The impact of cognitive and psychiatric impairment of psychotic disorders on the test of memory malingering (TOMM)

The author analyzes the scores of inpatient psychiatric patients with varying degrees of cognitive impairment who met criteria for a psychotic disorder on the following tests: the Test of Memory Malingering (TOMM), the California Verbal Learning Test-Second Edition, Conner's Continuous Performance Test-Second Edition, and the Brief Psychiatric Rating Scale-Expanded Version. Group 1 consisted of psychotic-disordered patients with significant concentration problems (concentration impersistence = 29). Group 2 consisted of psychotic disordered patients without significant concentration problems (no concentration impairment = 21). Although psychotic patients with concentration problems showed greater variability across TOMM trials, both groups obtained mean scores above 45 on Trial 2 and the retention trial on the TOMM. These findings indicate that cognitive impairment associated with psychosis generally does not negatively impair TOMM performance to such a level that would produce a false positive on the TOMM. Implications for forensic assessment, study limitations, and future directions are discussed.     

Excessive self-focused attention and defensiveness among psychiatric patients: a vicious cycle?

The contribution of defensive coping to the phenomenon of excessive self-focused attention was studied in 20 depressed or anxious psychiatric outpatients comprising the negative affect group, 20 patients with psychotic disorders, and a control group of 21 patients of an orthopaedic clinic. Self-focused attention was assessed using the Self-reflectiveness and Internal State Awareness subfactors of the Private Self-consciousness Scale. In accordance with other research on self-focused attention, the negative affect group obtained higher scores on the Self-reflectiveness scale than the control group (t39=2.40, p<.03). To examine the relationship between self-focus and defensiveness, Weinberger, Schwartz, and Davidson's approach was employed, using median splits of short forms of the Taylor Manifest Anxiety Scale and the Marlowe-Crowne scale to differentiate among four groups of subjects. The highest self-reflectiveness was found for those participants who were high in both defensiveness and anxiety. This group scored higher than the nondefensive high anxious group (t30= -2.31, p<.03). The heightened self-focused attention might result from automatically instigated states of self-focused attention and paradoxical effects of defensive efforts to avoid self-focus.     

A preliminary exploration of predictors of outcome and cognitive mechanisms of change in cognitive behaviour therapy for psychosis in people not taking antipsychotic medication

BackgroundCognitive behaviour therapy (CBT) has been shown to be effective in an open trial for people with psychotic disorders who have not been taking antipsychotic medication. There is little known about predictors of outcome in CBT for psychosis and even less about hypothesised mechanisms of change.Method20 participants with schizophrenia spectrum disorders received CBT in an exploratory trial. Our primary outcome was psychiatric symptoms measured using the PANSS. Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning, and hypothesised mechanisms of change included appraisals of psychotic experiences, dysfunctional attitudes and cognitive insight. We also measured patient characteristics that may be associated with outcome.ResultsT-tests revealed that several of the hypothesised mechanisms did significantly change over the treatment and follow-up periods. Correlational analyses showed that reductions in negative appraisals of psychotic experiences were related to improvements on outcome measures and that shorter duration of psychosis and younger age were associated with greater changes in symptoms.ConclusionsCBT based on a specific cognitive model appears to change the hypothesised cognitive mechanisms, and these changes are associated with good outcomes. CBT may be more effective for those who are younger with shorter histories of psychosis.     

Sexualdelinquenz bei Schizophrenie

Studies suggest a complex relationship between schizophrenia and sexually offensive behaviour. This study aimed to preserve first findings of sex offence features and behaviours exhibited by psychotic men in Germany. Furthermore a typology of the schizophrenic offender group was developed. A comparative trial design was used to differentiate the psychotic and non psychotic offender group. A checklist was developed and applied to the records of 64 male restricted hospital order in-patients in Berlin with an index conviction for a contact sex offence against a woman. Social isolation, antisocial behaviour, psychosexual variables and adverse childhood experiences are found for schizophrenic and sexual offenders in general. Different sexual offensive behaviours appeared in the schizophrenic subgroups. Negative symptoms of schizophrenia as well as antisocial traits had a great impact on schizophrenic sexual offending. A heterogeneous group of psychotic offenders can be supposed.     

Network and mutual support for parents bereaved following the violent deaths of their 12- to 28-year-old children: A longitudinal,prospective analysis

Abstract

Social support provided by bereaved parents' networks was examined in this study. Seven dimensions of support were assessed over time. Of special interest to the investigators were the types and frequency of posttreatment contacts among bereaved parents who participated in an experimental support program. The study compared those who reported high versus low social support and high versus low numbers of network confidants on selected outcome and coping variables. The authors recruited a community-based sample of 171 bereaved mothers and 90 bereaved fathers whose 12- to 28-year-old children had died by accident, suicide, or homicide 4 months previously. Parents were randomly assigned to a 12-week bereavement program or control group. It was expected that intervention group parents would report more social network in involvement and greater satisfaction with support received than control group parents. This hypothesis was only partially supported. Only 20% of the parents who participated in the bereavement program remained in contact after the experimental program ended. Finally, significant differences detected between parents who reported high and low support were minimal and not sustained over time. The number of network confidants did not significantly affect the outcomes examined. However, in general, those with more confidants reported lower symptoms. Additional studies are needed to address these complex issues.     

