Clinically useful assessments: substance use and comorbid psychiatric disorders

This review addresses the assessment of substance use and related constructs with persons having severe and persistent mental illness. The review contains two major sections. The first section focuses on issues particular to the assessment of substance use and abuse in the context of major mental illness; these include the social and motivational context of assessment, the impact of mental status and acute symptoms, limitations associated with acute and chronic cognitive impairment, and the psychosocial relevance of assessment items. The second section highlights a selected set of substance assessment tools for use with this population; evidence for the reliability, validity, and/or feasibility of these tools is summarized. Each instrument meets the criteria of being: (a). relatively brief; (b). easy to administer and interpret; and (c). useful for treatment planning, motivational feedback, and/or monitoring change.     

Marshaling administrative data to study the prevalence of mental illness in assault on law enforcement cases

A substantial body of literature has investigated many issues surrounding police encounters with persons with mental illness. This paper focuses on a specific type of encounter – individuals with mental illness charged with assaulting officers because of their behavior during a psychiatric crisis – and uses administrative data to examine its prevalence in one state. Results suggest that individuals with mental health histories comprise a small but meaningful percentage (c. 9%) of assault on law enforcement charges, and c. 10% of these charges have an offense date within 14 days of an emergency mental health custody order, increasing the likelihood that psychiatric symptoms influenced their behavior at the time of the offense. Further results describe different categories of relevant charges, charge classifications, final dispositions, and sentences. Results are discussed in the context of outcomes for persons with mental illness and law enforcement as well as the role and limitations of forensic mental health assessment in these cases. The paper concludes with a call for similar data collection across jurisdictions.     

Mental animation: inferring motion from static displays of mechanical systems.

Reaction-time and eye-fixation data are analyzed to investigate how people infer the kinematics of simple mechanical systems (pulley systems) from diagrams showing their static configuration. It is proposed that this mental animation process involves decomposing the representation of a pulley system into smaller units corresponding to the machine components and animating these components in a sequence corresponding to the causal sequence of events in the machine's operation. Although it is possible for people to make inferences against the chain of causality in the machine, these inferences are more difficult, and people have a preference for inferences in the direction of causality. The mental animation process reflects both capacity limitations and limitations of mechanical knowledge.     

Rehabilitative Beit Midrash as a means for advancing the community integration of Ultra Orthodox Jewish persons with severe mental illness

ABSTRACT

Religious Jews with severe mental illness often encounter barriers to involvement in religious activities in their community affecting their ability to become integrated into their community. Therefore, a study was conducted in Israel examining the contribution to community integration through a programme providing religious persons with mental illness an opportunity to participate in religious studies. An A-B research design was implemented among 42 Ultra-Orthodox Jewish persons with severe mental illness utilising a culturally-oriented structured instrument. The study showed that the opportunity for involvement in religious studies could advance the participants’ sense of social interaction in their community as well as their sense of psychological integration with other religious people. It also strengthened their confidence in their ability to further get involved in religious studies in the community. Rehabilitation services providing persons with severe mental illness an opportunity for involvement in religious studies can act as a springboard for advancing their community integration.     

Role of Political Skill in Job Performance Prediction Beyond General Mental Ability and Personality in Cross‐Sectional and Predictive Studies1

Political skill is the capacity to understand others in working life effectively, and to apply such knowledge to induce others to act in ways that add to one's personal or organizational goals. The present investigation reported the results of 2 studies designed to examine the job performance prediction effectiveness of political skill when investigated in conjunction with general mental ability (GMA) and personality characteristics. The results demonstrated that political skill accounted for a significant proportion of job performance variance beyond GMA and personality variables cross‐sectionally in Study 1, and predictively (i.e., using a 1‐year timeframe) in Study 2 examining effects on multiple dimensions of job performance. The implications of these results, strengths, limitations, and directions for future research are discussed.     

