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Patients with chronic pain (CP) and substance use disorder (SUD) are complex, not yet adequately described, and in need of comprehensive treatments that address both diseases concurrently. Our objectives were to (a) describe a cohort of CP patients who failed traditional treatment (mainly opioids) – then developed opioid use disorder (OUD) and other SUDs and (b) evaluate a comprehensive inpatient treatment program for these patients. Patients were enrolled in an inpatient CP program. Treatment consisted of medical detoxification, group process/education, external and internal qigong, osteopathic manual medicine, and qigong-based mindfulness. Patients also received 20 h per week of 12-step recovery-based SUD treatment. Patients were evaluated at the beginning of treatment (first assessment, day 1–5 range) and at days 30 and 45. Assessments were: Beck Depression Inventory-II, Brief Pain Inventory, West Haven-Yale Multidimensional Pain Inventory (patient section), and McGill Pain Questionnaire. The Global Impression of Change Scale was administered at day 45. A mixed model analysis was used to evaluate treatment progress. Demographic data revealed an older cohort with OUD, other SUDs, and multiple pain diagnoses who failed traditional treatment. Questionnaire evaluations were consistent and similar across all of the above measures: patients’ scores showed marked, statistically significant improvements in depression, pain, and quality of life ratings. The most substantial improvements occurred between the first and second assessments. The findings are sufficiently encouraging to warrant further evaluation of the protocol and to plan comparative studies.

Objective. To identify correlates of perceived pain-related restrictions in a community sample of women with fibromyalgia. Method. The fibromyalgia group was composed of white women with a self-reported, physician-given fibromyalgia diagnosis ( N = 238) from the Biopsychosocial Religion and Health Study (BRHS). BRHS respondents had participated in the larger Adventist Health Study-2. To identify associations with pain-related restrictions, we used hierarchical linear regression. The outcome measure was subjects' pain-related restrictions (one SF-12 version 2 item). Predictors included age, education, body mass index (BMI), sleep apnea, and fibromyalgia treatment in the last year, as well as standardized measures for trauma, major life stress, depression, and hostility. To better interpret the findings, pain-related restrictions also were predicted in women with osteoarthritis and no fibromyalgia. Results. Women with fibromyalgia reporting the more severe pain-related restrictions were those who had experienced trauma accompanied by physical pain, were older, less educated, more depressed, more hostile, had high BMI scores, and had been treated for fibromyalgia in the last 12 months (adjusted R 2 = 0.308). Predictors in women with osteoarthritis were age, BMI, treatment in the last 12 months, experience of a major life stressor, and greater depression symptom severity (adjusted R 2 = 0.192). Conclusions. In both groups, age, BMI, treatment in the last 12 months, and depression predicted pain-related restrictions. Experience of a traumatic event with physical pain was the strongest predictor in the fibromyalgia group. These findings may be useful in constructing novel treatments and prevention strategies for pain-related morbidity in fibromyalgia patients.

The contribution of stress to the pathophysiology of fibromyalgia has been the subject of considerable debate. The primary purpose of the present study was to evaluate the relationship between traumatic and major life stressors and a fibromyalgia diagnosis in a large group of older women and men. Data were from the federally-funded Biopsychosocial Religion and Health Study, and subjects were 10,424 of the 10,988 survey respondents—two-thirds women and one-third men—providing responses to a fibromyalgia question. Average age was 61.0 ± 13.5 years. A physician-given fibromyalgia diagnosis in a subject’s lifetime was reported by 3.7% of the sample, 4.8% of the women and 1.3% of the men. In two multivariable logistic regression models (all respondents and women only, controlling for age, sex, race/ethnicity, and education), two traumatic experience types (sexual and physical assault/abuse) were associated with a fibromyalgia diagnosis. Two other trauma types (life-threatening and emotional abuse/neglect) and major life stress experiences were not. The highest odds ratios in both models were those for sexual assault/abuse followed by physical assault/abuse. The relationship between age and fibromyalgia was curvilinear in both models (odds ratios rising until approximately age 63 and declining thereafter). In the all-subjects model, being a woman increased the odds of a fibromyalgia diagnosis, and in both models, fibromyalgia was associated with being White (versus non-White) and lower education. We recommend that researchers investigate the relationship between stress and fibromyalgia in concert with genetic and biomarker studies.

