PubMed Health⌕ Search

Biomedical subjects

W R Leber

Publications and source records attributed to W R Leber.

18 recordsLinked to original sources
PubMed1993

Temporal course of change of depression.

Two hundred fifty moderately to severely depressed outpatients were randomly assigned to 16 weeks of cognitive-behavioral therapy, interpersonal psychotherapy, imipramine plus clinical management (IMI-CM), or pill placebo plus clinical management. Two hundred thirty-nine patients actually began treatment. The most rapid change in depressive symptoms occurred in the IMI-CM condition, which achieved significantly better results than the other treatments at 8 and 12 weeks on 1 or more variables. Change over the course of treatment on variables hypothesized to be most specifically affected by the respective treatments was found only in the case of pharmacotherapy, in which imipramine produced significantly greater changes on the endogenous measure at 8 and 12 weeks.

Adult↗
PubMed1992

The role of instructional set on alcoholic performance.

This study was conducted to determine whether alcoholic and control subjects respond differently to manipulations that either enhance personal involvement (PI) or reduce negative affect (R, relaxation) on tests of neuropsychological function. In Phase 1, 48 male alcoholics and 36 male control subjects completed neuropsychological tasks under standard instructional sets. In Phase 2, subjects completed equivalent forms of these tests under one of three randomly assigned conditions; the PI condition in which subjects were encouraged to identify specific ways of improving their performance, the R condition in which subjects participated in a short relaxation exercise designed to reduce anxiety, or a No Treatment (NT) condition in which no attempt to manipulate the subjects' involvement or affect was made. Alcoholics were inferior to controls in both Phase 1 and Phase 2 [Fs (1,82) > 5.03, ps < 0.03]. The experimental manipulation differentially affected measures of negative affect and effort in the predicted direction. There were no group x condition interactions. Alcoholic and control subjects responded comparably to the experimental manipulations. This investigation, in combination with others using related manipulations, reinforces the hypothesis that alcohol-related cognitives dysfunction reflects an underlying deficit in brain states.

Adult↗
PubMed1991

Patient predictors of response to psychotherapy and pharmacotherapy: findings in the NIMH Treatment of Depression Collaborative Research Program.

OBJECTIVE: The authors investigated patient characteristics predictive of treatment response in the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program. METHOD: Two hundred thirty-nine outpatients with major depressive disorder according to the Research Diagnostic Criteria entered a 16-week multicenter clinical trial and were randomly assigned to interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Pretreatment sociodemographic features, diagnosis, course of illness, function, personality, and symptoms were studied to identify patient predictors of depression severity (measured with the Hamilton Rating Scale for Depression) and complete response (measured with the Hamilton scale and the Beck Depression Inventory). RESULTS: One hundred sixty-two patients completed the entire 16-week trial. Six patient characteristics, in addition to depression severity previously reported, predicted outcome across all treatments: social dysfunction, cognitive dysfunction, expectation of improvement, endogenous depression, double depression, and duration of current episode. Significant patient predictors of differential treatment outcome were identified. 1) Low social dysfunction predicted superior response to interpersonal psychotherapy. 2) Low cognitive dysfunction predicted superior response to cognitive-behavior therapy and to imipramine. 3) High work dysfunction predicted superior response to imipramine. 4) High depression severity and impairment of function predicted superior response to imipramine and to interpersonal psychotherapy. CONCLUSIONS: The results demonstrate the relevance of patient characteristics, including social, cognitive, and work function, for prediction of the outcome of major depressive disorder. They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities, which may be of value in the selection of patients for alternative treatments.

Adult↗
PubMed1990

Mode-specific effects among three treatments for depression.

In the NIMH Treatment of Depression Collaborative Research Program (TDCRP), 250 depressed outpatients were randomly assigned to interpersonal psychotherapy, cognitive-behavioral therapy, imipramine plus clinical management, or pill placebo plus clinical management treatments. Although all treatments demonstrated significant symptom reduction with few differences in general outcomes, an important question concerned possible effects specific to each treatment. The therapies differ in rationale and procedures, suggesting that mode-specific effects may differ among treatments, each of which was precisely specified, applied appropriately, and shown to be discriminable. Outcome measures were selected for presumed sensitivity to the different treatments. Findings provided only scattered and relatively insubstantial support for mode-specific differences. None of the therapies produced consistent effects on measures related to its theoretical origins.

Adult↗
PubMed1989

National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments.

We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and cognitive behavior therapy, for the treatment of outpatients with major depression disorder diagnosed by Research Diagnostic Criteria. Two hundred fifty patients were randomly assigned to one of four 16-week treatment conditions: interpersonal psychotherapy, cognitive behavior therapy, imipramine hydrochloride plus clinical management (as a standard reference treatment), and placebo plus clinical management. Patients in all treatments showed significant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total samples without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management. Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical management. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on initial level of severity of depressive symptoms and impairment of functioning, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients.

Adult↗
PubMed1985

Neuropsychological test results are related to ratings of men alcoholics' therapeutic progress: a replicated study.

The relationship of tests of neuropsychological functioning to clinical ratings of participation in therapeutic activities and predictions of outcome were investigated in two groups of men alcoholics. Factor analysis of the clinical ratings confirmed the existence of three factors: cognitive, clinical improvement and interpersonal. Significant relationships were found in the first group of alcoholics (N = 52) between neuropsychological test scores and scores on each of the three factors. These findings were replicated in the second group of alcoholics (N = 28) drawn from the same population. Patients rated by therapists as having a poor prognosis performed significantly worse on certain neuropsychological tests, especially measures of abstracting and problem solving, than patients rated as having a good prognosis. These data provide evidence that neuropsychological tests are sensitive to many of the same dimensions assessed by clinicians in evaluating therapeutic progress.

