Thomas G. Bowers

The Efficacy of Acamprosate and Naltrexone in the Treatment of Alcohol Dependence: A Relative Benefits Analysis of Randomized Controlled Trials

Random controlled trials on the efficacy of naltrexone and acamprosate in the treatment of alcohol dependence were reviewed, using a Relative Benefit (RB) analysis approach. A total of 42 studies were included, showing acamprosate use demonstrated a modest improvement, with a RB of 1.76 at three month follow-up. Short-term administration of naltrexone significantly reduced the relapse rate, but was not associated with modification in the abstinence rate. There was insufficient data available to ascertain the efficacy of naltrexone and acamprosate over prolonged periods of time, or the effectiveness of the medications relative to each other.

A Developmental Index Using the Wechsler Intelligence Scale for Children Implications for the Diagnosis and Nature of ADHD

The possible utility of Wechslers Deterioration Index (WDI) in analyzing childrens Wechsler Intelligence Scale for Children-Revised (WISC-R) results was explored in this study. Clinical records of children with learning disabilities (LD) and children with attention deficit-hyperactivity disorder (ADHD) were reviewed to determine if the WDI predicted the presence or severity of the disorders. The ages of the children ranged from 6 to 14. In two independent samples of children with LD (n=35 and n=26), the WDI did not predict LD status or severity. The LD samples were mostly male—85% and 57%, respectively. However, the WDI scores did significantly distinguish children with ADHD (n=10) from nondisabled children (n=10). The results were cross-validated on an independent sample of children with ADHD (n=17) when compared to non-ADHD children (n=22) who experienced significant behavioral difficulties. The ADHD samples were also mostly male—90% and 89%, respectively. The WDI classified only 59% of the children with ADHD and 86% of the non-ADHD children correctly. It is recommended that the WDI be considered a developmental index rather than a deterioration index in children. It is also recommended that significant WDI elevation (>.20) be considered to raise the question of ADHD, rather than simply yielding a diagnosis of ADHD.

Nicotine fading, behavioral contracting, and extended treatment: effects on smoking cessation

Twenty-eight subjects were randomly allocated to either a nicotine fading or a maintenance condition. The maintenance condition utilized behavioral contracting and extended treatment in addition to the nicotine fading to improve treatment outcome and avoid relapse. The maintenance condition achieved superior outcome on smoking measures at post-treatment and follow-up periods for self-reported smoking levels. Carbon monoxide levels were significantly lower for the maintenance condition at post-treatment, three month and six month follow-up. Saliva thiocyanate levels were significantly lower for the maintenance condition at the three month follow-up. Changes in health functioning indicated significantly lower diastolic and systolic blood pressure at six month follow-up for the maintenance condition. Additional research on nicotine regulation during nicotine fading and thiocyanate levels during experimental smoking would be useful. The use of behavioral contracting to enhance maintenance without therapeutic support warrants further research as well.

Pre-Employment Psychological Testing of Police Officers: The MMPI and the IPI as Predictors of Performance

There are strong and compelling reasons for the careful selection of police officers, and careful assessment of candidates includes psychological assessment. The most commonly used instruments include the MMPI, MMPI-2 and the IPI. To assess the relative relationship of validity findings for the respective tests, 18 studies, which empirically related test findings to later police functioning, were reviewed in this study. The findings indicated both MMPI versions and the IPI provide modest correlations and effect size relationships to police behaviour (rs = 0.17 and 0.28, respectively). In addition, the IPI scores provided significantly higher findings along these lines. There continues to be a need for additional studies, as these results are based on only 18 studies, but the findings to date indicate better prediction of police job performance with the IPI. These results argue for increased use of the IPI, at times in combination with the MMPI-2, with increased attention to the normative samples and with increased assessment of the police, academy and corrections populations.