Serious mental illness often is associated with an increased risk of diabetes and sub-optimal diabetes care.To examine diabetes prevalence and care among Medicaid patients from one county mental health system.Retrospective cohort study combining county records and 12 months of state Medicaid claims.Patients ages 18 to 59 receiving mental health services between November 1 and 14, 2004.Dependent variables were glycolated hemoglobin A1C (HbA1c) testing, lipid testing, and eye examinations. Psychiatric status was assessed by second generation antipsychotic prescription (SGA) and low Global Assessment of Functioning (GAF) score.Among psychiatric patients, 482 (11.8%) had diabetes. Among those with diabetes, 47.3% received annual HbA1c testing, 56.0% lipid testing, and 31.7% eye examinations. Low GAF scores were associated with lower likelihood of lipid testing (OR 0.43). SGA prescription reduced the likelihood of HbA1c testing (OR 0.58) but increased the likelihood of eye examinations (OR 2.02). Primary care visits were positively associated with HbA1c and lipid testing (ORs 5.01 and 2.21, respectively). Patients seen by a fee-for-service psychiatrist were more likely to have lipid testing (OR 2.35) and eye examinations (OR 2.03).Among Medicaid psychiatric patients, worse diabetes care was associated with SGA prescription, more serious psychiatric symptoms, and receiving psychiatric care only in public mental health clinics. Diabetes care improved when patients were seen by fee-for-service psychiatrists or primary care physicians. Further study is needed to identify methods for improving diabetes care of public mental health patients.

The value of alexithymia assessments in medical and psychiatric research is well documented, but such assessments in cannabis abusers are scarce. Moreover, despite repeated calls for multimethod alexithymia evaluations, researchers typically use 1 self-report only: the 20-item Toronto Alexithymia Scale. Herein, we evaluated (1) the psychometric properties of the Observer Alexithymia Scale (OAS), (2) the correspondence between 3 alexithymia measures, (3) OAS raters' affect and its relationship to OAS scores, and (4) cannabis abusers' alexithymic features. Eighty-seven cannabis abusers completed self-reports measuring alexithymia (Toronto Alexithymia Scale, Bermond-Vorst Alexithymia Questionnaire-B), depression (13-item Beck Depression Inventory), and anxiety (State and Trait Anxiety Inventory-Form Y) and asked relatives to rate them using the OAS. The raters also completed the self-report scales. The OAS met acceptable reliability and validity standards, with the exception of relatively low interrater reliability for one of its subscales. Rater affect appeared to influence OAS scores, albeit slightly. Patients' OAS scores were higher than scores reported for people-in-general samples and lower than those for outpatient clinical samples. Alexithymia rates were similar to those previously reported in cannabis abusers. Our results demonstrated the adequacy and appropriateness of the OAS in these (and related) clinical samples, which may encourage multimethod alexithymia assessments in both research and clinical practice.

Objective: To calculate binge drinking rates among California adults and describe the characteristics of female and male binge drinkers. Method: Analyses of 2005 California Health Interview Survey (CHIS) data. Results: At least one binge drinking episode over a 30-day period was reported by 1.4 million California women (10.7% of all adult women) and 3.2 million California men (24.7%). For both women and men, factors associated with binge drinking included being 18–44 years of age, smoking, and having mid-range psychological distress scores. There were gender differences in binge drinking risk by race/ethnicity and health status. Method: Given the multi-stage sampling design and non-responses in the 2005 California Health Interview Survey-Specific techniques were employed to ensure that the 43,020 compteted result yeilded reasonable state wide estimates. Conclusion: Binge drinking is a serious public health concern that affects millions of adult Californians.

Objectives Our objectives were to evaluate the psychometric properties of the Observer Alexithymia Scale (OAS) in eating disorder patients, alexithymia severity across diagnostic subgroups, and correspondence among three alexithymia measures. Method Seventy-five women, each with an eating disorder diagnosis, completed two alexithymia self-reports, the 20-item Toronto Alexithymia Scale (TAS-20) and the Bermond–Vorst Alexithymia Questionnaire—version B (BVAQ-B), and asked a relative or an acquaintance to rate them using the OAS. Results The OAS showed acceptable discriminant validity and interrater reliability. Patients' OAS scores were higher than scores reported for people-in-general samples and lower than those for outpatient clinical samples. No statistically significant OAS, TAS-20, and BVAQ-B score differences were found between the patients with anorexia nervosa restrictive type and those with bulimia nervosa. OAS, TAS-20, and BVAQ-B total scores were moderately, positively, and significantly correlated. Conclusion These clinical data show the psychometric strength of the OAS, which reasonably can be recommended for use with the TAS-20 in research and clinical practice.

The purpose of the present study was to evaluate posttraumatic stress disorder (PTSD)-related hospitalizations in the United States (2002-2011). Over this period, there were an estimated 1,477,944 hospitalizations (915,591 women) with either a primary (reason for hospitalization) or secondary PTSD diagnosis. Population-based hospitalization rates rose from 2002 to 2011; women in the age range of 20 to 44 years had the highest rates and the steepest rise. Most of the hospitalizations for men and women younger than 45 years had been assigned a primary diagnosis of mental illness (including PTSD). Mood and substance use disorders were among the most commonly co-occurring psychiatric diagnoses with PTSD. Suicidal ideation/suicide attempts declined with increasing age. The strongest predictor of this criterion was mood disorder, and its importance as a predictor increased as people aged. Total inflation-adjusted charges for all PTSD-related hospitalizations were $34.9 billion, with 36% being for hospitalizations where a mental illness (including PTSD) was the primary diagnosis.

