Age and sex modulate effects of stress on the immune system: a multivariate analysis

Multivariate analyses indicate that both age and sex can modulate examination stress effects on immune factors. Stress lowered eosinophil counts in females but raised them in males. Age modulated stress effects on CD4 and CD8 cells, hemoglobin, and erythrocytes. CD4 decreased more in older subjects; CD8 increased in older and decreased in younger subjects; hemoglobin decreased in younger but not older subjects; erythrocytes increased in older and decreased in younger subjects. Initial age and/or sex differences in levels of neutrophils and lymphocytes were not statistically altered by stress. Stress effects not modulated by age or sex increased serum IgA and IgM, CD19, and stimulated phagocytic activity but decreased serum IgG, CD3, basophils, and unstimulated phagocytic activity. The immunological effects of stress are multiple and are influenced by variations in age and sex of the person.

Transference interpretation in the psychotherapy of borderline patients: a high-risk, high-gain phenomenon

The effectiveness of transference interpretation in the psychodynamic psychotherapy of patients with borderline personality disorder has been highly controversial. Both highly expressive approaches that stress the value of transference interpretation and supportive strategies that eschew transference work have been advocated in the literature. We review this literature and identify three emerging trends in thought: (1) Primarily interpretive approaches should be reserved for patients with greater levels of ego strength. (2) Whichever technique is used, a strong therapeutic alliance is the foundation of treatment. (3) Expressive and supportive techniques should not be juxtaposed as polarized opposites; supportive interventions often pave the way for transference interpretation. Our psychotherapy process study revealed that transference interpretations tended to have greater impact--both positive and negative--than other interventions made with patients with borderline personality disorder. We conclude that such factors as neuropsychologically based cognitive dysfunction, a history of early trauma, patterns of object relations involving interpersonal distance, masochistic tendencies, and anaclitic rather than introjective psychopathology are among the patient characteristics that influence the impact of transference interpretation on the therapeutic alliance. Bias toward expressive technique and countertransference issues appear to be relevant to the therapist's difficulty in shifting to a more supportive approach when indicated.

Child abuse and treatment difficulty in inpatient treatment of children and adolescents

This study examined the associations between abuse and staff perceived treatment difficulty in sixty-nine hospitalized children and adolescents. Subjects were rated on a treatment difficulty scale, and clinical charts were reviewed for evidence of physical abuse, sexual abuse, abuse between parents, and parental history of abuse. Subjects with histories of abuse were not rated as more difficult or less responsive to treatment than other patients. Physically abused youngsters were rated as more self-destructive and more accessible to treatment than non-abused children, while sexually abused youngsters were self-destructive and demanding, and their families were seen as more distant and unavailable.

Comorbidity in an inpatient eating disordered population: clinical characteristics and treatment implications

Data are presented that describe the clinical characteristics of 96 patients treated at the C.F. Menninger Memorial Hospital, Topeka, Kansas, from November 1983 to June 1989. Their Axis I eating disorder diagnoses were as follows: 53 had diagnoses of bulimia; 21 had anorexia nervosa; 2 had both diagnoses; 17 had atypical disorders or eating disorders not otherwise specified; and 2 had a diagnosis of psychological factors affecting physical conditions. Seventy-three percent of the cohort were found to have either Axis I or Axis II disorders or both, comorbidity. Borderline personality disorder was found in 46% of the sample, although 20% of the patients with borderline disorders were diagnosed retrospectively. Depression was the largest comorbid Axis I diagnosis. Patient variables for sexual abuse, drug and alcohol addiction, purgative behaviors, and interpersonal relationships are also described. The authors conclude that a substantial subpopulation of eating disordered patients are significantly comorbid for other psychiatric illnesses. This high incidence of comorbidity may help explain the frequency of refractoriness of many eating disordered patients who do not respond to outpatient or short-term inpatient hospitalization. The authors recommend that additional research studies address the problems of the comorbid eating disordered patient and suggest that the findings be taken into account by clinicians and payers.

The effect of attention/information processing impairment of tardive dyskinesia and neuroleptics in chronic schizophrenics

In this article we report the results of a test of the hypothesis that a form of attention/information processing dysfunction, attentional set impairment, is exacerbated by facial-oral tardive dyskinesia in schizophrenics. This hypothesis was tested in the context of a study that was aimed at determining whether the Reaction Time Crossover Effect, a well-established form of attentional set impairment in schizophrenia, was "affected" by neuroleptic treatment. Our results indicate that the crossover effect is resistant to modification by neuroleptics, but that it is exacerbated by facial-oral tardive dyskinesia. We speculate that neurophysiological mechanisms underlying tardive dyskinesia interact with or are similar to those underlying attentional set impairment.

