Developing an efficient clinical information system for a comprehensive psychiatric institute: II. Initial evaluation form

This paper describes the objectives, design, organization, content, evaluation, and implementation of the initial evaluation form, first component of a comprehensive psychiatric institute’s clinical information system. Major features of this effort are the involvement of a large number of clinicians in the form’s development, the use of complementary narrative and standardized components, the use of an expanded DSM-III multiaxial diagnostic format, pilot testing with over 1,000 patients, the evaluation of the form’s usefulness and interrater reliability, the form’s computerization, facilitating data retrieval and coordination with other institutional data bases, and the form’s monitoring.     

Mental health care for Hispanic Americans: a current perspective

In this article, the authors review patterns and challenges in the conceptualization, implementation, and academic support of the mental health services of Hispanic Americans. A critical analysis was conducted on information obtained through manual and computerized searches of published literature and conference reports. New clinical care approaches include the DSM-IV's cultural formulation with its complement of standardized multiaxial diagnosis, integration of services across clinical disorders or conditions and across sources of care, as well as pluralistic criteria and judges for service outcome appraisal. Emerging clinical approaches offer an opportunity to enhance the mental health care of Hispanic Americans within an increasingly multicultural U.S. society.     

On the renaissance of personality assessment and personality theory

Both personality assessment and personality theory have experienced a significant decline in the past two or three decades, giving way to alternate professional interests by some, and being attacked as both empirically unsupportable and devoid of conceptual merit by others. Several tangible signs suggest that a resurrection is underway owing to position reversals by former critics, the changing character of patient populations, refinements in personality-oriented psychometric techniques, the refurbishing of analytic, interpersonal, and learning theories of personality, and the central role assigned personality disorders in the multiaxial format of the DSM-III. Looking toward the future, the paper proposes a series of comprehensive and parallel diagnostic criteria for the personality disorders to be included in either DSM-IIIR or DSM-IV.     

How Can I Help You? Dimensional versus Categorical Distinctions in the Assessment for Child Analysis and Child Psychotherapy

ABSTRACT

This paper describes the process of a psychoanalytically-informed or a psychodynamic diagnostic assessment with children, contrasting it with a DSM-like diagnostic process. The importance of understanding and sensitively addressing the experience of parents when they bring their child to a professional for help is highlighted. The promotion of a psychoanalytic atmosphere, the unique contribution of a child analyst or psychodynamic clinician to the general mental health field, is an approach which promotes the development of a therapeutic alliance. This allows both parents and children to express their underlying issues as openly as possible. In addition to the basic assumptions of psychoanalysis (the ubiquity of unconscious mental activity and the impact of the past on the present/the developmental perspective), several factors are crucial to bear in mind: the importance of understanding the nature of the child’s (and the parent’s) emotions, emotion regulation, development of mental representations of self and other, and their conflicts and defense mechanisms. Potential therapeutic approaches are highlighted, including stressing the need to empirically study how decisions are made by a mental health provider when moving from assessment to treatment recommendation.     

计算精神病学：抑郁症研究和临床应用的新视角

抑郁症是一种复杂而异质的精神疾病, 给全球带来沉重的疾病负担。尽管基于症状学的诊断方法已被广泛应用于各领域, 但这种方法并不利于病理机制的探讨。另外, 该诊断方法预测效度较低, 导致其难以准确评估和比较各种治疗方案的疗效。计算精神病学方法则能通过理论驱动和数据驱动两种互补的方法解决上述问题, 从而提高对抑郁症的认识、预防和治疗。理论驱动方法基于经验知识或假设, 利用计算建模方法对数据进行多水平分析; 数据驱动方法则基于机器学习算法分析高维数据, 提高抑郁症诊断和预测的准确性, 进而提高治疗的精准度。理论驱动和数据驱动方法的发展与结合, 以及人才和资源的整合, 将会更有效地推进抑郁症的防治。     

