Empathie und Persönlichkeitsstörungen aus neurobiologischer Sicht

In contrast to the vague application of the term empathy in general usage, the neurobiological literature differentiates between cognitive empathy and emotional empathy. The former includes cognitive recognition of the mental state of someone else due to reflexive acquisition of perspectives and theory of mind functions, the latter includes the reflexive intuitive sympathy and sharing the emotions of others. Both independent from each other and interindividual differently expressed facets can be assigned to different brain networks which process these events. Early evolutionary processes of emotional empathy are already developed in infants by mirror image imitation of mimicry and gestures of the primary contact person. They involve premotor regions, areas of the sensomotor cortex, the inferior parietal lobule and the anterior insular regions. Phylogenetically younger processes of cognitive empathy are represented in particular in midline structures, such as the medial prefrontal cortex, superior temporal sulcus, posterior cingulum or precuneus as well as in the temporoparietal junction. They have their beginning in shared attention processes in early dyadic processes. Both facets of empathy are involved in moral decision-making processes. In this context, neurobiological studies show that psychopaths have undisturbed cognitive empathic capabilities and are principally able to recognize and apply moral values but confer little attentional importance to them when they compete with own targets. Individuals with borderline personality disorders in contrast to psychopaths show impairments in cognitive empathy. The deficits affect mentalization functions, which involve the understanding of the mental state of others and oneself and are also the starting point for many misunderstandings in an interpersonal context. Additionally, individuals with borderline personality disorder have a tendency to share emotions with other people. They therefore succeed in showing sympathy and compassion although associated with the danger of diffusion of self and third party borders.     

Employment and Roles of Counselors in Mental Health Agencies

The authors studied the employment of counselors with master's degrees in multiservice mental health agencies. The study focused on the types of clients seen, the direct care services provided, and the administrative duties performed. Results suggested that the employment of counselors does not differ significantly from the employment of individuals with master's degrees in psychology and social work. Also, the data indicated that counselors are delivering direct care services that traditionally have been offered in mental health centers, that clients seen by counselors demonstrate a range of mental disorders, and that counselors are responsible for fulfilling various administrative duties.     

Genetics of autism spectrum disorders

Characterized by a combination of abnormalities in language, social cognition and mental flexibility, autism is not a single disorder but a neurodevelopmental syndrome commonly referred to as autism spectrum disorder (ASD). Several dozen ASD susceptibility genes have been identified in the past decade, collectively accounting for 10-20% of ASD cases. These findings, although demonstrating that ASD is etiologically heterogeneous, provide important clues about its pathophysiology. Diverse genetic and genomic approaches provide evidence converging on disruption of key biological pathways, many of which are also implicated in other allied neurodevelopmental disorders. Knowing the genes involved in ASD provides us with a crucial tool to probe both the specificity of ASD and the shared neurobiological and cognitive features across what are considered clinically distinct disorders, with the goal of linking gene to brain circuits to cognitive function.     

Counselor performance in treating anxiety and depressive symptoms in integrated care: A client outcomes study

Depression and anxiety are two of the most common mental disorders treated in Integrated Primary and Behavioral Healthcare programs. We investigated the within and between performance differences of mental health counselors on anxiety and depressive symptomatology in an integrated service with a sample of 1573 clients and 10 licensed professional counselors. The results of growth curves within the framework of Multilevel Modeling showed significant within and between performance differences among counselors treating anxiety and depressive symptoms. Some counselors performed better in treating anxiety symptoms while others did better treating depression. Implications for counselor education, client care, and legislation are provided.     

Reflecting on imagery: a clinical perspective and overview of the special issue of memory on mental imagery and memory in psychopathology

The authors provide an overview of the papers in the special issue of Memory on mental imagery and memory in psychopathology. The papers address emotional, intrusive mental imagery across a range of psychological disorders including post-traumatic stress disorder (PTSD), agoraphobia, body dysmorphic disorder, mood disorders, and psychosis. They include work on information processing issues including modelling cravings, conditioning, and aversions, as well as imagery qualities such as vividness and emotionality. The overview aims to place the articles in a broader context and draw out some exciting implications of this novel work. It provides a clinical context to the recent growth in this area from a cognitive behavioural therapy (CBT) perspective. We begin with PTSD, and consider links to imagery in other disorders. The clinical implications stemming from this empirical work and from autobiographical memory theory are discussed. These include consideration of a variety of techniques for eliminating troublesome imagery, and creating healthy, realistic alternatives.     

Infusing Ethics in Psychopharmacology Course Design

Creatively infusing ethics in psychopharmacology course design can better prepare future counselors to work with the complexities of holistic client concerns in a modern context. The authors provide a sample course design from a psychopharmacology course within a counselor education program targeting counselors-in-training to increase counseling ethics and values awareness. Implications for future mental health and school counselors are provided.     

