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Biomedical subjects

L H Roth

Publications and source records attributed to L H Roth.

At least 19 recordsLinked to original sources
PubMed2000

A classification tree approach to the development of actuarial violence risk assessment tools.

Since the 1970s, a wide body of research has suggested that the accuracy of clinical risk assessments of violence might be increased if clinicians used actuarial tools. Despite considerable progress in recent years in the development of such tools for violence risk assessment, they remain primarily research instruments, largely ignored in daily clinical practice. We argue that because most existing actuarial tools are based on a main effects regression approach, they do not adequately reflect the contingent nature of the clinical assessment processes. To enhance the use of actuarial violence risk assessment tools, we propose a classification tree rather than a main effects regression approach. In addition, we suggest that by employing two decision thresholds for identifying high- and low-risk cases--instead of the standard single threshold--the use of actuarial tools to make dichotomous risk classification decisions may be further enhanced. These claims are supported with empirical data from the MacArthur Violence Risk Assessment Study.

Actuarial Analysis↗
PubMed2000

Sources of coercive behaviours in psychiatric admissions.

OBJECTIVE: Coercion during psychiatric admissions has been a topic of debate for many years. Although there has been considerable research on patients' perceptions of coercion, there has been no work on who places pressures on patients to be admitted. METHOD: This article integrates interview data from interviews with patients, admitting staff and family and friends to describe the pressures brought to bear on patients to be admitted. RESULTS: Health-care professionals appear to be the most important source of pressures on patients, and to have the most impact on patients' perceptions of coercion. However, there are differences in type of pressure, and the pressures used by family and friends appear to have the most longstanding impact. CONCLUSION: Legal and clinical efforts to reduce the level of coercive pressures on patients need to recognize the importance of mental-health professionals, including especially those who are not legally mandated to participate in the admission process.

Adolescent↗
PubMed2000

Developing a clinically useful actuarial tool for assessing violence risk.

BACKGROUND: A new actuarial method for violence risk assessment--the Iterative Classification Tree (ICT)--has become available. It has a high degree of accuracy but can be time and resource intensive to administer. AIMS: To increase the clinical utility of the ICT method by restricting the risk factors used to generate the actuarial tool to those commonly available in hospital records or capable of being routinely assessed in clinical practice. METHOD: A total of 939 male and female civil psychiatric patients between 18 and 40 years old were assessed on 106 risk factors in the hospital and monitored for violence to others during the first 20 weeks after discharge. RESULTS: The ICT classified 72.6% of the sample as either low risk (less than half of the sample's base rate of violence) or high risk (more than twice the sample's base rate of violence). CONCLUSIONS: A clinically useful actuarial method exists to assist in violence risk assessment.

Actuarial Analysis↗
PubMed1999

Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation.

BACKGROUND: Poor medical compliance has been held responsible for a large proportion of deaths occurring subsequent to initial postoperative recovery. However, beyond clinical reports, there has been little empirical examination of this issue, or of the extent to which major psychiatric disorder and failure to adjust to the transplant predict long-term physical morbidity and mortality. We prospectively examined whether a full range of compliance behaviors and psychiatric outcomes during the first year post-transplant predicted subsequent mortality and physical morbidity through 3 years post-transplant. METHODS: A total of 145 heart recipients who had received detailed compliance and mental health assessments during the first year post-transplant were followed up at 3 years post-transplant. Interview data and corroborative information from family members were used to determine compliance in multiple domains, psychiatric diagnoses, and psychiatric symptomatology during the first year post-surgery. Medical record reviews were performed to abstract data on acute graft rejection episodes, incident cardiac allograft disease (CAD) and mortality from 1 to 3 years post-transplant. RESULTS: After controlling for known transplant-related predictors of outcome, multivariate analyses yielded the following significant (p < 0.05) results: (a) risk of acute graft rejection was 4.17 times greater among recipients who were not compliant with medications; (b) risk of incident CAD was elevated by persistent depression (Odds Ratio, OR = 4.67), persistent anger-hostility (OR = 8.00), medication noncompliance (OR = 6.91), and obesity (OR = 9.92); and (c) risk of mortality was increased if recipients met criteria for Post-Traumatic Stress Disorder related to the transplant (OR = 13.74). CONCLUSIONS: The findings, plus data we have previously reported that showed which patients are most likely to have compliance and psychiatric problems early post-transplant, suggest that interventions focused on maximizing patients' psychosocial status in these areas may further improve long-term physical health outcomes in this population.

