Psychische Störungen bei HIV-Infektion und Aids

The human immunodeficiency virus (HIV) is the pathogen responsible for acquired immune deficiency syndrome (AIDS). Worldwide there are currently about 40 million people infected with HIV and an estimated 44,000 in Germany. If left untreated after a few years the infection leads to the manifestation of AIDS and eventually to death through opportunistic infections and malignant tumors. Infection with HIV is not curable. Nevertheless, antiretroviral treatment can slow the progress of the disease and prolong life expectancy significantly. Once antiretroviral treatment has started the medication must be taken regularly and lifelong. Serious side effects of the medication pose a significant stress on physical and psychological well-being and impair adherence. Infection with HIV means a total change in life perspectives and requires extensive adaptations in lifestyle. Problems with adaptation and mental disorders (e.g. depression, anxiety disorders, adjustment disorder) are, therefore, frequent. With disease progression neurocognitive impairments are increasingly likely. Mental disorders and neurocognitive impairments adversely affect treatment adherence, increase health risk behavior and reduce immune function. Psychological interventions contribute significantly to the reduction in health risk behavior, improve treatment adherence and are successful in the treatment of depression and anxiety.     

Mental disorders,brain disorders,neurodevelopmental disorders: challenges for the philosophy of psychopathology after DSM-5

The publication of DSM-5 has been accompanied by a fair amount of controversy. Amongst DSM's most vocal ‘insider’ critics has been Thomas Insel, Director of the US National Institute of Mental Health. Insel has publicly criticised DSM's adherence to a symptom-based classification of mental disorder, and used the weight of the NIMH to back a rival research strategy aimed at a more biology-based diagnostic classification. This strategy is part of Insel's vision of a future, more preventative psychiatry in which mental disorders are not only understood as biological disorders of the brain, but also as neurodevelopmental disorders. This paper examines the interest and merit of Insel's views of mental and neurodevelopmental disorder for the philosophy of psychopathology, with a special focus of his neurodevelopmental model of schizophrenia. Pitman's ‘moderate materialism’ will be used both as a philosophical lens through which to examine Insel's position, as well as an example of a philosophical framework that may require updating and revision in the light of moves towards a neurodevelopmental conception of mental disorder.     

Spousal Influence on CPAP Adherence: Applications of Health‐related Social Control

Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders in the United Sates and is a risk factor for poor health outcomes. Continuous positive airway pressure (CPAP) therapy is an effective treatment for OSA, but adherence rates are poor. Although the spouses of patients with OSA have high potential to influence adherence, there has been minimal research to date. The purpose of this review is to summarize key findings regarding spousal influence on health‐related behavior change and treatment adherence from other medical fields (e.g., type 2 diabetes and cardiovascular disease) in which this line of inquiry has been more thoroughly developed. Recommendations are presented to guide future research investigating spousal influence on CPAP adherence based on findings from other patient populations. In particular, we emphasize the use of spousal health‐related social control as it applies to adherence and provide guidance regarding conceptual and methodological moderators.     

Overcoming Barriers to Collaboration Between Basic Behavioral Scientists and Public Health Scientists in Research on Mental Disorders

The behavioral and public health sciences both have a long and rich history supporting basic, translational, and applied research aimed at improving human lives and reducing human suffering. Through the complementary expertise of these disciplines, investigators have contributed to significant, worldwide improvements in mental and physical health. Further gains can be achieved through collaborative research among scientists in these 2 fields. Unfortunately, there are a number of barriers to such collaboration originating in different intellectual traditions, research methods, and the structure and values of academia. We identify these barriers and potential strategies for overcoming them. Several areas for future collaborative research appear promising, especially comorbid mental and physical disorders, adherence to interventions, stigma, and emotional processes. Theory-guided preventive interventions may represent especially fertile areas of collaborative effort.     