The purpose of the present study was to examine the relationships among ratings for depression and health-plan and medical-care satisfaction using data from the 1998 National Research Corporation Healthcare Market Guide® (HCMG) survey (N=120,855). Respondents in families in which one or more members had depression (self-report) gave lower satisfaction ratings than those in families in which no member had depression on four global and four composite satisfaction measures. Although satisfaction ratings, generally, were high and depression effects were small, the authors nevertheless recommend efforts to improve access and quality of mental health care.

Chronic tension-type headache (CTTH) in children and adolescents is a serious medical condition, with considerable morbidity and few effective, evidence-based treatments. We performed a chart review of 83 adolescents (age range = 13-18 years; 67 girls and 16 boys) diagnosed with CTTH. Two treatment protocols were compared: multimodal (osteopathic manipulative treatments, mindfulness, and qi gong) and pharmacologic (amitriptyline or gabapentin). Four outcomes (headache frequency, pain intensity, general health, and health interference) were assessed at three time points (baseline, 3 months, and 6 months). A fifth outcome, number of bilateral tender points, was recorded at baseline and 6 months. All five were evaluated statistically with a linear mixed model. Although both multimodal and pharmacologic treatments were effective for CTTH (time effects for all measures were significant at p .001), results from each analysis favored multimodal treatment (the five group by time interaction effects were significant at or below the p .001 level). Headache frequency in the pharmacologic group, for example, reduced from a monthly average (95% Confidence Interval shown in parentheses) of 23.9 (21.8, 26.0) to 16.4 (14.3, 18.6) and in the multimodal group from 22.3 (20.1, 24.5) to 4.9 (2.6, 7.2) (a substantial group difference). Pain intensity (worst in the last 24 hours, 0-10 scale) was reduced in the pharmacologic group from 6.2 (5.6, 6.9) to 3.4 (2.7, 4.1) and from 6.1 (5.4, 6.8) to 2.0 (1.2, 2.7) in the multimodal group (a less substantial difference). Across the other three assessments, group differences were larger for general health and number of tender points and less so for pain restriction. Multimodal treatment for adolescent CTTH appears to be effective. Randomized controlled trials are needed to confirm these promising results.

Our study presents pain-related interference rates in a sample of community-dwelling, older adults and determines factors associated with these restrictions. Participants were 9506 respondents to the Biopsychosocial Religion and Health Study (66.8% female and 33.2% male; average age = 62.3 years). In this sample, 48.2% reported no pain-related interference, whereas 37.7% reported moderate and 14.1% reported severe interference. As hypothesized, older age, female gender, lower education, financial strain, traumatic experiences, worse health, increased body mass index, poor sleep, and depressive symptoms all were associated with higher pain interference ratings (ordered logistic regression/three-level pain criterion; odds ratios p < 0.05). Our findings are similar to those from younger adults, and they suggest enduring effects of trauma on health and reveal the complexity of chronic pain in community-dwelling, older adults.

The authors compare trends in the salaries of physician faculty in academic departments of psychiatry with those of physician faculty in all academic clinical science departments from 1980-2006.The authors compared trend lines for psychiatry and all faculty by academic rank, including those for department chairs, by graphing inflation-adjusted (2006 dollars) Association of American Medical Colleges Faculty Survey data over the 27-year span and computing compound annual growth rates.Physician faculty salaries in both psychiatry and all departments increased between 1980 and 2006. Compared with salaries for physician faculty in all specialties, those for psychiatrists were lower and the trend lines were flatter. Salary gaps between chairs and professors increased considerably in all faculty and psychiatry departments.Salaries for academic physicians are rising, and they are keeping pace with inflation. Relatively large and growing gaps exist between psychiatry and all faculty and between chairs and professors in both psychiatry and all clinical sciences departments.

This study attempts to determine the ratio of full-time-equivalent psychiatrists to members and that of nonphysician mental health professionals to psychiatrists in staff and group model health maintenance organizations (HMOs), and to compare the psychiatrist-to-member ratio with previous estimates of the required psychiatrist-to-population ratios in fee-for-service and managed care environments.The Group Health Association of America (now the American Association of Health Plans) collected data on mental health staffing, enrollments, and other characteristics for 30 staff and group model HMOs. The authors evaluated the number of full-time-equivalent psychiatrists and nonphysician mental health professionals per 100,000 HMO members, and the ratio of full-time-equivalent nonphysician mental health professionals to psychiatrists.The overall mean number of full-time-equivalent psychiatrists and nonphysician mental health professionals per 100,000 members in the responding HMOs was 6.8 and 22.9, respectively. The overall mean ratio of nonphysician professionals to psychiatrists was 4.5. The overall number of psychiatrists per 100,000 members is less than half the requirement estimated by the Graduate Medical Education National Advisory Committee in 1980, which assumed a fee-for-service environment, but it is about 40% to 80% greater than that estimated by other studies under the assumption of a managed care environment.Although a practice environment dominated by managed care may not require as high a psychiatrist-to-population ratio as a predominantly fee-for-service environment, it may well support a greater number of psychiatrists than previous studies have suggested.

