Driving-induced stress in urban college students

Urban college student commuters (N = 407) were surveyed about their experiences with stress induced by driving. Of the participants 23.6% reported becoming angry at another driver more than once per day. They rated stress from other drivers as equal to the stress experienced during a college examination but gave slightly lower ratings to traffic congestion, road construction, and finding a parking place as sources of stress. Slow drivers, a child not restrained, and a vehicle following too closely were the highest rated annoying situations. Of participants, 21.6% had reported another driver to the police; nearly 22% said they carried a weapon for protection from other drivers (5.4% said a gun). Men were more than twice as likely as women to carry a weapon and three times as likely to carry a gun. Of the total sample, 19.1% feared being shot by another driver. Most participants (75.8%) said drivers were more aggressive and dangerous than they were five years ago.     

Women and Political Torture:

Although women and children represent 80% of persons who flee their countries for reasons of persecution as refugees, scant attention has been given women in the literature describing severe human rights abuses, including torture. Torture is an extreme form of trauma that involves the strategic destruction of the human being. The torturer uses every aspect of the person's being. In the case of women, their own femaleness is used as a weapon. This paper focuses on special issues faced by women who are survivors of torture. The author directed the first center in the United States providing a multidisciplinary care for survivors of political torture.     

Psychotic symptoms in posttraumatic stress disorder

Recent data suggest that the presence of psychotic symptoms in patients suffering from posttraumatic stress disorder (PTSD) may represent an underrecognized and unique subtype of PTSD. Among combat veterans with PTSD, 30% to 40% report auditory or visual hallucinations and/or delusions. The presence of psychotic symptoms in PTSD is associated with a more severe level of psychopathology, similar to that of chronic schizophrenia. In this review, the differential diagnosis of psychotic symptoms in PTSD is discussed, including possible comorbid schizophrenia, psychotic depression, substance-induced psychosis, and personality disorder. A recent biologic study supporting the existence of a unique subtype of PTSD with psychotic features is also addressed, as are the similarities between PTSD with psychotic features and psychotic depression disorder. Finally, data on the treatment implications of psychotic symptoms in PTSD are presented. The intriguing recent findings on psychotic symptoms in PTSD need further investigation in noncombat-related PTSD populations before findings can be generalized to all individuals with PTSD.     

The Experience of Caregiving Among Mothers of Adults Suffering from Psychotic Disorders: Factors Associated with Their Psychological Distress

To identify correlates of psychological distress among multiple indicators, 99 women with adult children suffering from a psychotic disorder were interviewed. The women, who were recruited through hospitals and self-help groups, represented different socioeconomic levels. A face-to-face standardized interview was conducted, mainly in the participants' homes. Multiple hierarchical regression analysis showed that dimensions of burden and social support were strongly associated with distress reported by the participants. The negative interactions that participants had with their main confidant or spouse constituted a more powerful correlate than their perception of the quality of this relationship. Furthermore, a perception of their own health as poorer is a strong correlate of their distress. Since no control group was studied simultaneously, these results suggest, but do not prove, the presence of differences between mothers of adults with psychotic disorders and other mothers.     

Mind wandering in schizophrenia: A thought-sampling study

Mind wandering has consistently been associated with impairments in cognition, emotion and daily performance. However, few experimental studies on mind wandering have been conducted in individuals with schizophrenia. The present study aimed to examine mind wandering in schizophrenia patients with a thought-sampling experiment embedded in a rapid go/no-go task and the relationship between the frequency of mind wandering and psychotic symptoms. Fifty-eight schizophrenia patients and 56 matched healthy controls were recruited and engaged in a task that assessed mind wandering. The results showed that schizophrenia patients (1.4%) reported less frequent mind wandering than healthy controls (5.8%). Moreover, there was no significant correlation between the frequency of mind wandering and psychotic symptoms in schizophrenia patients. Further studies in different stages of schizophrenia and in patients with more severe psychotic symptoms are needed to demonstrate a more comprehensive picture of mind wandering in schizophrenia.     

