Psychological distress and treatment adherence among children on dialysis.

Among 23 pediatric renal dialysis patients, we obtained self-reported assessments of psychological adjustment and biochemical and subjective ratings of adherence. Findings indicate elevated levels of depressive symptoms and substantial nonadherence. Depressive symptoms were associated with higher levels of hopelessness, more negative self-perceptions, and more depressogenic attributional style. The psychological adjustment measures did not significantly correlate with adherence. Nonsignificant associations among different measures of adherence underscore its multifaceted nature. Implications for monitoring the adjustment of children on dialysis, assessing adherence, and future research are discussed.

A preliminary study of partial hospital management of severe obsessive-compulsive disorder.

OBJECTIVE: The study examined the effectiveness of a partial hospital treatment program combining behavioral therapy, medication, and psychosocial intervention for severe and treatment-resistant obsessive-compulsive disorder. METHODS: A total of 58 patients with a primary diagnosis of obsessive-compulsive disorder who underwent treatment in a partial hospital program were assessed at baseline, at program discharge, and at six-, 12-, and 18-month follow-ups. Obsessive-compulsive symptoms, depression, anxiety symptoms, and global functioning were rated. RESULTS: The majority of patients (71 percent) met the criterion for a successful outcome, which was a 25 percent decrease in score on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Fifty-five percent finished the program with YBOCS scores of 16 or less, indicating only mild symptoms. Most of these patients sustained their improvement at six, 12, and 18 months after discharge, and many showed further improvement with continued outpatient management. CONCLUSIONS: The partial hospital treatment program for obsessive-compulsive disorder appears to be an effective intervention that should be implemented and investigated further.

Psychosocial treatment for obsessive-compulsive disorder.

State-of-the-art psychosocial treatment for obsessive-compulsive disorder is based on behavior therapy strategies and techniques with adjunctive pharmacological treatment. The critical therapeutic element is the prolonged confrontation of the individual with the stimuli that provokes obsessive thoughts or compulsive actions, without the individual then engaging in cognitive or ritualistic avoidance behaviors. For the clinician, a decision model for treating this disorder is drawn from recent behavioral and pharmacological research, as well as from the individual's self-help capacities. Judicious use of currently available treatments can reduce suffering and restore lost psychosocial functioning in obsessive-compulsive patients and their families.

Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder.

We used positron emission tomography to investigate local cerebral metabolic rates for glucose (LCMRG1c) in patients with obsessive-compulsive disorder before and after treatment with either fluoxetine hydrochloride or behavior therapy. After treatment, LCMRG1c in the head of the right caudate nucleus, divided by that in the ipsilateral hemisphere (Cd/hem), was decreased significantly compared with pretreatment values in responders to both drug and behavior therapy. These decreases in responders were also significantly greater than right Cd/hem changes in nonresponders and normal controls, in both of whom values did not change from baseline. Percentage change in obsessive-compulsive disorder symptom ratings correlated significantly with the percent of right Cd/hem change with drug therapy and there was a trend to significance for this same correlation with behavior therapy. By lumping all responders to either treatment, right orbital cortex/hem was significantly correlated with ipsilateral Cd/hem and thalamus/hem before treatment but not after, and the differences before and after treatment were significant. A similar pattern was noted in the left hemisphere. A brain circuit involving these brain regions may mediate obsessive-compulsive disorder symptoms.

An experimental analysis of the interaction of chemotherapy and behavior therapy in anorexia nervosa.

The interaction of imipramine and operant conditioning on weight gain in an anorexia nervosa patient was examined by a single-subject experiment consisting of a baseline and four treatment phases: phase 1--contingency management only; phase 2--contingency management plus imipramine; phase 3--contingency management plus imipramine placebo; phase 4--contingency management only. The results showed that the interaction of drug and behavior therapy had no significant effect on weight gain, but that imipramine may have contributed to a decrease in depression. Observations are made regarding weight changes related to passes and medication refusals.

A comparison of black and white children's WISC/WISC-R differences.

Administered the WISC and WISC-R to 20 white child psychiatric out-patients in a counterbalanced design. The white Ss' WISC/WISC-R differences were compared to equivalent data obtained from black children (Munford, 1978). For the white Ss, no differences were found between WISC and WISC-R Verbal, Performance, and Full Scale IQs, whereas black children scored significantly lower on the WISC-R than on the WISC on all three IQ measures. These findings indicate increased cultural bias in the WISC-R, despite apparent efforts to produce contrary results. A possible reason for this seemingly paradoxical outcome is offered, and future research possibilities are suggested.

A comparison of the WISC and WISC-R on black child psychiatric outpatients.

Administered the WISC and WISC-R in a counterbalanced design to 20 black child psychiatric outpatients. The resulting test scores revealed the two to be essentially different with lower Verbal, Performance and Full Scale IQs Subtests WISC-R scores were also lower than those on the WISC. Significant practice effects occurred when the WISC was preceded by the WISC-R, but not when the order of test presentation was reversed. The boys' combined WISC and WISC-R scores were higher than the girls' on the Information, Arithmetic, Similarities, Vocabulary, Picture Completion, Block Design, Object Assembly, and Coding Subtests and Verbal and Full Scale IQs. The girls scored higher on Coding. The tests were found to be highly correlated. The major implication is that greater numbers of black children may be given developmental disability labels.

Differential attention in the treatment of operant cough.

This case study reports the successful use of differential attention in the treatment of chronic operant coughing of 6 months' duration in a 13-year-old boy. The boy was hospitalized, where the symptom was ignored and his adaptive age-appropriate behaviors were reinforced with points and praise. Fines were levied for self-derogatory statements. Obtrusive and unobtrusive observations revealed the cough rate higher when the patient was aware of being observed than when he was unaware of being observed. After 4 days the cough rate dropped to zero, where it remained except for a slight recurrence on the day of discharge. His parents were trained in maintaining the differential attention contingencies in effect in the hospital and were able to transfer these conditions to the home. Thus, when the cough again returned once the patient was home, they were able to immediately terminate it. Follow-up of over 36 months revealed the boy to be symptom free.