Drugs as instruments from a developmental child and adolescent psychiatric perspective

Developmental, epidemiological, and neurobiological studies indicate that the adaptive and maladaptive functions, as well as immediate and long-term consequences of drug use, may vary by age. Early initiation seems to be associated with a reduced ability to use drugs purposely in a temporally stable, non-addictive manner. Prevention strategies should consider social environmental factors and aim to delay age at initiation.     

The student counsellor as a team member

Describing the future roles and services of British counsellors in higher and further education must not be done in professional isolation. We need to consider how the future roles of professional counsellors will positively affect the counselling done by academic staff Furthermore, rather than making generalisations about counselling needs, it may be better for working parties or task forces to develop counselling models which are appropriate to particular institutions. Such task forces should address some of the pressing issues confronting academic institutions: for example, (1) the revitalisation of the curriculum; (2) the improvement of the out-of-classroom relationships between academic staff and students; and (3) the development and maintenance of effective systems of academic government. If counsellors are to develop services which will help to resolve some of the problems associated with these issues, they will have to be increasingly clear about their own values.     

Foreign citizens as patients at a psychiatric clinic

On 98 hospitalizations of foreign patients admitted to psychopathic wards of the mental hospital of Karl-Marx-Stadt from 1983 to 1987 is reported. Basing upon whose course of the disease and under consideration of special literature of medicine, selected questions concerning boundary-exceeding psychiatry are discussed. The proceeding practical importance of questions regarding intercultural psychiatric problems is mentioned.     

The psychiatric patient as a person

The dehumanization which is so much a part of a technological society is keenly felt by psychiatric patients. Pastors must treat them with care if they are to recover their personhood. The author suggests certain pastoral approaches intended to reflect the values of the inherent worth of persons and their moral responsibility and right to self-fulfillment. Included in the approach is the need to gather the facts, establish rapport, empathize, listen with love, interpret, and have a plan of action.Professor Barnette is Professor of Christian Ethics Emeritus at the Southern Baptist Theological Seminary. He presently serves as Clinical Professor, Department of Psychiatry, University of Louisville School of Medicine, Louisville, Kentucky 40201.     

The differential effect of team members' trust on team performance: The mediation role of team cohesion

This study examines team performance as affected by various trusting relationships: trust between team members and the team's trust in their direct manager and in top management. Data for the study were collected from a survey of 690 professional elite athletes (belonging to 59 different sports clubs) playing in the regular, top professional Spanish leagues. The model was tested at the team level. Findings reveal that team member trust with respect to the different foci has both a direct and indirect effect on team performance, and that team player trust and cohesion play a mediating role. This study illustrates the dynamic relationship within teams, and, as such, trust among teammates mediates the relationship between trust in the coach as well as team cohesion in determining team performance. The implications for managing teams in other contexts are also evaluated.     

The Mini-Mult with criminal psychiatric patients.

In order to determine the usefulness of the Mini-Mult with criminal psychiatric patients, 107 MMPI profiles were rescored for the Mini-Mult and compared with the standard MMPI. Correlations between the two test forms were high but eight of the eleven means of the scales on the Mini-Mult were significantly different from the MMPI. A modest correspondence between indexes of psychopathology and scale peaks was found. Results were interpreted as indicating that the use of the Mini-Mult is not justified with this population.     

Teaching ethics on rounds: The ethicist as teacher,consultant, and decision-maker

This paper explores the relationship between teaching and consulting in clinical ethics teaching and the role of the ethics teacher in clinical decision-making. Three roles of the clinical ethics teacher are discussed and illustrated with examples from the authors' experience. Two models of the ethics consultant are contrasted, with an argument presented for the ethics consultant as decision facilitator. A concluding section points to some of the challenges of clinical ethics teaching.     

Distribution of DSM-II diagnoses in a child psychiatric setting

While DSM-II contains more diagnostic categories related specifically to children than did the earlier DSM-I, clinical utilization studies of the various categories have not been extensive. The present study reports data on the distribution of diagnoses of childhood disorders and analyzes relationships among several diagnostic categories and subject variables. Results indicate that clinicians are using a wide range of DSM-II diagnoses for childhood disorders, including some which were intended for use with adults as well as those which were designed specifically for children. Transient Situational Disorders and Behavior Disorders are assigned almost equally to two-thirds of the sample. Chi-square analyses revealed a relationship between diagnostic categories and subject variables of age and sex. These data suggest that boys, particularly between the ages of 6 and 13, are more frequently than girls categorized as Behavior Disorder, and that the Transient Situational Disorder category is overutilized for adolescents, both male and female.The authors are indebted to James H. Johnson for his valuable contributions in all phases of this study and to Peggy Louro for her assistance in data collection.     

Prognosis of the rehabilitation of psychiatric patients by Leonhard's differential diagnosis

There is a report on rehabilitation results of chronic patients after 10-years-follow-up in a psychiatric community hospital. Indication for therapy, prognosis and main fields of treatment are differently dependent on variable diseases according to the diagnostic classification given by Leonhard. Where as illness duration and professional basis don't correlate with favourable rehabilitation results additional accentuated behaviour and unfavourable social situations in interhuman relations render the rehabilitative therapy more difficult. Future research into that direction might be a basis for more effective therapeutic action.     

Multiply-divorced job hoppers presenting as psychiatric patients

Six cases are described of multiply-divorced job hoppers presenting as psychiatric patients. Following a finding by Vaillant and Milofsky (1980) in their study of the life cycle of inner-city males, a relationship is suggested in the sample of six between marital and job instability. While the six showed a capacity for the intimacy of marriage and the demands of work, they showed an inability to persevere in these demanding relationships. It is speculated that their failure to persevere in difficult, demanding relationships placed them at special risk to become psychiatric casualties.     

Medicine as metaphor and medium in group psychotherapy with psychiatric patients

A conceptualization is presented which encourages a renewed exploration of the way in which psychiatric patients discuss their medications in the group therapy setting. It is suggested that process-oriented group therapists tend to harbor subtle prejudices which may inhibit examination of this material. If we listen to medication-related discourse more carefully, we find that patients disclose important information about hopes and fears about treatment, self-efficacy, attitudes about control and authority, and other sensitive or disowned parts of experience. The process of interactions about medicines often reveals interpersonal difficulties, particularly around intimacy. Suggestions for intervening more effectively with this type of material are presented. The importance of medication attributions in revealing curative fantasies is discussed.