Multivariate prediction of posttraumatic symptoms in psychiatric inpatients.

Based on a conceptual framework for the long-term effects of childhood abuse, this study examined the capacity of childhood family environment (caretaker dysfunction, neglect, perceived social support), violent abuse (physical and sexual), and individual variables (other abuse) to predict adult psychiatric symptoms of PTSD, dissociation, and depression. Complete interview data were obtained from 178 psychiatric in patients who varied greatly on abuse status and severity. Results of multiple regressions of predictor variables onto the three outcome variables showed that the predictor variables accounted for 15% (for depression) to 42% (for PTSD) of the variance in these symptoms and that violent abuse uniquely accounted for a significant proportion of the variance in outcomes for all three of the symptom groups studied.

Expired gas analysis of field simulated CPR.

The concentration of expired oxygen and carbon dioxide that a rescuer may give during cardiopulmonary resuscitation was originally determined without adjusting for conditions that can exist in real life. This study was devised to investigate how simulated field conditions might effect the concentrations of these gases that a rescuer would give a victim. The expired gases were measured from volunteers who performed one person cardiopulmonary resuscitation on manikins for two minutes. They then stopped the resuscitation, walked or ran 200 meters, and performed another two minutes of cardiopulmonary resuscitation while listening to loud ambulance sirens. For the thirty-eight volunteers that were tested, it was found that the percentage of carbon dioxide increased by an average of 11% and the oxygen concentration only changed by a negligible amount. This amounted to a statistically significant increase in the carbon dioxide concentration (p << 0.01), without a significant change in the oxygen concentration (p > 0.05). In conclusion, exertion before performing CPR will cause an increase in the percent of CO2 expired, while not affecting the concentration of O2.

Patterns of dissociation in clinical and nonclinical samples.

Research has consistently found elevated mean dissociation scores in particular diagnostic groups. In this study, we explored whether mean dissociation scores for different diagnostic groups resulted from uniform distributions of scores within the group or were a function of the proportion of highly dissociative patients that the diagnostic group contained. A total of 1566 subjects who were psychiatric patients, neurological patients, normal adolescents, or normal adult subjects completed the Dissociative Experience Scale (DES). An analysis of the percentage of subjects with high DES scores in each diagnostic group indicated that the diagnostic group's mean DES scores were a function of the proportion of subjects within the group who were high dissociators. The results contradict a continuum model of dissociation but are consistent with the existence of distinct dissociative types.

Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study.

OBJECTIVE: The Dissociative Experiences Scale has proved a reliable and valid instrument to measure dissociation in many groups, but its capacity to distinguish patients with multiple personality disorder from patients with other psychiatric disorders has not yet been conclusively tested. METHOD: A discriminant analysis was performed to classify 1,051 subjects as having or not having multiple personality disorder. Another discriminant analysis was performed on a subgroup of 883 subjects more closely representing patients in a typical psychiatric facility in terms of base rates of dissociative disorders. A cutoff score of 30 was also used to classify subjects, and Bayes's theorem, which allows for the calculation of the positive predictive value and the negative predictive value of a screening test, was applied. RESULTS: According to discriminant analysis of the total study group, the scale's sensitivity was 76% and its specificity was also 76%; according to discriminant analysis of the more representative subgroup, the scale's sensitivity was 76% and its specificity was 85%. Use of the cutoff score of 30 produced similar results. Results of the application of Bayes's theorem showed that 17% of the subjects scoring 30 or higher would actually have multiple personality disorder and 99% of those scoring less than 30 would not have multiple personality disorder. CONCLUSIONS: These results indicate that the Dissociative Experiences Scale performs quite well as a screening instrument to identify subjects with multiple personality disorder. In addition, the consistency of responses to scale items across centers indicates that the symptoms reported by patients with multiple personality disorder are highly similar across diverse geographic centers. This consistency supports the reliability and validity of the diagnosis of multiple personality disorder across centers.

Treatment of multiple personality disorder: a survey of current practices.

