10 years' comparison of inpatient treated affective diseases

A comparison was carried out between 237 hospitalised patients with emotional disorders during the years 1972-1975, and 316 patients between 1982 and 1985. The number of admissions as a percentage of all psychiatric admissions rose from 18.21% to 26.49%. There was a significant rise in the number of readmissions, notably from the third admission upwards, but a considerable reduction in the length of stay in hospital. During the period the number of admissions to general hospitals within the catchment area was reduced by about one half, with the result that there was no appreciable overall increase in the number of admissions for in-patient treatment of emotional disorders in the ten-year period.     

On the broad applicability of the affective circumplex: representations of affective knowledge among schizophrenia patients

Abstract - Studies of affective experience are guided by the assumption that the structure of affect generalizes across people. Yet this assumption has not been tested among educationally and economically diverse community residents or among individuals with psychopathology. This study explicitly examined the broad applicability of the valence-arousal circumplex and whether schizophrenia patients and nonpatients have comparable knowledge structures of affective phenomena. Patients and nonpatients completed similarity ratings of 120 pairs of affect words. Similarity judgments were analyzed separately for each group using a multidimensional scaling procedure, and solutions were compared. Results revealed the same two-dimensional valence-arousal solution for schizophrenia patients and nonpatients, although there were subtle differences between the groups. These findings provide additional evidence that the circumplex model is a useful formalism for representing affective phenomena across diverse populations, and they bolster confidence in existing interpretations of schizophrenia patients' reports of affective experience.     

Factors delaying rehabilitation in inpatient treatment of schizophrenic patients

An empirical study involving 104 German and 208 Soviet schizophrenics showed that the main factors delaying rehabilitation are a large number of previous hospitalizations, long periods preceding hospitalization, the type of schizophrenia, the desired aim of treatment, disturbed relationship of he patient to his or her environment and performance disturbances. Apart from certain personality deviations, the therapeutic measures also involve factors that delay rehabilitation. The rehabilitation barriers mentioned here could be overcome by the more widespread establishment of follow-up care centres.     

Desperation and other affective states in suicidal patients

Data collected from 26 therapists who were treating patients when they died by suicide were used to identify intense affective states in such patients preceding the suicide. Eleven therapists provided comparable data on 26 patients they had treated who were seriously depressed but not suicidal. Although the two groups had similar numbers diagnosed with MDD, the suicide patients showed a significantly higher total number of intense affects in addition to depression. The acute affective state most associated with a suicide crisis was desperation. Hopelessness, rage, abandonment, self-hatred, and anxiety were also significantly more frequently evidenced in the suicide patients.     

Changes in defensiveness and in affective distress following inpatient treatment of eating disorders: Rorschach comprehensive system and self-report measures

Conceptualizing eating disorders (EDs) as forming a coping mechanism against facing psychic pain, in this study, we examined the contribution of weight stabilization and ED behaviors to psychological outcomes of affective distress, defensiveness, and contact with inner/external reality among 2 subgroups of adolescent inpatients with (a) "restricting type" anorexia (AN-R) and (b) bingeing/purging type EDs (B/P). We administered Rorschach Comprehensive System (CS; Exner, 2003) and self-report measures at acute admission and on discharge. Data indicated that in both subgroups, stabilization of weight and disordered eating behaviors was accompanied by reduced explicit (self-reported) affective distress, yet by elevated implicit affective distress (D, SumShd). Subgroups' different Rorschach change trends indicated different dynamic processes in defensive style and contact with inner/external reality.     

Catamnestic studies of patients with writer's cramp following inpatient psychotherapy

The paper gives the results of a follow-up study of 58 patients after psychotherapeutic treatment as in-patients for writer's cramp. Where as immediately after discharge 74.1% of the patients felt an improvement in their condition, at the time of the follow-up study only 17.2% were demonstrably improved, with 37.9% subjectively feeling an improvement over their state before treatment as in-patients. These results suggest that the customary psychotherapeutic methods employed have less effect on the evidently multifactorial extrapyramidal-motor basic complaint but rather have the effect of improving the patient's ability to cope with this in daily life.     

Differential efficacy of standard inpatient treatment between Mormon and non-Mormon patients

Despite differences in doctrine and belief structure, much of current research and most therapeutic practice continue to treat the thirty six recognised denominations of Christianity identically. Analysis of 298 inpatients (37.6% Mormon) at a large state psychiatric hospital found differential efficacy based on denomination (Mormon versus Non-Mormon) on seven of the 24 items of the Brief Psychiatric Rating Scale. Differential efficacy of treatment was also found based on gender for four of the 24 items with those differences possibly stemming from gender differences in openness to therapy. Finally, two denominations by gender interactions were noted as well. Taken together, the results of the current study indicate that specific denomination membership may have a more significant impact on the outcome of therapy than current practice implies. Additionally, the current study documents some of the unique challenges and issues in treating Mormon patients.     