Disproportionate Diagnosis of Mental Disorders Among African American Versus European American Clients: Implications for Counseling Theory,Research, and Practice

Research generated by the professions of psychiatry and psychology reveals that African Americans are more often diagnosed with specific mental disorders (e.g., psychotic disorders) compared with European Americans. No research to date, however, has investigated whether professional counselors make differential diagnoses according to client race. This study (N = 1,648) found that counselors diagnosed African Americans with psychotic and childhood disorders at a disproportionately high rate. Implications for counseling theory and practice are discussed.     

Abnormalities in Anxiety Implications for Cognitive Neuroscience

Experimantal psychopathologists have increasingly relied on the concepts methods of cognitive psychology to elucidate information-processing associated with anxiety disorders. However, research has without reference to how these abnormalities are instantiated in brain. The purpose of this article is to provide a survey of points of between the cognitive and neurobiological perspectives with regard disorders.     

Reflecting on imagery: A clinical perspective and overview of the special issue of Memory on mental imagery and memory in psychopathology

The authors provide an overview of the papers in the special issue of Memory on mental imagery and memory in psychopathology. The papers address emotional, intrusive mental imagery across a range of psychological disorders including post‐traumatic stress disorder (PTSD), agoraphobia, body dysmorphic disorder, mood disorders, and psychosis. They include work on information processing issues including modelling cravings, conditioning, and aversions, as well as imagery qualities such as vividness and emotionality. The overview aims to place the articles in a broader context and draw out some exciting implications of this novel work. It provides a clinical context to the recent growth in this area from a cognitive behavioural therapy (CBT) perspective. We begin with PTSD, and consider links to imagery in other disorders. The clinical implications stemming from this empirical work and from autobiographical memory theory are discussed. These include consideration of a variety of techniques for eliminating troublesome imagery, and creating healthy, realistic alternatives.     

The Convergence of Counseling and Psychiatric Genetics: An Essential Role for Counselors

Research in psychiatric genetics shows that many mental disorders commonly seen by counselors are associated with the presence of specific genes. Although findings in gene research call for some changes in the way counselors approach intervention, in most cases, the importance of the counseling profession's core commitments is underscored. This article introduces the field of psychiatric genetics, clarifies the importance of counseling interventions in gene‐associated mental disorder, and highlights practice questions stimulated by growing knowledge in pychiatric genetics.     

Do They Know How Happy They Are? On the Value of Self-Rated Happiness of People With a Mental Disorder

Quality of life is often measured using questions about happiness. This method presumes that respondents are able to judge their life. Research suggest that this is typically the case, but this is not to say that everybody can. In that context one may doubt whether people with a mental disorder can judge their life adequately. Happiness can be rejected as a indicator for quality of life for people with mental disorders, because of affective and cognitive distortions. We therefore checked the validity of happiness and satisfaction measures in the context of mental disorders. Psychiatric diagnoses were determined at baseline and at 12 and 36 months follow-up in a representative sample (N = 7,076) of the Dutch population, using a full Composite International Diagnostic Interview. Respondents indicated how often they had felt happy during the past month and how satisfied they were with their lives in general. The measurements have a satisfactory concurrent, ecological and predictive validity for people with mental disorders. Though the level of happiness is lower among the people with mental disorders, conditions for happiness and contentment appear to be similar.     

L’enfance et l’adolescence in situ : facteurs environnementaux facilitateurs et inhibiteurs de troubles cognitifs et comportementaux

The definition of mental health associates three fundamental variables: biological variables, psychological variables and environmental variables. In this article, we will focus on environmental variables that inhibit and facilitate cognitive and behavioural disorders in childhood and adolescence. Environmental psychology considers the interrelations between human and environment in its spatial, social and chronological dimensions and considers it as a characterized and undissociated system. We will bring to mind social and physical environmental variables with which children and adolescents interact frequently and, through a literature review, we will enlighten environmental variables that are susceptible to induce behavioural disorders and psychological variables that modulate children's and adolescent's relations to environment. We then suggest possible outcomes of this approach in clinical practice as well as in terms of therapeutic applications in child psychology and psychiatry. Finally, we evoke the necessity of taking in account neurobiological fields in order to outline a model of human development integrating the three variables that define mental health.     