Adult↗
PubMed1999

Dimensional approach to delusions: comparison across types and diagnoses.

OBJECTIVE: A dimensional approach to the characterization of delusions was used to examine the use of non-content-related descriptors of delusions in revealing differences across diagnostic categories and delusion types. METHOD: Interviews with 1,136 acutely hospitalized psychiatric patients identified subjects as definitely or possibly delusional on the basis of screening questions derived from the Diagnostic Interview Schedule. Subjects with delusions were given the MacArthur-Maudsley Delusions Assessment Schedule, which generates scores on six dimensions of delusions. Delusions were classified by type, and diagnoses were assigned by using the DSM-III-R checklist. RESULTS: A total of 328 subjects (29%) were rated as definitely or possibly delusional. Their ratings on dimensions of the MacArthur-Maudsley Delusions Assessment Schedule were significantly but modestly intercorrelated. Subjects with schizophrenia generally had more intense delusions than those in other diagnostic categories. Grandiose and religious delusions were held with the greatest conviction, whereas persecutory delusions were marked by strong negative affect and a propensity to act. Factor analysis of the dimensions revealed a consistent two factor solution-"intensity and scope" and "affect and action"-regardless of the diagnosis or delusion type. CONCLUSIONS: The stability of the dimensional structure of delusions across diagnoses and delusion types suggests that even seemingly diverse delusions are more like than unlike each other; this is consistent with common etiologic mechanisms. The utility of a dimensional approach is indicated, in addition, by the ability to characterize delusions of different types and diagnoses so as to highlight therapeutic and other implications.

Acute Disease↗
PubMed1999

Patients' revisions of their beliefs about the need for hospitalization.

OBJECTIVE: An influential rationale for involuntary hospitalization is that prospective patients who refuse hospitalization at the time it is offered are likely to change their belief about the necessity of hospitalization after receiving hospital treatment. The authors examine how patients changed their evaluations of psychiatric hospitalization following hospital treatment. METHOD: The authors studied 433 patients who were interviewed about their hospitalization within 2 days of their admission to a psychiatric hospital; 267 of these patients were reinterviewed 4-8 weeks following discharge. RESULTS: When reinterviewed at follow-up, 33 (52%) of 64 patients who said at admission that they did not need hospitalization said that, in retrospect, they believed they had needed it. Only 9 (5%) of 198 patients who said at admission that they needed hospitalization shifted to saying that they had not needed it. CONCLUSIONS: Many of the patients who initially judged that they did not need hospitalization revised their belief after hospital discharge and reported that they had needed hospital treatment. However, perceptions of coercion were stable from admission to follow-up, and patients' attitudes toward hospitalization did not become more positive. Coerced patients did not appear to be grateful for the experience of hospitalization, even if they later concluded that they had needed it.

Adult↗
PubMed1998

Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods.

BACKGROUND: The public perception that mental disorder is strongly associated with violence drives both legal policy (eg, civil commitment) and social practice (eg, stigma) toward people with mental disorders. This study describes and characterizes the prevalence of community violence in a sample of people discharged from acute psychiatric facilities at 3 sites. At one site, a comparison group of other residents in the same neighborhoods was also assessed. METHODS: We enrolled 1136 male and female patients with mental disorders between the ages of 18 and 40 years in a study that monitored violence to others every 10 weeks during their first year after discharge from the hospital. Patient self-reports were augmented by reports from collateral informants and by police and hospital records. The comparison group consisted of 519 people living in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks. RESULTS: There was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse. Substance abuse symptoms significantly raised the rate of violence in both the patient and the comparison groups, and a higher portion of patients than of others in their neighborhoods reported symptoms of substance abuse. Violence in both patient and comparison groups was most frequently targeted at family members and friends, and most often took place at home. CONCLUSIONS: "Discharged mental patients" do not form a homogeneous group in relation to violence in the community. The prevalence of community violence by people discharged from acute psychiatric facilities varies considerably according to diagnosis and, particularly, co-occurring substance abuse diagnosis or symptoms.

