Predicting the nursing care needs of children in an inpatient psychiatry unit

This study examined factors that could be used in the prediction of nursing care needs of the child or adolescent requesting admission into an inpatient psychiatric unit. Using a time sampling observer methodology, nursing care activities provided to 40 child/adolescent inpatients were recorded and used as estimates of nursing care needs. Results indicated a great deal of variability in the nursing care needs of the inpatients. An encouraging finding of this study was that with relatively little difficulty, information can be obtained that is predictive of the child's or adolescent's nursing care needs. Significant predictive contributions were particularly noted for information pertaining to the sex of the child/adolescent, ratings of intellectual functioning, and history of possible abuse and/or neglect.     

Assessment of the use of timeout in an inpatient child psychiatry treatment unit

This article describes the use of response contingent brief social isolation (i.e., timeout) with 770 children admitted to an inpatient child psychiatry treatment unit during a 2-year study period. A total of 2,256 timeouts were recorded during the study period. Preliminary normative frequency, duration, and reason for timeout information are reported for age and sex groups and for common diagnostic categories. Only a third (255) of the inpatients earned one or more timeouts during their hospitalization. The results suggest 2 trends for timeout in this inpatient setting. First, there was an inverse relationship between timeout frequency and subjects' age; i.e., frequency of timeouts tended to decrease as subjects' age increased. Second, there was a positive relationship between timeout duration and subjects' age; i.e., older subjects required longer timeouts. A third and tentative finding suggested that the frequency of timeout was differentially associated with primary diagnosis for some groups. Alternative treatment procedures are discussed.     

Observations on the factor structure of the WAIS-R

Confirmatory factor analyses (CFAs) revealed 2 important characteristics of the standardization data of the Wechsler Adult Intelligence Scale Revised. One finding was that Digit Symbol fit better on an attentional factor in younger groups, but fit was better when Digit Symbol loaded on a visual-perceptual factor in older groups. A second observation was that specifying correlated errors or a fourth factor to explain covariance between Block Design and Object Assembly improved model fit in all age groups except 70- to 74-year-olds. The results illustrate the value of CFA and have implications for investigating other samples and other Wechsler tests.     

The hazards of writing or disclosing information in psychiatry

The health care professional must be aware of the potential hazards in writing or disclosing information about a patient or a non-patient. Two important interests are pitted against each other: dissemination of scientific information versus confidentiality. Presented is a discussion of the legal and ethical issues involved in (1) writing an article or book about a patient, (2) writing about a research subject, (3) writing about a subject of a forensic examination on behalf of the court or attorney, and (4) writing in a medical record.     

Examiner Errors on the WAIS-R: A Source of Concern

Munchausen syndrome (MS) is characterized by patients' chronic and relentless pursuit of medical treatment for combinations of symptoms of consciously self-inflicted injury and falsely reported symptomatology. MS patients are adults, as are perpetrators of Munchausen syndrome by proxy (MSBP). MSBP is an unusual form of child abuse in which a parent, usually the mother, brings a child for medical attention with symptoms falsified or directly induced by the mother. Most reports of MSBP have been of a few cases appearing in medical and pediatric literature. Motivation in both disorders is unclear, and diagnosis and treatment present difficult problems that require more research.     

Thought Disorder on the WAIS-R Relative to the Rorschach: Assessing Identity-Disordered Adolescents

Clinical researchers have noted that compared with other diagnostic groups, adults with Borderline Personality Disorder tend to demonstrate relatively more thought disorder on unstructured projective tests (e.g., Rorschach) than on structured objective tests of cognitive performance (e.g., Wechsler Adult Intelligence Scale; WAIS). Using archival data, our study found evidence that adolescents with Identity Disorder tend to exhibit this same phenomenon. The records of 62 adolescent inpatients who had been administered the WAIS or WAIS-R and the Rorschach were examined. Of the 62 cases, 25 were diagnosed with Identity Disorder, 14 with Conduct Disorder (Group Type), 15 with Oppositional Defiant Disorder, and 8 with Schizophreniform Disorder. For each participant, the WAIS or WAIS-R and the Rorschach were scored according to the Thought Disorder Index (TDI; Johnston & Holzman). Adolescents with Identity Disorder revealed a significantly larger discrepancy between TDI scores on the WAIS or WAIS-R and TDI scores on the Rorschach than did adolescents with other diagnoses. The findings suggested that the discrepancy between the degree of thought disorder on structured versus unstructured psychological tests (i.e., differential decompensation) is related to diagnosis.     

Male-Female Response Profile Differences on the WAIS-R in Clients Suffering from Borderline Personality Disorders

One hundred nineteen clients diagnosed with borderline personality disorders participated in a correlational study using standard intelligence and achievement measures. We expected to confirm the presence of an organic subtype that might help clinicians who work with this group of clients (average IQ = 79.3). We found gender differences that tended to support previous research on male-female differences. In general, the data supported the presence of an organic subtype. Analyses of arrest history and additional differential diagnoses showed this category of client relatively free of dependency concerns but manifesting signs of an anxiety disorder.     

The abduction of disorder in psychiatry.

