Conducting Outcomes Research in a Clinical Practice Setting: The Effectiveness and Acceptability of Acceptance and Commitment Therapy (ACT) in a Partial Hospital Program.

Multiple challenges exist integrating research into clinical practice, particularly in acute care settings where randomized controlled trials may be impractical or unethical. Partial or day hospitals are one such setting. As compared to outpatients and inpatients, relatively little research is conducted or reported in partial hospital program (PHP) patients, leaving providers in this setting without a solid empirical basis from which to draw.

Improving treatment adherence in patients with bipolar disorder and substance abuse: rationale and initial development of a novel psychosocial approach.

Patients with comorbid bipolar and substance use disorders are at particularly high risk for treatment nonadherence and a host of negative consequences. However, no previous interventions have been designed specifically to address this problem. In the current study, we describe the rationale for and initial development of an adjunctive psychosocial intervention that targets adherence in patients with bipolar disorder who are substance abusers.

The treatment of psychotic major depression: is there a role for adjunctive psychotherapy?

Background: Psychotic depression is a relatively prevalent mood disorder associated with greater symptom severity, a poorer course of illness and higher levels of functional impairment compared with nonpsychotic depression. Separate lines of investigation suggest that various forms of cognitive-behavioral therapy are efficacious for treating severe forms of nonpsychotic depression as well as primary psychotic disorders. However, there currently are no empirically supported psychotherapies specifically designed for treating psychotic depression.

Managing risk when considering the use of atypical antipsychotics for elderly patients with dementia-related psychosis.

In 2005, responding to several studies, the FDA issued a black box warning on atypical (second generation) antipsychotic medications, noting that the drugs may increase the risk of cerebrovascular adverse events in elderly patients with dementia-related behavior disturbances. The black box warning has raised concern for clinicians, among whom atypical antipsychotics have gained favor for having a more tolerable side-effect profile than many other pharmacological treatment options. Complicating this concern are studies suggesting that other medications may have similar risks and a dearth of unbiased head-to-head studies comparing different treatment options.

Course of illness in psychotic mania: is mood incongruence important?

Previous research is inconsistent regarding the significance of mood-incongruent psychotic symptoms in relation to the severity and course of bipolar disorder. In the present study, bipolar I patients were assessed at index hospitalization using standardized symptom measures and followed up to 28 months. We contrasted the symptomatic course in patients experiencing mood-congruent versus mood-incongruent psychotic symptoms.

Nicotine dependence symptoms among adolescents with psychiatric disorders: using a Rasch model to evaluate symptom expression across time.

Little is known about the longitudinal course of symptoms of nicotine dependence among adolescents following interventions designed to affect smoking behavior, particularly among high-risk samples. We used an item-response modeling strategy to examine how well nicotine dependence symptoms cohere to a latent construct, the stability of the construct over time, and the sensitivity of the nicotine dependence symptoms to changes in smoking patterns among adolescents with comorbid psychopathology. Assessments occurred prior to cessation treatment delivered within a randomized clinical trial and again at 6 and 12 months after treatment.

Self-disclosure in psychotherapy supervisors: gender differences.

Objective: This article will explore the possible reasons for gender differences found in self-disclosure in psychotherapy supervisors.

Method: Trainees and supervisors in the Brown University Department of Psychiatry and Human Behavior completed a questionnaire that asked about the appropriateness of the actions of a psychotherapy supervisor.

Results: On three items, male and female supervisors differed significantly in their perceptions of appropriate boundaries.

Readiness to quit cigarette smoking, intimate partner violence, and substance abuse among arrested violent women.

Cigarette smoking is a leading cause of preventable mortality in the United States. Not much data are available regarding the prevalence and correlates of cigarette smoking in female perpetrators of intimate partner violence (IPV). Ninety-eight arrested violent women were recruited from court-referred batterer intervention programs.

Epidemiology of trauma, post-traumatic stress disorder (PTSD) and co-morbid disorders in Chile.

Background: In this study we examined the prevalence rates of post-traumatic stress disorder (PTSD), types of trauma most often associated with PTSD, the co-morbidity of PTSD with other lifetime psychiatric disorders, which disorders preceded PTSD, and gender differences in PTSD and trauma exposure in a representative sample of Chileans.

Method: The DSM-III-R PTSD and antisocial personality disorder modules from the Diagnostic Interview Schedule (DIS) and modules for a range of DSM-III-R diagnoses from the Composite International Diagnostic Interview (CIDI) were administered to a representative sample of 2390 persons aged 15 to over 64 years in three cities in Chile.

Results: The lifetime prevalence of PTSD was 4.

Body dysmorphic disorder: recognizing and treating imagined ugliness.

Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a severe psychiatric disorder that occurs around the world. However, the diagnosis is usually missed in clinical settings. It is important to recognize and diagnose BDD, because this disorder is relatively common and causes significant distress and impairment in functioning.

Law & psychiatry: Legal concerns for psychiatrists who maintain Web sites.