Dimensional models for research and diagnosis: a current dilemma

This commentary focuses on the current dilemma regarding the application of dimensional models for research and diagnosis. Four articles are used to review the positive contributions of dimensional approaches. Although categorical approaches are integral in deciding the characteristics of the group to be studied (i.e., development of inclusion/exclusion criteria), the generation of cutpoints for categorical classification is, in reality, working with dimensional data. Ultimately, new methodological strategies need to be incorporated that address both categorical and dimensional aspects of the overall diagnostic framework. These refinements will be vital in determining the extent and reality of co-occurrence of disorder and the determination of boundaries across specific disorders.     

An Introduction to Neuropsychological Assessment

Since its inception in the 1940s, clinical neuropsychology has evolved into a field encompassing a diverse and sometimes bewildering array of theoretical points of view and technical approaches. The purpose of this article is to acquaint counselors with the primary historical developments, current perspectives, and clinical applications of neuropsychology so that they can make optimal use of this valuable diagnostic approach. Neuropsychological assessments are significant for counselors in evaluation, remediation, and ongoing counseling of clients and their families. These assessments allow the identification of patients whose cognitive deficits have been underestimated or overestimated by other diagnostic procedures and provide clinically relevant information about potential for and specific means to promote recovery. Advocacy for clients, as broadly conceived, is also an important role for counselors.     

A life-cycle framework in the treatment of underorganized* families

The view presented in this paper is that frameworks are needed to help understand the nature of the organization and problems of severely underorganized families. Some basic propositions are suggested as a ‘rule of thumb’ diagnostic tool. Requirements for healthy development are outlined, against which the family context of many underorganized families is illustrated. It is proposed that the life-cycle framework of such families is essentially ‘two generational’. This has implications for those offering help in these situations, and suggestions are made about appropriate treatment approaches.     

Generalisierte Angststörung

The core features of generalized anxiety disorder (GAD) are excessive worry about various topics which are perceived as uncontrollable and mostly last for at least 6 months. Worrying is accompanied by a number of symptoms (e.g. muscle tension and irritability). Various etiological models suggest that avoidance of internal processes (e.g. cognitive, emotional, and physical) by worrying is central to the development and maintenance of GAD. Empirically well supported cognitive-behavioral interventions are worry exposure, applied relaxation, treating metacognitions, intolerance of uncertainty and negative problem orientation. Initial studies indicate the efficacy of mindfulness and acceptance-based approaches as well as psychodynamic approaches to treat GAD. The present article reports central diagnostic procedures, important differential diagnoses and illustrates actual (psycho) therapeutic treatment options.     

No more psychiatric labels: Why formal psychiatric diagnostic systems should be abolished

This article argues that psychiatric diagnoses are not valid or useful. The use of psychiatric diagnosis increases stigma, does not aid treatment decisions, is associated with worsening long-term prognosis for mental health problems, and imposes Western beliefs about mental distress on other cultures. This article reviews the evidence base focusing in particular on empirical findings in relation to the topics of: aetiology, validity, reliability, treatment and outcome, prognosis, colonialism, and cultural and public policy impact. This evidence points toward diagnostic based frameworks for understanding and intervening in mental health difficulties being unable to either improve our scientific knowledge or improve outcomes in clinical practice and suggests that we need to move away from reliance on diagnostic based approaches for organising research and service delivery. Alternative evidence-based models for organising effective mental health care are available. Therefore formal psychiatric diagnostic systems such as the mental health section of the International Classification of Diseases Tenth Edition (ICD-10) and Diagnostic Statistical Manual Fifth Edition (DSM 5) should be abolished.     

