A comparison of the effects of computer and manual reminders on compliance with a mental health clinical practice guideline.

OBJECTIVE: To evaluate the relative effectiveness of computer and manual reminder systems on the implementation of a clinical practice guideline. DESIGN: Seventy-eight outpatients in a mental health clinic were randomly assigned within clinician to one of the two reminder systems. The computer system, called CaseWalker, reminded clinicians when guideline-recommended screening for mood disorder was due, ensured the fidelity of the diagnosis of major depressive disorder to criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and generated a progress note. The manual system was a checklist inserted in the paper medical record. MEASURES: Screening rates for mood disorder and the completeness of the documentation of which DSM-IV criteria were met by patients who were said to have major depressive disorder were compared. RESULTS: The CaseWalker, compared with the paper checklist, resulted in a higher screening rate for mood disorder (86.5 vs. 61 percent, P = 0.008) and a higher rate of complete documentation of DSM-IV criteria (100 vs. 5.6 percent, P < 0.001). CONCLUSIONS: In an outpatient mental health clinic, computer reminders were shown to be superior to manual reminders in improving adherence to a clinical practice guideline for depression.

Persistence predicts latency to relapse following inpatient treatment for alcohol dependence.

Male alcoholics (N = 85) were followed for 6 months after inpatient treatment for alcohol dependence. Latency to relapse was predicted by two related persistence measures (the RD2 Persistence scale and the Orderliness/Persistence factor scale of the Tridimensional Personality Questionnaire, TPQ) as well as by job status at the time of admission to treatment, a history of vagrancy or public intoxication, amount of prior substance abuse treatment and the number of criteria met for a diagnosis of Antisocial Personality Disorder. Persistence predicted relapse latency even when the other predictors were used as covariates, supporting the hypothesis that normal-range personality variables may enhance the prediction of clinical outcome. Further, the relations between TPQ scales and antisocial behavior as well as the severity of alcohol dependence were examined.

Ethanol self-administration patterns and taste aversion learning across inbred rat strains.

Initial self-administration of high doses of EtOH is shown to be associated in some inbred rat strains with the eventual development of a low preference for EtOH, presumably as a consequence of taste aversion learning occurring during initial intake. Only modest support was obtained for the hypothesis that strain differences in the aversiveness of EtOH affects taste aversion learning. The instrinsic palatability of EtOH and the salience of EtOH as a conditioned stimulus may also affect EtOH preference, but there do not appear to be differences among strains in their general ability to form taste-toxicosis associations.

Affective correlates of alcohol and cocaine use.

The affective correlates of alcohol and cocaine use were investigated in two studies. In the first, alcoholics (n = 50) and cocaine addicts (n = 40) were administered factor scales from the Inventory of Drinking Situations as well as the General Temperament Survey. Substance use in negative affect states was reported more often by alcoholics than by cocaine addicts, even when age and race differences were statistically controlled. Alcoholics also reported higher levels of negative temperament, and substance use in negative affect states was correlated with negative temperament across groups. In a study using subjects dependent on both drugs (n = 21), alcohol was more likely to be used in negative affect situations than was cocaine. Thus, the affective correlates of substance use are associated with both individual differences and drug-specific effects. Possible reasons for the differential association of alcohol with negative affect are proposed.

Relation between self-reported affect and drug urges and cravings in continuing and withdrawing smokers.

In 2 experiments we investigated the effects of withdrawal and stress on the affective correlates of urges to smoke. In both, habitual cigarette smokers were divided into continuing and withdrawing smoker groups. In the 1st study, 44 adults reported current mood, urge, and expectations over a 24-hr period. In the 2nd, a controlled laboratory study, urge, affect, and physiological data were obtained from continuing and withdrawing groups (N = 64) exposed to high- or low-stress conditions. Urges among withdrawing smokers were positively associated with negative affect and negatively associated with positive affect; continuing smokers reported urges that were directly associated with positive affect and unrelated to negative affect. Stress and withdrawal produced urge self-reports that were related to negative affect. Moreover, subjects who smoked after exposure to withdrawal and stress reported greater pleasure and arousal than did other subjects.

Effect of body weight on ethanol-induced taste aversion learning.

Saccharin aversions were conditioned using ethanol (EtOH) in rats of different body weights. There was a nonuniform relation between EtOH dose (g/kg) and strength of conditioned taste aversion. Heavier rats learned stronger aversions at the same dose, and a weak dose (i.e., 1.0 g/kg) was effective only in heavier rats. It is suggested that rats be equated on body weight in studies of EtOH-induced taste aversion learning and in studies of EtOH preference.