Using 1989 data from the Faculty Roster System of the Association of American Medical Colleges, the authors examined gender differences in retention and rank attainment of psychiatry faculty who had received their first full-time medical school appointments in 1978. Retention differences between men and women were not significant in either the M.D. or the Ph.D. subgroup. Women M.D.’s in the sample had advanced through the academic ranks to a significantly lesser extent than had men M.D.’s; the rank attainment differences among Ph.D.’s, however, were not significant. These results underscore the need for more study of gender differences in the career paths of faculty in academic psychiatry departments.

Variability in mental health services utilization by race/ethnicity was evaluated with a Behavioral Model approach. Subjects were 17,705 children 5 to 11 years of age in the 2005, 2007, and 2009 California Health Interview Surveys. Parents identified minor emotional difficulties in 18.7% of these children (ranging from 14.8% in Asians to 24.4% in African Americans) and definite or severe difficulties in 7.4% (5.5% in Asians to 9.7% in “other race”). Overall, 7.6% of children had at least one mental health visit in the prior year (2.3% in Asians to 11.2% in African Americans). Parent-identified need was the most salient predictor of mental health visits for all racial/ethnic groups. Beyond need, no consistent patterns could be determined across racial/ethnic groups with regard to the relationship between contextual, predisposing, and enabling measures and mental health service utilization. Different factors operated for each racial/ethnic group, suggesting the need for studies to examine mental health need, mental health service use, and determinants by racial/ethnic subgroup. These findings suggest that a “one-size-fits-all approach” with regard to policies and practices aimed at reducing mental health disparities will not be effective for all racial/ethnic groups.

PURPOSE The purpose of the present study was to evaluate primary care outcomes for the Loma Linda University School of Medicine (LLUSM), using Association of American Medical Colleges (AAMC) data files. The two principal objectives were to estimate the percentages of LLUSM graduates who are practicing or will practice primary care medicine and to determine what information available on application to LLUSM is useful in predicting graduates' specialty choices (i.e., primary versus non-primary care). METHOD In 1993-94 data were taken from several AAMC data files (available to all medical schools), including the Graduate Medical Education (GME) Tracking Census and the American Medical College Application Service (AMCAS) Applicant Master File. The second and fourth years after graduation were used as points of evaluation. Primary care (generalist) was defined as taking or having completed a residency in family practice, internal medicine, or pediatrics, and not having taken any fellowship training. RESULTS Fourth year after graduation: 42.4% of the 1,064 LLUSM graduates (1983 to 1990) were training in or had completed residencies in family practice (19.8%), internal medicine (16.2%), or pediatrics (6.4%). Second year of GME: of the 1,365 LLUSM graduates (1983 to 1992), 49.3% were in the primary care pipeline (19.8% in family practice, 21.9% in internal medicine, and 7.6% in pediatrics). Two variables available on admission to medical school were associated with being in the primary care pipeline (second-year GME generalist): being a woman and being a member of a non-underrepresented minority. One variable was associated with being in the non-primary care pipeline: having a rural county code. Undergraduate grades and Medical College Admission Test scores were not good predictors. CONCLUSION The AAMC data files, available to all medical schools, are useful for estimating and evaluating primary care outcomes.

Objective This report describes the postdoctoral research training of faculty in departments of psychiatry and relates research training characteristics to current involvement in research. Method Data were taken from a survey of 3,107 doctoral-level faculty in departments of psychiatry at 116 U.S. medical schools. The survey instrument gathered information about faculty members' postdoctoral research training and current research activities and elicited recommendations for research training programs. Results Of the survey respondents, 34.8% had had some form of postdoctoral research training. Most of those had trained in medical schools or intramural programs of the National Institutes of Health and federal institutes on alcoholism, drug abuse, and mental health. Most funding came from the federal government. Postdoctoral research training was significantly related to greater current research involvement across all degree types--M.D., Ph.D., and M.D.-Ph.D. Length of training was related to level of research involvement for M.D.s and Ph.D.s but not M.D.-Ph.D.s. Although most researchers believed their training programs prepared them for independent research, a smaller proportion of M.D.s than M.D.-Ph.D.s or Ph.D.s responded affirmatively to that question. Researchers were more likely than nonresearchers to consider their training adequate. Respondents rated time with mentor, course work in statistics, and length of training as the most important training program features. Both research training and research activities were concentrated in a relatively few institutions. Conclusions These data show the critical importance of both federal support of research training and postdoctoral research training for subsequent research involvement of psychiatric faculty.