Adolescent↗
PubMed1998

Temporal profiles of physical health in family members of heart transplant recipients: predictors of health change during caregiving.

This study examined patterns of change in the physical health and well-being of 133 family caregivers to heart transplant recipients during the 1st year after transplant. Caregivers were assessed at 2, 7, and 12 months after transplant. Cluster analysis was used to identify temporal profiles reflecting unique patterns of change in the direction and nature of caregivers' physical health; their temporal profiles showed either (a) a worsening of general medical condition, with weight gain (14% of the sample); (b) worsening medical condition with weight loss (15%); (c) weight gain with stable medical condition (41%); (d) weight loss with slightly improving medical condition (21%); or (e) worsening health perceptions with relatively little objective evidence of change in medical condition or weight (8%). Subsequent multivariate analyses indicated that caregiver characteristics measured at baseline and reflecting caregiving burden, coping styles, demographics, and health history reliably predicted membership in the pattern-of-health-change groups. Among the findings, caregivers who showed a pattern of medical decline with weight loss had a poorer health history and weaker coping styles (lower mastery and higher use of avoidance coping) than other caregivers. Caregivers who experienced medical decline with weight gain had the greatest levels of caregiver burden. These findings are relevant to the design of interventions to maximize not only caregivers' health, but the health of the family members for whom they provide care.

Activities of Daily Living↗
PubMed1998

Factual sources of psychiatric patients' perceptions of coercion in the hospital admission process.

OBJECTIVE: The purpose of this study was to determine what predicts patients' perceptions of coercion surrounding admission to a psychiatric hospital. METHOD: For 171 cases, the authors integrated data from interviews with patients, admitting clinicians, and other individuals involved in the patients' psychiatric admissions with data from the medical records. Using a structured set of procedures, coders determined whether or not nine coercion-related behaviors occurred around the time of admission. Correlation and regression analyses were used to describe the predictors of patients' scores on the MacArthur Perceived Coercion Scale. RESULTS: The use of legal force, being given orders, threats, and "a show of force" were all strongly correlated with perceived coercion. A least squares regression accounted for 43.3% of the variance in perceived coercion. The evidence also suggested that force is typically only used in conjunction with less coercive pressures. CONCLUSIONS: Force and negative symbolic pressures, such as threats and giving orders about admission decisions, induce perceptions of coercion in persons with mental illness. Positive symbolic pressures, such as persuasion, do not induce perceptions of coercion. Such positive pressures should be tried in order to encourage admission before force or negative pressures are used.

Adult↗
PubMed1997

The validity of mental patients' accounts of coercion-related behaviors in the hospital admission process.

Although the recent development of a measure for perceived coercion has led to great progress in research on coercion in psychiatric settings, there still exists no consensus on how to measure the existence of real coercive events or pressures. This article reports the development of a system for integrating chart review data and data from interviews with multiple participants in the decision for an individual to be admitted to a psychiatric hospital. The method generates a "most plausible factual account" (MPFA). We then compare this account with that of patients, admitting clinicians and other collateral informants in 171 cases. Patient accounts most closely approximate the MPFA on all but one of nine dimensions related to coercion. This may be due to wider knowledge of the events surrounding the admission.

Adult↗
PubMed1996

Prevalence and predictors of depression and anxiety-related disorders during the year after heart transplantation.

