Benefits of a multidisciplinary predialysis program in maintaining employment among patients on home dialysis.

We evaluated the benefits of a multidisciplinary predialysis intervention to help home dialysis patients maintain employment. This program was shown to be successful with in-center hemodialysis patients in a case-controlled study published in the American Journal of Kidney Disease in September, 1993. We looked at 30 patients on home dialysis (28 on continuous ambulatory peritoneal dialysis and 2 on home hemodialysis) as of March, 1995. The age of the patients ranged from 28 to 63 years, with a mean of 46.8 years. Forty-three percent of the patients were diabetic. The patients went through a multidisciplinary predialysis program which consisted of: (1) psychosocial assessment, (2) education about dialysis and choice of modalities, (3) orientation to dialysis unit, and (4) counseling sessions with patient, significant family members, and others. During this time, patients were referred to the program approximately six months before beginning dialysis. There was continued collaboration among members of the multidisciplinary team. Of the 30 patients, 11 were already disabled when beginning dialysis. Of the 19 who were working once dialysis began, 14 maintained employment (3 diabetic), with 1 retiring and 4 becoming disabled. Therefore, 74% of patients maintained employment. In conclusion, employment was maintained by this predialysis multidisciplinary program.

An intervention for employment maintenance among blue-collar workers with end-stage renal disease.

An evaluation study was conducted to test the benefit of a predialysis intervention in assisting blue-collar workers with end-stage renal disease (ESRD) to maintain employment. Patients with ESRD were recruited from a large southern California health maintenance organization. In a nonrandomized control trial, employment status among 45 ESRD patients who received a predialysis orientation program followed by in-center dialysis was compared with that of 57 ESRD patients dialyzed at community centers not providing predialysis intervention. Participants had a mean age of 50 years. Sixty-two percent of participants were men and 38% were women. The sample was predominantly Afro-American (35.8%), Hispanic (28.9%), and white (24%). Employment status was assessed prior to dialysis and at least 6 months after beginning maintenance dialysis treatments. The intervention consisted of physician referral to a licensed clinical social worker prior to the initiation of in-center maintenance dialysis treatments, social worker assessment, patient education and counseling, orientation to the dialysis unit, and follow-up care from physicians, licensed clinical social workers, and other team members. A significantly higher proportion of blue-collar workers who received the intervention continued working after beginning dialysis (46.7%) when contrasted with control group blue-collar workers who did not receive the early intervention (23.5%) (chi-squared text = 3.78, P < 0.05). Odds ratio calculations showed that blue-collar workers who received the intervention were 2.8 times more likely to continue working than control group blue-collar workers. The effectiveness of the intervention highlights the importance of early psychosocial intervention in assisting in-center hemodialysis patients in maintaining employment.

REM latency in Alzheimer's disease.

Latency to the first episode of rapid eye movement sleep (REML) has been proposed as a potential biomarker for Alzheimer's disease (AD). In this study, we compared REML values from 28 AD patients and 28 age- and sex-matched controls. We employed multiple definitions of REML and multiple cutoffs to classify patients and controls. Results indicated that the best REML definition and optimal cutoff criterion resulted in only 65% correct classifications. We discuss the longer REML in AD patients relative to controls in terms of both overall sleep disturbance and selective deterioration of the REM-cholinergic system. As REML may be relatively short in other forms of psychopathology (e.g., affective disorders), REML may still hold promise in the differential diagnosis of dementia and pseudodementia.

Correlations of self-directed violence in acute schizophrenics with clinical ratings and personality measures.

Schizophrenic patients admitted to an acute inpatient unit were evaluated with the Comprehensive Psychopathological Rating Scale (CPRS), items reflecting hostility from the same scale, the Eysenck Personality Questionnaire (EPQ), and the Socialization and Self-Control scales of the California Psychological Inventory (CPI). Incidents of violent and nonviolent suicidal behavior and suicidal ideation before admission, and assaultiveness against self subsequent to admission were recorded. It was determined that behavioral ratings of degree of schizophrenic symptoms on the CPRS are more highly likely than ratings of hostility to correlate with self-directed violence before and subsequent to admission. Personality measures that reflect violence toward others (Psychoticism on the EPQ and Socialization on the CPI) also correlate with violence toward self.

Early parental discipline and adult self-destructive acts.

Forty-five male inpatients with major depressive episodes by DSM-III criteria (296.2, 296.3, 296.5) were examined for correlates of inpatient self-destructive behavior. It was found that 44% of the variance for inpatient self-destructive acts could be accounted for by a combination of history of severe childhood discipline and parental conflict. Losses experienced during childhood were of less importance than these measures of family instability. Such information may be of use in the clinical prediction of self-destructive acts by depressed patients.

Fantasized companions and suicidal depressions: two case reports.

Two acutely suicidal adult patients with fantasized companions integral to the formation of suicide intent are presented. The phenomenon of the fantasized companion is reviewed, differentiated from true hallucinatory or psychotic phenomena, and related to other fantasy and dissociative states, such as daydreaming and multiple personalities. In this regard, the concept of hysterical psychosis is discussed. The functions served by the fantasized companions and their involvement in the successful treatment of the patients are described.