Capacity and retention capability of working memory modify the strength of the RT/IQ correlation: a short note

The limited capacity theory assumes that working memory (WM) has limited capacity to process information and, at the same time, to store other pieces of information, necessary for further processing. Quick processing of data is supposed to be the only way to solve the task without the risk of losing vital pieces of information. We predicted, then, that the correlation between mental speed, measured by reaction time (RT), and the intelligence quotient (IQ) should not appear in the case of persons who possess a relatively capacious WM store, or who show increased retention capability of their WM store. Such persons do not need to be fast, whereas, for people who show poorer indices of capacity or retention capability of WM, mental speed is the only way to tackle a complex and difficult intellectual task. As predicted, the RT/IQ correlation appeared much stronger in the group of subjects characterized by lower retention capability and capacity of WM.     

Relation between sport and spatial imagery: comparison of three groups of participants

The literature suggests that sport may be considered a spatial activity and that engaging in spatial activities increases the capacity of an individual to implement mental imagery. Moreover, mental rotation calls upon motor processes that are heavily involved in sporting activities. For these reasons, the authors hypothesized that athletes ought to perform mental rotation tasks better than nonathletes. Also, athletes trained to react quickly to constantly changing environments should be faster at processing the information in a mental rotation task than athletes operating in more settled environments. The results of this study show that athletes performed the mental rotation task significantly faster than nonathletes. These results support the suggestion that there is a link between sport and the ability to perform mental image transformations; however, this ability may not be specific to the conditions in which the athlete performs.     

The Relationship of Functional Variables and Psychopathology to Aggressive Behavior in Persons With Severe and Profound Mental Retardation

A number of hypotheses have emerged regarding the etiology of physical aggression in persons with mental retardation. Although a multicomponent model is appropriate, results of functional analysis-based studies have yielded promising results in identifying instigating and maintaining factors of aggression. However, the relationship between functional variables and conditions such as psychiatric diagnosis to aggressive behavior has yet to be investigated in persons with mental retardation. We conducted a study examining the prevalence of environmental or physical factors in aggressive behavior in mentally retarded persons with and without psychiatric disturbance. One hundred and thirty-five individuals with mental retardation who exhibited physical aggression were assessed with the Questions About Behavior Function Scale (QABF) to identify environmental or physical contribution to aggressive behavior. One or more behavioral functions were identified for 75% of the participants. Additionally, of 66 of the participants scoring above the clinical cutoff on an assessment for dual diagnosis, 75% met criteria for an environmental or physical function for aggression. No significant differences in number of participants with an identifiable function of aggression were found between the no dual diagnosis and dual diagnosis groups. Our findings underscore the importance of identifying functions underlying aggressive behavior in persons with mental retardation, and the need to consider functional variables regardless of psychiatric condition in treatment planning efforts for such individuals.     

Acculturation in Women with Mental Retardation and Its Impact on Genetic Counseling

The provision of genetic counseling to women with mild mental retardation poses many challenges, some directly related to their developmental and cognitive disabilities. Traditional genetic counseling models, in which decision-making is largely based on the understanding of factual information, are particularly affected by the intellectual limitations which characterize this population. Equally important, however, are these women's attitudes, perceptions, and behaviors related to their involuntary inclusion into a highly stigmatized social group. Common themes among these women which surface in the genetic counseling setting include the denial of mental retardation, a hierarchical perception of their own and others' disabilities, and a strong motivation to conceive and parent a child. Such attitudes and behaviors may be symptomatic of acculturation, as these women struggle to take on accepted social roles while rejecting the stigma of intellectual disability. In contrast to factual information, the counselee's ability to discuss emotions and perceptions is not necessarily hampered by her intellectual limitations. A focus on the recognition and discussion of psychosocial issues provides a more meaningful approach than traditional genetic counseling models for facilitating informed reproductive decisions among women with mental retardation.     

