Paul J. Carpenter

A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms.

A randomized nonblinded study was performed in three cancer centers to test over a 10-day period the efficacy of (1) a triazolobenzodiazepine, alprazolam, 0.5 mg three times a day and (2) use of a behavioral technique in which patients were trained in progressive muscle relaxation at an initial session with a behavioral psychologist and then asked to listen at home to an audiotape of the session three times a day. Of 147 cancer patients who met entry levels of distress and completed the study, uncontrolled for site or disease stage, 70 were randomized to drug, 77 to relaxation. Four measures of anxiety and depression were used: Covi, Raskin, Affects Balance, and Symptoms Checklist-90 (SCL-90). Results showed that both treatment arms resulted in significant (P less than .001) decrease in observer and patient-reported anxious and depressed mood symptoms. Although both treatment arms were effective, patients receiving the drug showed a slightly more rapid decrease in anxiety and greater reduction of depressi...

Sibling adaptation to childhood cancer collaborative study: prevalence of sibling distress and definition of adaptation levels

A multisite collaborative study assessed the frequency and intensity of emotional/behavioral distress in siblings of children with cancer. A sample of 254 siblings, aged 4 to 18 years, and their parents completed interviews and self-report measures 6 to 42 (average 22.5) months after diagnosis of cancer in a brother or sister. Matched controls were obtained from respondents to the Child Health Supplement of the National Health Interview Survey administered in 1988 (CHS88). Before diagnosis, the prevalence of parent-reported emotional/behavioral problems among siblings was similar to that in the general population (7.7% vs 6.3%; p = not significant). After diagnosis, prevalence rose to 18% among siblings. When siblings were grouped according to the presence or absence of problems exacerbated by and/or arising after diagnosis, four levels of adaptation, consistent with scores on the Behavior Problem Scales from the CHS88, emerged. This differentiation may help explain inconsistencies in sibling response reported previously and provides a framework for investigating factors that enhance adaptation. J Dev Behav Pediatr 15:353–366, 1994. Index terms: chronic illness, childhood cancer, siblings, adaptation, coping, psychosocial stress.

Sibling adaptation to childhood cancer collaborative study : The association of sibling adaptation with maternal well-being, physical health, and resource use

This multi-institutional study investigated the association of behavioral/emotional adaptation among siblings of children with cancer with maternal general well-being, physical health, and resource use. One hundred seventy siblings and mothers completed standardized interviews and self-report measures 6 to 42 months after the cancer was diagnosed. As a group, mothers of children with cancer reported significantly lower levels of well-being than matched controls. When stratified according to the level of the siblings behavioral/emotional adaptation, mothers of siblings in the Dysfunctional group (1) reported the lowest levels of well-being; (2) during the preceding year, were more likely to have sought professional services than mothers of children in the Resilient group; and (3) were least likely to have found social support helpful. Our results support an association between maternal well-being and sibling adjustment but show it is unlikely that nonspecific social support will improve adjustment. The rationale for problem-solving training for mothers is provided.

A survey of psychotropic drug utilization by patients with advanced neoplastic disease

The utilization of psychotropic drugs in patients with advanced neoplastic disease was studied over a 14-month period. Eight hundred twenty-four (82.4%) of one thousand consecutively admitted patients were prescribed at least one psychotropic agent. Antipsychotic agents were prescribed for 61.3% and hypnotics for 55.8% of the total patient sample. Only one out of ten patients received an antidepressant medication. Significantly more psychotropic drugs were prescribed for the relatively younger patients (less than 50 years). Diphenhydramine, prochlorperazine, and haloperidol were the most frequently prescribed psychopharmacologic agents. The most common reasons for prescribing psychotropic medications were for psychologic distress, sleep disorders, and nausea and vomiting. Clinical consequences are discussed.

