Which monotherapy for hypertension

The comparative blood pressure lowering and hemodynamic effects of four types of antihypertensive drugs, i.e.indapamide (diuretic), atenalol (betablocker), verapamil (calcium antagonist), and captopril (converting enzyme inhibitor), were evaluated among 30 middle aged men with mild to moderate essential hypertension in a double-blind randomized multiple crossover study. Blood pressure reduction were comparable regardless of hypotensives used. However atenolol 100 mg once daily also produced significant reduction in exercise-induced rate-pressure product and improved LV compliance echocardiogram indices within 2 weeks. Antihypertensive therapy is lifelong. Thus a daily single dose drug is advantageous for better patient acceptability and compliance during longterm antihypertensive therapy.(Auth)

The relationship between MCMI personality scales and clinician-generated DSM-III-R personality disorder diagnoses.

This study examined the relationship between elevations on the personality scales of the Millon Clinical Multiaxial Inventory (MCMI) and clinician-generated Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) diagnoses for 101 psychiatric patients at a VA medical center/psychiatric hospital in the Southeastern United States. Personality disorder diagnoses were made by employing a personality symptom checklist that consisted of all the verbatim criteria for personality disorders contained in the DSM-III-R. Clinicians who completed the checklists were required to have had at least 5 hr of direct contact with the patients who completed the MCMI. The results indicated that only the Schiozotypal scale of the MCMI was related to its respective DSM-III-R personality disorder in the simple correlation. An examination of the diagnostic efficiency statistics for each of the MCMI personality disorder scales revealed overall low sensitivity, poor specificity, poor positive predictive power, and low diagnostic power, which suggests that the MCMI may have only limited utility in identifying personality disorders.

The elderly mentally retarded person: current perspectives and future directions.

The elderly retarded population continues to grow rapidly, yet there remains a lack of understanding regarding many of the characteristics and needs of these individuals. The aging retarded person presents unique difficulties to care providers because of inconsistencies in population definition, lack of coordination between resources for the aging and retarded, and past neglect in the research literature. The literature regarding the elderly retarded individual is reviewed relative to (1) physical, behavioral, and emotional characteristics, (2) service delivery and programming needs, and (3) suggestions for improved research methodology which emphasize a consumer-oriented knowledge base. Caveats regarding the application of programming mandates for mentally retarded individuals to an aging population are also presented. Future work relating to elderly retarded individuals must take into consideration the rapidly shifting nature of the population through changes in the quality of health care, extent of programming, and governmental policies concerning care of the aged and the mentally retarded person.

A reevaluation of the use of the MMPI in the assessment of combat-related posttraumatic stress disorder.

This study attempts to validate previously developed, empirically based Minnesota Multiphasic Personality Inventory (MMPI) decision rules (Keane, Malloy, & Fairbank, 1984) to aid in the diagnosis of combat-related posttraumatic stress disorder (PTSD). Four groups of 21 subjects each were identified: PTSD, psychotic, depressed, and chronic pain. A decision rule based on the standard clinical scales resulted in a correct classification rate (PTSD vs. non-PTSD) of 81% across the four-group sample. An empirically derived MMPI PTSD scale resulted in a correct classification rate of 77%. However, 43% of the PTSD subjects were incorrectly classified as non-PTSD by these rules. Independent, blind sorting of the 84 MMPI profiles by two doctoral-level clinical psychologists resulted in "hit rates" similar to the MMPI decision rules. The present results suggest that the previously derived, empirically based MMPI decision rules for PTSD do scarcely better than chance on correct classification of individuals with PTSD. We suggest that the differential diagnosis of PTSD is difficult because of the wide variety of symptoms in common with other diagnostic groups, and hence the variability of PTSD subjects on psychometric measures. We also suggest that the MMPI decision rules of Keane et al. (1984) may have utility in identifying subgroup(s) of combat-related PTSDs.

Treatment of posttraumatic stress disorder with relaxation and biofeedback training.

This study investigated the use of biofeedback and relaxation training on six patients with posttraumatic stress disorder (PTSD) referred routinely for biofeedback treatment in a VA medical center. Subjects received between 8 and 14 sessions of training overall, as well as concurrent individual and group therapy. Measures used to assess treatment outcome include pre- and posttreatment MMPI, State-Trait Anxiety Inventory, Beck Depression Inventory, and Multidimensional Health Locus of Control scores, as well as electromyographic and subjective measures of tension within each session. Additionally, an overall posttreatment clinical rating of change and 1- to 2-year follow-up data were obtained for each subject. Slight to marked improvements were demonstrated for each subject, as evidenced by improvements on the State Anxiety Inventory Scale and the Beck Depression Inventory, a decrease in overall MMPI scores, and lowered EMG and subjective tension ratings for all participants. Possible alternative explanations for improvement (situational demand characteristics, regression toward the mean, lack of independent subject evaluation) are described, along with other study limitations. This preliminary investigation suggests that the use of relaxation training and biofeedback may be a particularly useful component within a comprehensive treatment program for this disorder.

The effect of note-taking on a simulated clinical interview.

This study investigated the effect of note-taking in a simulated therapeutic session on the ratings of therapist's effectiveness, client's perception of the session, and total therapeutic impact. Half of 34 social work graduate students were shown a videotaped dramatization of a therapy session with the interviewer taking notes, the other half an identical session but without note-taking. The latter was rated as significantly higher than the session with notes. Similarly, the ratings of the therapist's effectiveness and of the client's perceptions of the therapy session were significantly higher for the session without notes. Neither the raters' age, clinical experience, nor stated theoretical orientation significantly influenced the ratings of the therapy sessions. The results indicate that note-taking is viewed by clinicians as a distracting and detrimental variable in a clinical interview. The generalizability of these results, the need for studies utilizing client instead of therapist ratings, and the role of videotaped control of variables are discussed.

A projective analysis of guilt: the Holtzman Inkblot Technique.

The group version of the Holtzman Inkblot Technique (HIT) and the three subscales of the Mosher Guilt Scales (Sex Guilt, Hostility Guilt, and Morality-Conscience Guilt) were administered to 44 undergraduate college females in an effort to determine whether or not high-guilt subjects would demonstrate response inhibition on the HIT. The results indicated response inhibition on the part of high-guilt subjects relative to the HIT Human, Movement, and Integration variables. It was concluded that high-guilt subjects responded to the HIT in a style that was less creative and more perceptually immature than low-guilt subjects.