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Biomedical subjects

W R Holcomb

Publications and source records attributed to W R Holcomb.

At least 19 recordsLinked to original sources

Matricide: primal aggression in search of self-affirmation.

Three major theories of matricide are presented and critiqued using epidemiological data, case studies, and descriptive research. The strengths and weaknesses of psychoanalytic theory, family systems theory, and cognitive behaviorism in explaining matricide are described. The social-interaction theory of violence and, in particular, self-affirmation motive is presented as the most helpful perspective for understanding murder of the mother. This review covers those concepts within psychoanalysis, cognitive behaviorism, and family systems theory that have historically been used to understand matricide and is not a critique of modern psychoanalysis, cognitive behaviorism or family systems theory. Matricide occurs in less than 1% of all homicides. Offenders are heterogeneous in their characteristics with at least three different types. Most prominent characteristics across matricide types are severe mental illness, a domineering mother, a hostile-dependent relationship with the mother, a passive or withdrawn father, and over kill behavior. Self-affirmation motive suggests several interventions to prevent violence against the mother or its equivalents. The author makes several conclusions about the nature of human aggression and family dysfunction.

Adolescent↗

The effect of hip position and electromyographic biofeedback training on the vastus medialis oblique: vastus lateralis ratio.

OBJECTIVE: PATELLOFEMORAL PAIN SYNDROME IS A PATELLAR TRACKING DYSFUNCTION USUALLY ASSOCIATED WITH VASTUS MEDIALIS OBLIQUE (VMO) WEAKNESS, AND SUBSEQUENTLY, A SMALL VMO: vastus lateralis (VL) ratio. Several early electromyographic (EMG) studies have defined specific limb positions (such as external rotation of the hip) that preferentially activate the VMO. However, whether preferential activation of the VMO successfully translates into increased VMO:VL ratios with training has not been investigated. The purpose of our study was to investigate the effects of hip rotation on the mean VMO:VL EMG ratio using EMG biofeedback training over a 5-day period. DESIGN AND SETTING: Subjects performed isometric quadriceps contractions, in terminal extension, in 1 of 3 hip positions: the anatomically neutral hip position (group A), external hip rotation (group B), and internal hip rotation (group C). Pretest to posttest data were analyzed with a 3 (group) x 2 (test) analysis of variance with repeated measures on the last factor. SUBJECTS: Thirty-six healthy female college students with no known right knee musculoskeletal dysfunction. MEASUREMENTS: Activity of the VMO and VL was recorded by EMG and reported as the VMO:VL ratio. RESULTS: The main effect for group was not significant, but the main effect for test was significant. No significant interaction between group and test was noted. CONCLUSIONS: The statistical analysis of our results suggests that hip position during EMG biofeedback training has no effect on the VMO:VL ratio. However, because subjects were able to significantly increase their VMO:VL ratio in 5 days regardless of hip position, EMG biofeedback can be recommended for the facilitation of VMO muscular recruitment.

Journal Article↗

Authors' response.

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Journal Article↗

Customer satisfaction and self-reported treatment outcomes among psychiatric inpatients.

OBJECTIVE: Relationships among different dimensions of patient satisfaction and selected demographic, clinical, and outcome variables were explored in a sample of severely ill people receiving inpatient psychiatric services. METHOD: The sample consisted of 81 patients admitted to and discharged from an inpatient psychiatric unit at a midwestern Veterans Affairs medical center. Stepwise multiple regression was used to examine the relationship between patient satisfaction and self-reported changes in quality of life, symptomatology, and level of functioning as measured by the Treatment Outcome Profile. Other variables such as diagnosis, length of stay, employment, living situation, and prior psychiatric and substance abuse treatment were also considered. A subsample of the most satisfied and dissatisfied patients was chosen to further explore variables contributing to satisfaction with services. RESULTS: Patient satisfaction was related to initial level of functioning, certain diagnoses, and treatment gains. Clinicians were highly accurate in identifying patients who were satisfied, based on blind chart reviews. CONCLUSIONS: This study underscores the significant relationships between patient satisfaction, psychiatric diagnosis, and other outcome measures, and argues for the validity and utility of patient satisfaction measures in assessing the efficacy of inpatient care.

Attitude to Health↗

Outcomes of inpatients treated on a VA psychiatric unit and a substance abuse treatment unit.