Self-report alexithymia, depression, and anxiety inventories were completed by 204 (84 women and 120 men) psychoactive substance-dependent patients during their first week of hospitalization. Eighty-five of the 204 patients (41.7%) scored in the alexithymic range on the revised Toronto Alexithymia Scale (TAS-20). Women's average alexithymia, depression (Beck Depression Inventory [BDI]), and anxiety (State-Trait Anxiety Inventory-State [STAI-S]) scores were higher than men's average scores. Ethnic (Hispanic whites v non-Hispanic whites) and diagnostic (alcohol v drug v mixed-substance dependence) group differences were not significant. To examine the interrelationships among alexithymia, depression, and anxiety, a causal model confirmed in medical students was tested. The model was reconfirmed; state anxiety predicted depression and alexithymia, and depression predicted alexithymia. These findings are consistent with previous research and compatible with the view that a state of alexithymia can result from severe anxiety and depression.

Student mistreatment in medical school is a persistent problem with both known and unexplored consequences [corrected].The purpose of this study was to determine whether a perception of having been mistreated in medical school had an association with planning a full-time career in academic medicine.Using Association of American Medical Colleges' 2000-2004 Medical School Graduation Questionnaire data, we evaluated the relationship between students' mistreatment experience and their career choice, academic versus nonacademic setting. Meta-analysis and regression were used to evaluate this relationship.At medical schools where relatively high percentages of graduating seniors were planning academic careers, students reporting mistreatment experiences were less likely at graduation to be planning careers in academic medicine.A perception of having been mistreated in medical school is related to students' career choices, a finding that may be useful to medical school administrators/faculty and students as mistreatment is addressed in program planning, counseling, and faculty recruitment.

Objective: To evaluate three aspects of diabetes care (foot checks, eye examinations, and hemoglobin AlC checks by a physician) among California adults with Type 2 diabetes and serious psychological distress (SPD). Method: Data were from the population-based 2005 California Health Interview Survey. Estimates were that in 2005, 1,516,171 Californians (5.75% of all adults) had a physician-given diabetes diagnosis, and of those, 108,621 (7.16%) had co-morbid SPD. Results: Among Californians with Type 2 diabetes, SPD was associated with fewer physician foot checks (odds ratio = 0.56, 95% Confidence Interval = 0.32 to 0.97) but not with fewer eye examinations or hemoglobin AlC checks. Conclusions: The findings highlight a specific area—foot complication evaluation and prevention—for improving the quality of diabetes care among adult Californians with Type 2 diabetes and SPD.

OBJECTIVES To evaluate the relationship between self-reported mental health and binge drinking, as well as health status, sociodemographic, social support, economic resource, and health care access indicators to antihypertension medication adherence. METHOD Analysis of 2003 California Health Interview Survey data. RESULTS Having poor mental health days predicted medication nonadherence, whereas binge drinking did not. Nonadherence predictors included younger age, Latino, non-US citizen, uninsured, less education, and no regular medical care. Adherence predictors were older age, African American, having prescription insurance, a college degree, poor health, comorbid diabetes or heart disease, and overweight or obese. CONCLUSION Better mental health may improve medication adherence among hypertensive individuals.

Binge drinking and poor mental health may affect adherence to treatment for individuals with asthma. The purposes were to (a) examine the relationship of self-reported binge drinking and mental health to adherence to daily asthma control medications and (b) identify other demographic and health-related factors associated with asthma control medication adherence. Secondary analyses of 2003 adult California Health Interview Survey data were undertaken, and these analyses identified 3.2 million California adults who had been told by a physician they had asthma. Of these, approximately 1.7 million were symptomatic. Binge drinking significantly predicted medication nonadherence among California adults with symptomatic asthma (OR = .63, 95% CI = .45-.89), whereas poor mental health did not. Other predictors of nonadherence (odds ratios1, p.05) included being overweight, younger age, having some college education, being a current smoker, and having no usual source of medical care. Predictors of adherence (odds ratios1, p.05) were older age, more frequent asthma symptoms, more ER visits, more missed work days, being African American, and being a non-citizen. Intervention efforts could be directed toward improving medication adherence among adult asthma patients who engage in risky health behaviors such as binge drinking. Also at risk for medication nonadherence and therefore good targets for asthma control medication management interventions are adults who are overweight, younger (18-44 age range), have some college education, and no usual source of medical care.

