Mark H. Townsend

Emotion Recognition in Schizophrenia : Further Investigation of Generalized Versus Specific Deficit Models

In this study, the authors examined the nature of emotion perception in schizophrenia. Two samples of people with schizophrenia, one receiving acute care for a recent exacerbation of symptoms and the other receiving extended care, were compared with a nonclinical control group on emotion perception and general perception measures. The nonclinical control group obtained the highest scores on all of the study measures, and the acutely ill group obtained the lowest scores. Furthermore, the acutely ill sample had a specific deficit in emotion perception that remained present after controlling for performance on the general perception tasks. Conversely, the deficits in emotion discrimination in the extended-care sample reflected generalized poor performance. Differences in performance on the emotion identification task between the 2 clinical groups were reduced when controlling for active symptoms.

How the Topic of Homosexuality is Taught at U.S. Medical Schools.

In 1991 the authors surveyed all U.S. medical schools to assess both the number of curriculum hours devoted to the topic of homosexuality and the instructional strategies employed in its academic treatment; responses were sought from faculty with responsibility for teaching the topic (mostly directors of medical student education in psychiatry). Of the 126 schools, 82 (65%) responded. The mean number of hours reported was 3 hours and 26 minutes, with significant differences based on geographic region. The most frequently cited strategy was lectures in human sexuality, followed distantly by panel presentations and meetings with gay men or lesbians (both health care providers and others). To enhance sensitivity and comfort with gay and lesbian issues and to counter stereotypic responses, the authors propose that the topic of homosexuality be wholly integrated throughout the curriculum.

Serum Cholesterol Levels in Patients with Generalized Anxiety Disorder (GAD) and with GAD and Comorbid Major Depression

Objective: To investigate risk for cardiovascular disease inpatients with GAD, as well as the effects of comorbid major depression (MD). Method: Predrug-trial serum cholesterol and triglyceride levels were assessed in 38 patients with pure GAD and compared with those of 21 patients with mixed GAD and comorbid (MD). Results: Significantly higher cholesterol and triglyceride levels were found in the GAD group. Conclusion: Increased noradrenergic activity may be responsible for elevations in lipid levels in patients with pure GAD.

Follow-up survey of support services for lesbian, gay, and bisexual medical students.

PURPOSE: To replicate and extend a pilot study conducted in 1990 regarding support services for lesbian, gay, and bisexual (LGB) medical students. METHOD: In 1994 the authors surveyed all 320 members of Lesbian, Gay, and Bisexual People in Medicine, a standing committee of the American Medical Student Association. Chi-square analyses were used to compare responses by subgroups. RESULTS: Responses were received from 185 students (58%) at 92 medical schools. Students who had access to school or community support groups were significantly more likely to disclose their sexual orientation and to know faculty with whom to discuss LGB issues. Nonwhite students were significantly less likely to know faculty with whom to discuss gay-related concerns, to disclose their orientation, and to know of support services. No difference between the academic experiences of lesbians and gay men was reported. Additionally, 115 (62%) of the students reported exposure to anti-gay comments, and 28 (15%) indicated they would not choose to enter the medical field if they were in college today. CONCLUSION: Although the needs of LGB medical students appear to be receiving increased attention (albeit with great variability from school to school), the survey results suggest that more student-faculty liaisons and more support groups are needed, that LGB patient care should be taught more widely, and that all medical students have too little exposure to non-pejorative descriptions of LGB patients.

Team cohesiveness, team size and team performance in team-based learning teams

The purpose of this study was to explore the relationships among variables associated with teams in team‐based learning (TBL) settings and team outcomes.

