Psychiatric Disorders in Clinical Genetics I: Addressing Family Histories of Psychiatric Illness

This is the first article of a two-part professional development series addressing genetic counseling for personal and family histories of psychiatric disorders. It is based on an Educational Breakout Session presented by the Psychiatric Special Interest Group of the National Society of Genetic Counselors at the 2006 Annual Education Conference. This article examines issues that arise in addressing family histories of psychiatric illness, while the second article in the series considers the generation and provision of individualized recurrence risks for psychiatric disorders. In this article we discuss the importance of managing uncertainty for affected individuals and their close family members who have been referred to genetics for a number of different indications. We then use four simulated cases to make recommendations about the scope and timing of discussions related to the psychiatric family history.     

Genetic Counselling for Psychiatric Disorders: Accounts of Psychiatric Health Professionals in the United Kingdom

Genetic counselling is not routinely offered for psychiatric disorders in the United Kingdom through NHS regional clinical genetics departments. However, recent genomic advances, confirming a genetic contribution to mental illness, are anticipated to increase demand for psychiatric genetic counselling. This is the first study of its kind to employ qualitative methods of research to explore accounts of psychiatric health professionals regarding the prospects for genetic counselling services within clinical psychiatry in the UK. Data were collected from 32 questionnaire participants, and 9 subsequent interviewees. Data analysis revealed that although participants had not encountered patients explicitly demanding psychiatric genetic counselling, psychiatric health professionals believe that such a service would be useful and desirable. Genomic advances may have significant implications for genetic counselling in clinical psychiatry even if these discoveries do not lead to genetic testing. Psychiatric health professionals describe clinical genetics as a skilled profession capable of combining complex risk communication with much needed psychosocial support. However, participants noted barriers to the implementation of psychiatric genetic counselling services including, but not limited to, the complexities of uncertainty in psychiatric diagnoses, patient engagement and ethical concerns regarding limited capacity.     

Psychiatric diagnoses in infancy: A comparison

This study investigated the specificity of diagnostic classification in two standardized systems: DSM-IV and Diagnostic Classification: Zero to Three. A sample of 82 infants aged 1–24 months suffering from various psychogenic and functional pediatric symptoms was diagnosed applying both systems. For DC: 0–3 (the Diagnostic Classification on Mental Health and Developmental Disorders of Infancy and Early Childhood), this study presents results with respect to the specificity of symptom patterns. Twelve out of 27 symptoms, specific for disorders in early infancy, showed high specificity and were significantly discriminative for the diagnostic entities. These symptoms were differentiated for frequency and severity of occurrence for each diagnosis. In the sample, DSM-IV and DC: 0–3 diagnoses were compared. Additionally, 13 items of biographical-biological data were collected (e.g., low SES combined with very young or older mothers resulted in an increased risk for psychiatric disorders in early infancy). The data provide support for the idea that the use of DC: 0–3 in early infancy may be helpful in relation to daily routines and research by increasing the range of clearly defined diagnostic entities.     

Teaching Psychiatric Patients: A Psychoanalytic Study

This paper attempts to describe some of the challenges of teaching psychiatric patients within a hospital environment. It uses post-Kleinian ideas to look at the unconscious processes at work within the learning/teaching dynamic and observes the psychotic mind's unique approach to learning. The central hypothesis of the paper is that psychoanalytic reflection of educational processes within a psychiatric institution is of clear benefit to both teacher and learner, and can also forestall several of the more problematic or even harmful outcomes of the increasing trend to ‘educate’ the patient.     

Psychiatric Epidemiology: Its Relevance for Counselors

Review of five articles from the epidemiological series appearing in the Archives of General Psychiatry, 1984, 41, 934–979.     

Suicide in Psychiatric Patients: Age Distribution

ABSTRACT: In eight years, 21183 San Diego County residents killed themselves. Of these, 52 had been at some time patients of one private psychiatric group. The suicide rate increased with age for the county population but not for the psychiatric patients. This difference was highly significant. Although older people generally are at greater risk for suicide, older psychiatric patients may be more responsive to treatment.     

Paranoid atmospheres: Psychiatric knowledge and delusional realities

In this paper I investigate the topic of paranoid atmospheres. This subject is especially of interest with respect to persons who are deluded, and also, I will demonstrate, sheds light upon the psychiatrist's "gaze" and knowledge of delusions. In my argument I will follow a path initially outlined by Karl Jaspers (1883-1969): modern psychiatric diagnosis of delusions is a diagnosis of form and not content. Jaspers' emphasis on the form of delusions enables psychiatrists to be self-critical about their professional knowledge and, consequently, prevent the development of dogmatic attitudes. In accord with Jaspers, my argument will focus on the basic structure of delusions and highlight the difference between delusional realities and non-delusional realities, a difference that follows from the possibility of self-criticism of one's own conscious and explicit convictions. I will demonstrate the importance of self-criticism with regard to paranoid atmospheres and also to psychiatric knowledge. In this manner, an understanding of delusions as lived experience will be developed, which argues that an escalation of the influence of delusional convictions, resulting in a profoundly paranoid atmosphere, is most problematic for the deluded person. To acknowledge this insight mirrors the need for a self-critique of psychiatric discourse, encourages an empathic and respectful relationship between professionals and deluded patients, and enables deluded persons to restrict their paranoid atmosphere. It is the main conclusion of my paper that a deluded person cannot do (with respect to his delusional convictions) what a psychiatrist must do (with respect to his psychiatric knowledge and his own existential convictions) in order to prevent a profoundly paranoid atmosphere in their relationship: be self-critical.     

Short-Term Psychiatric Treatment

With the increasing prevalence of short-term psychiatric hospitalization, brought about in part by reduced inpatient insurance coverage, decisions must be made concerning both the nature of treatment and who will provide services. The impracticality of traditional rehabilitative services in these settings has serious implications for the future role of occupational therapists in psychiatric health care. It is proposed that necessary modifications to treatment approaches must and can be made without abandoning fundamental theories of practice. Recommendations are made to upgrade the current level of practice via improved communication of information concerning short-term methodologies, to develop long-range plans to strengthen professionalism, and to make greater use of community-based alternatives for the delivery of services no longer practical in short-term treatment settings.     

Personality Traits and Psychiatric Rehospitalization: A Two-Year Follow-up

This study followed 188 people with psychiatric impairments for 2 years after their discharge from a public psychiatric facility to assess the impact of personality traits on rehospitalization. A Cox regression analysis revealed a significant relation between the pattern of personality traits and psychiatric rehospitalization. The significant relation was retained after age, sex, race, education. Axis I diagnosis, subscale scorns on the Brief Symptom Inventory, Methods of Coping Scale, Level of Expressed Emotion Scale, and scores on the alcohol and drag dependence scales of the MCMI-II were included in a stepwise inclusion analysis. The implications of these results for the assessment and treatment of people with psychiatric impairments are discussed.     

Childhood Cruelty to Animals: Psychiatric and Demographic Correlates

This retrospective study compared frequencies of aggressive behaviors and abuse histories noted during a psychiatric intake assessment for children where animal cruelty was endorsed and a control sample of youth for whom animal cruelty was not endorsed to determine if rates of concerning behaviors differed significantly. Relative to the control group, the cruelty group was significantly more likely to have had problems with peers, perpetrated bullying, experienced sexual abuse, and have a history of sexually acting out. Recommendations for childhood animal cruelty screening in mental health settings are discussed.     

Walter Glannon: Psychiatric neuroethics: studies in research and practice

Theoretical Medicine and Bioethics -