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Biomedical subjects

R A McCormick

Publications and source records attributed to R A McCormick.

At least 19 recordsLinked to original sources
PubMed1999

A survey of assaultive behavior in Veterans Health Administration facilities.

OBJECTIVE: To more clearly define the scope and impact of violence in health care facilities, national data on assaults in VA medical centers and freestanding clinics were examined. METHODS: A survey was distributed to all VA medical centers and freestanding clinics asking for cumulative data for one fiscal year (October 1990 through September 1991). Data were obtained on number, types, and locations of physical assaults and other assaultive behavior; the types of staff assaulted and number of workdays lost due to injuries; diagnoses of perpetrators; recommendations made after the incidents were reviewed; training in prevention and management of assaultive behavior; and the impact of training on rates of assaultive behavior. RESULTS: During the survey year, 24,219 incidents of assaultive behavior were reported by 166 VA facilities; 8,552 incidents involved battery or physical assault. Weapon possession by perpetrators was common (8.5 percent of incidents), and weapons were used in 130 assaults (1.5 percent of assaults). Assaults occurred most frequently in psychiatric units (43.1 percent), followed by long-term-care units (18.5 percent) and admitting or triage areas (13.4 percent). Assault-related injuries were most common among nursing personnel. Perpetrators of assaults were most typically diagnosed as having psychoses, substance use disorders, or dementia. On inpatient psychiatry units, an inverse correlation was found between expenditures on staffing and the frequency of assaultive incidents. Staff training on management of assaultive behavior varied widely. CONCLUSIONS: Assaultive behavior is a significant problem for health care workers. Staff in all clinical areas need to be prepared to deal with assaultive patients. More research is needed on staff training and interventions for preventing and limiting assaults.

Data Collection↗
PubMed1999

Repeated assaults by patients in VA hospital and clinic settings.

OBJECTIVE: The study aim was to determine the prevalence of repeated assaults on staff and other patients and characteristics of patients who commit repeated assaults in the Veterans Health Administration of the Department of Veterans Affairs. METHODS: Patients in VA medical centers and freestanding outpatient clinics who committed two or more assaults in fiscal years 1995 and 1996 were identified through a survey of facility quality or risk managers. For each repeatedly assaultive patient, structured information, including incident reports, was obtained for all assault occasions. RESULTS: A total of 153 VA facilities responded, for a response rate of 99 percent. The survey identified 8,968 incidents of repeated assault by 2,233 patients, for a mean of 4.02 assaults per patient in the two-year study period. In 92 percent of the incidents, the assaultive patient had a primary or secondary psychiatric diagnosis. The mean age of the repeat assaulters was 62 years. Ninety-eight percent of the repeat assaulters were male, and 76.6 percent were Caucasian. At least 16 percent of the assaulters, 22 percent of the patients assaulted, and 20 percent of the staff assaulted required medical attention for injuries, which, along with the number of lost work days, indicates that repeated assaults are costly. CONCLUSIONS: Repeatedly assaultive patients represent major challenges to their own safety as well as to that of other patients and staff. Identifying patients at risk for repeated assaults and developing intervention strategies is critically important for ensuring the provision of health care to the vulnerable population of assaultive patients.

Adult↗
PubMed1998

Personality subtypes, coping styles, symptom correlates, and substances of choice among a cohort of substance abusers.

To explore the use of normal personality measures in clinical populations, we investigated the usefulness of the Five-Factor personality domains measured by the NEO Personality Inventory (NEO-PI) in identifying subtypes among a cohort of 3,256 substance abusers. Three groups were reliably identified across clustering methods and the groups differed in reported coping style, psychopathological symptoms, and pattern of substance choice. The largest differences between group members' personality dimensions were found for measures of neuroticism, agreeableness, and conscientiousness. Members of groups characterized by elevated levels of neuroticism demonstrated low levels of conscientiousness and agreeableness. The more extreme the group members' levels on these personality dimensions, the higher their reported levels of depressive symptoms, aggressive/hostile cognitions, impulsiveness, maladaptive coping styles, and likelihood of abusing more than one substance. Results support the use of measures of normal domains of personality in identifying meaningful subtypes of substance abusers.

Adaptation, Psychological↗
PubMed1995

Testing a tripartite model: II. Exploring the symptom structure of anxiety and depression in student, adult, and patient samples.

L. A. Clark and D. Watson (1991) proposed a tripartite model of depression and anxiety that divides symptoms into 3 groups: symptoms of general distress that are largely nonspecific, manifestations of anhedonia and low positive affect that are specific to depression, and symptoms of somatic arousal that are relatively unique to anxiety. This model was tested by conducting separate factor analyses of the 90 items in the Mood and Anxiety Symptom Questionnaire (D. Watson & L. A. Clark, 1991) in 5 samples (3 student, 1 adult, 1 patient). The same 3 factors (General Distress, Anhedonia vs. Positive Affect, Somatic Anxiety) emerged in each data set, suggesting that the symptom structure in this domain is highly convergent across diverse samples. Moreover, these factors broadly corresponded to the symptom groups proposed by the tripartite model. Inspection of the individual item loadings suggested some refinements to the model.

Adult↗
PubMed1995

Testing a tripartite model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptom scales.

