Allan L. Callies

Depressed Mood and Other Variables Related to Bone Marrow Transplantation Survival in Acute Leukemia

Routine psychiatric evaluations of 100 adult patients undergoing allogeneic bone marrow transplantation for acute leukemia were reviewed to examine the possible relationship of psychiatric and psychosocial factors to duration of survival following the procedure. Three variables were found to independently affect outcome: illness status (first remission vs. other status), presence of depressed mood, and the extent of perceived social support. Patients transplanted while in their first remission had significantly improved survival; patients with depressed mood, regardless of specific psychiatric diagnosis, had poorer outcomes; and patients with a high level of perceived social support had improved survival. The possible mechanisms by which these variables affect outcome are discussed.

Lifetime prevalence of psychiatric disorders in patients with alopecia areata

Thirty-one patients with alopecia areata were administered a structured psychiatric interview (the Diagnostic Interview Schedule; DIS). Overall, 74% had one or more lifetime psychiatric diagnoses. Particularly noteworthy were the high lifetime prevalence rates of major depression (39%) and generalized anxiety disorder (39%). In addition, patients reported increased rates of psychiatric disorders in first-degree relatives: anxiety disorders (58%), affective disorders (35%), and substance use disorders (35%). Patients with patchy alopecia areata were more likely to have a diagnosis of generalized anxiety disorder. No relationships were found between major depression and any variable characterizing alopecia areata history. Possible interrelationships between psychiatric disorders and alopecia areata are discussed. The study suggests that patients with alopecia areata are at increased risk for psychiatric disorders, and calls attention to the need for psychiatric assessment in this population.

Psychosocial Adjustment of Hmong Refugees during Their First Decade in the United States: A Longitudinal Study

Over their first decade in the United States, 100 Hmong refugees were studied on three occasions. Data included demographic characteristics, acculturation skills, traditional affiliations and pastimes, material acquisitions, psychosocial problems, and self-rating scales. In addition to a description of the data changes, a multiple regression analysis was performed. Changes demonstrated considerable evidence of acculturation, psychiatric care seeking, and greatly reduced symptom levels for several symptom complexes. However, a large minority of subjects remain illiterate, unable to speak English, generally involved with other Hmong but not with the majority society, and/or have high symptom levels on self-rating scales. Regarding symptom changes, depression, somatization, phobia, and selfesteem symptoms improved the most with time and acculturation. On the contrary, anxiety, hostility, and paranoid symptoms changed little. Multiple regression analyses indicated that strong traditional ties (e.g., large household size, being an herbal healer), older age, marital problems, and medical complaints were most associated with high symptom levels

Welfare status and psychosocial adjustment among 100 Hmong refugees

Although the mental health of recently employed persons has been well studied, the mental health of welfare recipients is not well understood. Among our increasing refugee population, many receive welfare benefits at some point. The Hmong are among those who are highly represented among welfare recipients in several areas of the United States. Do psychiatrists have anything to contribute toward the resolution of high welfare rates? This question is especially relevant in refugee populations who are at increased risk for several psychiatric disorders, including depression, paranoia, and adjustment disorders. This study was undertaken among 100 Hmong refugees who had been in the United States for 8 years. Indices of mental health included two rating scales (the Zung Depression Scale and the SCL-90), five-axis DSM-III diagnoses, Hamilton Anxiety and Depression Scales, Global Assessment Scale, Brief Psychiatric Rating Scale, Inpatient Multidimensional Scale, and Mini-Mental State Exam. These indices were compared with current welfare status and the duration of time on welfare. Other comparisons with welfare included demographic characteristics, material possessions, acculturation characteristics, health and social problems, and nonoccupation avocations. Results indicate that welfare recipients show lower acculturation and elevated psychiatric symptom levels. Suggestions for ameliorating this situation are extrapolated from studies in the literature on chronically unemployed persons.