OBJECTIVE: The utility of the Treatment Outcome Profile (TOP) for measuring the effectiveness of acute inpatient psychiatric and substance abuse treatment was tested, including its internal reliability, validity, and sensitivity to treatment gains. The relationship between patients' satisfaction with services and treatment gains in quality of life, symptoms, and level of functioning was explored. METHODS: A pre-post research design was used with consecutive admissions to an inpatient psychiatric unit (N = 66) and a substance abuse treatment unit (N = 88) at a VA medical center. At admission and at discharge, the TOP, a self-report instrument assessing quality of life, symptoms, level of functioning, and patient satisfaction with services (at discharge only) was completed. Multivariate analysis of variance and univariate analysis of variance were used to test differences in scores between admission and discharge. RESULTS: Patients demonstrated significant treatment gains. Overall, compared with patients on the substance abuse unit, those receiving psychiatric treatment were more impaired at admission and had lower levels of self-reported therapeutic gain at discharge. Improvement for both groups occurred in quality of life, symptoms, and level of functioning. Both groups reported high levels of patient satisfaction, comparable with levels in other service industries. A high positive correlation (alpha = .61) was found between patient satisfaction and overall self-reported treatment gain. CONCLUSIONS: The results indicate that it is important to compare treatment effectiveness as well as costs when seeking less costly alternatives to inpatient care. The TOP is a valid and sensitive outcome measurement tool. Patient satisfaction is an important outcome variable and positively related to treatment gains in quality of life, symptoms, and level of functioning.

Analysis of Variance↗

The effect of icing with the pro-stim edema management system on cutaneous cooling.

The simultaneous administration of ice, compression, and electrical stimulation is a technique sometimes used to control the magnitude and duration of edema. The Pro-Stim Edema Management System (TKO, Inc, Alameda, CA) was developed to make this simultaneous treatment both simplistic and more effective. The system is designed to be more effective because the stimulating electrodes are incorporated into the fabric of the ice pack thus providing little insulation to cold. The purpose of our study was to test the effectiveness of icing with Pro-Stim on cutaneous cooling by comparing it to ice bag application with conventional stimulator electrodes. Twelve subjects received the ice portion of the two experimental conditions for 30 minutes. Cutaneous temperatures were monitored at two sites: one under the electrode and one away from the electrode (centered between the stimulating electrodes). Temperatures were recorded via surface probes interfaced to digital thermometers each minute for 5 minutes before and after icing and during the 30 minutes of ice application. Temperature data were analyzed with three-way factorial analysis of variance with repeated measures. The administration of ice decreased the temperature for all conditions. However, the temperature under the electrode with Pro-Stim was significantly lower during the treatment period than the temperature under the electrode with the conventional system. Thus, Pro-Stim provides more cooling of the entire treatment area. Further research should include an investigation of the effect of the Pro-Stim Edema Management System on cooling while using electrical stimulation.

Journal Article↗

Reliability and concurrent validity of the level of care and utilization survey.

A level-of-care instrument was developed for individuals with severe mental illness. A random sample of 300 patients residing in two state hospitals and a state-operated nursing home was used to test the concurrent validity and reliability of the instrument. Analysis indicated excellent test-retest reliability, good split-half reliability, adequate internal consistency, and reasonable concurrent validity. Thus, the questionnaire may provide a base for clinicians and administrators responsible for designing programs and health-care systems of treatment in the least restrictive environment possible.

Hospitalization↗

Development of a structured interview scale for measuring quality of life of the severely mentally ill.

An objective, semi-structured interview questionnaire (QOLIS) was designed and tested with 201 severely mentally ill people who were living in a state hospital and in community residential facilities. Factor analysis resulted in eight factors with face validity and acceptable coefficient alphas. The factors were found to be related meaningfully to overall level of functioning, total symptom scores, self-reported life satisfaction, and an established objective measure of quality of life. Criterion validity was established and the QOLIS factors significantly differentiated people who were living in the community vs. living in a state hospital. These results suggest that the QOLIS has potential as a valid outcome measure and program evaluation tool.

Activities of Daily Living↗

Family violence: impact on children.

Violence within the family is increasingly being recognized as a serious societal problem in the United States. Four types of family violence are discussed: violence toward children, siblings, women, and the elderly. This paper explores the development of violent relationships in the family from both biological and psychological perspectives, with the latter encompassing four frameworks--the psychopathological model, the social learning model, the aversively stimulated aggression concept, and systems theory. The authors also examine the risk factors for and the effects of violence as well as the characteristics of the aggressor and the victim. Available intervention strategies for various types of violent behavior are then discussed.

Adolescent↗

Personality characteristics of a community sample of adolescents with conduct disorders.

