Postmodern reflections on modern psychiatry: The diagnostic and statistical manual of mental disorders

This article found elevated levels of trauma symptoms related to the terrorist attacks of 9/11 in students at a university in Northern California. In an analogue comparison, the impact on trauma symptoms of 2 interventions—journal writing and story listening—was examined. College students were randomly assigned to write about their emotional reactions to 9/11 or to listen to stories evoking themes relevant to the national tragedy. Participants in both conditions reported significant improvements in trauma symptoms on the final day of each condition. Students with prior bereavement had greater improvements in trauma symptoms on 1 measure in the story listening condition. The implications of these findings for the use of exposure-based interventions in the treatment of trauma are discussed.     

Dimensional versus categorical classification of mental disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and beyond: comment on the special section

The value of including dimensional elements in the Diagnostic and Statistical Manual of Mental Disorders (DSM) has been recognized for decades. Nevertheless, no proposals have been made for introducing dimensional classification in the diagnostic system in a valid and feasible manner. As an initial step in this endeavor, the authors suggest introducing dimensional severity ratings to the extant diagnostic categories and criteria sets. Although not without difficulties, this would begin to determine the feasibility of dimensional classification and would address some limitations of the purely categorical approach (e.g., failure to capture individual differences in disorder severity, and clinically significant features subsumed by other disorders or falling below conventional DSM thresholds). The utility of incorporating broader dimensions of temperament and personality in diagnostic systems beyond the fifth edition of the DSM is also discussed.     

A comparison of characteristics,developmental disorders and motor progression between children with and without developmental coordination disorder

Background and aimChildren with Developmental Coordination Disorder (DCD) have difficulty in the development of motor coordination and with learning new motor skills. Studies demonstrate that children with DCD differ in terms of the nature and severity of their motor difficulties, the incidence of co occurring conditions and family background. However, little is known whether these profiles may relate to motor progression over time. The aim of this study was to describe the profiles of children with and without DCD and track motor progression over time.MethodThe characteristics of thirty-four 7–14 year old children (M = 10.07, 85.3% boys) with and without DCD were compared and their motor progression monitored over a two academic years. DCD was identified using DSM5 criteria. The Movement Assessment Battery for Children-2 (MABC-2) was used to classify children as TD (≥25th percentile), having moderate motor coordination difficulties (6-16th percentile) or severe motor coordination difficulties (≤ 5th percentile). The Kaufman Brief Intelligence Test – 2 (KBIT-2) was used to measure full scale IQ. Parent questionnaires were used to gather information on socio economic status and co occurrence of other developmental disorders. We used ANOVA to assess whether there were differences in characteristics between the TD children, children with severe motor coordination difficulties and children with moderate motor coordination difficulties. Linear mixed effect modelling was used to estimate any change in motor performance over time and whether this differed between the three groups of children.ResultsChildren with severe motor coordination difficulties had distinct profiles in motor and non-motor domains, lower IQ and a greater likelihood of having associated characteristics of 2 or more developmental disorders. We found significant differences between the poor motor performance of the severe group compared to the other two groups. Longitudinal analyses revealed stable, persistent and lower motor competence for the severe group. The rate of change in motor proficiency for the typical and severe groups was similar. However, the group with moderate motor difficulties gained on average more points per week compared to the typical group and achieved motor scores in the typically developing range over time.ConclusionsThis is one of the first studies to compare the characteristics and rate of motor progression of children with and without DCD using different motor proficiency cut off scores. The children with severe motor coordination difficulties progressed at the same rate as typically developing peers but remained in the severe group over time, whereas the children with moderate motor coordination difficulties caught up to TDC. The results indicate that different intervention may be required according to the nature and severity of the characteristics in both the motor and non-motor domains of children with DCD.     

A proposed adaptation of DC: 0‐3R for primary care,developmental research,and prevention of mental disorders

The development of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0‐3; Zero to Three: National Center for Clinical Infant Programs, 1994) has been an important step in the field of infant mental health. In this paper, we propose some additions to the existing classification system. These additions include the development of criteria for infant, toddler, and family strengths, and the development of criteria for symptomatology that represents risk for disorder, but not fully manifest disorder. These additions will give DC: 0‐3R greater potential for use in the primary health care of children, thereby increasing the system's utility in diagnosing and preventing infant mental health problems.     

The epidemiology of alcohol, drug, and mental disorders among homeless persons.

This article describes recent research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness. Methodological problems in homelessness research are reviewed, particularly in relation to definitions of homelessness and sampling- and case-ascertainment methods. Prevalence rates of ADM disorders are much higher in homeless groups than in the general population. As is true of homeless people in general, homeless substance abusers and mentally ill persons are characterized by extreme poverty; underutilization of public entitlements; isolation from family, friends, and other support networks; frequent contact with correctional agencies; and poor general health. Knowledge of these disadvantages should be used to advocate for better services to prevent homelessness and support homeless people.     