THE EFFICACY OF WOMEN'S RESISTANCE STRATEGIES IN RAPE SITUATIONS

The effectiveness of women's resistance strategies for reducing the severity of sexual abuse and physical injury during sexual assaults was analyzed in a variety of assault circumstances. Data were obtained from police reports and court testimonies of 274 women (96% White, 4% Black) who either were raped or avoided rape by subsequently incarcerated violent stranger rapists. Statistical analyses showed that particular resistance strategies were effective in specific situations. Women who fought back forcefully were more likely to avoid rape than women who did not fight back, regardles of whether a waepon was present. Forceful fighting resistance was related to increased physical injury when a weapon was present, but most physical injury was caused by nonlethal weapons. Women who screamed or fled when confronted with weapons experienced less severe sexual abuse. Increased physical injury was associated with pleading, crying, or reasoning indoors. Women who used drugs or alcohol experienced more severe sexual abuse and physical injury.     

Cognitive Insight in Inpatients with Psychotic, Bipolar, and Major Depressive Disorders

The Beck Cognitive Insight Scale (BCIS; Beck, Baruch, Balter, Steer, & Warman, 2004) was administered to 42 (28%) inpatients with psychotic disorders, 52 (35%) with a bipolar disorder, and 56 (37%) with a major depressive disorder (MDD). The hypotheses were (a) that the mean level of cognitive insight in a psychotic or a bipolar disorder is lower than that in a MDD, (b) that the mean levels of cognitive insight in psychotic and bipolar disorders were comparable, and (c) that the mean BCIS index score for a bipolar disorder in which the most recent episode had been mania is lower than the mean BCIS index score for a bipolar disorder in which the most recent episode had been mixed or depressed. All three hypotheses were supported. The results were discussed as supporting cognitive insight as a psychological construct that varies predictably according to the nature of a psychiatric disorder.     

Suicidality and psychosis: beyond depression and hopelessness

The present study examined recent suicide attempters with and without psychotic disorders in order to understand factors that contribute to suicide ideation during and following the suicide attempt. Patients with psychotic disorders endorsed higher levels of suicide ideation than patients without psychotic disorders. Even when depression, hopelessness, substance abuse, and social problem solving were controlled for, there was a significant association between psychotic disorder and suicide ideation. During the follow-up period, patients with psychotic disorders subsequently attempted suicide at a significantly higher rate than patients without psychotic disorders. The clinical relevance of these findings is discussed.     

Gender Disparities in the Mental Health of Urban Survivors of Trauma

Women who experience traumatic events are at higher risk for mental health problems compared to men; however, gaps remain in our understanding of this disparity. A sample of 170 urban adults completed self-report measures. Women were significantly more likely to experience sexual assault and domestic violence compared to men, and they were significantly less likely to experience a robbery or mugging, being threatened with a weapon, or witnessing a death or assault compared to men. Also, women were more likely than men to meet criteria for probable post-traumatic stress disorder (PTSD) and depression after controlling for covariates and trauma level. Our findings suggest a possible differential vulnerability to the development of PTSD and depressive symptoms in women.     

Performing under pressure: gaze control, decision making and shooting performance of elite and rookie police officers

Gaze of elite (E) and rookie (R) officers were analyzed as they faced a potentially lethal encounter that required use of a handgun, or inhibition of the shot when a cell phone was drawn. The E shot more accurately than the R (E 74.60%; R 53.80%) and made fewer decisions errors in the cell condition when 18.50% of E and 61.50% of R fired at the assailant. E and R did not differ in duration of the draw/aim/fire phases, but the R's motor onsets were later, during the final second compared to the E's final 2.5 s. Across the final six fixations the E increased the percent of fixations on the assailant's weapon/cell to 71% and to 86% on hits, compared to a high of 34% for the R. Before firing, the R made a rapid saccade to their own weapon on 84% of trials leading to a failure to fixate the assailant on 50% of trials as they fired. Compared to the R, the E had a longer quiet eye duration on the assailant's weapon/cell prior to firing. The results provide new insights into officer weapon focus, firearms training and the role of optimal gaze control when under extreme pressure.     

Frontal lobe epilepsy presenting as a psychotic disorder with delusions and hallucinations: a case study

Although psychotic symptoms are a recognized manifestation of epilepsy, these are more often associated with seizures of the temporal lobe type. While 10% of children with temporal lobe epilepsy develop a psychotic disorder by adulthood, the literature does not report any cases of psychotic disorders associated with frontal lobe seizures in children. This article presents a unique case of a girl whose frontal lobe seizures were associated with delusional psychotic symptoms. Once her seizure disorder was identified through electroencephalography (EEG) and appropriate anticonvulsant therapy was initiated, her associated psychotic symptoms resolved.     

