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Biomedical subjects

L Covi

Publications and source records attributed to L Covi.

At least 19 recordsLinked to original sources
PubMed1995

Effects of combined fluoxetine and counseling in the outpatient treatment of cocaine abusers.

Three methods of analysis were used to determine the effects of the combination of counseling with fluoxetine (20, 40, or 60 mg) and "active" placebo (diphenhydramine, 12.5 mg) randomly assigned. Forty-five cocaine-only dependent subjects were treated as outpatients with "interpersonal" counseling, medication, and drug use monitoring three times per week for up to 12 weeks. Treatment effects were analyzed: first, by comparing the three original assignments and placebo; second, by comparing the placebo group to fluoxetine subjects with detectable fluoxetine/norfluoxetine blood levels and those with no detectable medication blood level; third, by examining relapse prevention versus use cessation through stratifying the subjects into four groups according to fluoxetine or placebo assignment and initial urine cocaine positivity or negativity. All three analyses showed improvement on some measures over time regardless of group assignment. The 60-mg fluoxetine group showed least effectiveness, the group with detectable blood levels had less cravings, and the fluoxetine subjects who were abstinent at the start of treatment were somewhat less likely to avoid relapse than those on placebo.

Adult↗
PubMed1986

Imipramine and chlordiazepoxide in depressive and anxiety disorders. I. Efficacy in depressed outpatients.

We randomly assigned 425 outpatients, independently classified as primarily depressed by two trained psychiatrists, to double-blind treatment with Imipramine hydrochloride, chlordiazepoxide hydrochloride, or placebo. Those patients who remained at least moderately depressed (following a two-week placebo washout period) were treated for an additional eight weeks. An endpoint analysis of 387 patients who completed two or more weeks of medication disclosed early therapeutic advantages of chlordiazepoxide. By week 4 of treatment, however, imipramine produced more improvement than did placebo and chlordiazepoxide. By six and eight weeks a general, marked therapeutic advantage was found for imipramine relative to placebo and to chlordiazepoxide on measures of depression, anxiety, anger-hostility, interpersonal sensitivity, and global improvement. Chlordiazepoxide-treated patients generally did significantly better on sleep difficulty but significantly worse on anger-hostility and interpersonal sensitivity than did imipramine- or placebo-treated patients.

Adult↗
PubMed1986

Imipramine and chlordiazepoxide in depressive and anxiety disorders. II. Efficacy in anxious outpatients.

A double-blind, placebo-controlled comparison at three collaborating university sites included 242 patients diagnosed as having anxiety disorders. A two-week placebo washout period preceded random assignment to eight weeks of imipramine hydrochloride, chlordiazepoxide hydrochloride, or placebo treatment. Antianxiety effects of imipramine were superior to those of the other two agents by the second treatment week; these effects became more clearly significant thereafter and were independent of degree of both baseline depression and anxiety. Excluding patients with possible panic-phobic syndromes from the analyses removed most significant antiphobic and antidepressant effects of imipramine but left intact imipramine's significantly superior antianxiety effects.

Adult↗
PubMed1986

Inpatient diagnoses during Adolf Meyer's tenure as director of the Henry Phipps Psychiatric Clinic, 1913-1940.

Between 1936 and 1950, detailed abstracts were prepared on all patients admitted to The Phipps Psychiatric Clinic from its opening in 1913 through 1950. Of these abstracts, 74% contained follow-up reports. Except for four papers on schizophrenia and affective disorders published between 1939 and 1943, none of this material has ever been analyzed. The present paper, the first of a series, examines the 8172 first admissions from 1913 through 1940, the period of Adolf Meyer's tenure as Clinic Director. Based on discharge diagnoses, we have sorted the patients into eight diagnostic groups with the following frequencies; schizophrenia, 17%; paranoid state, 3%; manic-depressive, 7%; depression, 27%; organic, 20%; neuroses, 15%; substance abuse, 6%; psychopath, 5%. Our manic-depressive group contains cases discharged primarily as hyperthymergasia, mania, or manic depressive insanity (MDI). Of the 349 cases diagnosed MDI at discharge, 10 had neither a history of nor present symptoms of mania, and these were put in the depression group. Frequencies for most of the diagnoses remained remarkably stable over the 28-year period. Only 9% were discharged recovered, whereas 43% were rated unimproved. Mean length of hospitalization was 76 days, with 10% of the patients readmitted. The mean length of follow-up was 9 years. Correlations of diagnoses, year of admission, length of stay, condition at discharge, age, sex, readmissions, change of diagnoses, somatic treatment, length of follow-up, and deaths in the clinic are presented. Meyer's influence on diagnostic practice is discussed.

