Male life-course persistent antisocial behavior: A review of neurodevelopmental factors

Life-course-persistent antisocial behavior, which is almost exclusively male, is arguably the single most important child clinical problem. The neurodevelopmental factors which contribute to this markedly male predominance stem from the greater male vulnerability to inherited and acquired neurodevelopmental impairments which increase the risk for antisocial behavior. The factors that contribute to this greater male vulnerability are discussed, and implications for prevention are presented.     

Psychosocial aspects of genital herpes virus infection

Genital herpes virus infection is one of the most prevalent and perhaps the most emotionally difficult of the sexually transmitted diseases. This article examines the current empirical and clinical understanding of the psychosocial aspects of the disease and proposes a framework for future investigation. Psychosocial issues of importance in the disease are discussed and responses characteristic of the psychosocial adjustment process are presented. Evidence of the role of stress and psychosocial factors is reviewed. Finally, a biopsychosocial research approach to the psychoneuroimmunological mechanisms of the disease is suggested as a way of understanding etiology and process.     

Why physicians should not do ethics consults

Increasing complexities facing physicians negotiating the bedside decision continue to fuel the debate over who is the appropriate party to offer ethics consults, should one be needed, during the decision-making process. Some very good arguments have been put forth on behalf of clinical ethicists as being the proper and best party to engage in ethics consultations. However, serious questions remain about the role of the clinical ethicist and his ability to provide the necessary level of objectivity called for in an ethics consult. I argue that the clinician's professional psyche, or mode of thinking as a professional, leaves him little room to maneuver as an objective and detached third party ethics consultant. Several factors are cited and discussed that greatly influence the analyses applied to a case problem by physicians. The most formidable of these factors are habits and the practice of defensive medicine. I conclude that clinical ethicists are less suited for the overall tasks required of an objective consultant in medical cases that appear to involve insurmountable ethical issues.     

The development of antisocial behaviour patterns in childhood and adolescence

A developmental model of antisocial behaviour is presented in this paper. Arguments and evidence are presented for the position that although many factors such as parent criminality, social and economic disadvantage, child temperament, and marital discord systematically affect the development of antisocial child behaviour, their influence is mediated by the extent to which they disrupt day-to-day parenting practices. Particularly, it is argued that irritable, ineffective discipline and poor parental monitoring are the most proximal determinants of the early development and maintenance of antisocial behaviour. The implications of this model for prevention and intervention in child conduct problems are discussed, using examples of promising clinical work that focuses on direct parent training.     

Complications in group psychotherapy with AIDS patients

AIDS has a unique set of characteristics that makes group psychotherapy more complex than with other populations: (1) the threat of an early death, (2) a highly variable course of illness, and (3) stigma related to the illness and to the preexisting lifestyles of most patients. The specific ways in which the three factors seriously interfere with establishing and maintaining group cohesion are discussed, and clinical guidelines are suggested. In addition, a model for understanding and working with these and other issues in group psychotherapy, based on Erik Erikson's interpersonal theory of development, is presented. Finally, particular countertransferential difficulties are discussed in relation to the heightened emotionality common to AIDS psychotherapy groups.     

Typologies of Alcohol Dependence. From Jellinek to Genetics and Beyond

The goal of typology research is to identify subtypes of alcohol dependent (AD) patients sharing fundamental characteristics and try to match each subtype, with the most precise treatment strategy. This review provides a comprehensive history of the literature on alcohol dependent subtypes starting from the earliest attempt made by Jellinek. The binary models identified most closely with Cloninger and Babor as well as the successively more complex classifications are discussed. Typology classification potentially useful in guiding the treatment of AD patients, especially in the case of the serotonergic medications. Contrasting data suggests that other factors could influence the response to a medication and/or that more complex typologies should be identified. In summary, typology models may assist in the ascertainment criteria for clinical trials performed in behavioral and pharmacotherapeutic interventions. Greater emphasis, however, must be made to more clearly delineate this field of research, while moving toward more standardized typologies.     

The five-factor model and its assessment in clinical settings.