Assessing need for extended psychiatric hospitalization

The authors developed a set of rating scales to assess a wide range of variables believed by clinicians to influence the optimal length of hospital stay. They report the results of interrater reliability studies, a factor analysis of the scales, and a correlational study of the factors with actual length of stay. They describe the potential applications of the scales to clinical practice and research.

Alterations in EEG amplitude, personality factors, and brain electrical mapping after alpha-theta brainwave training: a controlled case study of an alcoholic in recovery

A controlled case study was conducted of effects of EEG alpha and theta brainwave training with a recovering alcoholic patient who experienced craving and fear of relapse after 18 months of abstinence. Training consisted of six sessions of thermal biofeedback to increase central nervous system (CNS) relaxation. Effects were documented with pretreatment and post-treatment personality testing, 20-channel digitized EEG evaluations both under relaxed conditions and under stress, minute-by-minute physiologic recordings of autonomic and EEG data during each training session, blood pressure, and heart rate indications taken both during relaxation and under stress, and by clinical observation. Results replicated those of a previous controlled study with chronic alcoholic patients not abstinent prior to treatment. New findings include post-treatment indications of more relaxed CNS functioning under stress, and of reduced autonomic activation both during relaxation and under stress. Brain-mapping indications of anxiety associated with painful cold-pressor stimulation were seen only in the pretest readings; at post-test the brain map indicated pain-associated EEG activity in the contralateral somatosensory area, but no apparent anxiety-associated EEG activity. At 4 months post-treatment the patient's wife and colleagues report the patient appears to function in a more relaxed way under the impact of stress, and he reports no longer experiencing craving for alcohol. Overall, support is provided for the possibility that alpha and theta brainwave training may be a useful intervention for the abstinent alcoholic experiencing stress-related craving and fear of relapse.

Air oxidation of hydrazine. 1. Reaction kinetics on natural kaolinites, halloysites, and model substituent layers with varying iron and titanium oxide and O- center contents

Air oxidation of hydrazine was studied by using a group of kaolinites, halloysites, and substituent oxides as models for the tetrahedral and octahedral sheets. The rate was found to be linear with oxygen. The stoichiometry showed that oxygen was the primary oxidant and that dinitrogen was the only important nitrogen-containing product. The rates on kaolinites were strongly inhibited by water. Those on three-dimensional silica and gibbsite appeared not to be. That on a supposedly layered silica formed from a natural kaolinite by acid leaching showed transitional behavior--slowed relative to that expected from a second-order reaction relative to that on the gibbsite and silica but faster than those on the kaolinites. The most striking result of the reaction was the marked increase in the rate of reaction of a constant amount of hydrazine as the amount of clay was increased. The increase was apparent (in spite of the water inhibition at high conversions) over a 2 order of magnitude variation of the clay weight. The weight dependence was taken to indicate that the role of the clay is very important, that the number of reactive centers is very small, or that they may be deactivated over the course of the reaction. In contrast to the strong dependence on overall amount of clay, the variation of amounts of putative oxidizing centers, such as structural Fe(III), admixed TiO2 or Fe2O3, or O- centers, did not result in alteration of the rate commensurate with the degree of variation of the entity in question. Surface iron does play some role, however, as samples that were pretreated with a reducing agent were less active as catalysts than the parent material. These results were taken to indicate either that the various centers interact to such a degree that they cannot be considered independently or that the reaction might proceed by way of surface complexation, rather than single electron transfers.

Do clinicians agree about who needs extended psychiatric hospitalization?

This report examines the level of agreement among 194 staff members of The Menninger Clinic and Harding Hospital about the optimal length of stay for 71 types of patients selected on the basis of hypothesized suitability for various lengths of hospitalization. There were differences of opinion associated with hospital affiliation and professional discipline, but there was sufficient consensus to enable the development of comprehensive criteria for predicting required length of hospitalization. The validity of these criteria will be tested in a future treatment outcome study.