Courts recognize three types of Web sites: passive, which provide basic information; business, on which business is conducted; and intermediate, which are somewhat interactive but conduct no business. Inviting contact from site visitors may lead to inadvertent doctor-patient relationships, with ensuing legal duties. Statements made may be considered explicit warranties, which are subject to lawsuits when not fulfilled.

Examining a conceptual framework of intimate partner violence in men and women arrested for domestic violence.

Objective: There is a paucity of research developing and testing conceptual models of intimate partner violence, particularly for female perpetrators of aggression. Several theorists' conceptual frameworks hypothesize that distal factors-such as personality traits, drinking patterns, and marital discord-influence each other and work together to increase the likelihood of physical aggression. The purpose of the present study was to investigate these variables in a relatively large sample of men and women arrested for domestic violence and court-referred to violence intervention programs.

Clinical characteristics and psychiatric comorbidity in males with exhibitionism.

Background: This study was constructed to detail the demographic and phenomenological features of males with exhibitionism.

Method: Male subjects with DSM-IV exhibitionism were administered a semistructured interview to elicit demographic data and information on the phenomenology, age at onset, and associated features of the disorder. Subjects also underwent structured clinical interviews to assess both Axis I and Axis II comorbidities.

Improving violence intervention outcomes by integrating alcohol treatment.

There is extensive empirical and theoretical support for a link between alcohol use and intimate partner violence. Recent innovations in the assessment of these constructs have shown a strong temporal link between alcohol use and intimate partner violence. The majority of men participating in batterer intervention programs have alcohol problems, and these men are at very high risk for violence recidivism.

Outcome study of kleptomania patients treated with naltrexone: a chart review.

Purpose: This study examines the response to treatment in 17 patients with kleptomania who were treated with naltrexone as monotherapy for up to 3 years.

Methods: Patients were treated with naltrexone (range, 50-200 mg/day) and were assessed at each clinic visit for stealing behavior, urges to steal, and for overall symptom severity. Liver function tests were examined regularly during treatment.

Placebo-controlled study of pimozide augmentation of fluoxetine in body dysmorphic disorder.

Objective: Although body dysmorphic disorder often responds to serotonin reuptake inhibitors (SRIs), most patients do not respond or respond only partially. However, placebo-controlled studies of augmentation of SRIs have not been done. Furthermore, although 40%-50% of patients are delusional, studies of antipsychotic medications have not been done.

Vicarious traumatization: potential hazards and interventions for disaster and trauma workers.

Disaster and trauma workers often disregard their own reactions and needs when focusing on caring for those directly exposed to traumatic events. This article discusses the concept of vicarious traumatization, a form of post-traumatic stress response sometimes experienced by those who indirectly are exposed to traumatic events. It includes an examination of how vicarious trauma reactions are experienced across different professions, and suggestions on how to limit or prevent vicarious traumatization.

Hazardous drinking and relationship violence perpetration and victimization in women arrested for domestic violence.

Objective: Research has shown that women who perpetrate partner violence or are victims of partner violence are more likely than comparison groups to have alcohol problems. The present study represents the largest sample collected to date of women arrested for domestic violence and court referred to batterer intervention programs. The aim of this study is to compare hazardous and nonhazardous drinking women on violence perpetration and victimization and to examine whether group differences in these variables are attributable to women's drinking, their general propensity for violence, their partners' drinking, or a combination of these factors.

Relationship aggression and substance use among women court-referred to domestic violence intervention programs.

Although there is extensive theoretical and empirical evidence linking men's alcohol abuse and marital violence, no previous studies have assessed the substance use characteristics of women arrested for domestic violence. We recruited 35 women who were arrested for domestic violence and court-referred to batterer intervention programs. We administered multiple measures of substance use and abuse and assessed the women's marital aggression, marital satisfaction, depressive symptomatology, use of general violence, and their relationship partners' substance use.

Finding order in the DSM-IV nicotine dependence syndrome: a Rasch analysis.

Little is known about the relative severity or typical sequence of Diagnostic and Statistical Manual (DSM-IV) symptoms of nicotine dependence. Using data from the National Comorbidity Study (NCS), the current study used a Rasch logistic item response model to assess the unidimensionality of the construct of nicotine dependence, to identify which symptoms are associated with high levels of dependence, and to determine whether the dependence symptoms and typical symptom patterns are influenced by age, gender, race and income level. The nicotine dependence symptoms provided reasonable coverage of the dependence syndrome and can be used to scale individuals reliably.

Family history and psychiatric comorbidity in persons with kleptomania.

The current study was constructed to examine the family history and psychiatric comorbidity of a group of persons with kleptomania. Thirty-one subjects with DSM-IV kleptomania were administered the Structured Clinical Interview for DSM-IV (SCID) and the Minnesota Impulse Disorders Inventory (MIDI). The Family History Research Diagnostic Criteria (FH-RDC) were used to collect information about psychiatric disorders in first-degree relatives.