Characteristics of patients completing referrals from an emergency department to a psychiatric outpatient clinic

Abstract Many patients referred from emergency departments for psychiatric outpatient treatment fail to make contact with the facilities to which they have been referred. 1–4 Completion rates in the range of 7.1%–63% have been typically reported. 2,3,5 While diverse explanations such as the method of referral 3 and characteristics of facilities 1 have been suggested as determinants of the low completion rate, research has focused largely on demographic characteristics of the patients referred. 3,5,6 For example, patients sex, 2,5 socioeconomic status, 1 race, 5 and age 2,3 have been found to relate to the completion of referrals made in the emergency department. While the clinical characteristics of psychiatric emergency department patients have received some attention, studies have focused more on describing these patients 6–9 than on investigating the relationship between their characteristics and successful completion of referrals. Furthermore, studies which have attempted to relate clinical characteristics to completion rates, 2,4,10 along with those focusing on demographic characteristics, have tended to overlook the question of whether patients who failed to complete their referrals to a particular facility actually made contact with some other psychiatric facility. The purposes of the present study are (1) to investigate both the demographic and clinical characteristics of patients who successfully complete referrals from a psychiatric emergency department to a psychiatric outpatient clinic and (2) to determine by means of a thorough follow-up the characteristics of patients who failed to complete the referral but sought treatment elsewhere in the community.

Dropouts and terminators from a community mental health center: Their use of other psyciatric services

Differences in patterns of utilization of psychiatric services were studied in 178 adult outpatients who either had dropped out of, or had terminated from treatment with the consent of their therapists. The Monroe County Psychiatric Case Register was employed to determine the use of psychiatric services by these patients within a period of two years before and two years after their admission to a community mental health center (CMHC). Dropping out of treatment was associated with a pattern of utilization of multiple psychiatric facilities. Of those individuals who made contact with a psychiatric facility both prior to and subsequent to their admission to the CMHC, the dropout group made, on the average, approximately twice as many contacts per person as the terminator group.

Scientific inquiry in childhood cancer psychosocial research. Theoretical, conceptual, and methodologic issues in the investigation and behavioral treatment of procedure-related distress

This paper discusses the current status of scientific inquiry in childhood cancer psychosocial research. The investigation and behavioral treatment of procedure‐related distress serves as a model for illustrating and outlining some of the theoretical, conceptual, and methodologic issues and problems that exist in the area of childhood cancer psychosocial research. Specifically, issues related to the process of scientific inquiry, theoretical/conceptual modeling, measurement and assessment, and behavioral treatment strategies are discussed. Examples of how these issues have been addressed in our investigations of procedure‐related distress are presented and recommendations for facilitating growth and development in the field of childhood cancer psychosocial research are offered.

Influence of professional background and sex of therapist on attitudes towards patients.

A brief report of the attitudes of therapists towards psychiatric outpatients, varying in socioeconomic background, insight levels and degrees of disturbances, is presented. Results suggest that the professional affiliation and sex of therapists influenced their attitudes towards the patients.

The Democratic Values Scale and professional affiliation

Therapists from four professional groups--nursing, psychiatry, psychology and social work--were compared on Lerners Democratic Values Scale. Significant professional differences were found on this scale. The findings raise questions about the predictive power of this scale when a variety of mental health professionals are studied.

A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms

A randomized nonblinded study was performed in three cancer centers to test over a 10-day period the efficacy of (1) a triazolobenzodiazepine, alprazolam, 0.5 mg three times a day and (2) use of a behavioral technique in which patients were trained in progressive muscle relaxation at an initial session with a behavioral psychologist and then asked to listen at home to an audiotape of the session three times a day. Of 147 cancer patients who met entry levels of distress and completed the study, uncontrolled for site or disease stage, 70 were randomized to drug, 77 to relaxation. Four measures of anxiety and depression were used: Covi, Raskin, Affects Balance, and Symptoms Checklist-90 (SCL-90). Results showed that both treatment arms resulted in significant (P less than .001) decrease in observer and patient-reported anxious and depressed mood symptoms. Although both treatment arms were effective, patients receiving the drug showed a slightly more rapid decrease in anxiety and greater reduction of depressive symptoms. These findings confirm efficacy of both alprazolam and relaxation to reduce cancer-related anxiety and depression. As safe, inexpensive, and effective interventions, physicians should consider their use in cancer patients experiencing anxiety and depressive symptoms.