The effects of behavioral activation therapy with inpatient geriatric psychiatry patients

This study examined the effects of Behavioral Activation (BA) treatment on depressive symptoms and quality of life among older adult patients in a geriatric psychiatry facility. There were 50 participants with mild to moderate cognitive impairment, each being 65 years of age or older. A 2 (between) × 3 (time of measurement) design was used in this study comparing control (treatment-as-usual) and experimental (BA) conditions at pre-, mid-, and posttreatment. BA consisted of eight 30- to 60-minute sessions across 4 weeks. Intent-to-treat analyses indicated a significant Group × Time interaction on depressive symptoms, with this effect remaining when only completer data were included. Further analyses indicated that this effect was due to significant change early in treatment in both the full and completer samples. There was no evidence of a significant effect on the quality-of-life measure. Cognitive status was not related to change in depressive symptoms, suggesting that BA may be useful across a range of older adults.     

Implicit and explicit memory for affective passages in temporal lobectomy patients

Eighteen temporal lobectomy patients (9 left, LTL; 9 right, RTL) were administered four verbal tasks, an Affective Implicit Task, a Neutral Implicit Task, an Affective Explicit Task, and a Neutral Explicit Task. For the Affective and Neutral Implicit Tasks, participants were timed while reading aloud passages with affective or neutral content, respectively, as quickly as possible, but not so quickly that they did not understand. A target verbal passage was repeated three times; this target passage was alternated with other previously unread passages, and all passages had the same number of words. The Explicit Affective and Neutral Tasks were administered at the end of testing, and consisted of multiple choice questions regarding passage content. Verbal priming effects in terms of improved reading speed with repetition for the target but not non-target passages were found for patients with both left and right temporal lobectomies. As in the Burton, Rabin et al. [Burton, L., Rabin, L., Vardy, S.B., Frohlich, J., Wyatt, G., Dimitri, D., Constante, S., Guterman, E. (2004). Gender differences in implicit and explicit memory for affective passages. Brain and Cognition, 54(3), 218-224] normative study, there were no interactions between this priming effect and affective/neutral content. For the explicit tasks, items from the repeated passages were remembered better than the unrepeated passages, and there was a trend for information from the affective passages to be remembered better than the neutral passages, similar to the normative pattern. The RTL group did not show the normative pattern of slower reading speed for affective compared to neutral passages that the LTL group showed. Thus, the present findings support the idea that intact right medial temporal structures are important for affective content to influence some aspects of verbal processing.     

Interpersonal attraction as a function of affective state and affective change

Interpersonal attraction has been found to be highly correlated with the affective states of subjects. It was hypothesized that attraction is also highly related to affective changes induced in subjects by interpersonal stimuli associated with a stranger. Byrne and Rhamey's (1965) experiment was replicated with one change: subjects' affective states were assessed at the beginning of the session and immediately prior to the subjects' evaluation of a stranger. Four levels of attitude similarity (1.00, .67, .33, and .00) and three types of evaluation conditions (positive, negative,and control) were employed in a 4 × 3 factorial design, with 19 subjects per cell. As hypothesized, attraction was found to be highly related to subjects' affective states and affective changes induced by attraction stimuli (p < .001).     

Methodologies of affective classification

Three methodologies to classify the affective domain are reviewed: phenetic, cladistic, and ontological. The merits and seeming deficiencies of these approaches are analyzed, and illustrative applications of these methodologies are presented. A systems analysis of the affective domain is proposed as most adequately performing the classification functions of grouping elements to emphasize their autonomy and homonomy, indicate their nature and degree of relatedness, and structurally represent abstract conceptualizations of this domain.     

Relatives' affective style and the expression of subclinical psychopathology in patients with schizophrenia

High expressed emotion (EE) is a measure of hostile, critical, and emotionally overinvolved attitudes expressed by a family member about a psychiatrically ill relative during an interview conducted in the patient's absence. EE is a robust predictor of relapse in schizophrenia, yet attempts to identify clinical characteristics that differentiate patients from high versus low EE families have mostly yielded negative findings. However, in a previous study, we found that patients with schizophrenia from high EE families exhibited greater levels of subclinical psychopathology when interacting with family members than did patients from low EE families. Patients from high EE families (N=32) also demonstrated considerable heterogeneity in their expression of subclinical psychopathology. The present study extends our previous work by demonstrating that this heterogeneity in patient subclinical psychopathology was associated with the extent to which family members expressed high EE congruent behaviors--as measured by the affective style (AS) coding system--when directly interacting with their patient-relative. Elevations in anxious/agitated behaviors and hostile/unusual behaviors were observed among patients whose high EE relatives behaved in a manner consistent with their EE status. These findings support a complex, bidirectional model of the role of high EE attitudes in influencing the course of schizophrenia.     

