P. Alex Mabe

Immersing Practitioners in the Recovery Model: An Educational Program Evaluation

The ascendance of the recovery movement in mental health care has led to the development and implementation of educational curricula for mental health providers to assist in mental health care system transformation efforts. The Medical College of Georgia (MCG) partnered with the Georgia State Department of Human Resources (DHR) to develop, implement, and evaluate such an educational curriculum for providers within an academic medical institution. This effort, entitled Project GREAT, led to the creation of a curriculum based on the SAMHSA-defined (2006) critical components of recovery. As an initial evaluation of educational curriculum effectiveness, the authors examined effects of the training program on recovery-based knowledge and recovery-consistent attitudes. We also compared MCG provider knowledge and attitudes to those of a similar group of providers at a neighboring medical institution who did not receive the intervention and training. Findings generally supported the effectiveness of the intervention in increasing providers’ knowledge of recovery and a shift in recovery-supporting attitudes.

Children's knowledge and concerns towards a peer with cancer: A workshop intervention approach

A brief school workshop intervention was conducted to assess childrens general knowledge of cancer and their attitudes and concerns towards a peer with cancer. The impact of the workshop upon the above issues was assessed via pre- and postworkshop assessments as well as a one month followup. The results indicated that children had a limited knowledge of cancer with those in earlier grades showing the greatest limitations. Children also manifested a number of concerns and negative attitudes towards peers with cancer which were not correlated with knowledge. Efficacy of the workshop was supported with significant increases in knowledge and decreases in personal concern and worrying which were maintained at the followup.

Peers and Peer-Led Interventions for People with Schizophrenia

This article provides a snapshot of the nature, guiding philosophy, and empiric status of interventions for people with schizophrenia that go beyond traditional psychopharmacological and psychosocial treatments to include peer-led interventions. The authors discuss the nature and principles of peer-led interventions for people with schizophrenia and the types of peer-led interventions along with evidence of their effectiveness in fostering the recovery of people with schizophrenia and other severe mental illnesses. Focus is on 3 types of peer-led interventions: (1) mutual support/self-help, (2) consumer-operated services, and (3) peer support services.

Smokeless tobacco use in adolescent females: Prevalence and psychosocial factors among racial/ethnic groups

From a stratified, random sampling of Southeastern, nonurban high schools, survey data on smokeless tobacco use and potential psychosocial risk factors were obtained from 5683 adolescent females. Of the 15.3% who reported trying smokeless tobacco, most (75%) reported only experimental use. Factor analysis of the psychosocial items resulted in four factors: perceived negative consequences, substance use, modeling, and active lifestyle. Discriminant analysis on use indicated that modeling influences and use of other substances were the strongest predictors of initial smokeless tobacco use. Level of use, however, was most strongly associated with lower perceived negative consequences for use and the use of other substances. Separate analyses on American Indian, Black, and White subgroups suggested that factors associated with initial use were similar but that substantial differences exist between subgroups on risk factors for level of smokeless tobacco use.

A brief neuropsychological screening battery to detect brain damage in a psychiatric population

Seventy-five patients admitted to the psychiatric unit of a general hospital were administered a brief neuropsychological screening battery. Discharge diagnoses obtained from the medical records revealed that 20% had brainbased pathology. A discriminant function analysis resulted in a five-variable model (Symbol-Digit Modalities Test, educational level, Psychiatric-Organic subscale of the MMPI, and Shipley Vocabulary and Abstraction scores) which correctly classified 84% of the subjects, with 87% correct identification of the brain-damaged group. A jackknife cross-validation procedure resulted in comparable hit rates.

The role of race and ethnic status on the psychosocial correlates of smokeless tobacco use in adolescent males

From a stratified, random sampling of non-urban high schools in the Southeast, survey data were obtained from 5374 adolescent males. Over half reported trying smokeless tobacco, and approximately one third of these reported a regular, substantial level of use. The average age at initial use was 12.2 yr. and was negatively correlated with the level of use. Factor analysis of the psychosocial items resulted in four factors: substance use/deviant style, modeling, perceived negative consequences, and health behavior. Discriminant analysis of initial use indicated that substance use and modeling influences were the strongest predictors of trying smokeless tobacco. Regression analysis of level of smokeless tobacco use indicated that substance use, modeling, and perceived negative consequences were equivalent in their contribution. Separate analyses were performed for American Indian, Black, and White males. Although predictors of initial use were similar, level of smokeless tobacco use was most associated with the use of other substances in Blacks and with modeling influences in Whites.

