The Character of Danger: Psychiatric Symptoms in Selected Communities: Vol. III. The Stirling Study of Psychiatric Disorder and Sociocul-Tural Environment by Dorothea C. Leighton,John S. Harding,David B. Macklin,Allister M. Macmillan,and Alexander H. Leighton

While the variety of responses of psychotherapy groups to new members is wide, this article addresses those that are treatment destructive, that is, murderous in that they are aimed at the elimination of a new sibling. A number of frequently encountered destructive response patterns to new members are illustrated and categorized. It is suggested that survival of the new member is best insured by adequate preparation of the group so that the nucleus of powerful feelings activated in this situation can be felt and expressed prior to the addition of the new member. A clinical example of appropriate preparation is offered, and the contributions of group therapists to new member casualties are noted.     

Psychiatric Issues Among Adjudicated Youth: Challenges,Failures, and Successes

ABSTRACT

Children and adolescents afflicted with psychiatric illness are at particularly high risk for becoming part of the juvenile justice system. More than two thirds of justice-involved youth have psychiatric disorders (Abram et al., 2003; Shufelt & Cocozza, 2006; Teplin et al., 2002). Given the involvement of the legal system, youth being separated from families, and a host of other factors, mental health service delivery in a juvenile detention facility poses unique challenges. This article focuses on an overview of the problems commonly encountered in this setting. A clinical vignette will be used to highlight key points. The role and significance of trauma, common psychiatric disorders, and relevant medication rationale will be explored.     

Psychiatric diagnosis,natural categories,and DSM-IV

The history, development, and use of DSM IV are reviewed, together with a consideration of the most significant departures from DSM-III-R. Conceptual analysis is focused on principles of organization and in particular possible conflation of prototypes as typical of mental operation, and as the building-blocks of a diagnostic artifact. Arguments for the importance of the DSM-IV and the merit in investing time and effort in its mastery are advanced     

Psychiatric Disorders in Clinical Genetics I: Addressing Family Histories of Psychiatric Illness

This is the first article of a two-part professional development series addressing genetic counseling for personal and family histories of psychiatric disorders. It is based on an Educational Breakout Session presented by the Psychiatric Special Interest Group of the National Society of Genetic Counselors at the 2006 Annual Education Conference. This article examines issues that arise in addressing family histories of psychiatric illness, while the second article in the series considers the generation and provision of individualized recurrence risks for psychiatric disorders. In this article we discuss the importance of managing uncertainty for affected individuals and their close family members who have been referred to genetics for a number of different indications. We then use four simulated cases to make recommendations about the scope and timing of discussions related to the psychiatric family history.     

Psychiatric history and stress: predictors of severity of unipolar depression.

Unipolar depression is frequently a recurrent or chronic disorder. In studies on predicting its course, outcomes are typically linked to either psychiatric features or stressful life events. In order to integrate the 2 approaches, 51 unipolar patients were assessed periodically over at least 1 year for symptoms, stressful events, and chronic stressors. It was hypothesized that adverse family history and early age of onset impair role functioning and coping capabilities, thereby contributing to stressful circumstances that predict severity of depressive reactions. Results of causal modeling analyses supported a model in which background factors were associated with severity of depressive outcomes as mediated by their effects on stress variables. Such a model implicates the self-perpetuating nature of clinical depression, both for the individual and across generations.     

Psychiatric rehabilitation of schizophrenia: Unresolved issues, current trends, and future directions

Psychiatric rehabilitation refers to a treatment philosophy and to a set of assessment and treatment techniques designed to reduce disability and maximize environmental adaptation. The field of psychiatric rehabilitation of schizophrenia is now well developed, and successful interventions exist for teaching many essential community-living skills and for promoting maintenance and generalization of these gains. Recent developments include the creation of new skills-training interventions and cognitive rehabilitation techniques and improvements in the delivery of vocational and substance abuse treatments. As a field, psychiatric rehabilitation is continuing to develop in a manner that is responsive to perceived treatment needs, shortcomings of existing interventions, and developments in related fields (e.g., social psychology, neuroscience of schizophrenia). Some of these developments in theory and research point to areas of conceptual/theoretical weaknesses in existing treatments and assessment measures and suggest directions for further development. This article reviews the current status of a number of areas within the psychiatric rehabilitation of schizophrenia, highlighting future needs.     

Use of Legal Drugs by Psychiatric Outpatients: Benefits, Costs, and Change

Caffeine, nicotine, and alcohol use by persons with a severe mental illness occurs frequently but is poorly understood. We used qualitative methods to elicit information regarding the functional relationships between legal substance use and its antecedents and consequences. This report summarizes responses provided by 37 psychiatric outpatients who participated in focus groups and key informant interviews regarding the use and functions of alcohol, caffeine, and nicotine. We describe major themes regarding positive and negative consequences, triggers for use, change efforts, and offer observations regarding substance use in this under-served population.     

Moral Responsibility, Psychiatric Disorders and Duress

ABSTRACT  The paper is a discussion of moral responsibility and excuses in regard to psychiatric disorders involving abnormal desires (e.g. impulse control disorders such as kleptomania and pyromania, psychosexual disorders such as exhibitionism, obsessive-compulsive disorder and others). It points out problems with previous approaches to the question of whether or not to excuse persons with these disorders, and offers a new approach based on the concept of duress. There is a discussion of duress in regard to non-psychiatric cases based on the core notion of duress involving a choice between undesirables, and the paper concludes with an argument that moral blame for individuals with these sorts of disorders should often be lessened and in some cases removed entirely.