Social cognitive models of health and exercise behavior: An introduction and review of conceptual issues

Abstract

This article reviews the major social cognitive models of adherence or compliance in health and exercise behavior and attempts to show that these models are more similar to each other than different from each other. Self-efficacy theory and the theory of reasoned action/planned behavior have guided most of the theory-based research on exercise behavior. Two other models, protection motivation theory and the health belief model, have guided much research on the role of social cognitive factors in other health behaviors. These models are comprised largely of the same basic set of social cognitive variables: self-efficacy expectancy, outcome expectancy, outcome value, and intention. Two other factors, situational cues and habits, although not common to all the models, round out the theoretical picture by explaining how the relationship between the major social cognitive variables and behavior may change with repeated performance of a behavior over time.An integration of these models is offered using the theory of planned behavior as a foundation. It is suggested that research on health and exercise behavior that pits one model against another to determine which one is the better predictor of behavior is likely to be unproductive due to the striking similarities of the models. It is suggested instead that theorists and researchers focus their efforts on integration of the major social cognitive models and on determining the relative predictive utility of the various social cognitive factors with various health behaviors and in various contexts.     

心理病理学网络理论、方法与挑战

对于精神障碍这一概念的理解, 传统DSM-ICD分类诊断系统和研究领域标准RDoC均基于潜变量视角, 认为精神障碍的症状由其潜在共同原因所致。这2种观点都忽略了症状间的相互作用。不同于分类和维度视角, Borsboom在2008年对精神障碍的概念化提出了的全新视角——心理病理学网络理论。此理论的核心观点是症状之间的动态因果关系构成了精神障碍。基于心理病理学网络理论的网络分析方法, 主要以结合EBIC的glasso算法估计症状间的偏相关网络, 并通过网络中节点中心性与网络连接性等指标, 来考查精神障碍症状的不同特性。近几年来, 研究者发现心理病理学网络分析方法在对症状间因果关系的推断、核心症状的识别和网络结构的可靠性与可重复性方面仍面临一些挑战。这些挑战为心理病理学网络理论与方法指明了未来可能的发展方向。     

ANTECEDENT INFLUENCES ON BEHAVIOR DISORDERS

The influence of antecedent events on behavior disorders has been relatively understudied by applied behavior analysts. This lack of research may be due to a focus on consequences as determinants of behavior and a historical disagreement on a conceptual framework for describing and interpreting antecedent variables. We suggest that antecedent influences can be described using terms derived from basic behavioral principles and that their functional properties can be adequately interpreted as discriminative and establishing operations. A set of studies on assessment and treatment of behavior disorders was selected for review based on their relevance to the topic of antecedent events. These studies were categorized as focusing on assessment of antecedent events, antecedent treatments for behavior disorders maintained by either positive or negative reinforcement, and special cases of antecedent events in behavior disorders. Some directions for future research on antecedent influences in the analysis and treatment of behavior disorders are discussed.     

心理对照策略的内涵、功能及其相关研究

心理对照是指人们在思维过程中首先想象目标实现后的收获,然后思考现实中阻碍实现目标的因素,通过对比目标实现后的收获和现实中的障碍,使未来和现实同时通达,在未来和现实之间建立起心理联结,激活个体达成目标(成功)的期望。心理对照策略不仅能够改变人们的认知和动机,还能够改变个体对于消极反馈的反应。文章系统梳理了心理对照策略的内涵、功能及其应用研究,在此基础上,提出了4点未来的研究展望。     

临床运动心理学研究:现状、问题与建议

本文对《临床运动心理学杂志》创刊以来的99篇论文进行内容分析,以揭示临床运动心理学研究的现状与问题.研究结果表明:临床运动心理学研究领域主要为运动功能障碍、心理健康、运动功能损害、运动表现发展;研究的热点问题主要为运动表现、饮食障碍、情绪障碍、成瘾、压力应对等;研究主要以认知行为理论为基础;42.4％的研究假设有待进一步验证;研究方法存在一些问题.基于上述研究结果,对我国运动心理学研究者提出以下建议:拓展研究领域;关注研究的本土化;丰富研究的理论基础;加强研究方法训练.     

Economic,life, and disorder changes: Time-series analyses

Implicit in recent social science research and political discussions is a model linking the economy to mental disorder through the intervening constructs of life change and trauma. Using time-series analysis of a 16-month survey in Kansas City, Missouri (n = 1,140), economic and noneconomic life events and the Midtown scale were predicted using a variety of economic measures for the standard metropoliton statistical area. Both life event variables and the symptom measure were related positively to unemployment, and absolute economic change measures lagged 1 and 2 months. However, the life event variables were not strongly associated with the Midtown scale. Most striking of the subgroup findings was that, on the Midtown scale, the low-income group was more responsive than the middle-income group to economic fluctuations.     

