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Biomedical subjects

R F Kokes

Publications and source records attributed to R F Kokes.

At least 19 recordsLinked to original sources
PubMed1990

Predictors of outcome among adult psychiatric first-admissions.

This study comparatively evaluated the prognostic potential of 10 demographic and clinical factors previously associated with psychiatric outcome. The longitudinal design employed intensive, structured, reliable interview techniques. One hundred forty-five subjects from a representative sample (N = 217) of community mental health catchment area first lifetime admissions were assessed at hospitalization and at 2-year follow-up. Predictors examined included premorbid functioning, overall health-sickness, diagnostic severity, social class, sex, age, IQ, race, and life events. Outcome was assessed multidimensionally with absolute-level and residualized indices of functioning and symptomatology. Phillips Premorbid Status and social class emerged from correlation and multiple regression analyses as the best predictors of functioning level and overall clinical status, while IQ was the most prominent indicator of symptomatology changes. Results support the notion that a general social competence factor predicts to psychiatric outcome across the entire spectrum of severe disorders.

Adaptation, Psychological↗
PubMed1990

Predictors of two-year outcome among psychiatric outpatients.

This study hypothesized that social competence and clinical factors previously associated with psychiatric outcome among inpatients would be effective predictors of outcome among outpatients (N = 77) as well. Intake and 2-year outcome status were assessed multidimensionally with absolute-level and residualized indices of functioning, overall clinical status, and symptomatology. Menninger health-sickness proved to be the best single predictor, although Phillips premorbid functioning, Strauss-Carpenter prognosis, social class, and diagnostic severity also predicted well to outcome. Patterns of associated predictor/outcome variable clusters were described. Results suggest that a general social competence factor predicts to psychiatric outcome across the entire range of disorders, but that life events stress does not.

Adaptation, Psychological↗
PubMed1989

IQ as a prognostic indicator in adult psychiatric first-admissions.

This study used IQ, along with measures of premorbid adjustment, health-sickness, symptom level, diagnostic severity and demographic data, to predict to 2-year outcome measures of level of functioning, health-sickness, and symptoms for a sample of 145 adult psychiatric first-admissions. It was hypothesized that IQ as an indicator of cognitive ability, or of general ability to adapt, would predict positively to improvement over the 2-year period. Data analysis was conducted with bivariate correlations and multiple regressions, using both absolute-level and residualized outcome variables. IQ showed modest, significant relationships with all absolute outcome indices and six of seven residualized measures, especially for a subsample of those with non-average IQ scores. Regressions showed that IQ provided independent prediction of symptom outcomes.

Adolescent↗
PubMed1989

Life events and psychopathology severity: comparisons between psychiatric outpatients and inpatients.

Relationships between life events stress variables and seven indices of psychopathology severity for a group of 97 never-hospitalized outpatients were compared with those of a previously studied group of 217 first-admission functional disorder psychiatric inpatients from the same geographical catchment areas. The hypotheses tested were that degree of life events stress would be correlated positively with indices of psychopathological severity and that the magnitudes of association would be higher for the outpatients. Bivariate correlations and stepwise multiple regression with other potential demographic and prognostic moderator variables provided evidence for significant, but somewhat differing, patterns in outpatient vs. inpatient stress/pathology relationships. Contrary to prediction, the magnitudes of significant and near-significant associations between life events and pathology severity were not different in the two samples.

Adjustment Disorders↗
PubMed1988

Social class and psychiatric disorder. The examination of an extreme.

Relationships between social status and various aspects of mental disorder have been of long-standing interest to both clinicians and researchers, and a large body of literature exists attesting to the importance of social status in understanding psychiatric illness and disability. Reports examining social status and schizophrenia suggest that relationships between socioeconomic status and psychiatric illness may rest heavily upon differences between the lowest socioeconomic stratum and the remainder of society. To investigate the extent to which relationships between socioeconomic status and psychiatric illness and disability reflect differences between a deviant lowest socioeconomic stratum and the remainder of society, data from 217 patients hospitalized for psychiatric disorder and reassessed at a 2-year follow-up were examined. At initial assessment, 17 patient characteristics were found to be associated with socioeconomic status; for seven of these 17 characteristics, the largest difference between classes was found between the lowest and the adjacent (next-lowest) social class. At follow-up, for five of 15 characteristics found to be related to social class, the greatest interclass difference occurred between the lowest and the adjacent social class. Both initially and at follow-up, significant associations between patient characteristics and social class remained when the lowest social class patients were excluded from the analyses.

Follow-Up Studies↗
PubMed1988

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric inpatients.

This study tested the hypothesis that the Last-Weiss (Last & Weiss, 1976) Rorschach Ego-Strength Scale would predict outcome among a representative sample of first-lifetime psychiatric admissions. One hundred seventeen patients were assessed with structured symptom, psychiatric history, and social data interviews at hospital admission, and 2-year follow-up. Outcome measures included a multidimensional variable involving rehospitalization time, social and work functioning, and recent symptom level and symptom measures. Unexpectedly, the Last-Weiss Sum E variable correlated significantly with negative multidimensional outcome, a result that was strengthened when any possibly confounding effects of social class, IQ, and number of Rorschach responses were partialled out. It was found that Sum E's predictive value for poorer outcome was due to the space response (S+) component of the ego-strength variable. Possible explanations of the findings and implications for the previously validated Klopfer's Rorschach Prognostic Rating Scale are discussed.