The Type A Structured Interview: A behavioral assessment in the rough

The Type A behavior pattern is the focus of considerable research in behavioral medicine because of its causal relevance to coronary heart disease. The primary assessment of Type A behavior is a global rating made from a structured interview. From the perspective of behavioral assessment, this Structured Interview (SI) is important for two reasons. First, it provides an example of the superiority of an observed behavioral measure compared to self-report questionnaires for the assessment of an overt behavior pattern. Second, it provides a unique opportunity for the application of behavioral assessment technology. However, while the SI has demonstrated its clinical and research utility as a diagnostic procedure, its usefulness could be further enhanced in the areas of treatment selection and evaluation. The historical relationship between behavior and coronary heart disease is described. The development of the SI and the strengths of this assessment relative to other measurement approaches are reviewed. The standard questions and administration procedures for the interview are presented, along with several variations and modifications. Following this overview, the SI is discussed from the perspective of behavioral assessment.     

Assessment of ego functioning in multiple personality disorder

The dissociative disorder known as multiple personality disorder (MPD) presents a diagnostic challenge to psychological assessment techniques. A case example is presented in which a new self-report, multifactorial measure of ego functioning discriminated distinct profiles for four personalities within one multiple personality organization. Interpretations of characteristics of the primary and secondary personalities based on the Bell Object Relations Reality Testing Inventory (BORRTI) are presented. The relationship between these findings and other approaches to psychological testing for dissociation and MPD are discussed. It is suggested that this approach will facilitate the clinical assessment of suspected MPD subjects and contribute to affording appropriate treatment to this population.     

General Newsletter

The dissociative disorder known as multiple personality disorder (MPD) presents a diagnostic challenge to psychological assessment techniques. A case example is presented in which a new self-report, multifactorial measure of ego functioning discriminated distinct profiles for four personalities within one multiple personality organization. Interpretations of characteristics of the primary and secondary personalities based on the Belt Object Relations Reality Testing inventory (BORRTI) are presented. The relationship between these findings and other approaches to psychological testing for dissociation and MPD are discussed. It is suggested that this approach will facilitate the clinical assessment of suspected MPD subjects and contribute to affording appropriate treatment to this population.     

Early communication development and intervention for children with autism

Autism is a neurodevelopmental disorder defined by impairments in social and communication development, accompanied by stereotyped patterns of behavior and interest. The focus of this paper is on the early development of communication in autism, and early intervention for impairments in communication associated with this disorder. An overview of components of communication is provided. Communication characteristics that are diagnostic of autism are summarized, with consideration of the overlap between social and communication impairment, particularly for children with autism functioning at the prelinguistic level. Early communication development and predictors of communication functioning in autism are examined, based on a review of prospective and retrospective studies. The focus of the discussion then turns to intervention. Consideration is given to the rationale for beginning intervention as early in life as possible for children with autism. Implications of motor, imitation, and play deficits for communication-based intervention are examined. Finally, issues related to the design and delivery of intervention for young children with autism are presented, along with a review of the major early intervention approaches for autism.     

Compulsive Hoarding: Current Research and Theory

Compulsive hoarding has emerged as a treatment refractory and impairing psychological disorder. Although promising research over the past decade has substantially furthered an understanding of hoarding, the etiology, diagnostic status, and associated features of this phenomenon are not yet completely understood. This article reviews current research on hoarding, including comorbidity and diagnostic issues, theoretical models, and treatment approaches. A cognitive–behavioral model of compulsive hoarding (R. O. Frost and G. Steketee, 1998) is presented, including the proposed information-processing deficits, beliefs and cognitions, and excessive emotional attachment to possessions. In addition, existing treatment approaches that target the cognitive and behavioral components of acquisition, difficulty organizing, and avoidance of discarding are described. Future directions for compulsive hoarding research are suggested to improve diagnostic clarity, refine therapeutic techniques, and enhance treatment response.     

Listening and Communication Skills Training: Implications for Counselor Accountability

This article describes the development and implementation of a training procedure in listening and communication skills for employment service counselors. Implications are drawn from the listening and communication skills training and other human relations training approaches for counselor staff development and counselor accountability.