Influence of Gun Ownership on Social Inferences About Women and Men1

In the past gun ownership was primarily a male-only phenomenon. There has been, however, an increase among American women in gun purchasing largely for purposes of self-defense. In the first study we examined the consequences of women and men owning handguns, versus not doing so, for social perception. Given that gun ownership is stereotype inconsistent for women but not for men, such a violation of expectancies was expected to have a greater impact on inferences about women than men. Subjects believed that women who owned handguns would possess masculine physical characteristics, although they were not perceived as losing feminine body attributes per se. Women who owned guns tended to be perceived as less likely to occupy female stereotypic social roles, while men who owned a weapon were perceived as more likely to do so. Men who owned a handgun were perceived as less likely to possess socially desirable male stereotypic traits, although women with a handgun gained in this respect. In the second study where a community sample was employed, the main pattern of outcomes was replicated. Affective reactions toward male and female gun owners were similar, and less positive than for persons who do not own guns. Individuals with both positive and negative attitudes toward guns displayed the same pattern of inferences based on gun ownership and target gender. These results are discussed in terms of their implications for social judgment and stereotype use.     

Physician Beliefs about Physical and Mental Competency of Patients Applying for Concealed Weapon Permits

Law enforcement officials have asked health care providers to evaluate patient applications for concealed weapon permits. The current study was designed to examine physician beliefs regarding competency to carry a concealed weapon for patients with specific physical and mental conditions. Among 222 North Carolina physicians who participated in this survey (40% response rate), large variation and uncertainty existed for determining competency. Physicians most frequently chose mild dementia, post-traumatic stress disorder, and recent depression as conditions that would render a patient not competent to carry a concealed weapon. Male physicians and those owning a gun were more likely to deem a patient competent. Almost a third of physicians were unsure about competence for most conditions. Physicians asked to assess competency of patients to carry a concealed weapon have quite disparate views on competency and little confidence in their decisions. If physicians are expected to assess patient competence to carry a concealed weapon, more objective criteria and training are needed. Copyright © 2015 John Wiley & Sons, Ltd.     

Differentiating psychotic patients from nonpsychotic patients with the MMPI-2 and Rorschach

The goal of this study was to examine the incremental validity and the clinical utility of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and Rorschach (Rorschach, 1942) with regard to differential diagnosis in a sample of adult inpatients with a primary psychotic disorder or a primary mood disorder without psychotic features. Diagnostic efficiency statistics have suggested that the Rorschach Perceptual Thinking Index (PTI; Exner, 2000a, 2000b) was better than MMPI-2 scales in discriminating psychotic patients from nonpsychotic patients. We compared the 84% overall correct classification rate (OCC) for the PTI to an OCC of 70% for the MMPI-2 scales. Adding the MMPI-2 scales to the PTI resulted in a decrease in OCC of 1%, whereas adding the PTI to the MMPI-2 resulted in an increase in OCC of 14%. Sensitivity, specificity, positive predictive power, negative predictive power, and kappa were equal or higher with only the PTI in the model.     

Metacognitive beliefs across the continuum of psychosis: comparisons between patients with psychotic disorders, patients at ultra-high risk and non-patients

BACKGROUND: Recent models of emotional disorders and psychosis implicate metacognitive beliefs in the development and maintenance of psychological distress. We predicted that patients with established psychotic disorders and those meeting at risk mental state (ARMS) criteria (and, thus, at increased risk of developing psychosis) would show higher levels of metacognitive beliefs than non-patient controls. Furthermore, we predicted that patients with psychosis would show higher levels of such beliefs than the at risk group. METHOD: The Metacognitions Questionnaire was administered to 73 patients with psychotic disorders, 43 ARMS patients and 188 non-patients. RESULTS: As predicted, patients with psychotic diagnoses and those at risk scored higher on metacognitive belief dimensions than non-patients. Patients with psychosis showed higher positive metacognitive beliefs than the at risk patients, indicating a greater range of unhelpful metacognitions overall, when compared to non-patients. CONCLUSIONS: These findings are consistent with metacognitive conceptualisations of psychological disorders. The implications of these findings for clinical practice are discussed.     