Diabetic ketoacidosis depletes plasma tryptophan.

Diabetic ketoacidosis (DKA) is a severe metabolic disturbance of insulin-dependent diabetes mellitus (IDDM) which has a significant effect on amino acid metabolism. Amino acids serve as precursors for various neurotransmitters which are involved in affective disorders, and patients with IDDM are known to have an increased prevalence of affective disorders. We monitored the plasma concentrations of 23 amino acids in six adolescents prior to treatment of DKA and at 6, 24 and 120 hours after initiation of treatment. The well-known increase in the concentrations of the glucogenic amino acids and the decrease in the branched-chain amino acids were observed in response to treatment of DKA. Low levels of tryptophan were found prior to treatment of DKA. Treatment increased the plasma tryptophan levels, but the mean concentration remained low throughout the sampling period. Only the glutamate-derived amino acids (glutamate, proline and glutamine) from the Krebs cycle pool were significantly affected by treatment. Glutamine declined initially, but recovered as the plasma pH normalized. Our results indicate that DKA causes a depletion of plasma tryptophan. This depletion may predispose some patients with IDDM to have affective disorders secondary to a neurotransmitter imbalance.

Child and adolescent psychiatric emergencies: family psychodynamic issues

Given the impact of the family on the etiology, identification, and treatment of child mental health problems, this article addresses the role of the family in psychiatric emergencies. This article covers relevant aspects of family evaluation in an emergency context, factors that determine the familys role in disposition, and planning of family considerations in several specific clinical emergencies. Improved understanding of the familys contribution leads to a more accurate diagnostic consideration and more appropriate disposition recommendations. A correct diagnosis and appropriate discharge plan lead to an improved prognosis for overall follow-up care and treatment.

Illness Coping Strategies and Hypochondriacal Traits among Medical Inpatients

The Illness Coping Strategies scale (ICS) is an 18-Likert-item scale developed to examine illness appraisal and coping by medical patients more comprehensively than instruments which screen for hypochondriacal traits in this population. This study has examined the association of hypochondriacal traits with illness coping strategies addressed by the ICS among 101 randomly selected inpatients drawn from a general medicine unit of a teaching general hospital. Despite the exclusion of patients with substance abuse or organic mental disorder, or referral for psychiatric consultations, hypochondriacal traits were prevalent in this inpatient sample. Five factor-derived subscales of the ICS (disease vigilance, limit activity, overresponsiveness, self-treatment and obsessive worry) were extracted, and internal consistency and test-retest reliabilities were determined. Multiple regression analysis on a composite measure of hypochondriasis revealed that the five ICS factor scales accounted for 26 percent of the variance. Patients with a high hypochondriacal index had associated high scores on symptom vigilance, limit activity and obsessive worry subscales, suggesting that these illness coping strategies may represent an important aspect of hypochondriacal illness presentation. The self-treatment subscale appeared to act as a suppressor variable, contributing to the prediction of the hypochondriacal index by extracting self treatment aspects from the other illness coping factors. Illness coping responses found to be associated with hypochondriacal traits in this study were rather passive strategies which promoted increased vigilance and concern about symptoms while providing few opportunities to reduce uncertainty regarding health status.

Recovery in Schizophrenia: Perspectives, Evidence, and Implications

The recovery model of schizophrenia represents a paradigm shift in both the conceptualization and treatment of schizophrenia. However, the varied use of the term “recovery” in research and clinical settings has caused confusion about what it means in relation to schizophrenia. Two views of recovery appear in the literature including a medical model, having its origins in treatment outcome studies; and a consumer model of recovery, which was conceived from the writing and testimonials of former patients. The medical model of recovery suggests that there are many possible outcomes in the prognosis of schizophrenia and many patients do experience periods of symptom remission and improved functioning. On the other hand, the consumer model of recovery suggests that recovery involves integrating illness into a multifaceted sense of self that actively pursues goals, interests, roles, and aspirations despite the limitations imposed by the illness. This model emphasizes hope, empowerment, and overall wellness regardless of the status of symptoms and functional disability. The current chapter is an overview of the medical and consumer views of recovery and studies supporting both models. Despite their distinct origins and focus, both models of recovery offer a hopeful view of recovery in schizophrenia; however, implementing the consumer model of recovery in mental health systems is freight with challenges.