Adjustment Disorders↗
PubMed1988

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric outpatients.

This study tested the hypothesis that the Last and Weiss (1976) Rorschach Ego-Strength Scale (sigma E) would predict outcome among a representative sample of never-hospitalized psychiatric outpatients. 78 patients were assessed with structured symptom, psychiatric history, and social data interviews at the time of initial clinic contact and at 2-yr. follow-up. Outcome measures included the Menninger Health-Sickness Scale, a multidimensional variable involving social and work functioning and recent symptom level, symptom measures, and an index of diagnostic severity. sigma E, controlled for number of responses, correlated significantly with Health-Sickness, neurotic symptoms, diagnostic severity, and psychotic symptomatology. Among the components of sigma E, M+, and FC+ had significant relationships or contributed to significant relations with outcome variables. Considered with an earlier study of inpatients, in which S+ sigma E component correlated inversely with outcome, this study suggested that sigma E components have differing prognostic significance, depending on adaptational level of the patient.

Adolescent↗
PubMed1986

Social class and psychiatric outcome.

Although social status has been shown to relate to rates of certain types of psychiatric disorder and to treatment received, little information is available regarding social class and clinical improvement over time. This report presents findings from a prospective follow-up study of a representative sample of first-admission psychiatric patients. A variety of clinical characteristics were analyzed at hospital admission and 2-year follow-up. The social status of the individual patient, the social status of the patient's parents, and the social status associated with the patient's residential area were found to be correlated with improvement over the 2-year follow-up period.

Adolescent↗
PubMed1985

Alternative strategies for creating "relational" family data.

A major problem facing family clinicians and researchers is creating data that will reflect the family as a unit. To address this problem, we present a framework for family assessment based on three measurement strategies: individual family member assessment, relational family assessment, and transactional family assessment. Within this context, we present several categories of methods for combining individual family member data into "relational" scores that reflect the couple or family as a unit. The problems and benefits of each method are presented, and it is suggested that the choice of method is dependent upon the content of the assessment, the theory underlying the content, and the statistical properties of the individual family member scores.

Data Collection↗
PubMed1985

Sex and race of patients admitted for their first psychiatric hospitalization: correlates and prognostic power.

Much attention has been focused on the advantages enjoyed by white males in the general society. Are they similarly advantaged in a psychiatric population? Two hundred seventeen patients from two demographically heterogeneous catchment areas admitted to inpatient care during a 1-year period were interviewed using standardized procedures; 80% of the original sample was available for follow-up 2 years later. Race and sex showed no consistent pattern of relationships with psychiatric symptoms, disability, and outcome; being both white and male was not advantageous in terms of any of the characteristics examined.

Adolescent↗
PubMed1984

Self-derogation and psychopathology.

To test empirically the oft-repeated clinical hypothesis of a relationship between the self-derogation component of low self-esteem and severity of psychopathology across the entire range of pathology, including nondepressive disorders, the present study examined this relationship in two samples of Ss. The first were 152 patients and expatients from two community mental health catchment areas followed up two years after their first functional-disorder psychiatric admission. The second group were 97 outpatients from the same catchment areas beginning therapy at a community mental health clinic. Within each sample self-derogation was related significantly to severity of diagnosis, overall health-sickness, numerous indices of symptomatology severity, and a measure of difficulty in social/employment functioning. These findings point to the need to recognize and treat self-derogation in psychopathological states other than depression. In addition, they raise the important question of direction of causality between self-derogation and observed psychopathology.

Adolescent↗
PubMed1982

First-admission psychiatric ward milieu: treatment process and outcome.

A two-year, prospective study of 123 first-admission patients examined the impact of different inpatient treatment decision-making styles on patient outcome on a therapeutic community ward and a medically oriented psychiatric ward. Ward philosophy, programmatic and administrative structure, and ward atmosphere defined the ward milieus. Data on length of stay and the use of various therapeutic modalities provided comparisons of treatment process. Standardized ratings of psychopathologic condition and levels of function, readmissions, and illness attitudes were used to assess two-year outcomes. The major finding was the absence of outcome differences despite longer lengths of stay on the therapeutic community ward. Hence, differences in ward decision-making style may not influence outcome, but may affect the process of care among diagnostically heterogeneous, first-admission patients treated in a university setting.

Adolescent↗
PubMed1982

Family free-play interaction: the role of the patient in the family interaction.

We have discussed the salient features of the family interaction in the free-play situation: the high rate of interaction with the child and general predominance of parental initiations in the parent-child interaction, the high correlation among all dyads on warmth. This led to the selection of three variables for study: rate of patient-child interaction, proportion of parental initiations to the child, and family warmth. There are major age changes: rate and proportion both decline with age. The patient's rate of interaction with the child and his proportion of interaction is lower than the spouse's rate. This holds for the 4- and 10-year-olds separately. We have tried to account for its reversal in the 7-year-old sample. Nonpsychotic patients have a higher rate of interaction, higher proportion of interactions, and higher family warmth than psychotics. Affectivity shows no relationship to these variables. Patients with a low global assessment score have lower rates, lower proportion, and less warmth than patients with a higher score. Patients who have been recently hospitalized have a lower rate of interactions with their sons than those who have been hospitalized longer.

Affect↗