Caregiver Knowledge and Adherence in Children With Sickle Cell Disease: Knowing is Not Doing

Though the impact of disease knowledge on adherence to medical recommendations has long been the focus of research, little of this research has focussed on sickle cell compliance in the child and adolescent population. The present study examined the relationship of caregiver knowledge of sickle cell disease (SCD) and children's adherence to prescribed behaviors. Though caregivers with high levels of knowledge of SCD were more likely to report higher levels of adherence, knowledge test score did not predict adherence for the majority of participants (72%). The effect of caregiver knowledge on reported adherence was greater among preadolescents (age ≤ 11) than adolescents (age ≥12). The relationship between knowledge and adherence may not be as strong or direct as is assumed in many theories of health behavior change.     

Commentary on evidence-based psychological treatments for older adults

This article comments on the articles in the Special Section on Evidence-Based Psychological Treatments for Older Adults. The articles apply criteria developed by the Society of Clinical Psychology to evaluate treatments for late-life anxiety, insomnia, behavior disturbances in dementia, and caregiver distress. The articles document that there are evidence-based psychological treatments that can help older adults. However, there are 2 substantial hurdles: evidence and access. Gaps in the evidence, as mentioned by the authors of the articles in the special section, result from disproportionate research attention to some psychotherapies and some mental disorders, with corresponding lack of research about other treatments and disorders. The challenge for access is to ensure that older adults with treatable mental disorders will get connected to psychologists trained in these evidence-based therapies.     

Guns,Impulsive Angry Behavior,and Mental Disorders: Results from the National Comorbidity Survey Replication (NCS-R)

Analyses from the National Comorbidity Study Replication provide the first nationally representative estimates of the co-occurrence of impulsive angry behavior and possessing or carrying a gun among adults with and without certain mental disorders and demographic characteristics. The study found that a large number of individuals in the United States self-report patterns of impulsive angry behavior and also possess firearms at home (8.9%) or carry guns outside the home (1.5%). These data document associations of numerous common mental disorders and combinations of angry behavior with gun access. Because only a small proportion of persons with this risky combination have ever been involuntarily hospitalized for a mental health problem, most will not be subject to existing mental health-related legal restrictions on firearms resulting from a history of involuntary commitment. Excluding a large proportion of the general population from gun possession is also not likely to be feasible. Behavioral risk-based approaches to firearms restriction, such as expanding the definition of gun-prohibited persons to include those with violent misdemeanor convictions and multiple DUI convictions, could be a more effective public health policy to prevent gun violence in the population. Copyright © 2015 John Wiley & Sons, Ltd.     

Prejudice,social stress,and mental health in lesbian,gay, and bisexual populations: conceptual issues and research evidence

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.     

病理性攻击行为的心理基础及其哲学本质

病理性攻击行为主要指心理、社会与生物因素导致的心理障碍或心理疾病所产生的对他人、物体与社会规范的侵犯行为.病理性攻击行为的病理基础是心理疾病(人格障碍和精神分裂症),心理基础是主体性格的多重性和矛盾性以及自我意识障碍,而病理性攻击行为的哲学本质是价值内容的紊乱和价值结构的整体性破坏.     

气温与气温变化对心理健康的影响

气温与气温变化对心理健康的威胁和影响引起越来越多研究者的关注。气温及气温变化对情绪体验、抑郁症等情感障碍、精神分裂症、阿尔茨海默等脑器质性精神障碍、物质滥用与依赖、自杀意念与行为等心理健康指标具有直接或间接的影响。气象情绪效应、棕色脂肪组织理论和血清素理论从生理角度解释气温影响心理健康的机制, 健康保持行为理论则从行为角度解释气温与心理健康的关系。儿童青少年、老年人、工人是高温与高温压力的易感人群。气温变化对心理健康的影响还存在性别、年龄、社会经济地位等方面的差异。未来研究应进一步区分不同的气温指标, 增加对低温与心理健康关系的关注, 控制其它因素对气温与心理健康关系的干扰, 并揭示群体间差异。     