Personality researchers have recently converged on the five-factor model as an adequate representation of the structure of personality traits. This article introduces the factors and the NEO Personality Inventory (NEO-PI), a questionnaire designed to measure the factors and some of the traits that define them. Data on the comprehensiveness of the model and on the reliability, validity, and stability of measures of the factors are reviewed, and correlations between scales from the NEO-PI and two instruments widely used in clinical practice (the Minnesota Multiphasic Personality Inventory [MMPI] and the Millon Clinical Multiaxial Inventory [MCMI]) are used to illustrate similarities and differences between normal and clinical assessment. Some issues regarding the clinical use of the five-factor model are discussed.     

Confidence in memory and other cognitive processes in obsessive-compulsive disorder

Previous studies have implicated beliefs about one's memory (i.e., meta-memory), in maintaining the symptoms of obsessive–compulsive disorder (OCD), particularly with respect to checking rituals. However, most research has focused on task- or situation-specific perceptions about memory performance. Expanding on this research, we undertook two studies with analogue and clinical cohorts to examine the relationship between general ‘trait’ beliefs about memory and related processes and OCD symptoms. Trait meta-memory as measured in the current study was conceptualised as a multi-dimensional construct encompassing a range of beliefs about memory and related processes including confidence in one's general memory abilities, decision-making abilities, concentration and attention, as well as perfectionistic standards regarding one's memory. Meta-memory factors were associated with OCD symptoms, predicting OCD symptoms over-and-above mood and other OCD-relevant cognitions. Meta-memory factors were found to be particularly relevant to checking symptoms. Implications for theory and research are discussed.     

Does theory have value in clinical child psychology?

Examines the value and importance of theory in child psychology, particularly with respect to clinical practice. Although it is readily apparent that theory is not an essential element of treatment, the role of theory is to provide a coherent framework for clinical intervention. Theory provides a foundation for understanding the presenting pathology, the factors that affect it, the patient's and therapist's roles within the context of treatment, and the specific intervention strategies to be utilized. Therapeutic commonalities are considered as they may affect treatment outcome, but they are not viewed as the essential factors in efficacy. The value and meaning of eclecticism are also discussed.     

The Object Relations Technique by Herbert Phillipson

AIDS has a unique set of characteristics that makes group psychotherapy more complex than with other populations: (1) the threat of an early death, (2) a highly variable course of illness, and (3) stigma related to the illness and to the preexisting lifestyles of most patients. The specific ways in which the three factors seriously interfere with establishing and maintaining group cohesion are discussed, and clinical guidelines are suggested. In addition, a model for understanding and working with these and other issues in group psychotherapy, based on Erik Erikson's interpersonal theory of development, is presented. Finally, particular countertransferential difficulties are discussed in relation to the heightened emotionality common to AIDS psychotherapy groups.     

Avoidance of Counseling: Psychological Factors That Inhibit Seeking Help

How do counselors reach out to individuals who are reluctant to seek counseling services? To answer this question, the authors examined the research on the psychological help‐seeking barriers from counseling, clinical and social psychology, as well as social work and psychiatry. Specific avoidance factors that have been identified in the mental health literature; important variations in the setting, problem type, demographics, and cultural characteristics that can influence the degree to which avoidance factors affect professional help‐seeking decisions; and suggestions for overcoming these avoidance factors are discussed.     

Ethical issues in the clinical application of fMRI: factors affecting the validity and interpretation of activations

The ability of functional magnetic resonance imaging (fMRI) to localize activations in a single patient, along with the safety and widespread availability of this methodology, has lead to an increasing use of fMRI for clinical purposes such as pre-surgical planning. As methodology continues to improve and more experience with fMRI in the clinical setting is acquired, clinical functional neuroimaging will likely have an increasing influence over patient care. Therefore, ethical use of fMRI, as with other medical techniques, requires understanding the factors impacting the interpretation of the methodology. Issues affecting the validity and interpretation of clinical functional neuroimaging, including effects of altered hemodynamic response function, head motion, and structural changes in the brain, are reviewed. The distinction between correlated and necessary activation in a clinical context is discussed. Different types of statistical errors in fMRI analysis are described, along with their consequences to the patient. Finally, for the future of clinical fMRI development, the need for normative patient data, as well as standardized tasks, scan protocols, and data analyses, is discussed.     