Outcome at discharge for patients in an ongoing follow-up study of hospital treatment

Methodological and practical difficulties have limited the growth of knowledge about outcome of psychiatric hospital treatment. The authors report on outcome at hospital discharge for 103 long-term and 93 short-term patients treated at the C. F. Menninger Memorial Hospital, part of an ongoing follow-up study of hospital treatment. Discharge outcome is based mainly on ratings of symptoms, global functioning, and therapeutic alliance as well as on patients' reports of satisfaction. At discharge both long- and short-term patients were found to have low levels of symptoms (based on the Brief Psychiatric Rating Scale) and a relatively adequate level of functioning (in the 51-to-60 range on the Global Assessment Scale) and to have been highly satisfied with treatment.

Fine needle aspiration cytology of talc granulomatosis in a peripheral lymph node in a case of suspected intravenous drug abuse

A fine needle aspiration (FNA) specimen of an epitrochlear lymph node from a 22-year-old suspected intravenous drug abuser was submitted for cytologic examination, which revealed numerous granulomatous tissue fragments, histiocytes, lymphocytes and giant cells. Polarizing microscopy revealed strongly birefringent material of varying shapes and sizes, including anisotropic crystals with the Maltese cross configuration characteristic of starch. A cytologic diagnosis of talc granulomatosis in the lymph node was made. This case emphasizes the value of FNA biopsy in the differentiation of inflammatory versus neoplastic processes; this appears to be the first case of peripheral talc granulomatosis diagnosed by FNA biopsy.

Skin-conductance orienting response in chronic schizophrenics: the role of neuroleptics

The primary aim of this study was to determine whether there is an association between neuroleptic treatment and skin-conductance orienting response (SCOR) nonresponding in chronic schizophrenics. In a design adapted to this purpose, we were unable to demonstrate a relationship between neuroleptics and nonresponding. Although inability to prove the null hypothesis precludes a claim that neuroleptic treatment and SCOR nonresponding are unrelated, internal evidence and prior studies strongly suggest that such a dissociation exists in most chronic schizophrenic nonresponders. We also found stable nonspecific and toxic skin conductance activity differences between SCOR "responders" and "nonresponders" on three occasions of testing. We interpret our results as bearing on state and trait issues in chronic schizophrenics.

An analysis of home practice patterns for non-drug headache treatments

Regular home practice of non-drug training techniques is assumed essential for improved headache control. In numerous research studies on non-drug treatment efficacy, subjects have been routinely required to practice daily self-regulation techniques. This paper examines the relationship between amount of home practice and treatment outcome, and the extent to which subjects adhere to training requirements. A total of 42 subjects completed daily home practice records for 32 weeks. Fourteen subjects had randomly been assigned to an autogenic phases group, 17 to an electromyographic biofeedback group, and 11 to a thermal training group. All subjects charted frequency of practice, change of feeling in the target area, time required to bring about the change, and general body relaxation. Relationships between subject compliance and 11 selected variables including demographics, headache activity components, treatment group, and treatment outcome were evaluated. Results support home practice, but place greater emphasis on its quality rather than its quantity.

Rorschach correlates of treatment difficulty in a long-term psychiatric hospital

There are no studies of the use of the Rorschach test to predict possible treatment difficulties with hospitalized psychiatric patients. To explore this area, the authors assessed the Rorschach protocols of 114 patients using 19 example-anchored rating scales. They conducted a factor analysis of the scales and correlated the resulting factor scores with the extent and type of treatment difficulty. Although there were few significant findings, the Rorschach factors of Dysphoric Affect, Mirroring, and Depreciation may warrant further investigation of their predictive value for treatment difficulty. Rorschach measures of severity of psychological disturbance, inability to represent aggression in ideation, and depreciation may help treaters anticipate types of treatment difficulty.

Skin-conductance orienting response in chronic schizophrenics: The role of neuroleptics

The primary aim of this study was to determine whether there is an association between neuroleptic treatment and skin-conductance orienting response (SCOR) nonresponding in chronic schizophrenics. In a design adapted to this purpose, we were unable to demonstrate a relationship between neuroleptics and nonresponding. Although inability to prove the null hypothesis precludes a claim that neuroleptic treatment and SCOR nonresponding are unrelated, internal evidence and prior studies strongly suggest that such a dissociation exists in most chronic schizophrenic nonresponders. We also found stable nonspecific and toxic skin conductance activity differences between SCOR "responders" and "nonresponders" on three occasions of testing. We interpret our results as bearing on state and trait issues in chronic schizophrenics.

