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Biomedical subjects

M Galanter

Publications and source records attributed to M Galanter.

At least 73 records · Page 4Linked to original sources

Cults and zealous self-help movements: a psychiatric perspective.

Modern cults and zealous self-help movements exercise an intense group influence and can have a major impact on their members' psychiatric status. On the basis of research findings, the author describes the charismatic group, a generic model for such cohesive, intensely ideological movements. He examines the psychological forces they tap and the way they can both relieve and exacerbate psychopathology. The model is then used to explain the operation of zealous self-help programs that address psychiatric syndromes; these are directed at problems of the medically ill, substance abusers, and relatives of psychiatric patients.

Adolescent↗

Treatment retention of patients referred by public assistance to an alcoholism clinic.

In order to ascertain the relative impact of coercion by a welfare program on retention in an ambulatory alcoholism program, records of 178 consecutive admissions to an inner-city alcoholism clinic were reviewed. Patients who came to the clinic via coerced referral from a public assistance agency were as likely to remain in treatment for at least nine sessions as self-referred patients.

Adult↗

Liver function, plasma dexamethasone, and DST results in detoxified alcoholics.

Alcohol abuse, alcohol withdrawal, and deterioration of hepatic function have been associated with abnormal dexamethasone suppression test (DST) results. Chronic alcohol abuse may also directly alter the pharmacokinetic disposition of dexamethasone. Plasma dexamethasone concentrations following a DST were determined in 53 detoxified alcoholics. Those with abnormal liver function had higher 4 p.m. plasma dexamethasone concentrations and lower DST cortisol concentrations. Those with normal liver function had lower plasma dexamethasone and higher DST cortisol concentrations consistent with induction of hepatic metabolic enzymes from chronic use of alcohol. The data indicate that liver function is one of the variables influencing dexamethasone disposition and DST cortisol suppression.

Adult↗

Low basal levels of cortisol distinguish detoxified alcoholics with major depressive disorder from non-MDDs.

Basal plasma levels of cortisol and its suppression by dexamethasone were measured in 60 inpatient alcoholics 12-13 days after detoxification. Both hypothalamic-pituitary adrenal system parameters were essentially within normal limits in most patients--those who did not meet criteria for major depressive disorder (n = 43) as well as those who met criteria for MDD per their episode (n-17). Basal levels of cortisol below 7 micrograms/dl distinguished alcoholics without MDD from those who met criteria for MDD per current episodes.

Adult↗

The current status of psychiatric education in alcoholism and drug abuse.

The authors conducted a survey of psychiatric education in alcoholism and drug abuse in the United States. Ninety-seven percent of 106 undergraduate training programs and 91% of 169 residency programs offered curriculum units in this field. Most of these programs also provided supervised clinical care. Areas of reported faculty dissatisfaction included problems with attitude and interest of psychiatric faculty and with the amount of curriculum time allotted. The authors conclude that although the amount of curriculum time devoted to training in alcoholism and drug abuse is growing, further investment in developing faculty and fellowships is warranted to increase the quality of teaching commitment.

Alcoholism↗

Zealous self-help groups as adjuncts to psychiatric treatment: a study of Recovery, Inc.

In a controlled study of Recovery, Inc., a self-help program for people with psychiatric problems, the author found a decline in both symptoms and concomitant psychiatric treatment after subjects had joined the group. Scores for neurotic distress reported after joining were considerably lower than those reported for the period before joining. Scores for psychological well-being of longstanding Recovery members were no different from those of community control subjects, and fewer long-term members than recent members were being treated with psychotropic medication and psychotherapy. The author concludes that peer-led self-help groups have value as an adjunct to psychiatric treatment.

Attitude to Health↗

Ethnic differences in drinking practices and cognitive impairment among detoxifying alcoholics.

The purpose of the present study was to determine whether ethnic differences existed among detoxifying alcoholic inpatients regarding drinking practices, psychosocial variables and cognitive impairment. Patients of Puerto Rican extraction (Hispanics) were found to be more often afflicted than Whites and Blacks by cognitive impairment, daily drinking, heaviest average amount drunk, unemployment and lack of residence. Whites were less affected by these variables than the other two ethnic groups. Amount and frequency of drinking predicted the occurrence of cognitive impairment to a degree that approached significance. Cognitive impairment was defined as inability to score less than 5 points in the Blessed Orientation-Memory-Concentration test. In a follow-up study, nearly all CT scans obtained on a similar group of 20 detoxifying alcoholics (mean age 40), who had cognitive impairment as defined in the first study, were found to demonstrate brain atrophy. Contrasting drinking practices rather than ethnicity may have accounted for the different rates of cognitive impairment observed among the three ethnic groups.