Graduation Questionnaire data collected by the Association of American Medical Colleges (AAMC) were used to identify student and medical school characteristics associated with future psychiatrists' career plans. Subjects were senior medical students in the class of 1986 who definitely planned to specialize in psychiatry or child psychiatry. Medical school variables such as research experience, publication history, and exposure to a research-oriented environment were associated with plans for a career in academic medicine or research (versus clinical practice). Membership in a non-underrepresented minority group, having taken elective course work at a military or government agency, and having attended a private medical school all were associated with plans for a career in salaried clinical practice (versus private clinical practice).

In general, salaries for academic physicians continue to rise and keep pace with inflation despite changes in health care reimbursement, such as the expansion of managed care. This study compared trends in the salaries of faculty in academic departments of psychiatry with those of faculty in all academic departments.

To explore the relationships between psychological symptoms and thyroid hormone levels in adolescent girls who had experienced the traumatic stress of sexual abuse.The study design was cross-sectional/correlational. Subjects (N=22; age range=12-18 years) had their blood drawn, and they completed 2 psychological tests (depression and general distress/posttraumatic stress disorder [PTSD]). A pediatrician completed a sexual abuse questionnaire after reviewing law enforcement and Child Protective Services reports and conducting forensic interviews and medical examinations.Girls' average free T4, total T4, free T3, total T3, and TSH levels were within age-specific laboratory reference range limits, as were most individual concentrations. The strongest correlations (p.05) were between free T3 and PTSD total score (-.50), PTSD-avoidance/numbing (-.49), and general distress (-.48); and between total T3 and depression (-.46), general distress (-.45), and PTSD-arousal (-.44).Our findings support one of the two contemporary models of the relationships between thyroid hormones (i.e., free and total T3) and psychological symptoms (i.e., depression, general distress, and PTSD)--one of "shutting down" (vs. "activation") in the face of trauma.

Medical education shapes students' attitudes toward substance-abusing patients, often in negative ways. Curricular interventions to foster more positive attitudes toward such patients and their treatment can have lasting effects on clinical practice. The nature and duration of such interventions, however, requires clarification.To test the hypothesis that spending 1 week of a 6-week psychiatry clerkship on an addication treatment site would improve attitudes toward substance-abusing patients without reducing the clerkship's benefits on attitudes toward, and knowledge about, psychiatry patients.Using the Medical Condition Regard Scale, preclerkship and postclerkship attitudes toward patients with alcoholism, major depression, and emphysema (a control condition) were examined in 3rd-year medical students following the conversion of 1 of the clerkship's weeks to an addiction treatment site assignment. Psychiatric knowledge was assessed by comparing scores on the Psychiatry Subject examination before and after the change.Mean regard scores increased significantly for patients with alcoholism and for patients with major depression but did not change for patients with emphysema. Subject examination scores before and after the curriculum change were not significantly different.Spending 1 week of a 6-week psychiatry clerkship on an addiction treatment site increased regard for patients with alcoholism without adversely affecting measures of attitudes toward, and knowledge about, psychiatric patients.

The purpose of this study was to evaluate the psychometric properties of the Observer Alexithymia Scale (OAS; Haviland, Warren, & Riggs, 2000) in a clinical setting. Clinical and counseling psychologists used the OAS to rate outpatients (n = 192) with various Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) diagnoses. Reliability and validity data are similar to the initial nonclinical data (n = 819): OAS scores are reliable (coefficient alpha = .90), and the five-factor structure--Distant, Uninsightful, Somatizing, Humorless, and Rigid--was confirmed. Moreover, the OAS does a relatively good job of differentiating clinical from nonclinical cases. The OAS is psychometrically sound, and it appears to be a useful tool for collecting and evaluating observer data on the clinically relevant, everyday expressions of alexithymia.

Chronic pain remains at epidemic levels in the United States, affecting approximately 20% of the population ( Breivik et al., 2006 ). At present, treatments generally target symptom relief and seldom address improvements in quality of life and overall healing. Recent insights in neurobiology have demonstrated that chronic pain is a degenerative disease of cortical and sub-cortical structures ( Tracy, 2008 ). Thus, treatments can be designed to enhance specific areas of the brain affected by chronic pain and, thereby, improve patients' cognitive and emotional abilities. For example, specific treatments can be designed that normalize function of frontal lobe areas negatively affected by the effects of chronic pain.

Using data collected by a 1989 American Psychiatric Association survey of full-time, salaried faculty in departments of psychiatry at US medical schools, we examined the number of faculty engaged in research, their levels of involvement in research, distribution, sources of funding, fields and topics studied, and training. Using a three-level measure of research involvement, we categorized 39.1% of the respondents as "researchers," 36% as "limited commitment researchers," and 25.1% as not involved in research. In a pattern similar to that observed for research funding in other studies, half of the researchers were concentrated in the top 15 of the 116 responding departments. Level of research involvement varied by degree type (joint-program MD/PhDs were most involved), sources of funding, fields, and topics. Among faculty with MDs, having had research experiences in medical school or postdoctoral research training was associated with a higher level of research involvement. The findings underscore the need to expand and improve postdoctoral research training--especially for MDs--and programs to recruit college and medical students into psychiatric research.

