Chemotherapeutic choices of native and foreign psychiatrists' preferences for an acute psychotic episode

To gain further understanding of psychiatrists' prescription preferences, samples of native and foreign psychiatrists specializing in chemotherapeutic treatment were presented with a standard case of a male experiencing an acute psychotic episode for whom they were asked to develop a treatment program. The current paper considers the degree of concordance in chemotherapeutic preferences. These data have shown little consensus. No “Tower of Babel” exists among these specialists regarding ratings of symptom severity or hierarchy of symptom importance. Upon moving to the next level of abstraction, the foreign psychiatrists considered schizo-affective and undifferentiated schizophrenia significantly more frequently than native psychiatrists. Neither a symptom hierarchy nor diagnostic approach accounted for the variance observed in these drug preferences.

Public views on ex-mental patients: a note on perceived dangerousness and unpredictability

The adjectives most strongly attributed to the concept of ex-mental patient by a sample of 30 male and female suburbanites were excitable, strange, tense, strong, uncertain, unsure, unpredictable, convincing, active, and mysterious. In addition, an r of .74 was found between dangerous and unpredictable. These findings may suggest that although the public stereotype of mental patients has undergone positive change since 1960, ex-mental patients still tend to be perceived as potential threat-bearers to the community. Unfounded fears based upon this perception may motivate resistances to community-based treatment programs for this group.

Public perception of ex-mental patients

Data are presented from two studies which show that perceptions of ex-mental patients appear to derive from a lack of information and that the provision of information alters the perception of former patients. Perceived unpredictability of behavior and dangerousness seem to form a dyad that causes the public to fear the mentally ill. More positive perceptions of mildly ill ex-mental patients were obtained when subjects were given short paragraphs describing typical behaviors and symptoms. These findings support the notion that a fear-motivated threat recoil cycle process is likely to be evoked by attempts to establish locally based treatment facilities, particularly in residential communities.

Combination drug therapy for the psychogeriatric patient: comparison of dosage levels of the same psychotropic drugs, used singly and in combination

The dosage levels for a number of frequently prescribed psychotropic drugs, used singly or in combination, were determined in 902 long-term psychogeriatric hospital patients. The data failed to support the hypothesis that physicians prescribe lower dosages when combination therapy is used. Rather, the tendency was toward higher dosages under these circumstances.

The effect of increased information upon community perception of ex-mental patients

Data are presented for 30 suburban homeowners, which suggest they respond differentially to three levels of severity when rating the concept ex-mental patients via the semantic differential technique after having been given descriptive information about typical symptoms and behaviors. This finding contrasts with those from a previous study of similar suburbanites which indicated nonindividuation among severity of illness levels under minimal information conditions. A more favorable perception of mildly ill ex-mental patients resulted from the exposure to more information.

Comparative survey of psychiatrists' prescription preferences: New York and Texas

The present survey compares the treatment preferences of New York and Texas psychiatrists using a questionnaire report of a single psychiatric case. The characteristics of this approach enable the investigator to hold and symptoms and syndromes of the patient constant. All clinicians respond to identical stimuli. What varies naturally, then, is the judgment of the clinician in developing his treatment procedure, thereby enabling estimation of the degree of standardization in treatment preferences. Three hundred twelve psychiatrists from New York and 133 from Texas provided data for comparative purposes. On the first admission 41% of the New York respondents and 24% of the Texas psychiatrists preferred a regimen that included more than one drug. When a combination of drugs was selected, chlorpromazine-trifluoperazine was preferred. But ten other specific combinations also were selected. Most were of potent neuroleptics, but some included antidepressant-neuroleptic combinations. None of the variables included in the study provided tangible systematic variance for these treatment preferences. A year and a half after first admission, followed by treatment in and out of hospital, the patient's clinical course continued to deteriorate. At this point more than 50% of the respondents in each state selected a regimen that included a minimum of two drugs. As many as 24 different combinations were selected for this single case. Nineteen percent of the New York respondents and 13% of the Texas respondents selected a regimen that included three or more psychoactive medications. The existence of these treatment preferences requires a more basic understanding of treatment preferences, for these seems to be no basis for them.

Interrelations among psychological needs of suburban heroin addicts

Among the 15 variables assessed by the EPPS for 59 male and female applicants to a suburban methadone maintenance program the pattern, direction and magnitudes of correlations between need states were significantly different from those of the normative sample. The implications of the tendency of addicts to associate positively a number of incompatible needs for: (1) counseling, (2) generating interpersonal conflict, and (3) understanding the addict as an individual were discussed.