Adult↗

Substance abuse among general psychiatric patients: place of presentation, diagnosis, and treatment.

This paper reviews the literature on patients presenting for general psychiatric treatment who are also substance abusers. Place of presentation, diagnosis, and treatment are considered. A considerable portion of patients seen in emergency rooms, as much as half in some settings, are substance abusers, and over a third of general psychiatry admissions have been found to have their presenting problems materially influenced or precipitated by substance abuse. Substance abuse is also frequently found among psychiatric inpatients. Diagnostically, the differentiation of general psychiatric and addictive syndromes can be difficult: primary and secondary affective disorder from consequences of long-term substance abuse; and self-medication patterns from primary general psychiatric syndromes. Treatment studies are often focused on concomitant psychotherapeutic management for patient being treated for addiction. Often, emphasis is placed on pharmacotherapy for enhancing outcome in the dually diagnosed. Qualitatively, new options tailored to this population still remain to be studied, however, as do the changes necessary in the treatment system to assure proper long-term management.

Alcoholism↗

Institutional self-help therapy for alcoholism: clinical outcome.

Self-help peer-led therapy can yield improved cost effectiveness and clinical outcome in hospital-based alcoholism treatment. This was demonstrated by comparing two ambulatory alcoholism treatment programs: a control program operated solely by professional staff, and an experimental one based on peer-led self-help (SH). The SH program was staffed by only half as many primary therapists as the control. Patients in both programs were evaluated over the course of one year. By means of the Patient Status Form, a clinical assessment instrument applied monthly, SH patients were found to score significantly higher on social adjustment, although retention and drinking rates, and utilization of Alcoholics Anonymous and disulfiram were no different from controls. This study is the continuation of an initial comparison in which SH patients were found to have enhanced retention in treatment after discharge from an impatient service.

Adult↗

Relationship between serum cortisol, liver function, and depression in detoxified alcoholics.

High levels of serum cortisol or abnormal dexamethasone suppression tests may be helpful in diagnosing major depressive disorder. However, a controversy exists as to whether abnormal liver function associated with alcohol abuse may negate the diagnostic value of the dexamethasone suppression test in alcoholics. We investigated the value of the dexamethasone suppression test in alcoholics by analyzing the liver function, cortisol levels, and psychiatric status of inpatients from an alcohol detoxification treatment center. The subjects met the DSM III criteria for alcohol dependence but took no chronic medication and had negative screening for substance abuse. They had routine blood screening to evaluate liver function, the afternoon cortisol test and dexamethasone suppression test to study glucocorticoid activity, and a structured evaluation to determine psychiatric diagnoses. The blood chemistry findings demonstrated a lack of significant liver synthetic dysfunction in this group, although 43% of the subjects had some elevation of their liver enzymes. We did not find differences in the liver function between patients with normal and abnormal cortisol levels. However, subjects with endogenous depression did have significantly elevated afternoon cortisol levels, and they tended to have more normal liver tests. These results indicate that modest liver dysfunction does not contaminate the validity of the plasma cortisol tests or the dexamethasone suppression test as diagnostic tools for assessing depression in this group of detoxified alcoholics. In addition, they demonstrate an association between depression and plasma cortisol levels and suggest a correlation between depression and better liver function in alcoholics who seek detoxification.

Adult↗

"Moonies" get married: a psychiatric follow-up study of a charismatic religious sect.

A 3-year follow-up of longtime engaged members of the Unification Church revealed remarkable compliance with the sect's unusual marital commitments. Of 305 subjects, 95% were still active in the church and 85% had been married in the interim to mates designated by their religious leader. Their scores on a measure of psychological well-being remained below those of the general population, and members who deviated from the sect's expectations showed even greater distress. Furthermore, analysis revealed that affiliative ties with the sect apparently counteracted the distress produced by the unusual marital experience and help to explain compliance with the sect's unusual behavioral norms.

Adult↗