The problem of how to assess "unbiased" symptoms of depression meaningfully in the context of alcoholism bedevils studies of concomitant alcoholism and affective disorder. This study summarizes this controversy and discusses its implications for developing improved measures of depression severity among alcoholics. The Beck Depression Inventory (BDI) responses of 130 alcoholic applicants applying for inpatient care were evaluated using a two-parameter normal item response model. This study demonstrates that a single dimension of depression severity accounts for patient responses well, but that seven BDI items were relatively poor markers of syndrome severity for these alcoholics. The study documents growing consensus among investigators as to which BDI items constitute a fair scale of depression severity among alcoholic patients The availability of "unbiased criteria" for assessing the severity of depression among alcoholics applying for inpatient treatment will enable investigators and clinicians to recognize patients with concomitant alcoholism and affective disorder for special attention and/or treatment. The modified BDI scale proposed here is a candidate for a clinical definition of depression severity among alcoholic patients by virtue of this study's demonstration that it defines a distinct syndrome in this patient sample; but the modified scale must undergo independent tests of validity before its clinical utility can be established.

Thyroid stimulating hormone (TSH) and prolactin (PRL) responses to thyrotropin releasing hormone (TRH) stimulation are sometimes blunted in alcoholic subjects; however, the mechanisms involved in these phenomena have not been established. We hypothesized that elevations in free thyroid concentrations might be related to these abnormal responses and then tested that hypothesis in a sample of nondepressed alcoholic inpatients (n = 21). Four alcoholic patients had delta max TSH responses that were7 mIU/l; three had PRL responses at or below 8 micrograms/l. Baseline TSH was the only significant predictor of peak TSH; however, free thyroxine (FT4) and baseline TSH both were significant predictors of peak PRL. The average baseline FT4 concentration in alcoholic patients was significantly higher than that in healthy control subjects (n = 10). Our data, thus, suggest that small elevations of FT4 play a role in the inhibition of TSH and PRL responses to TRH among nondepressed, abstinent alcoholic patients.

High norepinephrine/cortisol ratios have been shown to be useful indicators of post-traumatic stress disorder (PTSD). Alexithymia can result from overwhelming stress; thus, we hypothesized that sympathetic-adrenal medullary/hypothalamic-pituitary adrenal ratios would be positively associated with alexithymia severity. In the present study, we correlated 3-methoxy-4-hydroxyphenylethylene glycol (MHPG)/adrenocorticotropic hormone (ACTH) and MHPG/cortisol ratios with self-report Toronto Alexithymia Scale (TAS) scores in a group (n = 17) of nondepressed, formerly alcohol-dependent men. The correlations between the respective ratios and TAS scores were 0.515 (p = 0.034) and 0.561 (p = 0.019). We suggest that increasing degrees of alexithymia are accompanied by an increasing separation of these two endocrine systems and then speculate that this dissociation has an anatomical basis in the lateralization of emotions.

An item response theory (IRT) model identified three dimensions assessed by the Toronto Alexithymia Scale (TAS) in a sample of 130 mate applicants for inpatient care at a Veterans Administration (VA) medical center alcoholism treatment program. A unidimensional solution did not capture all of alexithymia's theoretical features. Subjects with lower alexithymia scores gave positive responses to items tapping emotional awareness deficits; only those with higher alexithymia scores gave positive responses to items tapping external, operative cognitive style. Thus, a total TAS score may not represent alexithymia accurately in substance-abusing patient populations.

The California Health Interview Survey (CHIS) (www.chis.ucla.edu) has been conducted biannually since 2001 and is the largest subnational household telephone interview survey in the United States. In 2005 there were completed responses for 43,020 adults, representing 29.7 million Californians. Among men, an estimated 3.2 million (24.7%) engaged in binge drinking. We conducted an ecological study of CHIS's estimated binge drinking rates per county and county group. Language: en

1198 W examined the relationship between general medical, psychiatric, and psychosomatic problems and use of the Internet for disease and wellness information, about which little is known. Data were taken from the 2001 Healthcare Market Guide Survey by the National Research Corporation (1), which was sent to 250,000 U.S. households. Responses were received from 152,208 households (61 percent). We evaluated responses to two questions: “In the last 12 months, have you or someone in your household used the Internet to access disease/wellness information?” and “Has any household member been diagnosed as having any of the following ailments [check all that apply]?” This question was followed by a list of 30 problems, and from these we created four groups: none (no problems, N=28,495 respondents), general medical (cancer, diabetes, or heart disease and none of the other 27 problems, N=9,307), psychiatric (attention deficit, depression-anxiety, or an eating disorder and none of the other 27 problems, N=4,878), and psychosomatic (indigestion–irritable bowel or sciatica–chronic back pain and none of the other 28 problems, N=2,039). We cross-tabulated Internet use and problem type, and the results are shown in Figure 1. Greater use of the Type of Illness and Use of the Internet for Health Information

The 1998 National Research Corporation Healthcare Market Guide Survey queried household members primarily responsible for family health care decisions. The authors examined responses to two questions. All things considered, how satisfied are you with your health plan? Does any household member have any of the following ailments: diabetes, sciatica, depression, arthritis/rheumatism, or asthma?