The Millon Adolescent Personality Inventory (MAPI) was used to compare the personality styles, expressed concerns, and behavioral correlates of a community sample of conduct-disordered (n = 13) and non-conduct-disordered (n = 137) adolescents. Structured interviews with adolescents and parents were used to classify subjects using DSM-III criteria. Significant differences were found between groups. Conduct-disordered youth reported being very critical, harsh, and not respectful of others. They tended to seek out the unpredictable and to be moody and pessimistic. They expressed a lack of confidence in school performance and dissatisfaction with family life. These results support the usefulness of self-report measurements with troubled adolescents in general, and the validity of the MAPI in particular. Implications for diagnosis and treatment are discussed.

Adaptation, Psychological↗

The development and construct validation of a consumer satisfaction questionnaire for psychiatric inpatients.

A consumer satisfaction scale was developed for psychiatric inpatients. The scale was administered to a state-wide sample of (n = 366) patients discharged from acute psychiatric units throughout Missouri. The scale was factor analyzed and given to another sample of (n = 390) discharges. Three out of five factors that were found in the first sample were replicated in a factor analysis of data from the second sample. Acceptable coefficient alphas were obtained on all three factors, demonstrating internal reliability. The three factors were labeled Treatment Effectiveness, Trust of Staff, and Hospital Environment. Comparable levels of satisfaction with prior studies were found on the first general satisfaction factor of Treatment Effectiveness. Subjects discriminated areas of satisfaction by expressing higher levels of dissatisfaction on the factors of Trust of Staff and Hospital Environment.

Acute Disease↗

Arrest rates among young adult psychiatric patients treated in inpatient and outpatient settings.

Within a statewide random sample of 611 young adult patients who received public inpatient, outpatient, and community residential care, 38 percent were found to have been arrested at least once in their adult lifetimes. Thirty-five percent had been arrested for felonies and 18.9 percent for violent crimes. Analyses by five major diagnostic groups showed that patients with a primary diagnosis of drug or alcohol abuse had the greatest overall frequency of arrests and also the greatest frequency of arrests for burglary, offenses against public order such as peace disturbance or loitering, and probation and parole violations. No significant differences between diagnostic groups were found for arrests for violent crimes. Characteristics that predicted which patients would be arrested in the year after receiving mental health services were a greater number of lifetime felony arrests, younger age, being black or a member of another minority group, and more years since first receiving public mental health care.

Adult↗

Who really treats the severely impaired young adult patient? A comparison of treatment settings.

To make informed decisions about allocation of resources between state hospitals and community services, it is necessary to have comparable data on patients being served in both kinds of settings. Using a random sample of 611 severely impaired young adult patients with major mental illnesses, a study in Missouri compared those who were treated in state-operated facilities with those treated in private, not-for-profit community mental health centers that received state funds. A major finding was that young adult patients were more likely to be treated in a state-operated facility, and that 89 percent of inpatient admissions of this group were made to state-operated facilities. Compared with patients seen in the centers, those served by state facilities were more likely to have histories of arrests or violence, to be minority-group members, to be poor or unemployed, to have a diagnosis of schizophrenia, and to come from more urbanized areas. Of the 26 percent of the sample defined as chronic patients, 73 percent were treated at state-operated facilities.

Adolescent↗

Stress inoculation therapy with anxiety and stress disorders of acute psychiatric inpatients.

Twenty-six consecutive inpatient psychiatric admissions with severe stress and anxiety disorders were assigned to three treatment groups: stress inoculation therapy; a combination of stress inoculation and medication therapy; and medication therapy. The dependent measures indicate that stress inoculation therapy was superior to chemotherapy from pre- to post-testing and from baseline to posttesting in reducing symptoms of depression, anxiety, and overall subjective distress. In a 3-year follow-up, subjects in the stress inoculation therapy group tended to require fewer readmissions for psychiatric problems than the other treatment groups. It is proposed that stress inoculation therapy is effective in reducing symptoms of severe anxiety and stress reactions of acute psychiatric inpatients and that medication sometimes may have an inhibitive effect upon possible gains through psychotherapy.

Adult↗

Depression and depressive symptoms in preschool children from the general population.

This multiphasic study used four independent sources of information to investigate depression and depressive symptoms in a sample of preschool-age children from a general population. The study provides evidence that major depressive disorder exists in preschoolers and that stressful life events are associated with depressive symptoms; it underscores the importance of the teacher's report for identifying the presence of depression in this age group. Details of the findings, including a new scale for rating depression in young children, are discussed.

Age Factors↗