Polypharmacy in psychiatry: a multi-state comparison of psychotropic drug combinations

Surveys of prescription practices have indicated that what was initially a novel treatment choice begins to be employed with greater frequency in psychiatric samples. While data from geriatric samples show an apparent restraint on the part of psychiatrists in use of potent neuroleptic combinations, it is clear, drug combinations are still employed in older patients. Combinations of specific psychotropic agents are related to sex and age of the patient with the most frequent combination of drug type being of neuroleptic and antidepressant. This study presents data derived from an incidental sample of psychiatrists from four states having large patient and psychiatrist populations. A single case questionnaire survey was devoted to identifying the types of drugs used in combination. It was clear that this sample of psychiatrists, from diverse backgrounds who are responding to the same set of symptoms, used a broad array of drug combinations. Chlorpromazine-trifluoperazine was the combination showing most frequent use. As the patients' symptoms persisted, combinations of drugs used in treatment became more unique and diverse. After one year of ineffective chemotherapy combinations of three and up to six potent neuroleptics were prescribed. It would seem that once drugs were prescribed in combination then it becomes easier to add another and another to a failing chemotherapeutic regimen. New York respondents combined two drugs most frequently. Some go to combinations of three, four, and as many as six drugs at one time. Pennsylvania psychiatrists were next most frequent in multiple drug use. California and Texas respondents used combinations least frequently. Nonetheless, concern regarding polypharmacy practices may need to give way to "maxipharmacy" which in the extreme was represented by a regimen of six neuroleptic agents which included: fluphenazine-haloperidol-promazine-thioridazine-thiothixene-trifluoperazine. The proliferation of potent but partially effective psychotropic drugs has advanced the development of unnecessary treatment procedures. Polypharmacy in psychiatry represents an example of a "legitimate" but unnecessary use of psychotropic agents. The use of combinations of psychoactive medications developed and continues largely out of arbitrary clinical experience instead of evolving from medical data. Use of polypharmacy in treatment is similar in kind to developing a new generation of treatment forms, essentially investigational with insufficient evidence available regarding compatibility, dose response factors, side effects and relative efficacy.

Early cigarette smoking and drug use: some comments, data and thoughts

This paper considers some recently reported cigarette smoking and drug-use data which indicate teenage smokers have a greater probability of using or becoming involved with illicit drugs than non-smoking peers. It is suggested that the epidemiological concept of high risk groups be applied to relationship between the use of socially approved substances like tobacco by young people and subsequent drug experiences because it acknowledges the empirical covariance between these events but does not have as strong causal implications as a “stepping stone” notion. By this, it is implied that a person who begins smoking, for example, at age 10 when his reference group will begin at age 15, may be more likely to become involved with substance abuse. Further suggested the decision to use drugs is an individual one which appears to be influenced by a multiplicity of factors as availability, personal needs, values, peer influences, personality characteristics and previous behavioral tendencies.

Personality characteristics of urban and suburban heroin abusers: more data and another reply to Sutker and Allain (1973)

Sutker and Allain (1973) suggest that nonincarcerated heroin addicts who are involved in the “street life style” would tend to obtain elevated scores on the Hs, D, Hy and Pd scales of the MMPI. If these findings were cross-validated, then personality descriptions of addicts would have to be modified accordingly. Also, improvement measured by decreases on the Hs and Hy scales soon after entering a drug-free environment may be a result of milieu differences rather than personality change. Four groups of heroin addicts, two hospitalized, urban drug abusers who were free of drug influence at testing (Hospitalized1 and Hospitalized2) were compared with two street addict samples, one from an urban (StreetNARA), the other a suburban (StreetSCNCC) environment. It was hypothesized that both the StreetNARA and StreetSCNCC groups would score significantly higher than the hospitalized groups and that there would be no differences between the hospitalized groups. As was expected, the street samples scored statistically higher on the Hs and Hy scales. However, data for the D and Pd scales failed to cross-validate the Sutker-Allain hypothesis. These data suggest that personality characteristics play a more dominant role in MMPI score elevations than the “street life style.” This contention was also supported by test-retest data on the Hospitalized2 sample measuring the effect of 90 days of hospitalization in a drug-free environment.

Indications of psychopathology in applicants to a county methadone maintenance program

The MMPI was completed by 74 applicants to a Suffolk County methadone maintenance program. All had measurable psychopathology as reflected in T scores of 70 or above on one or more of the original clinical scales. Data demonstrated heterogeneity in MMPI protocol code types, character structure, and psychopathological indications. Comparisons with previously reported data for addict samples committed to federal and state treatment units indicates fewer neurotic and sociopathic, but more schizotypic, incipient schizophrenic, or schizophrenic personality types applying to the methadone maintenance clinic. The most prevalent code type seen (842'), however, was identical with that reported for a sample of 117 patients seen at a VA methadone maintenance clinic.

Some comments about the personality comparison of incarcerated and street heroin addicts

This note questions the assumption that the greater personality deviance seen in the MMPI profiles of street heroin addicts than in those of incarcerated heroin addicts is a function of environmental and situational differences between these samples. The street addicts' elevations on the scales comprising the neurotic triad may instead represent a drug effect.