Mothers’ Perspectives on Their Child’s Mental Illness as Compared to Other Complex Disorders in Their Family: Insights to Inform Genetic Counseling Practice

To facilitate the development of a therapeutic alliance in genetic counseling, it is important that the counselor understands how families might perceive the condition that constitutes the reason for the referral. Through training and professional practice, genetic counselors develop a thorough understanding of families' perceptions of the conditions that are common indications for genetic counseling. But, for referral indications that are less frequent, like serious mental illnesses, genetic counselors may feel less confident in their understanding of the family's experience, or in their ability to provide psychosocial support when serious mental illness is reported in a family history. This may impede the establishment of a therapeutic alliance. As research shows that most referrals for genetic counseling related to serious mental illness are for female first-degree family members of affected individuals, we sought to explore how this group perceives serious mental illness. To provide a frame of reference with which genetic counselors may be more familiar, we explored how women perceived serious mental illness compared to other common complex disorders in their family. We conducted semi-structured interviews with women who had a child with a serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder) and a first-degree relative with another common complex disorder (diabetes, heart disease, cancer). Interviews were transcribed and subjected to thematic analysis. Saturation was reached when nine women had participated. Serious mental illness was perceived as being more severe and as having a greater impact on the family than diabetes, heart disease, or cancer. Themes identified included guilt, stigma, and loss. Some of the most important issues that contribute to mothers' perceptions that serious mental illness is more severe than other common complex disorders could be effectively addressed in genetic counseling. Developing a heightened awareness of how family members experience a relative's mental illness may help genetic counselors to be better able to provide psychosocial support to this group, whether serious mental illness constitutes the primary reason for referral or appears in the family history during counseling for a different referral reason.     

Forty years on: Uta Frith's contribution to research on autism and dyslexia, 1966-2006

Uta Frith has made a major contribution to our understanding of developmental disorders, especially autism and dyslexia. She has studied the cognitive and neurobiological bases of both disorders and demonstrated distinctive impairments in social cognition and central coherence in autism, and in phonological processing in dyslexia. In this enterprise she has encouraged psychologists to work in a theoretical framework that distinguishes between observed behaviour and the underlying cognitive and neurobiological processes that mediate that behaviour.     

Prisoners’ competence to die: hunger strike and cognitive competence

Several bioethicists have recently advocated the force-feeding of prisoners, based on the assumption that prisoners have reduced or no autonomy. This assumed lack of autonomy follows from a decrease in cognitive competence, which, in turn, supposedly derives from imprisonment and/or being on hunger strike. In brief, causal links are made between imprisonment or voluntary total fasting (VTF) and mental disorders and between mental disorders and lack of cognitive competence. I engage the bioethicists that support force-feeding by severing both of these causal links. Specifically, I refute the claims that VTF automatically and necessarily causes mental disorders such as depression, and that these mental disorders necessarily or commonly entail cognitive impairment. Instead, I critically review more nuanced approaches to assessing mental competence in hunger strikes, urging that a diagnosis of incompetence be made on a case-by-case basis—a position that is widely shared by the medical community.     

Assessment and Diagnosis of Eating Disorders: A Guide for Professional Counselors

Despite the prevalence of and risk associated with disordered eating, there are few guidelines for counselors on how to conduct an eating disorder assessment. Given the importance of the clinical interview, the purpose of this article is to provide recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment.     

The Mental Status Examination: Its Use by Professional Counselors

Although not a formal psychometric instrument, the mental status examination (MSE) has been used predominantly in psychiatry, clinical psychology, and social work for several decades, but is being increasingly used by counselors in work settings requiring assessment, diagnosis, and treatment of mental disorders. The MSE is used to obtain information about the client's level of functioning and self‐presentation. Generally conducted (formally or informally) during the initial or intake interview, the MSE can also provide counselors with a helpful format for organizing objective (observations of clients) and subjective (data provided by clients) information to use in diagnosis and treatment planning.     

Psychoanalytic and biological approaches to mental illness: schizophrenia.

Biological psychiatrists tend to look upon the phenomena of mind and meaning, which are the data of psychoanalysis, as meaningless epiphenomena, and propose reductive explanations of complex mental states, whereas psychoanalysts tend to ignore the proliferation of neurobiological data indicating the importance of constitutional factors in mental illness. Interactive models which confuse biological causes and psychological consequences, or vice-versa, are theoretically unsound. A scientific model hierarchy is proposed, along with some principles for coexistence and collaboration between neurobiology and psychoanalysis. The problem is illustrated with schizophrenia, a condition whose probable biological underpinnings are now generally considered to remove it from the realm of psychoanalysis. Schizophrenia-vulnerable phenotypes consistent with organic findings and clinical observations are hypothesized, and some ideas about their development in the context of early object relations, leading to pathological forms of symbiosis, are elaborated. A neurobiological rationale for the psychoanalytic treatment of schizophrenia is presented, and special problems related to the biological and symbiotic substrate are examined.