OBJECTIVE: Reported cases of multiple personality disorder have increased dramatically in the last decade. Few data are available on the treatment of multiple personality disorder. Current recommendations are based on the experience of individual clinicians rather than on systematic research. METHOD: A questionnaire study of 305 clinicians representing a spectrum of mental health professionals was conducted to survey the types and relative efficacy of treatment modalities currently used with cases of multiple personality disorder. RESULTS: Individual psychotherapy facilitated by hypnosis was uniformly endorsed as the primary treatment by all practitioner groups. The average patient was in twice-weekly psychotherapy facilitated by hypnosis for 3.8 years. Antidepressant and anxiolytic medications were reported to be moderately useful adjunctive treatments. CONCLUSIONS: These findings support current impressionistic treatment recommendations for multiple personality disorder regarding the primacy of psychotherapy and the moderate benefits of psychopharmacology with antidepressant and antianxiety agents.

An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder.

Chronic complex dissociative symptoms can be readily inquired about in the diagnostic interview leading to a clinical diagnosis of MPD in many cases. It is most useful to begin with inquiry about amnesia, autohypnotic, posttraumatic, pseudopsychotic, and passive-influence symptoms, and childhood abuse or traumatization. As this proceeds, overt dissociation is commonly noted including spontaneous trances, age-regression, blending or overlap of states, or frank switching. When this occurs, the interviewer can pursue more detailed information about the patient's experiences. Tracking these processes may readily lead to the clear appearance of an alter personality or will help make the patient sufficiently comfortable that he or she will allow the full emergence of an alter if this is directly requested. In other cases, however, methods such as use of ideomotor signals, formal induction of trance, and even barbiturate-facilitated interviews may be necessary to permit the full emergence of an alter. The symptom-cluster method is a useful clinical diagnostic tool to elicit dissociative symptoms for the diagnosis of MPD. Combined with diagnostic tools such as the DES, the DDIS, and the SCID-D, this method can help the clinician make the diagnosis of MPD in a far more expeditious and rigorous fashion. In addition, all psychiatric patients should be screened for a history of blackouts, time loss, trance experiences, childhood trauma, and PTSD symptoms. This will improve case finding to help clinicians begin to treat the single largest preventable cause of mental illness: the sequelae of childhood abuse, trauma, and family violence.

Rational psychopharmacology in the treatment of multiple personality disorder.

The current state of the data concerned with psychopharmacologic interventions for multiple personality disorder (MPD) is reviewed. Common sense guidelines are provided for drug treatment of MPD. An overview is given for use of medications for specific symptoms commonly found in MPD patients, such as affective, posttraumatic stress disorder, and sleep disorder symptoms.

Characteristics of patients with multiple personality and dissociative disorders on psychological testing.

We describe a new psychological testing procedure used on a consecutive series of 14 patients with multiple personality and dissociative disorders who met DSM-III-R and research criteria for dissociative disorders. Once dissociative phenomena were accounted for in testing, most patients displayed response patterns markedly different from those of schizophrenic and borderline patients. Patients showed striking variability on cognitive and projective tests, often related to posttraumatic intrusions. Rorschach protocols showed unusual thinking accompanied by psychological complexity and highly developed self-observing capacity. In contrast to classical conceptualizations about these patients, most subjects had personality profiles that were intellectualized, obsessive, and introversive, not histrionic or labile.

Behavioral medicine in the general hospital.

The application of behavioral procedures to the treatment of medical disorder has greatly expanded the techniques available to the psychiatrist practicing in the general hospital. While there are diverse behavioral strategies that have proven quite useful, the bases for these are limited and readily implemented in the hospital setting. In this paper, the behavioral methods of assessment and various strategies of treatment of medical, psychophysiological, and "psychosomatic" disorders are overviewed.

Experiential sampling in the study of multiple personality disorder.

The authors describe the application of experiential sampling, a new time-sampling method, to the assessment of rapid state changes in a woman with multiple personality disorder. She was signaled at random intervals during study periods and asked to provide information on alternate personality switches, amnesia, and mood state. The alternates displayed some characteristics that were as different as those occurring between separate individuals studied previously with this method. There were notable discrepancies between the self-report study data and information reported during therapy hours. The authors conclude that the phenomenology of multiple personality disorder is frequently more complex than is suspected early in the course of treatment.

Sleep EEG in Korsakoff's psychosis and Alzheimer's disease.

All-night sleep EEGs were compared in the following age-equivalent groups: seven men with Korsakoff's psychosis (KP), six men and two women with presumptive Alzheimer's disease, and six healthy men and three healthy women. KP patients had significantly increased intermittent time awake than both controls and Alzheimer patients, and shorter REM latency minus time awake than controls. Alzheimer patients had significantly reduced delta sleep than controls. Differences in the pattern of sleep EEG abnormalities may be due to different pathogenic mechanisms, but their utility in differential diagnosis requires further study.