This study longitudinally evaluates prevalence, clinical characteristics, and risk factors for DSM-III-R Major Depression, Generalized Anxiety Disorder (GAD), associated Adjustment Disorders, and Post-Traumatic Stress Disorder related to the transplant (PTSD-T) in a large, representative sample of heart recipients followed during the first year after transplantation. Lifetime pretransplant prevalence as well as 1-year posttransplant rates were determined for the 154 recipients via standardized clinical interview schedules. Major Depression was the most prevalent disorder posttransplant (1- year rate of 17.3%), followed by PTSD-T (13.7%), and Adjustment Disorders (10.0%). There were no cases of GAD. Specific pretransplant and perioperative factors increased recipients' risk for any psychiatric disorder (vs none) posttransplant, including pretransplant psychiatric history; poor social supports from primary family caregiver, other relatives, and friends; the use of avoidance coping strategies for managing health problems; and low self-esteem early posttransplant. Within diagnostic groups, additional risk factors distinguished recipients with anxiety-related vs depressive disorders posttransplant: those at highest relative risk for anxiety had waited more briefly for a donor heart, were more likely to have a family psychiatric history, had the poorest family and friend support of all recipients, utilized the poorest coping skills, and had a poor sense of mastery. The findings have implications for the development of primary and secondary prevention strategies for psychiatric disorder in heart recipient populations.

Adaptation, Psychological↗
PubMed1996

Medical compliance and its predictors in the first year after heart transplantation.

BACKGROUND: Although poor medical compliance is a major risk factor for morbidity and mortality after heart transplantation, no prospective data are available on rates of noncompliance with each component of the posttransplantation regimen. Little is known about the impact of health history, sociodemographic, or perioperative psychosocial variables on long-term compliance. METHODS: Compliance in eight domains was examined in a cohort of 101 heart recipients followed through the first year after transplantation. Patients received detailed interviews at 2, 7, and 12 months after transplantation. Additional corroborative information was obtained from family member interviews and nurse evaluations. Potential predictors of noncompliance were obtained from medical record reviews and from initial patient interviews. Predictors pertained to cardiac-related history, psychiatric history, sociodemographic variables, and perioperative psychosocial status (psychologic adaptation, social supports, coping strategies). RESULTS: Although degree of noncompliance varied across timepoints, rates of persistent noncompliance during the year were as follows: 37% (exercise); 34% (monitoring blood pressure); 20% (medications); 19% (smoking); 18% (diet); 15% (having blood work completed); 9% (clinic attendance); and 6% (heavy drinking). Compliance in most areas worsened significantly (p < 0.05) over time. Background health-related and sociodemographic characteristics showed no significant influence on any area of posttransplantation compliance. Perioperative psychosocial characteristics were strong and significant predictors of noncompliance. CONCLUSIONS: Pretransplantation screening for background and demographic variables may have limited utility for compliance outcomes. Strategies to improve compliance should focus on psychosocial risk factors pertaining to early psychologic reactions to transplantation, the quality of family relationships, and patients' styles of coping. These risk factors are each potentially modifiable through appropriate educational and supportive interventions.

Adolescent↗
PubMed1995

Semipreparative separation of intact hopanoids from Zymomonas mobilis.

Hopanoids are an important class of molecules that play a structural and physiological role in the membrane processes of prokaryotic and plant cells. Studies on the function of hopanoids require milligram quantities but have been limited by current procedures for isolation and characterization: most separations have isolated only derivatized compounds of hopane in microgram quantities. Our method employs aminopropyl bonded-phase solid-phase extraction columns with sequential elution and silica semipreparative HPLC with isocratic elution. When applied to freeze-dried cells of Zymomonas mobilis, the procedure separated the three major hopanoids present (bacteriohopanetetrol, bacteriohopanetetrol-glucosamine, and bacteriohopanetetrol-ether) from the other lipid classes. Using the solid-phase extraction column, a fraction containing an average of 3.3 mg of bacteriohopanetetrol per gram dry weight of cells was recovered without any detectable impurities along with a fraction that contained a mixture of the other two hopanoids. After this mixture was subsequently purified by semipreparative HPLC, approximately 4.7 mg of bacteriohopanetetrol-glucosamine and 3.6 mg of bacteriohopanetetrol-ether per gram dry weight of cells could be separated and recovered.

Chromatography, High Pressure Liquid↗
PubMed1995

Perceived coercion in mental hospital admission. Pressures and process.

