David W. Purcell

Social anxiety and HIV transmission risk among HIV-seropositive male patients.

The role of psychological factors in predicting HIV sexual transmission risk behavior is increasingly of interest in prevention research. Social anxiety, or anxiety about being evaluated in interpersonal situations, is associated with unprotected insertive anal intercourse among young men who have sex with men (MSM) and with other behavioral risk factors for unprotected intercourse, such as depression, smoking, alcohol use, and drug use. Social anxiety may be especially relevant in understanding HIV risk among HIV-seropositive men, given its stronger association with unprotected insertive than with receptive anal intercourse. In the present study, for which participants were recruited between October 2002 and May 2003, HIV-positive men attending regularly scheduled primary care medical appointments at a community HIV clinic were approached by research personnel and informed about the study topic and procedures. Ninety percent of patients approached agreed to participate, resulting in a sample of 206 patients. The sample was primarily African American, unemployed, of low educational level, and 95% of the sample had an AIDS diagnosis. The present study replicated and extended previous research from community samples by demonstrating an association between social anxiety and unprotected insertive anal intercourse with non-HIV-positive partners in a clinical sample of HIV-positive MSM and men who have sex with women (MSW). This association was maintained controlling for depression, smoking, and club drug use. Social anxiety is a relatively robust risk factor for unprotected insertive anal intercourse among MSM. Future work should examine the mechanisms by which social anxiety is associated with sexual risk among MSM.

Birth order in a contemporary sample of gay men.

The birth order of a contemporary North American sample of 97 gay men was quantified using Slaters Index. For the 84 probands with at least one sibling, the results showed a late mean birth order compared with the expected value of .50. Additional birth order indices derived from Slaters Index suggested that the mean later birth order was accounted for more strongly by the probands number of older brothers than by his number of older sisters. The present findings constitute a replication of a series of recent studies and add to the growing body of evidence that birth order is a reliable correlate of sexual orientation in males.

Severe mental illness and HIV-related medical and neuropsychiatric sequelae.

Medical and neuropsychiatric sequelae of HIV infection present a spectrum of diagnostic and treatment challenges to mental health clinicians. Both HIV and the many opportunistic infections that manifest in patients due to their immunocompromised state also can affect the central nervous system (CNS). Thus, mental health clinicians need to be familiar with the diagnosis and management of HIV-related medical and psychiatric complications. This article provides an overview of the CNS-related manifestations resulting from HIV disease, including HIV-related dementia, psychotic disorders, delirium, CNS opportunistic infections and tumors, systemic abnormalities, psychoactive substances, and the adverse effects of certain medical treatments. Treatment strategies for individuals with HIV disease and comorbid severe mental illness are outlined and recommendations for future research are offered.

Gender and Age in the Relation between Stress and Children's School Adjustment

The role of gender and age in the relations between childrens school adjustment and negative stress was studied in a sample of 60 fifth and 61 seventh graders. Maladjustment and competence in the school setting were indicated by the Teacher-Child Rating Scale. Negative stress was measured by the amount of negative change reported by the child on the Life Events Checklist. Results indicated that, in the context of high stress, boys, relative to girls, were rated as more maladjusted but not as engaged in more acting out. Some support was found for the hypothesis that early adolescents are more likely than younger children to be rated as less competent in relation to more stress. Results suggest that gender is more central than developmental state in the relation between childrens stress and school adjustment. Some implications for teachers and school counselors are discussed.

Therapy with lesbians and gay men: A cognitive behavioral perspective

Issues related to lesbians and gay men typically are not found in discussions of culture and therapy. However, successfully working with clients who are lesbians or gay men necessitates some familiarity with lesbian and gay culture generally, and receptivity to whether your client specifically identifies with that community. In this article, important background information about lesbians and gay men is outlined first; then, the focus shifts to therapy with lesbian and gay male clients. Because basic cognitive-behavioral principles apply to working with lesbians and gay men, the emphasis is on providing information about cultural factors, client factors, and therapist factors affecting therapy with lesbians and gay men rather than on specific therapeutic techniques.

