Biomedical subjects
Publications and source records attributed to L Coyne.
Factors contributing to clinical recommendations for length of hospitalization for children and adolescents were investigated. Diagnosis, chronicity, severity of symptoms, response to prior treatment, and family resources were found to relate strongly to length-of-stay recommendations. Guidelines representing the consensus of experienced clinicians are proposed.
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.
On an 8-bed adolescent psychiatric unit, 69 patients were rated over the course of more than one year [corrected]. A set of rating scales was used to determine the relationships of treatment and therapeutic alliance difficulties with staff ratings of patient qualities, family issues, and treatment outcome. Findings underscore the clinical relevance of treatment difficulty and therapeutic alliance in conceptualizing the therapeutic action of the hospital treatment.
The C. F. Menninger Memorial Hospital is conducting an ongoing follow-up study of the effects of extended hospitalization. The authors report key indicators of outcome at one year postdischarge for 110 patients hospitalized on extended care units for at least 180 days. Outcome is determined by postdischarge rates of rehospitalization, postdischarge suicide attempts, and occupational functioning at the time of the one-year follow-up interview. After comparing these areas with preadmission levels of symptomatology and functioning, the authors report significant improvement in each category at the time of follow-up.
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.
Because ample evidence from both clinical and research realms has demonstrated that family intervention can be crucial for the process and outcome of psychiatric hospital treatment, greater attention should be given to assessing the extent and content of such interventions. The authors present their rating system for assessing the focus of family interventions during psychiatric hospitalization; they also provide results of a study of the interrater reliability of the scales and a factor analysis of the scales. These Family Intervention Scales are designed for application in hospitals that vary widely in structure, setting, staffing patterns, and program emphasis. The factor analysis yields four factors that make good clinical and conceptual sense: Information-Education, Family System Approach, Family Therapeutic Alliance, and Spouse Involvement.
There are few studies of treatment difficulty with children and adolescents. The authors describe a preliminary phase of research in this area, specifically the development of a set of rating scales to assess factors in treatment difficulty, a study of interrater reliability, and factor analyses of the content of these scales. The next steps in this ongoing research project are outlined.
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The need to synthesize clinical and empirical considerations in naturalistic studies of psychologically oriented alcoholism treatment is discussed. Well done naturalistic studies are viewed as a necessary complement to more traditional controlled studies of treatment in order to maintain an interface of clinicall reality with scientific respectability. A general clinical framework and scientific model for naturalistic study are proposed by which scientific and clinical considerations may be reconciled.
According to their scores on the Michigan Alcoholism Screening Test, close to one-third of the homosexual men surveyed in four urban areas of Kansas were alcoholics.
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This study examined the effects of phenothiazine treatment on attentional-perceptual, cognitive, and psychophysiological dysfunction in chronic schizophrenics. Under double-blind conditions, 20 patients receiving chlorpromazine and 20 receiving placebo for eight weeks were tested by performance measures, clinically rated, and monitored for skin resistance and heart rate on four occasions. Phenothiazine effects on measures of attention-perception and on psychophysiological response were demonstrable, but not on tests and ratings of cognitive dysfunction. The direction of effects was toward normalization of function. Drug treatment tended to improve ability to sustain set, to increase efficiency of selective attention, and to increase rate of information processing. Autonomic reactivity was reduced and a deactivation effect suggested. Clinical improvement was correlated with reduction in attentional dysfunction. The results are discussed in terms of their implications for hypothesized behavioral mechanisms of drug action, primary "behavioral site" of drug action, therapeutic response measurement, and functional theories of schizophrenic psychopathology.
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The authors made a survey of all admissions to Topeka (Kans.) State Hospital from a three-county catchment area over an 11-year period during which a private psychiatric clinic in the area assumed the functions of a comprehensive community mental health center. The center's activities brought a significant decrease in the number of direct admissions to the hospital from the catchment area. However, the center consistently referred more patients with psychotic disorders to the state hospital than would be expected on the basis of over-all state hospital admissions. Similarly, a high proportion of patients with organic brain syndromes were admitted directly to the hospital from the three-county area. The authors say the findings suggest that the public mental hospital still has an important role to play on the delivery of mental health services.
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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.