中国国民心理健康素养的现状与特点

本研究以系统的全国抽样调查方式, 了解我国国民心理健康素养现状。结果显示, 我国成年公众的心理健康素养总体处于中偏低水平; 其发展水平在地域、人口学分布上比较均衡; 在结构上, 公众心理健康素养的发展表现出心理健康维护和促进的素养高于心理疾病应对的素养, 自助的素养高于助人的素养两个特点。调查还发现, 个体心理健康素养中, 知识观念部分个体差异较大, 态度和习惯部分个体差异较小; 在心理健康素养的社会性影响因素方面, 社会经济地位是所考察变量中效应最大的因素, 且其对素养的知识观念方面影响较大, 对素养的态度习惯方面影响较小。调查结果提示, 要充分认识心理健康素养提升任务的艰巨性; 在实践策略上, 宜以提升心理疾病应对的素养作为当前的工作重点和突破口。     

Dialectical behavior therapy: current status, recent developments, and future directions

Dialectical behavior therapy (DBT) was developed as a treatment for parasuicidal women with borderline personality disorder and has been adapted for several other populations. This article describes standard DBT and several adaptations of it and reviews outcome studies with borderline patients in outpatient, inpatient, and crisis intervention settings, borderline patients with substance use disorders, suicidal adolescents, patients with eating disorders, inmates in correctional settings, depressed elders, and adults with attention-deficit/hyperactivity disorder. This treatment outcome review is followed by discussion of predictors of change in DBT, possible mechanisms of change, and current developments in theory, practice, and research.     

Effective Treatment for Mental Disorders in Children and Adolescents

As pressure increases for the demonstration of effective treatment for children with mental disorders, it is essential that the field has an understanding of the evidence base. To address this aim, the authors searched the published literature for effective interventions for children and adolescents and organized this review as follows: (1) prevention; (2) traditional forms of treatment, namely outpatient therapy, partial hospitalization, inpatient treatment, and psychopharmacology; (3) intensive comprehensive community-based interventions including case management, home-based treatment, therapeutic foster care, and therapeutic group homes; (4) crisis and support services; and (5) treatment for two prevalent disorders, major depressive disorder and attention-deficit hyperactivity disorder. Strong evidence was found for the treatment of attention-deficit hyperactivity disorder, depression, anxiety, and disruptive behavior disorders. Guidance from the field relevant to moving the evidence-based interventions into real-world clinical practice and further strengthening the research base will also need to address change in policy and clinical training.     

Resolving the paradox of common, harmful, heritable mental disorders: which evolutionary genetic models work best?

Given that natural selection is so powerful at optimizing complex adaptations, why does it seem unable to eliminate genes (susceptibility alleles) that predispose to common, harmful, heritable mental disorders, such as schizophrenia or bipolar disorder? We assess three leading explanations for this apparent paradox from evolutionary genetic theory: (1) ancestral neutrality (susceptibility alleles were not harmful among ancestors), (2) balancing selection (susceptibility alleles sometimes increased fitness), and (3) polygenic mutation-selection balance (mental disorders reflect the inevitable mutational load on the thousands of genes underlying human behavior). The first two explanations are commonly assumed in psychiatric genetics and Darwinian psychiatry, while mutation-selection has often been discounted. All three models can explain persistent genetic variance in some traits under some conditions, but the first two have serious problems in explaining human mental disorders. Ancestral neutrality fails to explain low mental disorder frequencies and requires implausibly small selection coefficients against mental disorders given the data on the reproductive costs and impairment of mental disorders. Balancing selection (including spatio-temporal variation in selection, heterozygote advantage, antagonistic pleiotropy, and frequency-dependent selection) tends to favor environmentally contingent adaptations (which would show no heritability) or high-frequency alleles (which psychiatric genetics would have already found). Only polygenic mutation-selection balance seems consistent with the data on mental disorder prevalence rates, fitness costs, the likely rarity of susceptibility alleles, and the increased risks of mental disorders with brain trauma, inbreeding, and paternal age. This evolutionary genetic framework for mental disorders has wide-ranging implications for psychology, psychiatry, behavior genetics, molecular genetics, and evolutionary approaches to studying human behavior.