Psychiatrists' characteristics and polypharmacy

A questionnaire which included a case history designed to elicit treatment preferences in psychiatric disease was distributed to psychiatrists on the staffs of seventeen state mental hospitals in New York State. Results of the survey, based upon a 45 per cent return, indicate that two of every five respondents selected polypharmacy as the preferred initial treatment regimen for the hypothetical patient described in the questionnaire. Recency of training (residency completion) and fewer private agency affiliations appeared to be the major characteristic of the psychiatrists in this sample, who tended to employ drug combinations. These data are interpreted as being consistent with the hypothesis that polypharmacy may currently be ‘in vogue’ as a therapeutic modality despite the lack of a clear cut rationale for its use or proof of its efficacy.

Personal adjustment and authoritarian attitudes toward the mentally ill

The relationship between authoritarian attitudes, which reflect the belief that mentally ill persons comprise an inferior class requiring coercive handling, and personal adjustment was examined for 77 female psychiatric aides at a large state mental hospital. Correlations and analysis of variance suggested the lack of a systematic association between the two variables.

Comparison of intercorrelations of scale scores from the opinions about mental illness scale

Intercorrelations among scores on the 5 factorially derived dimensions of the Opinions About Mental Illness Scale (OMI) were computed for 77 female psychiatric attendants at a large state mental hospital. Four rs were significant. However, rs were smaller and, in some cases, directionally different from those in previous studies. Type of institution sampled, temporal factors, and changes in attitude were suggested as possible explanations for these differences in intercorrelations.

Relationships among Raven progressive matrices avoidable and atypical errors and Bender Gestalt errors

The Raven Progressive Matrices tests of 89 hospitalized, chronic schizophrenic males were scored for atypical and avoidable reasoning errors. A total error score on the Bender Gestalt was also computed for each S. Total error score on the Bender correlated .41 and .01 with atypical and avoidable errors respectively. The two Raven error indices correlated –.41. Thus, atypical errors may be assessing the influences of psychopathology on the Raven's perceptual spatial factor while avoidable errors may be reflecting the effects of the illness upon the general intellectual factor the Raven is said to measure.

Raven Progressive Matrices avoidable errors as a measure of psychopathological ideational influences upon reasoning ability

The Raven Progressive Matrices protocols of 88 narcotic addicts, divided into four MMPI profile pattern groups, were scored for avoidable errors. Ss having psychotic-like profiles (428′ and 987′) made significantly more avoidable reasoning errors than Ss with sociopathic patterns (42′ and 49′). These data were interpreted as evidence of the sensitivity of avoidable error measures to disturbances in consistency and accuracy of comparative and analogical reasoning performance. It was suggested that avoidable error indices might be used to (a) judge the effects of pathological ideation upon complex reasoning, (b) estimate potential level of intellectual functioning in clinical populations, and (c) serve as a criterion for treatment efficacies.

Emotions profile index (EPI) pattern for paranoid personality types: cross-validation and extension

The possibility of defining an emotion profile consistent with personality type was examined in this cross-validational study. The procedure contrasted a sample of newly admitted acute paranoid schizophrenic patients, who were identified by clinical procedures and judgment, with a group of narcotic users who were defined as paranoid personality types on the basis of their responses to self-report inventories. When the resulting Emotions Profile Index scores were compared for these two groups, they showed high similarity. This suggests the possibility of identifying emotion profile types which are consistent with underlying personality types.

Performance errors on Ravens progressive matrices (1938) by sociopathic and schizotypic personality types

In an attempt to identify the existence of reasoning errors in psychiatric patients, the performance of male narcotic users defined as sociopathic ( N = 36) and schizotypic ( N = 34) by MMPI profile patterns was analyzed for avoidable errors on the Ravens Progressive Matrices (RPM). An avoidable error was defined as a failure to solve an item whose difficulty level was within the testee's range of ability as measured by his performance. Construct validity was defined in terms of the intercorrelations of Ravens centile and item difficulty levels. Parametric and non-parametric tests of significance indicated that the schizotypic group commit significantly more identifiable reasoning errors than the sociopathic group.

Ravens Progressive Matrices (1938): normative data on male narcotic addicts

The Ravens Progressive Matrices (RPM), a test of intellectual ability, was administered to 396 male narcotic users. Norms are given, and concepts basic to the validity and reliability of the RPM tested. Significant shifts were found in item order in sets A, B, C, and D. Differences were not considered crucial for each set, which was progressively more difficult than the preceding set; thus the total structure of the test was supported by the sample. The discriminative power of most items ranged from good to excellent. In investigating properties of distractors, answer four was chosen significantly more often than other alternatives as the wrong answer in sets C, D and E identifying the possible operation of a positional distractor. Test-retest reliability, content and concurrent validity coefficients were of the order of .8. Correlation of formal education with RPM was of the order of .2. Previously available normative data on patient samples ae extended and use of the RPM as a measure of intellectual performance relatively free from language and cultural bias is supported.