COGNITIVE AND NEUROPSYCHOLOGICAL CHARACTERISTICS OF ATTENTION DEFICIT HYPERACTIVITY DISORDER CHILDREN RECEIVING STIMULANT MEDICATIONS

10 children receiving stimulant medication for Attention Deficit Hyperactivity Disorder were compared to normal children on cognitive and neuropsychological dimensions in a pilot study. When compared with 10 normal children the ADHD children showed significant differences on cognitive measures, including the Wechsler Developmental Index, the Bender Visual-motor Gestalt Test, and the Benton Revised Visual Retention Test. Elevated levels of polyspike EEG activity were also noted for these children. Analysis suggested that ADHD children receiving stimulant medications may have persisting neuropsychological difficulty. Further research on the neuropsychological correlates of ADHD seems warranted.

Behavior therapy better than placebo treatments: fact or artifact?

Brodys comment on our meta-analysis (Bowers & Clum, 1988) seems to suggest that the efficacy of behavior therapy has not been established relative to placebo control conditions, especially for «neurotic conditions». The comments appear directed at defending an earlier meta-analysis (Priouleau, Murdock, & Brody, 1983) that concluded that psychotherapy was not more efficacious than a placebo control. We agree with Brody regarding the need for increased use of the heteromethod approach and longer follow-up for psychotherapy studies. However, we do not agree that the 10 studies Brody selected do not support the effectiveness of behavior therapy relative to placebo controls

Deinstitutionalization of the mentally ill: Evidence for transinstitutionalization from psychiatric hospitals to penal institutions1

Abstract Since the deinstitutionalization movement, many researchers have suggested that psychiatric patients have moved from one type of institution to another—a process known as transinstitutionalization. This study sought to assess evidence that suggests the mentally ill from Pennsylvania psychiatric hospitals have been transinstitutionalized to penal institutions over the years 1978 to 2010. We gathered data from a number of state agencies and found a significant negative correlation between the incarceration rate and number of psychiatric hospital beds, even after taking into account via partial correlation the changes in population and economic indices such as unemployment and poverty rates in the state. Regression analysis indicated that 6.8% of the year-to-year variation in incarceration rate could be accounted for by the decrease in statewide psychiatric hospital beds after controlling for population and unemployment rate. These transinstitutionalization effects were estimated to cost the state

Expressive writing disorders: An analysis of theoretical views

...

PREDICTING NEUROPSYCHOLOGICAL IMPAIRMENT BY SCREENING INSTRUMENTS AND INTELLECTUAL EVALUATION INDICES: IMPLICATIONS FOR THE MEANING OF KAUFMAN'S FACTOR III

Three prominent theories of writing were found in a literature review of Psychlit, educational journals and Medline, and a fourth global theory relating writing to intact cerebral integrity was also hypothesized. These theories were then tested by attempting to predict writing scores among a sample of 44 individuals with academic difficulties. Significant support was found for a memory and attention model, the dysgraphia model, and an abstract sequential analysis model. Surprisingly, measures of the overall cortical integrity were not significantly related to writing behavior in this sample, but this finding may reflect excluding brain damaged subjects in this study. Also, the abstract sequential analysis model appeared to function differently than expected. The results indicate it is important to assess the cognitive contributions of writing difficulties to guide remediation. Larger scale research on the sources of writing disorders is also recommended.

Comparisons of Intelligence and Behavior in Children With Fetal Alcohol Spectrum Disorder and ADHD

Neuropsychological impairment, as evaluated by the Halstead Impairment Index, was predicted on the basis of intellectual test scores, impairment indices from the intellectual test, and organic screening instruments. Traditional screening indices and tests performed relatively poorly, but a linear combination of Kaufmans Factor III scores and errors on the Benton Visual Retention Test yielded the best prediction of impairment. Kaufmans Factor III score, generally considered as Freedom from Distractibility, was the better of the two predictors. The exclusion of the remaining indicators of impairment did not significantly alter the regression results. The final over-all prediction gave correct classification of 82% of the cases, with a multiple R of .62. These results were considered to indicate attentional processes may be central signs of cortical dysfunction. Methodological issues require cross-validation of these results, but the results also suggested the desirability of further research on the relationship between attentional processes and neuropsychological impairment.