Dissociation, trauma, and the role of lived experience: toward a new conceptualization of voice hearing

Voice hearing (VH) is often regarded as pathognomic for schizophrenia. The purpose of this article is to review and integrate historical, clinical, epidemiological, and phenomenological evidence in order to suggest that VH may be more appropriately understood as a dissociative rather than a psychotic phenomenon. First, we discuss the lifetime prevalence of VH in the general population, which is estimated to range between 1% and 16% for adult nonclinical populations and 2% and 41% in healthy adolescent samples. Second, we demonstrate how the ubiquity of VH phenomenology, including variables like voice location, content, and frequency, limits its diagnostic and prognostic utility for differentiating psychotic from trauma-spectrum and nonclinical populations. Finally, we report on the empirical associations between VH, measures of dissociation, and trauma particularly (though not exclusively) childhood sexual abuse. There are 2 main conclusions from this review. First, we argue that available evidence suggests that VH experiences, including those in the context of psychotic disorders, can be most appropriately understood as dissociated or disowned components of the self (or self-other relationships) that result from trauma, loss, or other interpersonal stressors. Second, we provide a rationale for clinicians to use psychotherapeutic methods for integrating life events as precipitating and/or maintaining factors for distressing voices. Potential mechanisms for the relationship between trauma, dissociation, VH, and clinical diagnosis are described, including the relevance of literature from the field of attachment in providing a diathesis for dissociation. Suggestions for future research are also discussed.     

Learning from women with psychosis

The article describes psychoanalytic reflections in the work of a consultant psychiatrist responsible for a recently developed female intensive care unit. The manifestations of aggression were observed to be different from that of male patients. The behavioural manifestation of aggression by women was linked to the themes of secrets, and of hidden aggression, which are described in the analytic literature as feminine characteristics. The relationships between women as sibling inpatients and with female staff may explain some of the difficulties in managing aggression. Hidden aggression in the dyad of female-to-female transferences and countertransference may contribute to problems in all female inpatient settings. Bringing together the themes of psychosis and of women from a psychoanalytic perspective, the author suggests that the care pathway leading to transfer to the intensive care unit may exacerbate psychotic symptoms in acute states, due to specific vulnerabilities of women. The provision of specialized inpatient services for women may be more therapeutic if female development and the nature of their relationships were better understood.     

Differentiation of personality types among opiate addicts

A wide range of studies indicate that although sociopathic characteristics are predominant in opiate addiction, depressive and psychotic features are also frequently observed. To test the hypothesis that there are really three types of individuals who become addicted to opiates (rather than a single, predominant personality style), fifty-three opiate addicts were given the Loevinger Sentence Completion Test, the Bellak Ego Functions Interview, and the Rorschach. Variables derived from these three procedures were submitted to cluster and discriminant function analyses. Three groups of addicts were identified--those primarily with impaired interpersonal relationships and affective lability (42%), those primarily characterized by thought disorder and impaired ego functioning (30%), and a group with diminished ideational and verbal activity (28%). Comparison of the assessment of these three groups with independently defined normal, neurotic, and schizophrenic samples provided support for three opiate-addicted personality types, each respectively characterized as character disordered, borderline psychotic, and depressed. Although there seems to be a predominance of character-disordered individuals who become addicted to opiates, the data indicate several additional types of opiate addicts with different types of psychopathology who may require different approaches to management and treatment.     

Differentiation of Personality Types Among Opiate Addicts

A wide range of studies indicate that although sociopathic characteristics are predominant in opiate addiction, depressive and psychotic features are also frequently observed. To test the hypothesis that there are really three types of individuals who become addicted to opiates (rather than a single, predominant personality style), fifty-three opiate addicts were given the Loevinger Sentence Completion Test, the Bellak Ego Functions interview, and the Rorschach. Variables derived from these three procedures were submitted to cluster and discriminant function analyses. Three groups of addicts were identified-those primarily with impaired interpersonal relationships and affective lability (42%), those primarily characterized by thought disorder and impaired ego functioning (30%), and a group with diminished ideational and verbal activity (28%). Comparison of the assessment of these three groups with independently defined normal, neurotic, and schizophrenic samples provided support for three opiate-addicted personality types, each respectively characterized as character disordered, borderline psychotic, arid depressed. Although there seems to be a predominance of character-disordered individuals who become addicted to opiates, the data indicate several additional types of opiate addicts with different types of psychopathology who may require different approaches to management and treatment.