Biomedical subjects

D M Purnine

Publications and source records attributed to D M Purnine.

11 recordsLinked to original sources

PubMed2001

Enhancing readiness-to-change substance abuse in persons with schizophrenia. A four-session motivation-based intervention.

This article describes a four-session intervention designed for persons with co-occurring substance abuse and schizophrenia-spectrum disorders, to be administered as an add-on module to supplement ongoing mental health treatment in an outpatient setting. The intervention targets those dually diagnosed individuals with low readiness-to-change as indicated by current use, and/or low level of engagement in treatment for substance abuse. The intervention is designed to increase problem recognition, to enhance motivation to change maladaptive patterns of substance use, and to facilitate engagement in substance abuse treatment. To achieve these goals, the authors have adopted constructs from the Transtheoretical Model of Change, the authors used principles of motivational and harm reduction interventions, and tailored them to the target population.

Adult↗

PubMed2001

Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.

OBJECTIVE: The high rates of comorbid substance use disorders among persons living with severe and persistent mental illness (SPMI) have increased interest in assessing and enhancing motivation to change substance misuse in this population. This study provides evidence for the psychometric adequacy of three self-report measures of readiness-to-change. METHOD: The sample consisted of 84 persons (65% men) with co-occurring substance abuse or dependence and an SPMI. After a psychiatric assessment, participants completed three measures of readiness-to-change, which yielded seven subscales: (1) the Stages of Change Readiness and Treatment Eagerness Scale (ambivalence about change, recognition of substance-related problems, taking steps), (2) Decisional Balance Scale (pros of using, cons of using) and (3) the Alcohol and Drug Consequences Questionnaire (costs of quitting, benefits of quitting). RESULTS: All of the subscales were stable over time, and 6 of the 7 subscales demonstrated excellent internal consistency. Reliability indices were comparable when analyses were repeated on subsets of participants defined by diagnosis, cognitive function, positive symptoms and negative symptoms. A pattern of theoretically meaningful intercorrelations provided convergent evidence of validity, and a general lack of relationships with demographic variables and indices of psychiatric status provided discriminant evidence of validity. CONCLUSIONS: These findings support efforts to quantify readiness-to-change substance misuse among persons with an SPMI.

Adolescent↗

PubMed2000

Treating substance abuse in the context of severe and persistent mental illness: clinicians' perspectives.

Patients with comorbid substance use and major mental disorders are treated frequently in the mental health system. Treatment models relevant for this subset of patients have emerged in recent years, however, few have been validated empirically and so relatively few sites benefit from this treatment development activity. Important additional sources of information about good treatment practices are the clinicians who have adopted the treatment of patients with dual disorders as a specialty. We conducted four focus groups (N = 12) with clinicians who were nominated by their peers as experienced and/or expert in treating persons with comorbid substance use and psychiatric disorders. Discussions followed a four-part outline that included (a) general questions about training and experience with the population, (b) preferred treatment methods, (c) motivational issues, and (d) recommendations to the field. Participants were trained in a variety of mental health disciplines and pursued substance abuse treatment credentials or other educational experiences outside of their primary training programs. Their treatment approaches emphasized psychoeducation, a good therapeutic relationship, and the need to be flexible regarding methods and goals. Abstinence was the preferred goal among most clinicians; even so, they expressed a pragmatic flexibility and other views consistent with the principles of harm reduction. Clinicians tended to respond to patients' ambivalent motivational states by addressing the consequences of behaviors in a nonconfrontive style; they also made use of positive incentives and external support. A number of recommendations were made to improve treatment, including greater institutional and programmatic support for the unique needs of this population.

Adult↗

PubMed2000

Assessing positive and negative symptoms in outpatients with schizophrenia and mood disorders.

The Positive and Negative Syndrome Scale (PANSS) was developed to assess symptomatology in inpatients with schizophrenia. We examined its reliability and validity among outpatients with schizophrenia (N = 75) and mood disorders (N = 61). Because the hypothesized three-scale structure of the PANSS has not been supported by existing research, we also examined its factor structure. Interrater reliability for individual items and the positive and negative scales was demonstrated. Evidence supported the internal consistency of each scale in the overall sample and the schizophrenia group but was mixed among those with mood disorders. PANSS scores were higher in the schizophrenia group. These scores, in turn, were lower than those generally reported among inpatients with schizophrenia, providing known-groups validity evidence. Four of five factors were similar to those reported among inpatients with schizophrenia. Together, these results support the use of the PANSS among outpatients and reinforce existing support for assessing positive and negative symptoms in mood disorders.

Adolescent↗

PubMed1999

Methods of changing patterns of substance use among individuals with co-occurring schizophrenia and substance use disorder.

Individuals with a severe mental illness and substance use disorder tend to have medical and social problems and to make slower progress in treatment than those who have either disorder alone. Nevertheless, little attention has been paid to the discovery of effective methods of modifying substance use in the severely mentally ill (SMI). The purpose of this study was to collect qualitative data as a way to help identify techniques that might help to change patterns of substance use in the SMI. The participants were 21 men and women who were psychiatric clinic outpatients and who had a current schizophrenia spectrum diagnosis. A total of 18 participants had a lifetime diagnosis of alcohol abuse or dependence, and 21 lifetime other drug diagnoses were recorded for the sample. These individuals participated in focus group discussions about topics related to substance use and people's experiences with trying to quit. The results showed that participants identified several therapeutic and extratherapeutic factors that helped them to initiate and maintain changes in their substance use, as well as factors that hindered change. The findings are related to knowledge about the effectiveness of substance use disorder treatment techniques in general, and implications of the data are discussed for the conduct of integrated treatment of individuals with severe mental illness and a substance use disorder.

