Walter E. Penk

Validating Antonovsky's Sense of Coherence Scale.

This study empirically supported Antonovskys predictions that a persons Sense of Coherence is implicated in coping with life stresses and psychological distress. Sense of Coherence scales accounted for as much variance in criterion measures of Life Events stressors, Depression, and Anxiety as did traditional locus of control and social support predictor measures. Sense of Coherence scales emerged as useful additions for studies of personality characteristics implicated in personal reactions to distressing life events.

Risk factors for psychiatric inpatient assaults on staff.

The risk of psychiatric patient assaults on staff members is increasing yearly, with resultant increases in employee victim suffering, medical expense, and lost productivity. Traditionally considered a clinician responsibility, the management of patient violence also has important administrative implications. This article presents a review of the risk factors associated with violence that includes the characteristics of patients who assault but adds the characteristics of employee victims of such assaults as well as contextual variables. Additional data from a two-year study of a peer-help crisis intervention program for employee victims of patient assaults are included. The mental health administrative implications of this approach are outlined.

Ethnicity: Post‐Traumatic Stress Disorder (PTSD) differences among black, white, and Hispanic veterans who differ in degrees of exposure to combat in Vietnam

Clinical observations and empirical evidence suggest that, among Vietnam combat veterans, Blacks are more maladjusted than Whites (e.g., Parsons, 1985; Penk et al., 1985). The prediction that minority group status is associated with poorer post-war adjustment and higher rates of PTSD was examined among Vietnam combat veterans who were seeking treatment for addiction disorders. Adjustment scores among groups comparable in combat exposure were found to be similar for both Whites and Hispanics; Blacks, however, score significantly higher on both PTSD symptoms on MMPI scales. These findings indicate that ethnicity contributes importantly to PTSD in selected instances, but that minority group status alone does not account for observed differences. Additional research is indicated in which careful attention is given to the complicating and interacting role of addiction disorders in sampling.

Assessing readiness for Change among persons with severe mental illness

Studies focusing on the readiness of persons to change have burgeoned in recent years. Assessing readiness for change is viewed as important for interventions aimed at promoting health behaviors, such as smoking cessation and substance abuse programs. This study is the first to examine readiness for change, as conceived by Prochaska and his colleagues, among a sample of persons with severe mental illness who were about to participate in a vocational rehabilitation program. We examined the reliability, validity, and other psychometric properties of the Change Assessment Scale and its ability to predict attrition and actual change.

Differentiating Post-Traumatic Stress Disorder (PTSD) from Major Depression (MDD) and Generalized Anxiety Disorder (GAD)

Questions about the differential diagnosis of Post-Traumatic Stress Disorder (PTSD) have been raised since this category was reformulated in DSM-III (APA, 1980). Clinicians have reported difficulties distinguishing PTSD from other categories, particularly from Major Depressive and Generalized Anxiety Disorders (MDD and GAD). Diagnostic validity can be established in several ways (e.g., through clinical descriptive studies, laboratory experiments, family history studies, etc.). In this paper, we describe one approach to validation thus far not applied to PTSD: This approach centers directly on whether clinicians can distinguish PTSD from other diagnostic categories. Experienced clinicians were asked to rate the extent to which a common set of 90 symptom items characterized PTSD, MDD, and GAD. Ratings were analyzed with multivariate and univariate analyses of variance and covariance, multiple discriminant function analysis, and factor analysis; moreover, characteristics of rates were examined for possible influences. Results indicated that clinicians readily distinguish PTSD from MDD and GAD as well as MDD from GAD. Findings are presented in terms of univariate analyses, 34 best discriminating items, and factors specifying dimensions differentiating the syndromes of PTSD, MDD, and GAD. Rater characteristics did not influence diagnostic accuracy, although significant differences in magnitude of symptom intensity were found.

Conducting applied research on Vietnam combat‐related post‐traumatic stress disorder

A paradigmatic shift in post-traumatic stress disorder (PTSD) research is underway. Formistic and mechanistic research designs, characterized by single-category, single-cause, single-effect models, gradually are being replaced by contextual and organistic research designs that feature multi-category, multi-cause, and multi-effect interactional models. Such changes in diagnostic and treatment outcome research require solving many methodological issues in such areas as: measuring types of traumas and stressors; measuring PTSD symptoms and subtypes; measuring subject dispositional characteristics (such as ethnic differences); assessing concurrent and/or pre-existing psychiatric (Axis I) disorders; classifying personality styles and concurrent and/or pre-existing personality (Axis II) disorders; evaluating phase in the development of PTSD as a disorder; measuring current environmental stresses and interpersonal interactions; and assessing secondary gains and readiness for treatment. These and other methodological problems must be addressed as research on PTSD shifts to longitudinal measurement of subjects randomly assigned to treatment conditions.

The effect of increased cocaine use on drug treatment

Abstract Trends in primary illicit drug use were monitored in an inpatient drug treatment program over a 10-year period, along with illicit drug use in a methadone maintenance program over a six-year period. The percentage of cocaine users admitted for inpatient treatment showed an increase for each six-month interval over the past three-year period. Cocaine was found to be the most frequently used illicit drug by methadone maintenance clients, and its continued use disrupted both inpatient and outpatient treatment. Implications for treatment are discussed.

Patients' threats expanded definition of assault

Most studies of patient assaults against staff operationally define violence as episodes of unwanted physical or sexual contact. This study empirically assessed a broader range of patient violence by including verbal and nonverbal threats in addition to sexual and physical assaults. Preliminary data from a statewide survey suggested that patient threats were frequent events. Data from a team of staff assaulted by patients in one hospital suggested that some verbal threats produced as much psychological distress for staff victims as did some physical assaults. These findings suggest the need to consider including threats in future studies of patient assaults.

Twelve-week outcomes from an investigation of high-dose nicotine patch therapy for heavy smokers with a past history of alcohol dependence.

This study reports findings from an investigation of the efficacy of high-dose nicotine patch (NP) therapy for heavy smokers with a past history of alcohol dependence. One hundred thirty participants were randomly assigned to 42 mg or 21 mg of transdermal nicotine for 4 weeks, followed by an 8-week dose titration. Follow-up assessments were conducted at 4 and 12 weeks. Differences between dose conditions were nonsignificant, although unexpectedly, outcomes favored participants in the 21-mg NP condition. Nicotine abstinence at follow-up was related to longer length of alcohol abstinence at time of enrollment. Future research should investigate ways to improve smoking quit rates in this population, including more frequent counseling sessions and/or other pharmacotherapies. These investigations should focus primarily on smokers in early alcohol recovery.

Predicting the outcome of contingency contracting for drug abuse

Contingency contracting was used in an attempt to reduce the illicit drug use of 21 methadone maintenance outpatients. Eleven subjects (compliers) showed a significant reduction in illicit drug use whereas 10 subjects (violators) showed no significant change. Subject variables differentiating the two groups were examined. The variables were divided into three categories: personality (MMPI scale scores); demographic (age, education, race, marital status, and employment status); and treatment history (methadone dosage level, years of narcotic addiction, attempts at detoxification, duration of current methadone treatment, total duration of methadone treatment, frequency of drug use during baseline, and types of drugs during baseline). Treatment history variables were most useful for differentiating the two groups.