The evolutionary cornerstone of J. C. Wakefield's (1999) harmful dysfunction thesis is a faulty assumption of comparability between mental and biological processes that overlooks the unique plasticity and openness of the brain's functioning design. This omission leads Wakefield to an idealized concept of natural mental functions, illusory interpretations of mental disorders as harmful dysfunctions, and exaggerated claims for the validity of his explanatory and stipulative proposals. The authors argue that there are numerous ways in which evolutionarily intact mental and psychological processes, combined with striking discontinuities within and between evolutionary and contemporary social/cultural environments, may cause nondysfunction variants of many widely accepted major mental disorders. These examples undermine many of Wakefield's arguments for adopting a harmful dysfunction concept of mental disorder.     

Unexpected improvement, decline, and stasis: a prediction confidence perspective on achievement success and failure

The authors hypothesized that reactions to performance feedback depend on whether one's lay theory of intelligence is supported or violated. In Study 1, following improvement feedback, all participants generally exhibited positive affect, but entity theorists (who believe that intelligence is fixed) displayed more anxiety and more effort to restore prediction confidence than did incremental theorists (who believe that intelligence is malleable). Similarly, when performance declined, entity theorists displayed more anxiety and compensatory effort than incremental theorists. However, when performance remained rigidly static despite a learning opportunity, incremental theorists evinced more anxiety and compensatory effort than entity theorists. In Study 2, this pattern was replicated when the entity and incremental theories were experimentally manipulated. Study 3 demonstrated that for both groups, theory violation impairs subsequent task performance. Taken together, these studies provide evidence that lay theory violation and damaged prediction confidence have significant and measurable effects on emotion and motivation. The authors discuss the implications of these findings for the literature on achievement success and failure.     

Relationships between patients' perceived improvement and their evaluations of treatment components in a behaviorally-oriented psychiatric inpatient unit

Patients on a behaviorally-oriented inpatient psychiatric unit were asked to rate their perceptions of treatment outcome and the value of 16 program components in producing that outcome. Significant correlations were found between perceived outcome and positive evaluations of the overall behavioral treatment plan, individual meetings with nursing staff, individual meetings with team psychologists, assertion group training, and daily group therapy. Patients perceived individual meetings with the nursing staff to be the single most valuable program component among those related to favorable outcome. Implications for the increased utilization of nursing staff during a time of dwindling resources for mental health are discussed.     

MMPI-A in the inpatient assessment of adolescents with eating disorders.

The MMPI-A (Butcher et al., 1992), like the older MMPI (Hathaway & McKinley, 1983), distinguishes between anorexia and bulimia. In this study, 245 adolescent girls diagnosed with anorexia, bulimia, or eating disorder not otherwise specified completed the MMPI-A. Multivariate analyses revealed significant differences between anorexia and bulimia on the MMPI-A's validity, clinical, content, and supplementary scales, particularly suggesting multiple impulse control problems among bulimic patients. However, profiles were also more homogeneous across eating disorder groups than in studies using the older MMPI, with high points involving some combination of Scales 1, 2, 3, and 0 for two thirds of the patients in this study. Implications are considered for understanding the common and differential psychopathology of eating disorders.     

Exceptionalism or Chinamerica: Measuring Religious Change in the Globalizing World Today

Religion is changing fast in this era of globalization. Major global trends include the growth of Muslims, the shrinking percentage of unaffiliated, and the rapid rise of Christianity in global China. By 2030, China is likely to become the largest Christian country in the world while retaining large numbers of Buddhists, Muslims, and folk religious believers. To capture religious changes more accurately, social scientists of religion must sharpen their measurement tools regarding religiosity; pay more attention to the reality of nonalignment among religious identity, belief, and practice; and acknowledge the reality of nonexclusive/multiple religious beliefs, practices, and identities. Scholars must also take responsibility for developing a clear and nuanced definition of religion, abandon exceptionalist thinking, and seek to discover common patterns of religious change across societies. Conceptual and measurement tools at the disposal of social scientists of religion should enable us to perceive and understand the converging changes of religion in China, the United States, and other societies, without ignoring their historical differences and contemporary particularities.     

A quarter century of the history of psychiatry.

This article reviews the development of the historiography of Anglo-American psychiatry over the past quarter century, while passing attention to work on the history of psychiatry in Europe. The relationship between earlier and later work is stressed, and recent trends in the field assessed.     

St. John's Wort: clinical status in psychiatry

Depression and anxiety are among the top 10 health problems for which complementary and alternative therapies (CATs) are most frequently used, and medicinal herbs are among the most popular of these treatments. St. John's wort (Hypericum perforatum) is a perennial herb that has become a widely used depression therapy. Extracts of hypericum have shown affinity for receptors within multiple neurochemical systems. The primary active substance responsible for the antidepressant effect is not well defined, but most work has concentrated specifically on the hypericin and hyperforin components. Although hypericum has demonstrated significant antidepressant and antianxiety effects in multiple studies, there are several recent studies that do not support the previous evidence. In all reported studies, hypericum extracts have been well tolerated. In addition, new psychiatric uses for hypericum in obsessive-compulsive disorder, generalized anxiety disorder, menopausal symptoms, and alcohol dependence have been reported. Because patients are choosing to pursue CAT as a first-line therapy, psychiatrists will need to have a better understanding of phytomedicines used for treating depression and anxiety, and thus be better prepared to serve as effective allies of their patients.