Robert G. Harper

SELF-REPORT EVALUATION OF HEALTH BEHAVIOR, STRESS VULNERABILITY, AND MEDICAL OUTCOME OF HEART TRANSPLANT RECIPIENTS

Objective The purpose of this study was to explore the value of patient self-report assessment in heart transplant candidacy evaluation, utilizing the Millon Behavioral Health Inventory (MBHI). Patients MBHI measures were related to important pretransplant patient characteristics and posttransplant measures of health behavior, medical morbidity, and mortality. Method Ninety heart patients with end-stage cardiac disease completed the MBHI during pretransplant candidacy evaluations, and also were interviewed concerning their coping effectiveness, support resources, and compliance history. Postransplant follow-up of 61 living and 29 deceased patients included measures of survival time, postsurgical medical care, rejection and infection episodes, and nurse ratings of medication compliance and problematic interpersonal health behaviors. Results The MBHI coping scales were found to significantly discriminate good and poor pretransplant compliance, and interview judgments of good and poor coping and support resources, with modest accuracy. The MBHI also was superior to these interview judgments in predicting posttransplant survival time and medical care used. Certain scales were also positively associated with physical parameters of pretransplant and posttransplant status. Conclusions Patient self-report with the MBHI can contribute to identification of patients at risk for a problematic outcome with transplant, by providing information pertinent to clinical decision making and outcome management analysis with this special population of cardiac patients.

Comments on «Speech understanding and aging» [J. Acoust. Soc. Am. 83, 859-895 (1988)]

The hypothesis advanced by the CHABA Working Group on Speech Understanding and Aging [J. Acoust. Soc. Am. 83, 859–895 (1986)] that the systematic decline in speech understanding with age might be explained by concommitant decline in extra‐auditory cognitive factors was tested by examining speech audiometric findings in patients with dementia. The fact that performance was consistent with normal central auditory function in 12 of 23 such patients, in spite of deficits in immediate memory for spoken material, tolerance of distraction, mental tracking and sequencing, cognitive flexibility, and set shifting argues against the hypothesis that speech understanding deficits in the elderly can be explained as the simple consequence of cognitive decline.

The Relative Utility of the Shipley-Hartford Scale: Prediction of WAIS-R IQ.

This study examined the utility of the Shipley-Hartford Scale in predicting WAIS-R Full Scale IQs when the test was administered with and without time limits in samples of cases obtained in a general acute care hospital (N = 156). While the correlation between predicted Wetzel IQ Score based on Paulson and Lins formula and actual Full Scale WAIS-R IQ was nearly the same under both conditions and similar to previously reported values, systematic overestimation of WAIS-R IQ was found. Stepwise multiple regression analysis showed slightly more accurate prediction with the speed than the power administration. However, underestimation of above average Full Scale IQs and overestimation of below average Full Scale IQs also was found. Advanced age was associated with low conceptual quotients, which suggests that normal older persons may be identified incorrectly as cognitively impaired. These findings point to significant limitations in the use of this paper-and-pencil estimate of intellectual functioning.

Detection of a Psychiatric Diagnosis in Heart Transplant Candidates with the MBHI

The utility of the Millon Behavioral Health Inventory (MBHI) in screening for the formal diagnosis of a psychiatric disorder was investigated in a sample of 90 heart transplant candidates, a population at risk for psychiatric disturbance. Psychiatric disorders were identified in 71% of patients, the majority being adjustment disorder. Sensitivity and specificity rates of >70% were determined in discriminant function analyses, for presence or absence of a psychiatric condition. When Axis I conditions were differentiated as “mild” (adjustment reaction only) or “severe” (all other Axis I conditions, including comorbid Axis II disorders), the MBHI correctly identified every severe case as a probable psychiatric diagnosis. The rate of “clinically significant” elevations on certain MBHI scales and severity of Axis I psychiatric condition was also significantly associated. These findings suggest that the MBHI may have potential utility in identifying high-risk patients with diagnosable psychiatric conditions and help justify mental health consultation referrals at a time when managed care entities are vigorously rationing ancillary services with medically ill populations.

Psychotherapy: Past training and current practice

Our 1988 survey of Texas psychiatrists indicates that hospital work is more common, and long-term psychotherapy less common than it had been in the 1982 APA survey. Almost 85% reported long-term psychotherapy experience as residents. Thirty-nine percent reported multiple patients treated for approximately 2 years. Use of audio techniques by resident and teacher in the post-1970-trained group predicted current long-term therapy activity as did an experience of personal therapy and seeing a patient at least twice weekly in training. Concurrent drug use is widely reported for long-term psychotherapy patients and to a lesser degree in psychoanalysis. Our data suggest a shift to increased hospital work and decreased long-term psychotherapy.

Brief neuropsychologic differentiation of demented versus depressed elderly inpatients

Recent investigations have suggested the utility of brief, psychometric screening batteries in the early detection of abnormal mental decline. This study extended the investigation of one of these batteries, comprised of three tests (Controlled Oral Word Association, Visual Retention, Temporal Orientation), to the difficult issue of differentiating dementia from depression in a hospitalized sample composed of a group of depressed only patients (N = 50) vs an age-matched demented group (N = 50), some of whom presented mixed dementia/depression syndromes. Demented patients consistently performed more poorly as a group than depressed patients on each of the three measures. This was the case even when three-group (demented only, mixed demented/depressed, depressed only) comparisons were conducted. Impairment was more common on one or more tests with demented vs depressed patients. However, limitations for screening purposes and for the definitive detection of dementia were noted in view of only moderate predictive power of the tests with discriminant function analysis. Nevertheless, the potential clinical utility of the three tests in the general hospital and other primary care settings was apparent.