The epidemiology of violent behavior in patients with a psychotic disorder: A systematic review of studies since 1980

Since the 19th century, it has been widely acknowledged that persons with a psychotic disorder are more often involved in violent crimes than those without mental problems, which is confirmed by several recent review papers and meta-analytic studies. However, the caveats and limitations of these studies have been largely neglected. In the present systematic review paper, the epidemiological studies that were published since 1980 on the link between psychosis and violent behavior were critically reviewed. Electronic databases were searched to initially identify 5756 articles. A total of 26 articles were eventually selected as they met all selection criteria. Studies were categorized according to their research design (i.e., birth cohort, community, register/record-based). Although schizophrenia and other related psychotic disorders seem to be undoubtedly associated with violent behavior (with OR's between 2 and 28), it should be kept in mind that underlying variables or risk factors (e.g., family history of violence, emotions such as anger and anxiety, impulsivity, childhood problems), the study design, and conceptual problems (i.e., definitions of violence/aggression and schizophrenia/psychosis) might be particularly relevant when interpreting the link between violence and psychosis.     

Reasonable accommodation for employees with mental disabilities: a mandate for effective supervision?

Reasonable accommodation under Title I of the Americans with Disabilities Act (ADA) for employees with mental disabilities is explored from a behavior analytic perspective. Although much of the attention in issues of reasonable accommodation is concentrated on persons with physical disabilities, it is argued that the needs of individuals with mental disabilities are in greater need of further study. The criteria for successful accommodation in the workplace for employees with mental disabilities is seen to be structurally different, but functionally similar to successful accommodations for employees with physical disabilities, and is based on the development of enabling environments. Behavior analysis offers a theoretical basis and performance management presents a methodological basis for analyzing, developing, implementing, and evaluating reasonable accommodation for persons with mental disabilities, largely in terms of effective supervision. It is concluded that Title I of the ADA may be seen as providing a mandate for effective supervision, which may also be extended to all employees.     

Relation between self-paced and synchronized movement in persons with mental retardation

The relation between self-paced and synchronized tapping in 64 persons with mental retardation whose mental ages ranged from 2 to 11 years and chronological ages from 13 to 23 years was investigated. In a self-paced tapping task no stimulus was presented, and subjects' easy and spontaneous tapping was measured. In a synchronized tapping task their synchronous tapping with an auditory stimulus present at a quick or slow tempo was measured. Under both tempo conditions, the lower the subjects' mental age, the larger the errors in the intertap interval they made. The subjects of low mental age showed significantly larger errors in the intertap interval in the Slow than in the Quick Tempo condition and tended to tap at a rate near the self-paced tapping. These results may suggest that ability to adjust one's self pace is one of the key factors in the development of motor synchronization in persons with mental retardation.     

The emotional health of the clergy

Summary and conclusions The health we seek is creative growth through all the relationships of life. We need an elastic concept of health, with a capacity to accept limitations and to do our best with these limitations in creative efforts to keep growing.We need to be aware of the particular hazards in this vocation, which may endanger the emotional health of the clergyman. Seeing these more clearly we can better prepare to cope with them.We must know to whom we belong, and learn to be at home with those persons and groups who become our living, working, and reciprocal community of outgoing care and forgiving love.If we can see emotional health as a dynamic process of ever-growing outreach and integration, we will value the stresses of our life and work. The pains as well as the joys contribute to the challenge and fulfillment of persons who grow through creative encounter with other persons.Continuing education will be needed for this crucial vocation of ministering to others, as it is in every serving profession where the complexities of life are so baffling. Academic courses and library study, though needed, will not suffice to prepare for effective work with other persons in face-to-face relations. There will be constant need for supervised evaluation of what we are and seek to become to others in the critical moments of meeting, listening, and responding as person to person in the ultimate concerns of our life in community.He is also a member of the Academy.     

Effects of the iodine deficiency on intellectual variables among children

An association between severe iodine deficiency and poor mental development has been found in many studies. We examined the relationship between moderate or mild iodine deficiency and intellectual capacity in order to determine whether problems common to severe iodine deficiency (including mental retardation) also emerge in a more subtle form. We also wished to know whether the classic methodology (comparing iodine-deficient zones with nondeficient zones) is the most adequate, and propose to combine this grouping by zones with urinary iodine presented by individuals in each zone. We measured IQ, manipulative and verbal capacity, attention, visual motor ability and disruptive behaviour, variables that have barely been studied in this kind of investigations. The sample comprised 760 schoolchildren from the province of Jaén (southern Spain). Our results show that children with low levels of iodine intake and with urinary iodine concentration lower than 100 microg/litre had a lower IQ and displayed more disruptive behaviour than children with high levels of the criteria. The other variables were not associated with iodine deficiency.     