A follow-up study of DSM-III-R generalized anxiety disorder with syndromal and subsyndromal major depression

OBJECTIVE The authors examined the long-term outcome of generalized anxiety disorder with depressive symptoms utilizing both categorical and dimensional analyses. METHOD Thirty-nine out-patients with a DSM-III-R diagnosis of generalized anxiety disorder (GAD) with depressive symptoms, both with (n=23) and without (n=16) syndromal major depression (MD) participated in an 11-week clinical trial. Approximately 18 months after initial screening, these individuals were once again evaluated using a structured diagnostic interview and a battery of rating scales. RESULTS Three distinct groups were discernible at follow-up. Twenty-three (60%) of the patients remained syndromal for GAD; 10 patients (43%) were in partial remission from GAD; six (15%) were asymptomatic. Of the 23 patients who were syndromal for MD at baseline, 13 (56%) remained syndromal for MD at follow-up. All of the patients who were syndromal for MD at follow-up remained syndromal for GAD as well. CONCLUSIONS Outcomes in this study were quite divergent, though they support the concept of GAD as a chronic illness in most patients, with or without MD. The presence or absence of MD versus subsyndromal depression at baseline appeared to have relatively little impact upon the outcome. Patients with subsyndromal anxiety and depressive symptoms may be at special risk for syndromal disorders over time.

Bipolar II disorder: current and future treatment options.

BACKGROUND Bipolar II (BPII) disorder is a significant public health problem in the United States, and there is a dearth of studies of effective treatment modalities to deal with the recurrent major depressive episodes that accompany the disorder. This review attempts to summarize available data on agents useful in treating patients with the disease. METHODS English language controlled clinical trials involving BPII patients obtained from an extensive Medline search were critically reviewed. RESULTS Agents that have potential utility in the treatment of BPII are profiled, based on their efficacy in bipolar I (BPI) or unipolar depression. CONCLUSIONS The most efficacious agents are likely those with bimodal stabilizing properties, such as lithium, carbamazepine, and quetiapine. In fact, on the strength of favorable efficacy data obtained in patients with major depressive symptoms accompanying bipolar disorder, quetiapine recently became the first agent to be indicated by the FDA for monotherapeutic use in the treatment of bipolar depression, including BPII depression. Aside from the aforementioned agents, lamotrigine also shows promise in the treatment of BPII.

Support services for homosexual students at U.S. medical schools.

This study reports the results of a national survey conducted to assess current programs directed toward gay and lesbian medical students and to identify their perceptions, needs, and wishes. Support services are limited and those that do exist vary on the basis of class size, institutional affiliation, and geographic region. The topic of homosexuality is taught in most medical schools in a circumscribed way. Implications of the findings concern the medical education of all students, irrespective of their sexual orientations.

Gay and Lesbian Issues in U.S. Psychiatry Training as Reported by Residency Training Directors

This study reports the results of a survey of U.S. residency training directors that explored the training milieu of gay and lesbian psychiatric residents. Of the 198 training directors surveyed, 134 (67.7%) completed the questionnaire. All but four of the directors reported the inclusion of gay and lesbian issues in the curriculum, most frequently in PGY-3. Using a 5-point rating scale, 47.3% reported that homosexuality was regarded at their programs as “normal” or “somewhat normal,” 51.2% as “neutral,” and 1.5% as “somewhat pathological” or “pathological.” In general, the directors’ overall assessment of departmental attitudes about homosexuality paralleled the findings previously reported by lesbian and gay residents, with some discrepancy concerning the disclosure of sexual orientation to psychotherapy patients. In the earlier study, nearly one-third of gay and lesbian residents reported such disclosure; in the current study, only three training directors (2.5%) regarded this practice favorably. The results of the present study reflect the diversity of opinion found among residency training directors on the topic of gay and lesbian issues.

Blood pressure, heart rate, and anxiety in schizophrenia.

Anxiety may worsen outcome in psychotic disorders. We assessed anxiety in 44 acutely psychotic subjects and found a positive association with heart rate and blood pressure. Risperidone treatment reduced anxiety but increased heart rate. We concluded that anxiety may adversely affect cardiovascular status in schizophrenia, but the anxiolytic effect of risperidone is not straightforward.