Adult↗
PubMed1984

Associative response bias and severity of thought disorder in schizophrenia and mania.

Studied severity of thought disorder related to putative, exaggerated tendency of schizophrenics to respond to associative intrusions. Three groups of patients, paranoid schizophrenics, nonparanoid schizophrenics, and manics, participated in the investigation. The findings were: vulnerability to associative distractors is not specific to schizophrenia; performance deficit is more related to severity of thought disorder than to a specific diagnosis; degree of cognitive impairment was found to negatively influence verbal performance; the three groups of patients manifested equivalent levels of cognitive impairment.

Bipolar Disorder↗
PubMed1983

Convergent and discriminant validity of the WIST.

Tested the ability of the Whitaker Index of Schizophrenic Thinking (WIST): (1) to distinguish schizophrenics from nonschizophrenics (N = 30); (2) to agree with clinically rated severity of thought disorder; and (3) to correlate with a measure of generalized cognitive deficit. The WIST was not found to discriminate accurately schizophrenics from nonschizophrenics, but was found to agree strongly with the Shipley Institute of Living Scale, a measure of generalized cognitive dysfunction. Finally, clinically rated estimates of schizophrenic thinking (i.e., conceptual disorganization, unusual thought content) failed to predict WIST Index. The WIST appears to be primarily a measure of generalized deficit.

Adult↗
PubMed1982

Locus of control and neuropsychological performance in chronic alcoholics.

Correlated neuropsychological performance and three dimensions of Locus of Control (LOC) were examined in 62 hospitalized male chronic alcoholics and 24 non-alcoholic males drawn from the community. Performance deficits in alcoholic Ss correlated significantly with high scores on the Chance (LOC-C) and Powerful Others (LOC-PO) scales for approximately half of the measures employed, while no such correlations were significant in the controls. Correlations between performance and scores on the Internal (LOC-I) scale were negligible. Controls scored significantly higher than alcoholics on the Internal dimension; Chance and Powerful Others orientation were not significantly different in the two groups. From these and other results we conclude: (a) alcoholics and controls manifest similar but not identical LOC orientations; (b) alcoholics and controls show different relationships between neuropsychological performance and LOC orientation; and (c) the correlation between LOC variables and performance in alcoholics cannot account for the widespread differences in performance levels between the two groups.

Alcoholism↗
PubMed1982

Verbal and visuospatial performance and aging: a neuropsychological approach.

The hypothesis that aging and hemispheric laterality interact to produce relatively greater decrements in older individuals in right hemispheric dominant (visuospatial) than left hemispheric dominant (verbal) tasks was examined in 24 early middle-aged (M = 37.6 yr) and 24 older (M = 71.2 yr) males equated for education. Participants performed structurally similar verbal and visuospatial paired-associated learning tasks (the Stark test) that have been found sensitive to left and right hemispheric dysfunction, respectively. They were also given the Shipley Institute for Living Scale and the Memory-for-Designs Test. No group differences were present on the Shipley verbal age scale, but the older group had significantly lower Shipley abstraction ages and memory-for-designs scores. They made more errors than the middle-aged group on both the verbal and visuospatial learning tasks. Similar patterns were found when the data were reanalyzed by decade cohorts. These data do not support the notion of a laterality effect associated with aging.

Adult↗
PubMed1981

Recovery of visual-spatial learning and memory in chronic alcoholics.

Administered the Memory-for-Designs Test and a verbal and visuospatial paired associate learning test to separate groups of alcoholics (N = 32) 3 and 11 weeks abstinent from alcohol and to a matched control group (N = 16). Alcoholics were not impaired in verbal learning. Alcoholics 3 weeks abstinent performed significantly less well than controls on all nonverbal tasks and less well than 11-weeks alcoholics on one nonverbal measure. No significant differences were found between 11-week alcoholics and controls. The results suggest that some recovery of function may occur in alcoholics after 10 weeks of abstinence. The data also support the hypothesis of impaired right hemisphere in alcoholics.

Alcoholism↗
PubMed1981

Assessment of neuropsychological functions in chronic alcoholics using a standardized version of Luria's Neuropsychological Technique.

The Standardized Version of Luria's Neuropsychological Technique was administered to separate groups of alcoholics 3 and 11 weeks abstinent from alcohol and to an equated control group. The alcoholics were impaired compared to controls on most of the battery scales; 3-week abstinent alcoholics performed poorer than 11-week abstinent alcoholics on most scales, however, only on the Rhythm scale was the difference significant. These results and other analyses suggest that chronic alcoholics suffer from a mild diffuse-generalized brain dysfunction which persists for up to at least 11 weeks of abstinence.

Adult↗
PubMedDate not supplied

Lack of recovery in male alcoholics' neuropsychological performance one year after treatment.

Thirty-seven middle-aged alcoholics and 20 nonalcoholic controls equated for age and education were examined on measures of verbal, learning/memory, abstracting/problem-solving, and perceptual-motor abilities 7 weeks after beginning detoxification and 13 months later. At 7 weeks, the alcoholics were significantly different from the controls on the verbal, abstracting/problem-solving, and perceptual-motor clusters and tended to differ on the learning/memory tests. At 13 months, the same pattern of differences was found except the groups no longer differed on the verbal tests. Alcoholics who resumed drinking during the 13 months differed from the controls to a greater extent than did abstainers on both the initial and final testings. These results have implications for treatment programs and recidivism.

Alcoholism↗