BACKGROUND: Patients' perceptions of coercion in admission may affect their attitude toward subsequent treatment, including their inclination to adhere to treatment plans. This study looks at the determinants of patients' perceptions of coercion. METHODS: A sample of 157 patients admitted to a rural Virginia state hospital and a Pennsylvania community hospital were interviewed within 48 hours of admission about their experience of coming to the hospital. All subjects were 17 years or older. Diagnoses were diverse, and 42% were involuntarily committed. The interview gathered an open-ended description of the admission experience followed by a structured interview that included several measures. RESULTS: Perceptions of being respectfully included in a fair decision-making process ("procedural justice") and legal status were most closely associated with perceived coercion, and a significant relationship was found with perceived negative pressures, ie, force and threats. However, only procedural justice was related to the perception of coercion at both sites and with both voluntary and involuntary patients. CONCLUSIONS: Patients' feelings of being coerced concerning admission appears to be closely related to their sense of procedural justice. It may be that clinicians can minimize the experience of coercion even among those legally committed by attending more closely to procedural justice issues.

Adult↗
PubMed1995

Integration of information-seeking skills and activities into a problem-based curriculum.

Recent trends in medical education include a shift from the traditional, didactic, lecture-oriented approach to a more student-driven, problem-based approach to learning. This trend provides librarians with an opportunity to develop programs to teach information-gathering skills that support and are integrated into problem-based learning (PBL). In 1992, the University of Pittsburgh School of Medicine implemented the initial phase of a curriculum revision that emphasizes PBL. Since that time, Falk Library of the Health Sciences has provided a large-scale, intensive program integrating information-seeking skills and activities into the first-year Patient-Doctor Relationship course, a sequence that initiates medical school. A multimodal approach to information seeking and sources is emphasized, utilizing print and audiovisual materials, computerized resources, and subject experts. The Falk Library program emphasizes the gathering and use of information as central to both PBL and student skills development. An informal, post-course evaluation was conducted to gauge which information resources were used and valued most by students. This article presents evaluation results, including data on the use of information sources and services, and student perceptions of the librarian's role in the PBL sessions.

Curriculum↗
PubMed1994

Psychosocial predictors of vulnerability to distress in the year following heart transplantation.

This study examines psychological symptomatology in a cohort of 72 heart transplant recipients followed longitudinally during their first year post-transplant. In keeping with research on other domains of life stressors and illnesses, a central study goal was to identify pre-transplant and perioperative psychosocial factors associated with increased vulnerability to, and maintenance of, elevated psychological distress levels post-transplant. Average anxiety and depression levels, but not anger-hostility symptoms, were substantially elevated in the early post-transplant period, relative to normative data. Average symptom levels improved significantly over time, although one-third of the sample continued to have high distress levels at all follow-up assessments. Recipients with any of seven psychosocial characteristics at initial interview were particularly susceptible to continued high average distress levels over time: a personal history of psychiatric disorder prior to transplant; younger age; lower social support from their primary family caregiver; exposure to recent major life events involving loss; poor self-esteem; a poor sense of mastery; and use of avoidance coping strategies to manage health problems. Recipients without such factors showed improvement in average distress levels across the assessment period. These effects were stronger for anxiety than depressive symptoms, with the exception of a sizeable relationship between loss events and subsequent depression. The findings suggest that clinical interventions designed to minimize prolonged emotional distress post-transplant need to be closely tailored to heart recipients' initial psychosocial assets and liabilities.

Adaptation, Psychological↗
PubMed1993

Inclusion, motivation, and good faith: the morality of coercion in mental hospital admission.

We administered a semi-structured interview to 157 patients shortly after their admission to a psychiatric hospital. In the first, and open-ended, part of the interview, patients were asked to talk about what had been going on in their lives that led to their coming into the hospital. Then, in a more structured format, they were asked more specific details about who was involved, the patients' relationships with those involved, whether any attempts were made to influence the patient to come into the hospital, and whether such attempts were perceived as fair by the patient. This article presents a qualitative review of the transcripts of a subset of these interviews. It attends specifically to patients' perceptions of the morality of attempts by others--primarily family members, friends and mental health professionals--to influence them to be admitted to the hospital, and of the morality of the process by which these influence attempts resulted in admission.

Coercion↗