Issues in the psychopharmacologic assessment and treatment of the orthodox Jewish patient

As with members of other cultural and religious groups, patients within the Orthodox Jewish community present with their own distinct clinical psychiatric issues related to their unique beliefs and practices. This article reviews the existing literature and anecdotal experience on the psychopharmacologic assessment and treatment of Orthodox Jewish patients. Specific aspects examined include this group's perceived intense stigma in receiving treatment, the priority this community places on cognitive functioning, and how the influence of Jewish laws on marriage and sexual practices impacts one's treatment decisions. The relevance of Jewish dietary laws, the Sabbath, and the community's interest in alternative treatments are also discussed. The limited ethno-psychopharmacology research related to Orthodox Jewish psychiatric patients is reviewed. We conclude that understanding issues such as these is critical if one is going to work within this cultural system in order to successfully address their mental health issues. However, the dearth of controlled research in this community needs to be addressed to provide more effective treatment.     

Attributions of behavior in the pediatric mild closed head injury (CHI) population

Forty-one children between the ages of 6 and 11 years with a history of a mild closed head injury and 23 age-, gender-, and IQ-matched typically developing control children participated. All of the children in the CHI sample were referred for a magnetic resonance imaging (MRI) scan at 3 months post-injury and children in the CHI sample were further divided into MRI-Negative (n=31) and MRI-Positive (n=10) conditions according to the MRI results. Parents and teachers completed behavioral checklists at three points, including just prior to the MRI and 6 months post-injury. Prior to the MRI (Time 2), in both samples of children with a CHI, parents reported an increase in externalizing symptoms after the CHI. At 6 months post-injury (Time 3: post-MRI), parents of children in the MRI-Positive group did not report any significant changes in their child's externalizing behaviors when compared with pre-MRI, yet parents of children in the MRI-Negative group reported a further increase in externalizing behaviors. Parent attributions also changed as a function of group membership; whereas no changes were noted in the other two groups, parents of children in the MRI-Negative sample ascribed more controllability at Time 3 when compared with Time 2.     

The factor structure of the CVLT-C in pediatric epilepsy.

The current study used archival data to evaluate the fit of six latent variable models, originally generated by Donders (1999), for the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, & Ober, 1994) in a large (N = 289) sample of pediatric epilepsy cases presenting at three tertiary treatment centers. Using confirmatory factor analysis, we found that a model including factors of Attention Span, Learning Efficiency, Free Delayed Recall, Cued Delayed Recall, and Inaccurate Recall demonstrated the best relative fit for our data. These findings are consistent with those reported by Donders (1999) in his reanalysis of the CVLT-C standardization sample data, supporting the validity of this factorial model in pediatric epilepsy populations.     

The exclusion of intimacy in the sexuality of the contemporary college-age population

The sexual mores of the contemporary college population have undergone some fundamental changes in the past twenty-five years. Converging evidence from a variety of reliable sources obtained from a wide range of seemingly adjusted subjects, including personal interviews by the author, indicates that sexual involvement between partners of the opposite sex has been sporadic, episodic, without commitment, and accompanied by a deliberate effort of both partners to suppress tender, romantic feelings and intimacy. The sources of this situation are linked to changes in five domains: the ethos, the ascent of women, advances in contraceptive methods, residential mobility, and changes in child-rearing patterns. This premeditated restraint of affect has led to a noticeable diminishment of gratification derived from sexual union. It has contributed to sexual apathy, to discord, and a substantial rise in the incidence of two types of psychiatric disturbance--depersonalization and derealization. Sexual union, instead of enhancing sociability, acts as a barrier and inhibitor of enduring attachment and a sense of continuity. The repercussions on the social fabric are unexplored and merit systematic study. It is suggested that the prevailing sexual conventions of college-age youth clash with the fundamental urge to form human attachments; diminish and often shut out the experience of passion in sexual unions; and bring about inner turmoil that weakens self-confidence. As a result, it is concluded that the prevailing college-age mores are maladaptive on the individual as well as the interpersonal level. In due time, they will be replaced by more fitting conventions. This process of replacement can be hastened by an appropriate educational intervention involving younger age groups.     