Sex differences in verbal IQ-performance IQ discrepancies among patients with schizophrenia and normal volunteers

Substantial verbal IQ (VIQ)-performance IQ (PIQ) discrepancies may reflect brain dysfunction. The authors examined 159 patients with schizophrenia (115 men and 44 women) or schizoaffective disorder (25 men and 19 women) and 79 normal participants (33 men and 46 women), calculated mean VIQ-PIQ discrepancy scores by sex and diagnosis, and identified persons with large VIQ-PIQ discrepancies (15-point difference in either direction). Schizophrenic/schizoaffective men had a larger mean VIQ-PIQ discrepancy than did other groups. The proportion of all patients with either VIQ > PIQ or PIQ > VIQ (17.8%) was not significantly different from that of normal participants (22.8%). However, significantly more men than women with schizophrenia exhibited a VIQ > PIQ pattern (20% vs. 3.2%). No unusual discrepancy patterns were noted among normal participants. Results were interpreted in light of theories of hemisphere dysfunction in schizophrenia.

A National, Randomized Survey of HIV/AIDS Knowledge and Attitudes Among Psychiatrists in Training

Given the broad spectrum of medical and psychiatric complications associated with HIV (human immunodeficiency virus) disease, HIV-related education is an important curriculum topic for all physicians. This study examined the HIV-related knowledge and attitudes among psychiatrists in training to evaluate their training needs. A survey instrument was developed containing 15 knowledge items, 15 attitude items, demographic items, and questions concerning how HIV/AIDS (acquired immunodeficiency syndrome) affected residency choice and self-perception of training needs. The questionnaire was mailed to 2,252 psychiatrists in training randomly selected and stratified by American Psychiatric Association district and postgraduate training year. The sample consisted of 825 respondents representing 37% of the initial pool. Knowledge was most lacking in areas dealing with HIV-related neuropsychiatric complications and issues concerning HIV/AIDS and special populations. In general, the respondents expressed positive attitudes about HIV-related issues; however, three items correctly endorsed by fewer than 75% of the sample dealt specifically with the management of neuropsychiatric complications, working with dying patients, and the range of normal sexuality. Targeted HIV-related education is needed for psychiatrists in training and particularly should encompass neuropsychiatric syndromes and issues of special populations.

Young People and HIV: A Call to Action

HIV is having a significant impact on young people, among whom the rate of new diagnoses is high and health disparities are more pronounced. Incidence is increasing among young gay and bisexual men, and, among Black males, the largest percentage of new infections occur among those aged between 13 and 24 years. Youths are least likely to experience the health and prevention benefits of treatment. Nearly half of young people with HIV are not diagnosed; among those diagnosed, nearly a quarter are not linked to care, and three quarters are not virally suppressed. Addressing this burden will require renewed efforts to implement effective prevention strategies across multiple sectors, including educational, social, policy, and health care systems that influence prevention knowledge, service use, and treatment options for youths.

Marital discord in intact families: Sex differences in child adjustment

Abstract Sex differences in child adjustment in response to marital discord in intact families are reviewed. The global hypothesis that boys are more adversely affected than are girls is examined. Contrary to this hypothesis, the review reveals that in intact families maladjustment in boys is not always related to concurrent marital discord more than is malad-justment in girls. However, the association between marital discord and adjustment difficulties is stronger in boys than in girls when clinic samples are used, when family members are the only informants, and when interparental aggression is incorporated in the definition of marital discord. Findings must be interpreted cautiously given the conceptual and methodological flaws of the research.

The Importance of Population Denominators for High-Impact Public Health for Marginalized Populations.

Background: Commentary -- no abstract Objective: Commentary Methods: Commentary Results: Commentary Conclusions: Commentary Clinical Trial: N/A [JMIR Public Health Surveill 2016;2(1):e26]