Can Ziskin withstand his own criticisms? problems with his model of cross-examination

Ziskin has mounted a concerted attack on the scientific basis of psychology and psychiatry and their ability to provide expertise to the courts. He has assailed both the clinical methods and conclusions rendered by these mental health professionals. To rebut expert testimony, Ziskin has proposed general principles of cross-examination. We discuss the limitations of this model and provide an initial study of its effectiveness.     

Spiritual Struggles and Mental Health: Exploring the Moderating Effects of Religious Identity

Although many studies have explored the salutary associations between multiple dimensions of religiousness and psychological well-being, a smaller body of work has focused on the links between spiritual struggles and negative mental health outcomes. Two types of spiritual struggles have received considerable attention in this literature: divine struggles, or troubled relationships with God, and struggles with belief, or religious doubts. Using data from a nationwide online survey of U.S. adults conducted in 2006, our study investigated links between these types of spiritual struggles and four aspects of psychopathology: depressed affect, anxiety, phobic anxiety, and somatization. In particular, we tested the hypothesis that these links vary according to religious identity, such that individuals who identify themselves as highly religious—and therefore are likely to be most invested in their roles as religious persons—experience the strongest negative effects of spiritual struggles, in comparison with persons who identify themselves as moderately religious, or not religious at all. Findings supported this overall hypothesis. The article concludes by noting several study limitations and identifying promising directions for further research.     

Memory of psychodiagnostic information: biases and effects of expertise

Problem-solving expertise has been associated with enhanced memory of domain-specific information. This enhanced memory is thought to play an important role in expert decisions. Meanwhile, research on psychodiagnostic decision making has found consistent limitations in experienced clinicians' ability to make optimal decisions. To what extent are these limitations associated with suboptimal memory processes? We compared memories of expert clinicians and novice graduate students for information learned while viewing a videotaped psychodiagnostic interview. Results of 3 tests suggest that expert clinicians exhibit enhanced memory that is flexible, selective, and accurate but with limitations that might contribute to poor decisions. Experts exhibited superior memory of personal criteria and disconfirmatory information. However, a framing manipulation induced performance in experts consistent with suboptimal decision making, and both groups needed exhaustive prompts for optimal memory search. Implications of these findings for expertise models are discussed.     

Sequential Presentation Protects Working Memory From Catastrophic Interference

Neural network models of memory are notorious for catastrophic interference: Old items are forgotten as new items are memorized (French, 1999; McCloskey & Cohen, 1989). While working memory (WM) in human adults shows severe capacity limitations, these capacity limitations do not reflect neural network style catastrophic interference. However, our ability to quickly apprehend the numerosity of small sets of objects (i.e., subitizing) does show catastrophic capacity limitations, and this subitizing capacity and WM might reflect a common capacity. Accordingly, computational investigations (Knops, Piazza, Sengupta, Eger & Melcher, 2014; Sengupta, Surampudi & Melcher, 2014) suggest that mutual inhibition among neurons can explain both kinds of capacity limitations as well as why our ability to estimate the numerosity of larger sets is limited according to a Weber ratio signature. Based on simulations with a saliency map-like network and mathematical proofs, we provide three results. First, mutual inhibition among neurons leads to catastrophic interference when items are presented simultaneously. The network can remember a limited number of items, but when more items are presented, the network forgets all of them. Second, if memory items are presented sequentially rather than simultaneously, the network remembers the most recent items rather than forgetting all of them. Hence, the tendency in WM tasks to sequentially attend even to simultaneously presented items might not only reflect attentional limitations, but also an adaptive strategy to avoid catastrophic interference. Third, the mean activation level in the network can be used to estimate the number of items in small sets, but it does not accurately reflect the number of items in larger sets. Rather, we suggest that the Weber ratio signature of large number discrimination emerges naturally from the interaction between the limited precision of a numeric estimation system and a multiplicative gain control mechanism.