The clinical utility of ambulatory blood pressure and heart rate monitoring in psychiatric inpatients.

Alterations in heart rate and blood pressure (BP) may occur in patients receiving psychiatric medication. Twenty-four-hour ambulatory blood pressure (ABP) monitoring was compared with nurses' conventional vital signs (CVS) for systolic (SBP) and diastolic (DBP) and heart rate (HR) measurements in psychiatric inpatients receiving multidrug treatments. Twelve consecutive subjects were enrolled. ABP monitoring and CVS measurements were concurrent but independent in each subject. Ambulatory BP monitoring recorded SBP, DBP, and HR thrice hourly from 6:00 AM to 10:00 PM and once hourly between 10:00 PM and 6:00 AM; CVS were obtained an average of 3.6 times/24 h. The frequency with which each BP and HR measurement method detected Level-1 (SBP 90 to 100 or 180 to 209 mm Hg; DBP 40 to 60 or 110 to 119 mm Hg; HR 50 to 60 or 110 to 119 beats/min) or Level-2 (SBP < 90 or > or = 210 mm Hg; DBP < 40 or > or = 120 mm Hg; HR < 50 or > or = 120 beats/min) events was determined, and disagreements between the two measurement systems were analyzed using the McNemar test for paired sample data. Ambulatory BP monitoring detected significantly more Level-1 and Level-2 events than CVS. A significant number of mostly low BP were documented by ABP monitoring and were undetected by the CVS obtained by the nursing staff. This finding may be of clinical relevance in view of the potential hemodynamic consequences of hypotension, especially in older patients receiving psychotropic multidrug treatment.

Analysis by gender and Visual Imagery Reactivity of conventional and imagery Rorschach.

Examined here are the effects of gender and Visual Imagery Reactivity in 80 consecutively selected psychiatric outpatients. The participants were grouped by gender and by the amounts of responsiveness to preceding therapy work using imagery (Imagery Nonreactors and Reactors). In the group of Imagery Nonreactors were 13 men and 22 women, and in the Reactor group were 17 men and 28 women. Compared were the responses to standard Rorschach (Conventional condition) with visual associations to memory images of Rorschach inkblots (Imagery condition). Responses were scored using the Visual Imagery Reactivity (VIR) scoring system, a general, test-nonspecific scoring method. Nonparametric statistical analysis showed that critical indicators of Imagery Reactivity encoded as High Affect/Conflict score and its derivatives associated with sexual or bizarre content were not significantly associated with gender; neither was Neutral Content score which categorizes "non-Reactivity." These results support the notion that system's criteria of Visual Imagery Reactivity can be applied equally to both men and women for the classification of Imagery Reactors and Nonreactors. Discussed are also the speculative consequences of extending the tolerance range of significance levels for the interaction between Reactivity and sex above the customary limit of p < .05 in borderline cases. The results of such an analysis may imply a trend towards more rigid defensiveness under Imagery and toward lesser verbal productivity in response to either the Conventional or the Imagery task among women who are Nonreactors. In Reactors, men produced significantly more Sexual Reference scores (in the subcategory not associated with High Affect/Conflict) than women, but this could be attributed to the effect of tester's and subjects' gender combined.

A simple method for evaluation of Rorschach Imagery Reactivity.

A general scoring system, previously developed for the analysis of pictorial associations within the paradigm of Visual Imagery Sequences, was applied in the evaluation of visual associations to memory images of Rorschach inkblots (Imagery condition) in a comparison with standard Rorschach responses (Conventional condition). The participants, 80 consecutively selected psychiatric outpatients, were divided into Clinical Reactor and Nonreactor groups, according to how productive they were of psychodynamically revealing material during insight-oriented therapy using imagery. For this simple scoring method (which does not include the customary Rorschach scores), conclusions concerning Imagery Reactivity in the Rorschach agreed with those of previous studies using a scoring system more unique to the Rorschach. The inferences drawn from statistical analysis by groups and conditions also contribute additional refinements to the understanding of the subtle interplay between defensiveness and sensitivity to imagery in determining the patterns of scorable components within the response complex. This general scoring method correctly identified 95.6% of Imagery Reactors and 100% of Imagery Nonreactors, an improvement over the 87% efficiency of the previously described, Rorschach-based method for assessing Imagery Reactivity in the Rorschach.

Effect of instructions given to reactors and nonreactors to produce visual imagery sequences following an imagined pleasant scene.

15 Visual Imagery Reactors and 15 Nonreactors were instructed to produce Visual Imagery Sequences using as a point of departure a pleasant scene imagined by themselves. Despite these instructions, Reactors developed significantly less pleasant scene materials, more High and Low Affect/Conflict, less Neutral Content, and briefer sequences preceding all Affect/Conflict. Four Reactors and no Nonreactors expressed difficulty in visualizing pleasant scenes. Reactors made more interruptions when attempting to continue imagery of the pleasant scene. Several additional scores occurred almost exclusively within a subgroup of Reactors. These results are consistent with previous studies using different test stimuli and are congruent with previously advanced theoretical formulations.

Clinical applications of Rorschach-based visual imagery reactivity.

A diverse set of findings from recent research suggests the value of visual imagery techniques in clinical practice.

Free visual imagery sequences in reactors and nonreactors.

The technique of Free Visual Imagery Sequences was used with 32 outpatients, M age of 33.9, to determine the differences between Visual Imagery Reactors and Nonreactors as defined in previous studies. Reactors showed significantly more responses associated with Affect/Conflict material, frequently including bizarre and distorted images. The Affect/Conflict responses occurred earlier and had longer duration spans in Reactors. Neutral content was more prevalent in Nonreactors. An interpretive approach involving a regulatory processing system is proposed. Free Visual Imagery Sequences appears to be a simple and efficient clinical technique which can contribute data useful in determining the extent to which imagery techniques could be employed in certain forms of psychotherapy.