Automatic affective processing

Abstract

Semantic and emotional priming below objective detection threshold was investigated using a binocular pattern masking procedure. In the first experiment lexical decision time to emotionally aversive target stimuli was significantly faciliated by the presentation of emotionally aversive primes and primes semantically related to the target, thus replicating the emotional and semantic priming effects found supraliminally in Hill and Kemp-Wheeler (1989). In Experiment 2, a significant semantic priming effect was again found but the subliminal emotional priming effect of Experiment 1 did not replicate.     

Preferences as expectation-driven inferences: effects of affective expectations on affective experience

Presents a model arguing that affect and emotion are often formed in an expectation-driven fashion. A pilot study and 2 experiments manipulated undergraduate Ss' affective expectations (e.g., how funny they expected a set of cartoons to be) and whether Ss' expectations were confirmed (e.g., whether the cartoons really were funny). When the value of a stimulus was consistent with an affective expectation, people formed evaluations relatively quickly. Even when the value of a stimulus was discrepant from an affective expectation, people sometimes assimilated the value of the stimulus to their expectations. Other times, such as when making a more fine-grained evaluation of the cartoons, people noticed that they were discrepant from their affective expectations. Under these conditions, people appeared to have more difficulty forming preferences. They took longer to evaluate and spent more time thinking about the cartoons.     

The structure of affective action representations: temporal binding of affective response codes

Two experiments examined the hypothesis that preparing an action with a specific affective connotation involves the binding of this action to an affective code reflecting this connotation. This integration into an action plan should lead to a temporary occupation of the affective code, which should impair the concurrent representation of affectively congruent events, such as the planning of another action with the same valence. This hypothesis was tested with a dual-task setup that required a speeded choice between approach- and avoidance-type lever movements after having planned and before having executed an evaluative button press. In line with the code-occupation hypothesis, slower lever movements were observed when the lever movement was affectively compatible with the prepared evaluative button press than when the two actions were affectively incompatible. Lever movements related to approach and avoidance and evaluative button presses thus seem to share a code that represents affective meaning. A model of affective action control that is based on the theory of event coding is discussed.     

Situational determinants of inpatient self-harm

Auto-aggressive individuals have a higher likelihood of engaging in interpersonal violence, and vice versa. It is unclear, however, whether ward circumstances are involved in determining whether aggression-prone patients will engage in auto-aggressive or outwardly directed aggressive behavior. The current study focuses on the situational antecedents of self-harming behavior and outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly aggressive behavior were monitored on a locked 20-bed psychiatric admissions ward for 3.5 years with the Staff Observation Aggression Scale-Revised (SOAS-R). A map of the ward was attached to each SOAS-R form, enabling staff members to specify locations of aggressive incidents. Time of onset, location, and provoking factors of auto-aggressive incidents were compared to those connected to aggression against others or objects. Of a total of 774 aggressive incidents, 154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly more prevalent during the evening (i.e., 50% compared to 32%), and reached its highest level between 8 and 9 P.M. (17% compared to 7%). The majority of self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed aggression was particularly common in the day-rooms (24%), the staff office (19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking factors of auto-aggressive behavior are less often of an interactional nature compared to outwardly directed aggression. The results suggest that a lack of stimulation and interaction with others increases the risk of self-injurious behavior. Practical and testable measures to prevent self-harm are proposed.     

Psychoanalytic aspects of inpatient treatment

This paper looks at the experience of inpatient hospital treatment at the Cassel Hospital and how formal psychoanalytic psychotherapy, with its emphasis on the transference and the inner world, fits into that context and orientates itself to some of the realities of the setting. It outlines how psychotherapy and nursing can work to inform and enrich each other, and what is psychoanalytic about the overall work. A bridge of understanding is built using the patients' perceptions of, adjustment to and conflict about the inpatient setting, and the affective impact of the processes on patients and staff alike. Two clinical examples of severe child abuse family cases are given, the first of Munchhausen syndrome by proxy, the second in which a baby sibling had been killed. They show how in-depth psychoanalytic work with mother and child and individual psychotherapy of the child can be combined with psychotherapy of the parents and intensive work in the therapeutic community. Such a combination can contribute, even in cases of severe pathology, to the development of the relationship between mother and child and promote successful rehabilitation in the outside community.     

The affective basis of violence

Violence is a complex matter, and understandingly perhaps, it is the objective, behavioral aspects that are commonly focused on. Here, however, it is the subjective psychological and especially affective substrates of violence that are brought to the fore. Psychoanalytic perspectives provide a way of thinking about these that also sets them in a human-developmental context. In this essay, psychoanalytic ideas about aggression and violence are considered, and what they have to say about the relationship between states of mind and behavior is critically reviewed. There also is an exploration of the ways that some recent findings in developmental science and neuroscience can refine and augment an understanding of these relationships, facilitating the construction of a psychobiological model, which may be placed in a social context. From this biopsychosocial perspective, aggression is seen as a heuristic concept that encapsulates numerous interacting elements that in ordinary development integrate and serve to promote optimal organism survival: By contrast, from this perspective, in humans violence may be understood as a pathological variant of aggression.