Learning (as supplement to Psy407 and Psy480)
Research Methods I
Graduate Behavioral Medicine
Graduate Clinical Practicum
Graduate Clinical Research Methods
Current Research Projects
Evaluating chronic pain patients for Spinal Cord Stimulators
A Spinal Cord Stimulator is an expensive procedure and most medical researchers have suggested that patients with psychological issues are not suitable candidates for this surgery. Unfortunately, empirical research regarding tools for exploring these issues is sparse. In a recent study, I administered the MMPI-2 to 175 chronic pain patients referred by pain management physicians for potential implantation of a Spinal Cord Stimulator. Norms obtained for this population was compared to the MMPI Standardization Sample and to a general medicine outpatient population. A poster was presented to EPA (March, 2011) and a manuscript is being considered for publication.
Dissimulation Effects (Faking) in Predicting Risk Factors for Opioid Therapy
The misuse of opioid medications (e.g. Oxycontin) is a national epidemic. Hydrocodone (e.g. Vicodin) is now the most widely prescribed medication in the United States and opioid medications have replaced marijuana as the new illicit drug of choice. Thus, medical practitioners face a major dilemma: recognizing that opioids are effective tools in ameliorating pain and suffering, while recognizing the major problems of misuse, abuse and diversion facing our society at large. Several instruments including interviews and questionnaires have been developed to identify risk factors for potential abuse/misuse. In one study, I examined the "fakability" of four published questionnaires. The results were quite sobering in demonstrating an especially robust faking main effect. A poster was presented to Sigma Xi and Psi Chi and a manuscript is being considered for publication.
Patient Awareness of Psychotic Illness
This research program begin with anecdotal evidence that the "Ups and Downs" associated with psychotic illness seemed to co-vary with patients' understanding of their symptoms. During periods of heightened symptoms, many patients seemed unaware of their illness. In turn, this lack of awareness seemed to lead issues of compliance with medication and treatment with deleterious effects on the progression of the disease. My research colleague, Sharon Sousa from our College of Nursing, developed a new scale to measure both positive and negative symptoms of psychotic illness. The scale, which we called the Levels of Recovery Scale (LORS) was easier to administer than existing scales (E.g., the PANNS) and could be completed both by a clinician and by the patient him/herself. As a measure of patient awareness, we developed a "derived scale" by simply subtracting the LORS-Patient Scale Score from the LORS-Clinician Scale Score. This became our LORS-Discrepancy Scale.
Our first research study examined the psychometric properties of our new LORS measures. As predicted, patients significantly underestimated their pathology. We also established the concurrent and discriminant validity of our measures by correlating them to a medication compliance measure, the PANNS, and a functional assessment. The results of a one month test-retest analysis showed exceptional test-retest reliability. We presented a paper on this research at EPA (A Powerpoint of our presentation is available here) and we are currently completing a manuscript.
A larger study was conducted to examine a new treatment intervention based on incorporating the LORS directly into treatment. This treatment included a Motivational Interviewing approach that discussed the apparent discrepancy between the LORS-Clinician Scale and the LORS-Patient Scale. We called this intervention LORS Enabled Dialogue (LED). At baseline, subjects were assigned to a control or treatment group. Subjects in the treatment group received 4 monthly treatment sessions. The results of that study are quite exciting in demonstrating that our LED intervention lead to a decrease in symptoms of psychotic illness and increased functional assessment. We will present this research at a conference in June and will complete a manuscript in the near future. (A handout on our conference presentation is available here.)