L.A. Clark and D. Watson (1991) proposed a tripartite model that groups symptoms of depression and anxiety into 3 subtypes: symptoms of general distress that are largely nonspecific, manifestations of somatic tension and arousal that are relatively unique to anxiety, and symptoms of anhedonia and low Positive Affect that are specific to depression. This model was tested in 5 samples (3 student, 1 adult, and 1 patient sample) using the Mood and Anxiety Symptom Questionnaire (MASQ; D. Watson & L. A. Clark, 1991), which was designed to assess the hypothesized symptom groups, together with other symptom and cognition measures. Consistent with the tripartite model, the MASQ Anxious Arousal and Anhedonic Depression scales both differentiated anxiety and depression well and also showed excellent convergent validity. Thus, differentiation of these constructs can be improved by focusing on symptoms that are relatively unique to each.

Adult↗
PubMed1995

Suicidal behavior among patients in the VA health care system.

A total of 167 Department of Veterans Affairs medical centers responded to a survey that sought information on suicidal behavior during a one-year period among patients in inpatient or outpatient treatment. Of 248 completed suicides during the period, about 60 percent occurred among patients in outpatient mental health treatment. The incidence of anxiety disorder diagnoses (17.7 percent), particularly posttraumatic stress disorder, among patients who completed suicide was much higher than that reported for persons who completed suicide in the general population. Many patients with psychiatric diagnoses who completed suicide had comorbid substance abuse diagnoses.

Adult↗
PubMed1988

Plasma cortisol and depression in pathological gamblers.

Basal serum cortisol and dexamethasone suppression test (DST) results were studied in 21 pathological gamblers who varied on the Beck Depression Inventory and selected scales of the Minnesota Multiphasic Personality Inventory, which had previously been shown to be related to depression in gamblers. All subjects were suppressors on the DST. There was a significant relationship between fluctuation in 08.00 h and 16.00 h basal cortisol levels and the psychological measures, suggesting a subtype of pathological gambler with potential clinical significance.

Adult↗
PubMed1987

Personality profiles of hospitalized pathological gamblers: the California Personality Inventory.

Studies of the personality of the pathological gambler have consisted primarily of case reports and findings on the MMPI. This article presents data on a sample of 70 pathological gamblers, 70 alcoholics in treatment, and 70 medical/surgical controls on the California Personality Inventory (CPI). Gamblers and alcoholics differed significantly from hospitalized controls on a number of scales, particularly on measures of socialization, ego control, and flexibility. Differences between the gamblers and alcoholics were few, with a trend for the alcoholics to be similar to the gamblers and intermediate between the other two groups. Implications for the treatment of the pathological gambler are discussed.

Adult↗
PubMed1987

Follow-up of pathological gamblers after treatment.

Pathological gamblers entering a comprehensive treatment program were thoroughly assessed before treatment and 6 months after completion of treatment. The reports of gamblers and collateral informants were highly consistent. Follow-up interviews were conducted with 57 of the 66 patients entering treatment. Total abstinence was reported by 56% (N = 32) of the patients located for follow-up, and significant improvement on a wide range of measures was documented. The authors feel that the results demonstrate that pathological gambling is a treatable mental disorder.

Adult↗
PubMed1987

The effect of computerized utilization review on patterns of psychiatric inpatient care.

An interactive computerized utilization review system for psychiatric inpatient care was developed and tested on a 30-bed acute admission ward, where staff were trained in its use. The program permitted staff to review clinical decisions affecting length of stay and to receive immediate feedback on the cost and revenue for each case. The impact of the system was evaluated by comparing the length of stay of patients on the study unit with that of patients on a similar unit where the system was not in use, and also by comparing the length of stay for both units before and after the system was implemented. The findings showed that the length of stay on the study unit was significantly reduced after the system's implementation, and that it was well accepted by the staff. Six-month follow-up data showed no increase in symptomatology for the study patients compared with the control group.

Adult↗
PubMed1987

The prevalence and impact of major life stressors among pathological gamblers.

Major traumatic events were discovered in the histories of 23% of pathological gamblers seeking hospital treatment. These high-trauma patients were compared with groups of gambler patients who had experienced insignificant, low, or moderate amounts of life trauma. High-trauma patients tended, as measured by standard psychometrics, to be more depressed, anxious, and avoidant in personality style; they were also more likely to be abusing alcohol or other drugs. In their discussion the authors focus on the concept of learned dysthymia, a chronic state of negative affect related to cumulative life trauma and seemingly instrumental in potentiating addictive euphoria.

Adult↗
PubMed1984

Affective disorders among pathological gamblers seeking treatment.

Clinical impressions and psychological testing suggest that pathological gamblers demonstrate a high incidence of affective disorders. To assess the frequency of such disorders, the Schedule for Affective Disorders and Schizophrenia was administered to 50 patients admitted successively to the gambling treatment program of a VA hospital. Seventy-six percent of the subjects were diagnosed as having major depressive disorder and 38% as having hypomanic disorder according to the Research Diagnostic Criteria. The patients with major depressive disorder and one patient with schizoaffective disorder, depressed type, were significantly more likely to miss work often due to gambling. A large number of patients displayed suicidal tendencies.

Absenteeism↗
PubMed1984

An outcome study of an inpatient treatment program for pathological gamblers.

In 1972 the Brecksville Unit of the Cleveland Veterans Administration Medical Center began the first inpatient treatment program for pathological gambling in the United States. The 30-day, highly structured gambling treatment program aims for abstinence from gambling, reduction of the urge to gamble, and restoration of a maximum level of social functioning. The authors report the results of a preliminary outcome study of 60 former patients who completed a survey form rating various aspects of their lives one year postdischarge. Fifty-five percent of the respondents reported complete abstinence from gambling since discharge. Chi-square analyses demonstrated significant relationships between abstinence from gambling and improved interpersonal relationships, better financial status, decreased depression, and participation in professional aftercare and Gamblers Anonymous. The authors believe that their initial results support the contention that pathological gambling is a treatable disorder.

Adult↗