Adult↗

PubMed1999

Decisional balance regarding substance use among persons with schizophrenia.

State-of-the-science treatment of substance abuse relies on decisional balance activities (weighing pros and cons of continued substance use) to enhance motivation for change. Few data are available regarding the feasibility of these activities among persons dually diagnosed with schizophrenia and substance use disorder. To address this lacuna in the literature, we completed focus groups with 21 participants, all of whom had a schizophrenia-spectrum diagnosis and lifetime substance abuse or dependence. These key informants discussed the pros and cons of substance use as well as the pros and cons of quitting in response to a structured group interview. Our qualitative data indicate that persons living with schizophrenia can generate rich and diverse decisional balance information. We describe salient themes, contrast complementary perspectives (i.e., the pros of using and cons of quitting), and suggest treatment implications based on these findings.

Adolescent↗

PubMed1999

Dyadic coorientation: reexamination of a method for studying interpersonal communication.

The coorientation method is used rarely to study communication in sexual dyads or other relationships due to uncertainty regarding the optimal way to calculate key variables (i.e., understanding, agreement, and perceived agreement). We examined this matter empirically, assessing sexual coorientation among 76 cohabiting couples; 152 adults completed measures of their own and their partners' sexual preferences as well as sexual satisfaction. Three sets of sexual preference coorientation variables were calculated using correlational, difference score, and combined approaches. These variables were then correlated with the sexual adjustment measures to determine which coorientation approach had greater explanatory power across several hypothesized relationships. Results clearly favored the correlational method. We identify several potential applications of the coorientation method and provide guidelines for its application to research on dyadic relationships.

Adult↗

PubMed1997

Interpersonal communication and sexual adjustment: the roles of understanding and agreement.

The influence of interpersonal communication on sexual adjustment in cohabiting heterosexual couples was investigated. Male and female partners from 76 heterosexual couples independently completed measures of their own and their partners' sexual preferences, as well as measures of sexual and general relationship adjustment, sexual difficulties, marital role preferences, depression, and social desirability. Results indicated that sexual satisfaction in both partners was associated with men's understanding of their partner's preferences and agreement between their preferences. The influential role of men's understanding was supported by hierarchical regression, convergent and discriminant evidence, and multiple regression models that accounted for 51% and 63% of variance in men's and women's sexual satisfaction. General relationship adjustment of both partners was associated with women's understanding of men's marital role preferences. An explanation of understanding's function is proposed, accounting for gender differences within and across sexual and general realms of relating.

Adaptation, Psychological↗

PubMed1996

The inventory of dyadic heterosexual preferences: development and psychometric evaluation.

This article describes the development and evaluation of an instrument that measures preferences for specific sexual behaviors of heterosexual men and women in a dyadic context. In Study 1, 74 statements of preference were reduced to 46 on the basis of reliability and range of responses. Factor analysis revealed that 27 of the 46 items loaded on 6 factors: Erotophilia, Use of Contraception, Conventionality, Use of Erotica, Use of Drugs/Alcohol, and Romanticism. In Study 2, factor analysis of fresh data from a second sample cross-validated these results. To establish construct validity of the revised 27-item Inventory of Dyadic Heterosexual Preferences (IDHP), relationships between each of its 6 scales and 6 criterion measures were examined. These analyses suggested that the last scale is more accurately characterized by the term Romantic Foreplay. We conclude that the IDHP measures 6 distinct domains of sexual preference with a brief, psychometrically sound instrument. Potential applications of the IDHP, suggestions for future research, and strengths and limitations of the current investigation are discussed.

Adolescent↗

PubMed1994

Gender differences regarding preferences for specific heterosexual practices.

Few investigations of sexual attitudes have restricted their focus to individuals' preferences for specific behaviors within a heterosexual relationship. None have examined gender differences in a broad and multidimensional array of such behavioral particulars. As part of an effort to develop a measure of preferred scripts in heterosexual couples, 258 men and women reported how much they agreed or disagreed with 74 statements of preference. A reduced and factor analyzed questionnaire included 38 items and was administered to a second sample (N = 228). Results offer qualified support that, compared to women, men are more erotophilic and show a stronger preference for incorporating erotic materials as well as drugs and alcohol into sexual relations with their partner. These results were more robust in the second sample, in which almost half of the subjects were tested in same-sex groups. Across both samples, women showed stronger preferences for activities reflecting romanticism. No gender differences were evident in sexual conventionality or in preference regarding the general use of contraceptives. However, results suggest that both sexes respond more favorably to a partner-focused or unspecified contraceptive method than to a self-focused method.

Adolescent↗

PubMedDate not supplied

Age and gender differences in sexual behavior preferences: a follow-up report.

This study extends prior research on gender differences in sexual behavior preferences. The authors administered the 6-factors Inventory of Dyadic Heterosexual Preferences (IDHP)1 to 76 married or cohabiting couples (mean age = 35 years). Their preference patterns were compared to similar data obtained previously from younger (mean age = 21 years), single respondents. Gender differences that were replicated included women's stronger preferences for romantic foreplay and men's greater erotophilia and preferences for using erotica and combining alcohol and drug use with sex. Women's stronger conventionality was not replicated among older partners, both of whom were less conventional than their younger counterparts. Older men and women were also more inclined toward the use of erotica. Unlike younger men, older men were more negative toward the use of contraception. Implications for sexual safety, adjustment, communication, and therapy are discussed.

Adult↗