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Biomedical subjects

J W Hull

Publications and source records attributed to J W Hull.

28 records · Page 2Linked to original sources
PubMed1994

A high-risk screen for psychiatric discharge planning.

This article tests the hypothesis that psychiatric inpatients at high risk for presenting difficulties in aftercare planning can be accurately identified on admission to an inpatient unit. A 16-item high-risk screening list is presented that was developed through an earlier analysis of discharge-delayed cases in a psychiatric hospital. The capacity of the list to accurately predict high-risk status was tested by comparing admission and discharge high-risk scores for 448 patients with a range of psychiatric disorders. Sixty-six percent of the patients rated high risk at admission were identically rated at discharge. Differences among risk groups were also found with respect to key demographic variables. The high-risk screen permits early identification of patients who will require immediate and intensive environmental interventions. Such data are critical to psychiatric social work in preventing overstays and in deploying department resources with maximum effectiveness.

Adolescent↗
PubMed1993

Time series analysis of intervention effects. Fluoxetine therapy as a case illustration.

This paper illustrates the advantages of time series analysis in documenting treatment effects through a case study of a trial of fluoxetine in a borderline woman being treated in a long-term inpatient unit for severe personality disorders. Data consisted of weekly self-reports of symptomatology over 58 weeks of hospitalization. Intervention analysis carried out after the patient was discharged documented the effectiveness of the medication and the differential timing of response in individual symptoms.

Adult↗
PubMed1993

Treatment response of borderline inpatients. A growth curve analysis.

This study examined the course of 40 hospitalized female borderline personality disorder patients over 25 weeks of inpatient treatment. Course was measured through weekly administration of the SCL-90-R. Level of identity and interpersonal problems, hypothesized by Kernberg to be at the center of the borderline patient's pathology, were found to be powerful predictors of treatment course. Patients with the most severe identity and interpersonal problems reported more symptoms throughout treatment and increasing symptom levels over time. This was very different from patients with the lowest level of identity and interpersonal problems, who reported fewer symptoms overall and decreasing symptoms over time.

Adult↗
PubMed1993

Subtypes of self-injurious patients with borderline personality disorder.

Twenty-seven female inpatients with borderline personality disorder were assigned to two groups on the basis of whether they did (N = 14) or did not (N = 13) report experiencing pain during self-injurious episodes. Ratings of depression, anxiety, impulsiveness, dissociation, and trauma symptoms were higher in the women who did not experience pain while injuring themselves, as were the number of suicide attempts and the prevalence of childhood sexual abuse.

Adolescent↗
PubMed1992

Acting up and physical illness: temporal patterns and emerging structure.

Many psychoanalytic writers have viewed acting out and somatization as alternate routes for the discharge of uncontained aggressive impulses in borderline patients. In order to investigate this empirically, we tracked the occurrence of two related behaviors--acting up and physical illness--over the course of one patient's long-term hospitalization. Daily scores on these variables were analyzed using a time series procedure. Results indicated that as treatment progressed, acting up and physical illness became more synchronized, and this occurred just prior to symptom remission. Material from psychotherapy suggested that these behavioral changes were associated with the patient's increased ability to verbalize aggressive impulses in the context of fantasy and memory.

Acting Out↗
PubMed1991

The addiction to negativity.

In this paper, we have described a type of resistance that has attracted increasing psychoanalytic attention in recent years. Patients exposed to intense negativity during early life may develop an addiction to negative experience as adolescents and adults, and this may constitute a central organizing feature of their personality. In almost all patients, however, some moments of negativity may be observed. We have traced the developmental origins of an attachment to negativity, drawing especially on psychoanalytic investigations of preoedipal pathology. Manifestations and derivatives of early negativity include anhedonia, attachment to physical pain, fear of success, masochism, deprivation of self and others, and negative voyeurism. In discussing the dynamic functions of negativity, we place particular emphasis on two motives: the patient's desires for revenge against early objects that have been a source of deprivation and frustration; and the defensive function of negativity in helping to express as well as ward off dangerous wishes to merge with the object. Deviant forms of autoerotism are likely to be used by these patients to deal with the reactivation of early experiences of neglect and rejection. When negativity is used as a defense or method of relating to others it can lead to a severe disruption of the psychotherapeutic relationship. We have reviewed suggestions for the management of extreme negativity in treatment. Resolution of the therapist's countertransference reactions, especially induced feelings of frustration, rage, and helplessness, is crucial. Emphasis also has been placed on the patient's desires for revenge against self and object, and the manner in which these may be understood and eventually resolved. Only when patient and therapist begin to investigate the adaptive functions of extreme negativity can this pathological symptom be resolved and the patient's awareness of self and sense of autonomy be enhanced.

Adolescent↗
PubMed1983

Predicting the abusive parent's response to intervention.

Data from Child Protective Services case files was used to establish a Responsiveness Index, measuring the extent to which, in the worker's opinion, an abusive individual had responded positively to various common interventions. Factors likely to predict parental responsiveness then were tested. Variables with predictive significance were: the number of abused children in the family, the number of birth and bonding problems, and the number of previous contacts with other service agencies by various family members. Other variables which are ordinarily assumed to forecast a favorable outcome did not approach significance.

Child↗
PubMed1979

Map survey strategy for locating areas with mental health problems.

As part of a community survey of mental health needs, respondents were asked to pinpoint areas high in need on a map of the catchment area. Knowledgeable personnel in agencies dealing with community problems were surveyed. Results indicated that map surveys can be useful in locating high-need census tracts, as evidenced by convergence with an independent service-utilization-based index of mental health need. However, respondents did not differentiate between need areas in terms of ratings on specific community problems.

California↗