Issues in engaging high-risk adolescent mothers in supportive work

This paper focuses on the identification of the factors associated with the productive and unproductive use of supportive and therapeutic services by high-risk teen parents. Referral and treatment data were analyzed and discussed, as were two case studies. The importance of family support and family relationships to the use of services is highlighted in both the statistical and clinical data. Treatment implications are discussed.     

Telephone counselling in Australia: applications and considerations for use

This paper describes Australian counselling services which use the telephone as the medium for counselling delivery. It provides a background to telephone counselling and describes its uses as reported in the research and clinical literature. Special considerations in utilising the telephone to provide counselling are discussed. The paper also reviews the clinical and research literature to determine which counselling techniques are most applicable for use over the telephone.     

Psychotherapy assessment: Theory and practice

The history and developments in psychotherapy assessment are reviewed. Suggestions for an extended assessment of several sessions derived from the clinical experience of a District Psychotherapy service are put forward with clinical illustrations. The advantages in terms of flexibility, and the ability to embrace the range of factors involved as well as the influence this has in generating a sense of containment in the patients, are discussed. The implications of this approach on technique, and its differentiation from ongoing psychotherapy, are highlighted. It is suggested that assessment should be seen as an entity in its own right, with its own clinical technique.     

Predictors of short-term treatment outcome in bulimia nervosa inpatients.

Recent studies, mostly performed on bulimic outpatients, did not find consistent predictors of treatment outcome in bulimia nervosa. This is the first study to investigate anamnestic and clinical factors predictive of the short-term outcome of hospital treatment in 31 female bulimia nervosa patients with a mean age of 22.9 yr. Treatment outcome was assessed by several self-rating instruments measuring different features of the specific and unspecific psychopathology of bulimia nervosa. The most relevant predictors of the outcome of the 8-week hospital treatment were duration of previous inpatient treatments for bulimia, the intensity of anorexic tendency and the pretreatment level of depression. The majority of predictors tested did not show a strong relationship to treatment outcome. The findings are discussed in relation to results of other studies as well as to possible implications for treatment and research.     

How psychiatrists weigh risk factors when assessing suicide risk

The clinical assessment of suicide risk is a difficult task that the traditional literature contributes to in a limited way. This study aims to complement the traditional literature by determining the ranking of suicide risk factors by a group of 81 psychiatrists. Hopelessness was ranked the most important risk factor, followed by Suicidal Ideation, Previous Attempts, the Level of Mood and Affect, Quality of Relationships, Signs and Symptoms of Depression, and Social Integration. Less highly ranked risk factors are also noted. The significance of these findings is discussed with respect to the literature and commonly used textbooks of psychiatry.     

Mild cognitive impairment: an overview

Mild cognitive impairment (MCI) refers to the transitional state between the cognitive changes of normal aging and very early dementia. MCI has generated a great deal of research from both clinical and research perspectives. Several population- and community-based studies have documented an accelerated rate of progression to dementia and Alzheimer's disease in individuals diagnosed with MCI. Clinical subtypes of MCI have been proposed to broaden the concept and include prodromal forms of a variety of dementias. An algorithm is presented to assist the clinician in identifying subjects and subclassifying them into the various types of MCI. Progression factors, including genetic, neuroimaging, biomarker, and clinical characteristics, are discussed. Neuropathological studies indicating an intermediate state between normal aging and early dementia in subjects with MCI are presented. The recently completed clinical trials as well as neuropsychological and nutritional interventions are discussed. Finally, the clinical utility of MCI, and directions for future research are proposed.     

Subjective assessment of sleep by Sleep Questionnaire

A 55-item Sleep Questionnaire is presented for possible use as a standardized instrument in psychological studies of sleep. A factor analysis of responses from 145 adults to the questionnaire indicated 7 factors accounted for 71.7% of the total variance. These factors are congruent with sleep dimensions discussed in the literature and with other factor analytic investigations. A set of 11 clinical judgment scales are also presented. The reliabilities of both factor and clinical scales are adequate as judged by test-retest, internal consistency, and comparisons of self vs spouse ratings. The construct validity is supported by three studies showing significant differences between (a) medical patients with and without sleep disturbances, (b) psychiatric patients with and without symptoms of depression, and (c) short and long sleepers.