Multiple personality disorder in a hospital setting.

Multiple personality disorder (MPD) should be considered in cases where there have been multiple diagnoses, failure of conventional treatments, a mixture of psychiatric and somatic symptoms, and/or extremely rapid shifts in symptoms and level of function. Proper diagnosis and treatment often leads to a significant amelioration in symptoms and increase in level of function for a patient previously refractory to treatment.

Psychiatric consultations at the NIH.

The history of the consultation-liaison psychiatry movement in America is briefly reviewed. Evaluation of a consultation-liaison program in a research hospital setting at NIH is described in the context of the historical paradigm.

Neuropsychiatric aspects of acquired immune deficiency syndrome.

Acquired Immune Deficiency Syndrome is a newly described, highly virulent, idiopathic syndrome characterized by lymphocyte dysfunction, multiple opportunistic infections and lymphoma, which primarily affects previously healthy, promiscuous homosexual males. Dementia and delirium due to infection and/or disseminated lymphoma may frequently occur in these patients, especially as the illness progresses. Consulting and liaison psychiatrists must be particularly alert to the possibility of organicity in these patients, in addition to the psychological distress caused by the AIDS syndrome itself.

The sleep of patients with obsessive-compulsive disorder.

Fourteen patients with obsessive-compulsive disorder (OCD) were studied with all-night sleep EEG recordings. Nine of these patients reported abnormal sleep patterns before the polygraphic study. Analysis of the sleep records disclosed significantly decreased total sleep time with more awakenings, less stage 4 sleep, decreased rapid-eye-movement (REM) efficiency, and shortened REM latency compared with those of a group of age- and sex-matched normal subjects. These abnormalities generally resembled those of an age-matched group of depressed patients, although significant differences remained. These findings suggest that such sleep abnormalities as shortened REM latency may not be entirely specific for primary affective illness. They also point to a possible biological link between OCD and affective illness.

Disturbances of sleep and cognitive functioning in patients with dementia.

The relationship of sleep, circadian rhythms, and cognitive impairment in dementia patients is briefly reviewed. All-night sleep EEG data were collected in relatively young and relatively unimpaired patients with presumptive Alzheimer's disease and eight age-matched controls. Delta sleep time and Delta sleep % (Stages 3 and 4)--but not REM sleep measures--were significantly reduced in the patients. Implications of these findings are discussed.

Nurses, physicians, and pharmacists: their knowledge of hazards of medications.

At a major tertiary care teaching hospital, random samples of 100 nurses, 102 physicians, and all of the hospital's 14 pharmacists were tested on their knowledge of the hazards of medications. The 25-question examination was generated by way of a rigorous validating procedure and was self-administered by the practitioners. Based on a perfect examination score of 100, the group mean scores of the nurses, physicians, and pharmacists were 72.3, 81.3 and 85.1, respectively. A one-way analysis of variance demonstrated that the difference in knowledge among the three groups of practitioners was significant (p less than .001). Pairwise (Scheffe) contrast tests revealed that the difference in knowledge between the physicians and nurses, and the pharmacists and nurses was significant; the nurses proved to be the least knowledgeable of the three practitioner groups. The nurses' scores were analyzed by years of nursing experience, type of educational preparation, hospital service affiliation, and hospital shift. A one-way analysis of variance revealed that there was a significant difference in nurses: knowledge by hospital shift (p less than .05). A posteriori contrast tests (Scheffe) indicated that the group mean score of the day shift nurses (mean = 75.6) was significantly different than the average of the evening and night shift nurses' scores (mean = 69.9).

Importance of correct identification of intrauterine contraceptive device.

PIP: A study to ascertain the proportion of patients who could identify their IUDs was carried out in a large hospital. Interviews were conducted with 268 women using 4 different types of IUDs. However, only 44% of women wearing the Dalkon Shield gave the correct response; this finding is disturbing because of the evidence of association of the Dalkon Shield with fatal second-trimester abortions. It is advisable to provide every IUD user with a card showing IUD type, date of insertion, and when reinsertion is necessary, which is especially important with the medicated IUDs, which must be periodically removed and replaced.^ieng