The utility of the spatial span in a clinical geriatric population

Spatial Span subtest of the Wechsler Memory Scale has been viewed as an indicator of working memory and visuospatial processing. The current study examined the impact of cognitive impairment and its severity on Spatial Span performance. A neuropsychological battery including Spatial Span was administered to 538 individuals (65-89) who were grouped by consensus into Alzheimer's disease, Vascular Dementia, Amnestic Mild Cognitive Impairment, Non-Amnestic Mild Cognitive Impairment and cognitively normal. Increase in level of impairment resulted in a decrease in Spatial Span Total Score. A weak relationship between age and Spatial Span Total Score was found. Spatial Span Forward remains relatively stable regardless of level of impairment. Spatial Span Backward was more sensitive to severity. No significant differences were found between individuals diagnosed with Alzheimer's disease and those with Vascular Dementia suggesting similar deficit patterns in the cognitive abilities measured by the Spatial Span. Mild Cognitive Impairment groups and normals did not differ suggesting visuospatial processes are not affected early in the dementing process.     

The role of comorbid disruptive behavior in the clinical expression of pediatric obsessive-compulsive disorder

This study explored the impact of disruptive behavior disorder (DBD) comorbidity on a number of theoretically relevant outcomes among 192 children and adolescents with obsessive-compulsive disorder (OCD). Youth were divided into three groups: OCD Only, OCD+DBD comorbidity and OCD+Other comorbidity. Relative to those without a comorbid condition and those with any non-DBD comorbidity, comorbid DBD was associated with greater family accommodation and less symptom resistance. Youth with comorbid DBD exhibited greater OCD symptom severity, OCD-related impairment, anxiety, and internalizing problems than those with no comorbidity. Those with comorbid DBD were over 3.6 times as likely to be taking an atypical antipsychotic medication relative to children without comorbidity. The present results suggest that comorbid DBD contributes to more severe illness presentation above and beyond an OCD diagnosis alone, and may be associated with differing pharmacotherapy prescribing practices.     

Magnetoencephalography in pediatric neuroimaging

Neural currents give rise to electroencephalogram (EEG) and magnetoencephalogram (MEG). MEG has selective sensitivity to tangential currents (from fissural cortex), and less distorted signals compared with EEG. A major goal of MEG is to determine the location and timing of cortical generators for event‐related responses, spontaneous brain oscillations or epileptiform activity. MEG provides a spatial accuracy of a few mm under optimal conditions, combined with an excellent submillisecond temporal resolution, which together enable spatiotemporal tracking of distributed neural activities, e.g. during cognitive tasks or epileptic discharges. While the present focus of pediatric MEG is on tailored epilepsy surgery, the complete noninvasiveness of MEG also provides unlimited possibilities to study the brain functions of healthy and developmentally deviant children.     

The detection and management of mental health disorders in pediatric primary care

We reviewed the literature on the detection and management of mental health disorders within the context of pediatric primary care. Pediatricians have displayed a low sensitivity and high specificity in research investigating the detection of mental health impairment in children. Active management efforts characterize approaches to identified cases with more recently trained primary care pediatricians displaying a wider range of skills in managing mental health disorders. Few efforts have been made by pediatric psychologists to develop strategies for enhancing detection rates and management or to empirically evaluate the integration of pediatric psychology services into the primary care context. A conceptual model of factors influencing detection rates and ongoing management of mental health disorders within pediatric primary care is presented. Recommendations are made for more direct involvement of pediatric psychologists within the primary care context.     

Neurocognitive outcomes in pediatric HIV

Cognitive impairment has long been associated with the natural history of HIV among vertically infected children. In children, HIV may have a direct or indirect impact on the developing brain, may lead to global or highly specific consequences, and may be responsible for minor cognitive consequences or, conversely, long-term and severe disability. This differential impact is related to multiple factors that influence the individual expression of the virus in any given child. This review provides an overview of the relevant literature on neurocognitive outcomes for infants, children, and youth vertically infected with HIV, with attention to those factors impacting neurocognitive outcome within a developmental framework. Research findings in both the era preceding and following the introduction of combined therapies are reviewed, since many of the issues identified prior to state-of-the-art treatment currently available in the United States and other developed countries still apply in much of the developing world. Intervention issues and directions for future research are also discussed.     

Delineating paternalism in pediatric care

Theoretical Medicine and Bioethics - Paternalism in the medical care of children is appropriate and ethically justifiable. However, dilemmatic disagreement by paternalistic agents as to which...     

The Scientist and the Artist: adaptive dissociation within the HIV-positive population

This paper reports on the findings of two independent qualitative studies which were conducted with HIV-positive cohort over a period of 2010–2012. Although the original studies used different qualitative designs (IPA and Grounded Theory), the authors have nevertheless sought to explore the combined utility of their findings by using a broad stance of phenomenological enquiry. The authors argue that evidence of a particular dissociative pattern in their accounts of an HIV-related experience is present in the contributors' narrative. Dissociation in this context occurred not in personality but between different or discrete mental faculties such as memory, emotions, perceptions and thought. It was suggested that it serves adaptive function and therefore could be utilised in clinical work when appropriate.