave satisfactory results.

Chlamydial infection of conjunctival tissues in culture

Baboon conjunctival cells removed as scrapings from the conjunctiva could be disaggregated and maintained in culture for up to 5 days without appreciable loss of viability. Attempts to infect cultures with a TRIC agent or its “fast” variant were unsuccessful. Nevertheless such cultures appeared to support the growth of TRIC agent since conjunctival cells obtained from infected baboons developed inclusions while maintained in vitro.

Cell viability and tissue structure were preserved over 6 days organ culture of conjunctivae. Organ cultures supported the growth of chlamydiae: the TRIC fast variant grew in low titre in baboon cultures; the highly virulent gp-ic agent grew to high titre in guinea-pig cultures. Frequent inclusion bodies and damaged epithelium were seen in histological examination of infected guinea-pig cultures; occasional sub-epithelial inclusions were detected, some of which were atypical in morphology.