Cumulative burden of comorbid mental disorders,substance use disorders,chronic medical conditions,and poverty on health among adults in the U.S.A.

The health of individuals in the U.S.A. is increasingly being defined by complexity and multimorbidity. We examined the patterns of co-occurrence of mental illness, substance abuse/dependence, and chronic medical conditions and the cumulative burden of these conditions and living in poverty on self-rated health. We conducted a secondary data analysis using publically-available data from the National Survey on Drug Use and Health (NSDUH), which is an annual nationally-representative survey. Pooled data from the 2010–2012 NSDUH surveys included 115,921 adults 18 years of age or older. The majority of adults (52.2%) had at least one type of condition (mental illness, substance abuse/dependence, or chronic medical conditions), with substantial overlap across the conditions. 1.2%, or 2.2 million people, reported all three conditions. Generally, as the number of conditions increased, the odds of reporting worse health also increased. The likelihood of reporting fair/poor health was greatest for people who reported AMI, chronic medical conditions, and poverty (AOR = 9.41; 95% CI: 7.53–11.76), followed by all three conditions and poverty (AOR = 9.32; 95% CI: 6.67–13.02). For each combination of conditions, the addition of poverty increased the likelihood of reporting fair/poor health. Traditional conceptualizations of multimorbidity should be expanded to take into account the complexities of co-occurrence between mental illnesses, chronic medical conditions, and socioeconomic factors.     

A comparative study of the impact of education vs. process groups for families of patients with affective disorders

This clinical project compares the relative impact of two types of multiple family groups on psychiatric inpatients and their families. Forty patients with a diagnosis of affective disorder, and their family members, were randomly assigned to a traditional multiple family group with a process orientation that emphasized support, destigmatization, and self-help about common problems; or to a psychoeducational multiple family group that emphasized the provision of information about the patient's illness and methods of coping with it effectively. Both groups, which met for four hours on a Saturday afternoon, were an integral part of an ongoing inpatient program specializing in the treatment of affective disorders. Pre- and post-measures were obtained regarding family and patient knowledge about affective disorders, level of personal distress, attitudes about the illness, and dyadic adjustment. In addition, both patients and family members were asked to rate their satisfaction with the group experience. A number of differences in knowledge, attitude and dyadic adjustment were found in the participants of both groups immediately following their respective group sessions, but there were only a few statistically significant differences between the two groups. Those who attended the psychoeducational session, however, reported significantly more satisfaction with the experience.     

ABCs of the Interview: The Role of Affective,Behavioral, and Cognitive Responses by Applicants in the Employment Interview

The purpose of this paper is to examine the influence of a job applicant's verbal statements on interviewer ratings of an applicant's interpersonal characteristics. Applicant verbal statements were coded as containing affective, behavioral, and cognitive components. Verbal statements were analyzed using regression analysis and findings indicated that behavioral and cognitive speech components significantly impacted interviewer ratings of an applicant's self-confidence. In turn, interpersonal characteristics of enthusiasm, self-confidence and effectiveness had a significant influence on an interviewer's rating of an applicant's overall quality and the ultimate hiring decision.     

The nature(s) of developmental change: Piaget,Vygotsky, and the transition process

This essay proposes (1) that more than one kind of large-scale developmental change exists; and (2) that more than one kind of developmental change mechanism is needed to explain them. These proposals are supported by work in nonuniversal theory which states that intellectual development should be characterized neither as domain-general nor as domainspecific, but as a spectrum of developmental domains that range from the universal to the unique. The current article extends nonuniversal theory by positing and then describing (1) a sixth region of development—a pancultural region: and (2) five basic change mechanisms (maturation, domain-specific structures, technologies, instruction, and equilibration) that differentially influence developmental change at particular points along the universal-to-unique continuum. The contributions of each of the five change mechanisms is illustrated by an analysis of children's ability to draw maps. The value of the universal to unique framework is demonstrated by showing how it helps resolve Piaget's and Vygotsky's seemingly contradictory views on the relationship between learning and development.     

The return of the repressed. On Robert N. Bellah,Norman O. Brown,and religion in human evolution

As much as Robert Bellah’s final work, Religion in Human Evolution, has been studied and dissected, no critic underlined the importance of psychoanalysis for its main argument and its theoretical framework. The paper shows the influence exerted by a controversial interpreter of Freud, Norman O. Brown, on Bellah’s ideas, intellectual profile, and writing style in the late-1960s and early 1970s. While in search for a new intellectual voice, Bellah was struck by Brown’s work and began to make intensive use of his book, Love’s Body, both in his teaching and in his research of the early 1970s, during his so-called “symbolic realism” period. While Bellah abandoned Brown’s ideas and style in the mid-1970s, some of the basic intuitions he had during that period still survived as one of the major theoretical intuitions of Religion and Human Evolution.