Rorschach-based indices of visual imagery reactivity.

A method using a specially developed Rorschach-based procedure was applied in conjunction with a visual imagery technique in evaluating protocols of 40 outpatient subjects. The subjects were divided into Reactor and Nonreactor groups, according to how productive in clinically significant material their responses were in the imagery condition contrasted to a conventional administration of the Rorschach. A scoring method correctly classified 35 of the 40 subjects as being Reactors or Nonreactors. In addition to previously demonstrated utility as a research tool, the method may be used in clinical situations.

Clinical comparisons and Rorschach response differences between visual imagery reactors and nonreactors.

Rorschach cards were administered to psychotherapy patients under two conditions. In the imagery condition, cards were presented to each subject briefly, following which the cards were visualized with eyes closed and any visual imagery sequences were reported. This procedure was preceded by a standard Rorschach administration. Subjects were classified into Imagery Reactor and Nonreactor groups, according to the degree to which they responded to the instructions. The examples presented illustrate the qualitative differences in conflictual and affect-laden material between Reactors and Nonreactors which can be obtained in using this type of Rorschach based visual imagery technique.

Effects of instructions for visual imagery on Rorschach responses.

The Rorschach was administered to two groups of 12 subjects under two conditions. The first group was classified as imagery Reactors based upon their prior responsivity to imagery instructions during therapy. The second group was labelled Nonreactors using the same clinical criteria. The condition administered first utilized the standard Rorschach; in the second, subjects were asked to produce sequences of visual imagery using Rorschach cards as stimuli. Both groups received both Rorschach administrations. Responses were scored without knowledge of the two classifications of subjects. Instructions for imagery appeared to have a disinhibiting effect and led to significant changes in several major Rorschach scoring categories and in a specially derived index of the amount of clinically relevant conflictual and affective material manifested. There were a number of significant differences between Reactors and Nonreactors in Rorschach response levels under the imagery condition, among other changes. Reactors yielded significantly more complex and clinically revealing material under imagery than did Nonreactors. The findings were considered to be particularly useful for diagnostic and therapeutic decisions with certain types of patients. The results also suggest the possibility of differences in personality structure between imagery Reactors and Nonreactors which warrant further investigation.

Specificity and genetic restrictions of the guinea-pig immune response to dinitrophenyl-lysyl-alanyl octapeptides.

A series of 2,4-dinitrophenyl (DNP) octapeptides containing L-lysine and L-alanine were prepared to examine the specificity and genetic restrictions of both cellular and humoral immune responses in inbred guinea-pigs. Strains 2 and 13 guinea-pigs were therefore immunized with Lys4-Ala3-Lys(DNP), Lys3Ala4-Lys(DNP), Lys2-Ala5-Lys(DNP) and Lys-Ala6-Lys(DNP). Only Lys4-Ala3-Lys(DNP) was under Ir gene control and could induce both antibody and T-cell responses in strain 2 guinea-pigs. In contrast, Lys4-Ala3-Lys(DNP) injected in strain 13 guinea-pigs and the other DNP-octapeptides injected in strain 2 or 13 guinea-pigs elicited only antibody formation and no specific T-cell mediated response. Antibody formed in the absence of specific T-cell responsiveness in either strain 2 or 13 was hapten specific and lacked the capacity to discriminate the immunizing antigen from closely related DNP-peptides. Antibody produced by animals with specific T-cell responses, on the other hand, was exquisitely specific for the immunizing peptide and could discriminate it from closely related peptides.

Towards a systems definition of psychiatric practice.

Assessment of psychiatric practice has been difficult largely because of the apparent diversity of psychiatrists' theories, procedures, and goals. Searching for a unifying principle, we propose system identification failure (SIF), a defect in data-processing, as the unit of psychopathology underlying all psychiatric disorder (and other behavioral error). Definitive treatment must not only identify and correct the data-processing defect, but also eliminate the secondary symptoms. Emphasis is not on method of treatment but on goal or intent. Preparatory treatment includes supportive psychological and environmental measures and somatic therapies (regardless of type, duration, or intensity) which make definitive treatment possible. Palliative treatment must be frequently reviewed. Preventive treatment should prevent SIF-formation. We consider our proposal a distillate of the aims and implicit intent of experienced psychiatrists regardless of their training or theoretical orientation. The search for a functional definition of the practice of psychiatry was perhaps at one time an academic or lexicographic exercise, but, with the advent of peer review, it has become a pragmatic matter deserving of earnest attention. What is psychiatric practice? In a universe criss-crossed by psychiatrists "riding madly off in all directions." not only are the descendants of Anna O. and Dora analyzed in vivo and those of Little Hans at one remove, but also are distant figures and cultures subjected, often iv vitro, to critical scrutiny, while the "talking treatment" is applied to couples, families, groups, "networks" and communities. When one adds to this the diversity of biological therapies and institutional, environmental, and behavioral manipulations, the task of finding a common theme, much less procedure, becomes a worthy problem in hermeneutics, general semantics, or system analysis. Thus we must ask not only the operational question, "What do psychiatrists do?" BUt also, "What did you to to treat the specific psychopathology of this patient?" "Did it work?" AND, "Hos do you know?" Failure to deal with such questions as these will mark psychiatry's inability to cope with a reality that includes Professional Standards Review Organizations and an imminent National Health Insurance...