Principal components analysis of the inventory of drinking situations: empirical categories of drinking by alcoholics.

Male alcoholics (n = 336) were given the Inventory of Drinking Situations (IDS), a 100-item questionnaire that asks subjects to rate the frequency with which they drank in various situations during the previous year. A principal components analysis of the responses suggests there are three major categories of situations in which alcoholics are likely to drink: negative affect states, positive affect states combined with social cues to drink, and attempts to test one's ability to control one's drinking. These categories are compared with recent empirical attempts to define categories of alcohol and smoking relapse.

Zinc deficiency conditions food aversions in rats.

Zinc (Zn) deficiency is shown to condition aversion to the Zn-deficient diet. After development of a Zn deficiency syndrome during which consumption of the deficient diet decreased, rats readily consumed a familiar Zn-normal diet. After Zn repletion, the previously deficient animals continued to avoid the Zn-deficient diet. These results would not be predicted by the competing hypothesis that Zn-deficiency is anorexigenic.

Effect of taste aversion learning on ethanol self-administration.

Ethanol (EtOH) oral self-administration studies using rats have had inconsistent outcomes: studies in which rats are fluid deprived report decreasing EtOH intake over trials, whereas studies not employing fluid deprivation report increasing intake over trials. The present study supports the hypothesis that differential taste aversion learning may account for some of this discrepancy. This study indicates that taste aversion learning is maximized under fluid deprivation conditions and that "latent inhibition," i.e., exposure to non-intoxicating amounts of the EtOH solution prior to conditioning, reduces taste aversion learning. It is suggested that the effect of fluid deprivation on taste aversion resulting from EtOH self-administration may be at least in part due to the development of latent inhibition in non-deprived animals during initial exposure to the EtOH solution.

Rat strain differences in ethanol self-administration and taste aversion learning.

Taste aversion learning was investigated in two inbred strains of rats known to differ in amount of ethanol (EtOH) they will self-administer orally. The "low EtOH preference" strain, WKYs, acquired an aversion to an EtOH solution during self-administration; but a "high preference" strain, M520s, did not. It was shown that a lower dose of EtOH will condition saccharin aversion in WKYs than in M520s, suggesting EtOH is a more effective US in the low preference strain. Analysis of patterns of EtOH self-administration indicates the pattern of the low preference strain is more likely to result in taste aversion learning. The implications of these results for the presumed relation between EtOH preference and other EtOH-related phenotypes is discussed.

Correspondence between MMPI PTSD measures and clinical diagnosis.

Correspondence of the Minnesota Multiphasic Personality Inventory (MMPI) posttraumatic stress disorder (PTSD) subscale and the clinical scale decision rules reported by Keane, Malloy, and Fairbank (1984) with clinical diagnoses of PTSD was measured on a sample of 595 veterans. The measures demonstrated good sensitivity and selectivity, but the false-positive rate was high. It is suggested the MMPI measures be used to rule out, but not to establish, the diagnosis of PTSD. The construct validity of the PTSD subscale was supported by the finding of a higher mean score in combat than noncombat veterans.

Nausea and radiation-induced taste aversions in cancer patients.

The development of taste aversions was studied in 34 oncology patients undergoing radiotherapy. A target flavor was paired with irradiation on four consecutive treatment days. Self-reported nausea on treatment days reliably predicted aversion learning. The implications of this finding for the anorexia of cancer patients and the role of nausea in human taste aversion learning are discussed.

Interfering with taste aversion learning in rats: the role of associative interference.

Six experiments with rats investigated the conditions under which one flavor interferes with aversion conditioning to a second, familiar flavor. Conditioning to the familiar flavor was weakest when the interference flavor was contiguous to lithium-induced toxicosis, novel, more intense, and strongly associated with toxicosis. In addition, conditioning to the familiar flavor was weakened even if multiple conditioning trials were used. The repeated finding of an inverse relationship between strength of aversion to the target and interference flavors is interpreted as support for an associative competition hypothesis of the interference effect. The possible relevance of the interference effect to the attenuation of taste aversions in cancer patients is discussed.

Alcohol and taste-mediated learning.

Taste-mediated learning is relevant to the alcohol consumption patterns of animals. This review concludes that taste aversion learning has thus far prevented development of an animal model of alcoholism. The presence of a taste cue, lack of control over alcohol administration, and high alcohol concentrations or dosages all facilitate the development of alcohol aversions. There is little evidence that taste preference learning is involved in the development of alcohol dependence. Data from taste-mediated learning research with animals are consistent with drinking patterns of human alcoholics.