Biological Psychiatry↗
PubMed1982

Cognitive group psychotherapy of depression: the close-ended group.

One of the most important recent contributions to the understanding and treatment of depression is that of the cognitive theory and cognitive-behavior therapy developed by A. T. Beck. This paper describes the rationale and the technique of a short-term group psychotherapy based on Beck's Cognitive Therapy. The therapy was conducted with small closed-membership groups of patients with major depressive illness who were participating in a treatment-outcome study. Details of the role induction, session structure, roles of therapist and cotherapist, phases of group treatment course, and possible effectiveness are discussed. The technique presented here includes two individual cognitive sessions for purposes of role induction and establishing a therapeutic relationship before the first group session. We make use of flipcharts and a blackboard to illustrate various cognitive techniques, highly structured sessions with specific individualized agendas, defined therapist and cotherapist roles. The usual phases in a 15-session group course are described and our present experience of the techniques effectiveness are discussed.

Cognition↗
PubMed1979

The Hopkins Symptom Checklist (HSCL)--factors derived from the HSCL-90.

A factor analysis of the 90-item version of the Hopkins Symptom Checklist, performed on the pretreatment self-ratings of nonpsychotic outpatients with symptoms of depression and anxiety, revealed the presence of 8 clinically meaningful factors. These eight orthogonal factors each contained at least 5 items with loadings above 0.40 and explained 4.5% or more of the matrix variance. They were labeled Somatization, Phobic-Anxiety, Retarded Depression, Agitated Depression, Obsessive-Compulsive, Interpersonal Sensitivity, Anger-Hostility and Psychoticism.

Adolescent↗
PubMed1979

Symptomatic volunteers in multicenter drug trials.

1. Symptomatic volunteers were recruited at two collaborating institutions for anti-anxiety and antidepressant drug trials. Advertisements were placed for volunteers with significant symptoms of anxiety, depression, or both, and who were not currently in treatment. 2. It was possible to recruit adequate numbers of volunteers who met the numerous criteria for severity of distress; and who were not ruled out by various exclusion criteria, such as medical contraindications, etc. 3. Acceptable homogeneity across the samples at the collaborating institutions was found for demographic characteristics, level of distress, duration of symptoms, etc. 4. Attrition rates for these volunteers were lower than for the typical anxiolytic and antidepressant trials using outpatients. 5. Symptomatic volunteers appear to present a feasible alternative to the increasingly diminishing pool of outpatients.

Adult↗
PubMed1979

Mental health of medical school applicants: the role of the admissions committee.

This study was of the role of admissions committees as it relates to the mental health of applicants. Two-part questionnaires were sent to 115 medical schools. The first part explored the composition of the committee. In most schools the dean selected the members, attempting to obtain equal representation from clinical and basic science departments; most of the schools had one or more psychiatrists on the committee. The second part focused on the policy for applicants with former mental health problems. Over one-third of the committees asked about previous or present mental illness or therapy. Ninety percent of the schools had no policy or guidelines for using such information; instead, most relied on psychiatric interview or outside reports in making admissions decisions. The impact of federal legislation regarding the handicapped on admissions procedures is discussed. Since more students with previous or current psychiatric problems may be admitted, schools must be prepared to respond to their needs as fully as they now respond to other medical problems.

Educational Measurement↗
PubMed1976

Drug and psychotherapy interactions in depression.

The authors conducted a series of multiple regression analyses of data from depressed patients. They found that 8 factors consistently predicted treatment response: a lower initial level of distress, imipramine treatment, a positive attitude toward group psychotherapy, and a good employment history predicted lower posttreatment distress levels; estrogen maintenance treatment was related to better response to diazepam, and a low level of intelligence predicted better response to both diazepam and imipramine; and a low initial level of interpersonal sensitivity and a significant other's having an unfavorable attitude toward psychiatric treatment were associated with better response to group psychotherapy.

Anxiety↗