Smokeless tobacco abstinence effects and nicotine gum dose

There were two experiments on abstinence from smokeless tobacco. The purpose of the first experiment was to determine abstinence effects from smokeless tobacco. The purpose of the second experiment was to examine the effects of different doses of nicotine gum on smokeless tobacco abstinence effects. The subjects were male Copenhagen smokeless tobacco users who underwent 3 days of baseline measurement while continuing to use smokeless tobacco ad libitum, and 5 days of the experimental condition. In the first experiment, the subjects were assigned randomly to one of two groups and compared: continuous smokeless tobacco users (n=10), and deprivation plus no nicotine gum (n=10). In the second experiment, subjects were assigned randomly and in a double-blind fashion to one of three groups and compared: (1) deprivation plus 0 mg nicotine gum (n=20); (2) deprivation plus 2 mg nicotine gum (n=20); and (3) deprivation plus 4 mg nicotine gum (n=20). The first experiment showed significant increases upon abstinence for the following variables: (1) craving; (2) difficulty concentrating; (3) restlessness; (4) excessive hunger; (5) eating; (6) reaction time; (7) variability of reaction time and (8) total withdrawal scores for both the self-rated and the observer-rated forms. The second experiment showed that nicotine gum failed to significantly reduce smokeless tobacco abstinence effects, although those with high cotinine levels may receive some benefit from nicotine gum.

Physical dependence on nicotine gum: effect of duration of use

This study examined whether longer duration on nicotine gum promoted dependence on nicotine gum. Subjects (N=128) answering an advertisement for smoking cessation research and wanting to quit smoking cigarettes were randomly assigned to 1- or 3-month duration of nicotine gum use. Assessments were made weekly for smoking status (with biochemical verification) and withdrawal symptoms during and at the end of treatment. Follow-up was conducted at 1, 6 and 12 months to provide exploratory data on treatment outcome. The results showed minimal nicotine gum withdrawal symptoms after gum cessation with virtually no difference in gum withdrawal between the 1- and 3-month groups. Withdrawal symptoms from the nicotine gum included difficulty with concentration, increased variability on a reaction time task, and decreased vigor. The results also showed that continuous use of the gum at 1 year was observed in 1.5% of subjects and estimated to be as high as 14%. Finally, the 3-month group experienced a 2-fold increase in abstinence compared to the 1-month group, although this difference was not statistically significant. We conclude that there is minimal physical dependence on nicotine gum.

A framework for the study of medical depression

Abstract The authors present a framework that classifies “medical depressive syndromes” according to three critical variables: nature of the medical illness, integrity of brain structure, and status of cognition/memory. They propose that this construct initially be applied to study organic affective syndrome, regarded by them as the most straightforward of the medical depressive syndromes. Assignment of groups of patients to the appropriate cells of the model may help to clarify differences in the natural course and treatment responsiveness of these disorders.

Situational factors and patterns associated with smokeless tobacco use

Situational factors and topographic features associated with smokeless tobacco use were examined. Male smokeless tobacco users (N=30) were asked to record the time, activity, and internal states associated with each dip of tobacco use over the course of 10 days. Additionally, these subjects were asked to record the activity and internal state they were experiencing every hour for a 15-hr waking period to obtain baseline rates of these events. Serum and saliva samples were obtained to measure cotinine concentrations. The activities significantly associated with smokeless tobacco use included after a meal, while driving, and while watching television. The internal states associated with smokeless tobacco use were feeling relaxed and depressed. Factor analysis of the events showed factors which are different from those found among cigarette smokers. Examination of the topographic measures of smokeless tobacco use showed that the total dip duration per day was 283.5 min, with a range of 79.7–757.1 min. This measure, along with duration of dipping time (time from onset to offset of smokeless tobacco use during the day), may be the best predictors of nicotine exposure.

Emergency Psychiatric Consultation to Medical-Surgical Services

A series of 465 consecutive psychiatric consultations to medical-surgical services was examined to compare consultations designated as emergencies with those requested on a routine basis. Twenty-three percent of the consultation requests were designated as emergencies, and psychotic thinking and suicidality were noted more frequently in this group. Emergencies, however, were invoked less frequently in patients 60 years of age or older. The consultants approach to emergency consultations demonstrates a more active role, with more recommendations for initiation of psychotropic drugs, more follow-up visits, greater numbers of recommendations for disposition, and greater numbers of contacts with outside sources of information effected. Notably, concordance with diagnostic and psychotropic drug recommendations and representation of psychiatric diagnosis in discharge summaries did not differ significantly between the two groups. The results underscore the usefulness of closely monitoring consultation outcomes and the need to explore and implement interventions that will enhance consultee responses in situations requiring acute psychiatric interventions.

Improving the effectiveness of psychiatric consultation

Abstract Drawing on their studies of consultation outcomes, the authors propose ways to improve consultees’ concordance with psychiatric consultants’ recommendations and diagnoses. Specific steps to improve outcome are presented. These include identification of cases at high risk for nonconcordance, attention to the form and substance of the consultation note, and monitoring the consultees’ responses to consultants’ recommendations.