The purpose of this investigation was to measure alexithymia in 90 newly abstinent alcoholism treatment candidates and to examine the relationship between alexithymia and depressive symptoms. Subjects completed the Schalling-Sifneos Personality Scale (SSPS) and the Beck Depression Inventory (BDI) at the time of application for care. The correlation between subjects' SSPS scores and their BDI scores was statistically significant (r = -0.398; p less than 0.001). Study participants with high BDI scores tended to be 'more alexithymic' than were those with low BDI scores. The authors conclude that alexithymia may serve as a defensive operation for alcoholic patients denying painful affect.

Association of American Medical Colleges survey data and a discriminant analysis were used to differentiate senior medical students planning to specialize in general psychiatry from their counterparts planning to subspecialize in child psychiatry. Of the 17 independent variables selected for study, four demonstrated some predictive power: (a) having taken elective coursework or a clerkship in pediatrics or a related subspecialty, (b) having not attended a research-oriented medical school, (c) being a woman, and (d) having not attended a primary care-oriented medical school. All were associated with plans to subspecialize in child psychiatry. J. Am. Acad. Child Adolesc. Psychiatry , 1988, 27, 4:404–407.

The effects of nocturnal light (500 lux) exposure on plasma melatonin were studied in seven men suffering from unipolar depression and in seven healthy men. Both groups showed significant declines in plasma melatonin concentrations during 1 hour's light exposure. Differential group declines were not detected.

The relationship between alcoholics' depressive symptoms during their preadmission evaluations and persistence in treatment for alcohol dependence is evaluated. Hierarchical multiple regression was used to determine the contribution of Beck Depression Inventory (BDI) scores to the prediction of the criterion: number of continuous days in treatment (up to 120). After several sources of variance were removed (age, race, age X race interaction, number of previous treatments and referral source), BDI score explained 10.8% of the criterion's variance. The full model explained 28.2%. Early withdrawal occurred in association with freedom from measurable affective distress during preadmission evaluation. A model for the prediction of number of continuous days in treatment is presented.

The purpose of this study was to determine the extent to which Toronto Alexithymia Scale (TAS) scores and derived subscale scores changed in a sample of newly abstinent alcoholic inpatients. Subjects completed the TAS and the Beck Depression Inventory (BDI) on the date of their application for care (Time 1) and at the end of their 3rd week in treatment (Time 2). Patients' mean BDI scores dropped significantly from Time 1 to Time 2; however, the expected concomitant drop in mean TAS scores did not occur. TAS subscales analysis suggests that the subscale associated with the ability to identify one's feelings and to distinguish them from bodily sensations may capture the alexithymia construct better by itself than when combined with the second 2 subscales, daydreaming and external thinking, to create the total TAS score.

The purposes of this paper were to complete factor and item analyses of the Toronto Alexithymia Scale (TAS) in a sample of mixed substance abusers and to examine the correlations between patients' TAS scores and other variables. Results indicate that the TAS is a reliable, valid measure of alexithymia for substance abusers. The factor structure we found is congruent with the theoretical construct and is similar to those published in the normative studies; coefficient alpha reliability was 0.68. Additionally, a high percentage of the subjects (50.4%) scored in the alexithymic range while 24% had scores in the nonalexithymic range. Patients' TAS scores were positively associated with Beck Depression Inventory scores, with a reported paternal history of alcoholism, and with attempted suicide; TAS scores were negatively associated with being Black.

• For this investigation, we used (1) Association of American Medical Colleges survey data to compare the career, research involvement, and research fellowship plans of 532 senior medical students in 1985 intending to specialize in psychiatry with plans of 10516 students designating other specialty preferences, and (2) discriminant analyses to identi6fy factors associated with psychiatry students' career, research, and fellowship plans. Although a higher percentage of the psychiatry students planned academic or research careers than did their classmates in the other specialties (34.6% vs 27.8%), a lower percentage expected to take a research fellowship (15.4% vs 20.7%). In the multivariate analysis, medical school experience variables such as research, publication, and exposure to a research-oriented environment all were associated with plans for a career in academic medicine or research, exclusive or significant research involvement, and plans to complete a research fellowship.