Indications for extended psychiatric hospitalization: a study of clinical opinion

The authors previously developed a conceptual model of factors bearing on length of stay from clinicians' vignettes describing patients considered ideal candidates for various lengths of stay. The previous study was conducted at The Menninger Clinic, the present study at Harding Hospital. The two hospitals provide a worthwhile contrast because Menninger specializes in long-term (LT) stays (averaging 1 year) and Harding in intermediate-term (IT) stays (averaging 2 to 3 months). The Harding findings generally replicated and complemented the Menninger results, and the authors used the combined data to generate a hypothesized set of general indications for various lengths of stay in these private psychiatric hospitals.

The effect of neuroleptics and tardive dyskinesia on smooth-pursuit eye movement in chronic schizophrenics

We sought to determine whether such state-related factors as neuroleptic treatment and facio-oral tardive dyskinesia (TD) influence smooth-pursuit eye movement (SPEM) in chronic schizophrenics. The design involved 100 schizophrenics, 64 of whom showed "abnormal" eye tracking. Experimentally drug-withdrawn patients, some of whom were clinically relapsed, were compared with control patients who continued taking medication in prewithdrawal and postwithdrawal SPEM tests. All groups showed a slight worsening in eye-tracking performance on two postwithdrawal tests, but significant group-by-test session "interactions" were not demonstrable. We also determined that patients with TD tend to substitute large, nontracking saccades for SPEM to a significantly greater extent than nondyskinetic patients. Our findings strengthen the supposition that impaired SPEM is a trait in many schizophrenics but suggest that patients with TD be excluded in future studies of SPEM addressed to trait issues.

Scales to assess the emphasis of psychiatric hospital treatment

There are few studies of psychiatric hospital treatment that include measures of the treatment process. Perhaps the greatest neglect exists in the failure to collect from the clinicians their observations about the treatment interventions they most emphasize in each patient's treatment. The purpose of this paper is to report the development of a set of rating scales that call on hospital clinical staff to assess the relative prominence of various forms of interventions, namely, degree of restriction, vocational and avocational activities, therapeutic and community groups, medication, degree of supportive versus expressive emphasis and individual psychotherapy. We present a study of interrater reliability in a variety of hospital settings and results of a factor analysis of a portion of the scales.

Assessment of therapeutic alliances in the psychiatric hospital milieu

The authors developed scales to assess long-term hospital patients' collaboration in milieu treatment and their working relationships with various staff members. A factor analysis of patients' ratings of their collaboration in several areas of treatment yielded three dimensions: Goal Orientation, Involvement, and Use of Structure. While each dimension of collaboration correlated positively with working relationships and progress, Goal Orientation was the most substantial contributor. Patients' and staff members' perceptions of their working relationships corresponded to a statistically significant-but modest-degree. Only nurses' ratings of progress related significantly to patients' ratings. The authors highlight divergent perceptions of the treatment process, and advocate that different perspectives be openly discussed and clarified in the service of improved collaboration.

The effect of therapist interventions on the therapeutic alliance with borderline patients

The authors draw attention to the problems of establishing and maintaining a therapeutic alliance in the psychotherapy of the borderline patient. They elaborate an extensive methodology designed to study the manner in which shifts in collaboration occur in response to therapist interventions. This report demonstrates how one particular borderline patient increased his ability to collaborate with the therapist in response to a transference focus in the psychotherapy. Methodological problems are noted as are directions for future research. Only a series of patients studied with this or with similar methodology will allow for a sophisticated and empirical rationale for choosing a particular form of psychotherapy for a particular kind of borderline patient.

Predictors of response of antisocial patients to hospital treatment

Although clinicians generally agree that patients with antisocial personality disorder should not be treated on general psychiatry units, little is known about the response to hospital treatment of personality disorder patients who have antisocial features or traits. In a study to identify predictors of positive and negative response to hospitalization, charts of all patients discharged from a private hospital with diagnoses of antisocial personality disorder or antisocial features over 52 months were reviewed. As a group the 33 patients did not respond well to treatment, and 70 percent left treatment prematurely. Significant predictors of negative response were histories of felony arrest and conviction; a history of repeated lying, aliases, and conning; and an unresolved legal situation at admission. Positive response was related to the presence of anxiety and an axis I diagnosis of depression. The authors believe that antisocial personality disorder is often underdiagnosed and that countertransference can present a significant obstacle to treatment of antisocial patients.