Negative affect predicts performance on an object permanence task

Recent research has demonstrated a strong connection between an infant’s ability to regulate their affective states and their attentional processes. In particular, negative affect can disrupt attention to the environment. In the object permanence literature, attention has been implicated as a factor in performance on the A‐not‐B task, yet factors that may disrupt attention, such as negative affect, have been largely ignored as a possible factor which predicts correct search. In the present study, we examined the effects of negative affect and attention on correct search performance for a sample of 36 9‐month‐old infants in a two location A‐not‐B task with a 5‐second delay between hiding and search. Infants’ levels of negative affect and attention to the task were coded on the third A trial of the A‐not‐B task. It was predicted that infants who searched incorrectly on the B trial would show high levels of negative affect and low levels of attention whereas infants who searched correctly would show the opposite pattern and furthermore, that negative affect would mediate the association between attention and search performance. The results of the study supported the hypotheses and are taken as indicating the importance of emotion‐cognition interactions in the development of cognitive competence.     

Chemical aversion treatment of alcoholism: Lithium as the aversive agent

Animal work indicating flavour aversion produced by chemical aversion therapy (CAT) with lithium might be effective in the treatment of alcoholism led to this treatment being given to 25 patients. The abstinence rate six months later of 36% was significantly better than the 12% rate for an equivalent group of patients, treated with a disulfuram-like drinking deterrent, calcium carbimide. The rate for the CAT group improves to 47% if 8 patients are excluded who did not develop sickness reactions to lithium. CAT with lithium appears safe given proper medical precautions.     

Clinical outcomes of a coping with stress training program among patients suffering from schizophrenia and schizoaffective disorder: a pilot study

This study evaluated the clinical effects of an intervention aimed at enhancing specific self-efficacy for coping with stress (CSSE) among patients with psychosis. Fourteen patients, 21–60 years old, diagnosed with schizophrenia or schizoaffective disorder voluntarily participated and were randomly assigned to a training and a control group. The Brief Psychiatric Rating Scale-24 was used to assess psychotic symptoms (primary outcomes) at baseline, post-intervention, and three- and six-month follow-ups. The participants also completed self-reports on well-being and satisfaction with intervention outcomes (secondary outcomes) at post-intervention and at the two follow-up assessments. Trained patients showed a significant decrease in all measures of psychotic symptoms (for disorientation, not significant (NS); effect sizes up to d = 4.80). This decline in symptoms remained significant at the follow-ups, with clinical enhancements on some of the subscales. By contrast, control participants showed no significant change in their symptoms. Short- and long-term overall well-being and satisfaction with outcomes were higher among the participants who received the training program. Our findings point out the relevance of enhancing CSSE among patients with psychosis, along with enhancing their coping skills for managing their illness. We conclude that CSSE training should be considered in future therapeutic interventions for psychotic disorders.     

Cognitive therapy for social phobia: individual versus group treatment

Cognitive-behavioural group treatment is the treatment of choice for social phobia. However, as not all patients benefit, an additional empirically validated psychological treatment would be of value. In addition, few studies have examined whether a group treatment format is more effective than an individual treatment format. A randomized controlled trial addressed these issues by comparing individual cognitive therapy, along the lines advocated by Clark and Wells (Clark, D.M. and Wells, A., 1995. A cognitive model of social phobia. In: R. G. Heimberg, M. Liebowitz, D. Hope and F. Schneier (Eds.), Social Phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford.), with a group version of the treatment and a wait-list control condition. 71 patients meeting DSM-IV criteria for social phobia participated in the trial, 65 completed the posttreatment assessment and 59 completed a six-month follow-up. Social phobia measures indicated significant pretreatment to posttreatment improvement in both individual and group cognitive therapy. Individual cognitive therapy was superior to group cognitive therapy on several measures at both posttreatment and follow-up. The effects of treatment on general measures of mood and psychopathology were less substantial than the effects on social phobia. The results suggest that individual cognitive therapy is a specific treatment for social phobia and that it's effectiveness may be diminished by delivery in a group format.     

Basic anxieties affecting psychiatric staff and their attitudes to psychotic patients

SUMMARY

Institutions can be used by their individual members to strengthen mechanisms of defence, especially against early paranoid and depressive anxieties. This is not to imply that institutios become psychotic, but that we would expect to find in them manifestations of unreality, splitting, hostility, suspicion and other forms of maladaptive behaviour which are the equivalent of psychotic symptoms of an individual.

This paper describes some of the attitudes of those who care for psychotic patients in a hospital setting. These attitudes seem to be influenced by basic fears that are provoked by the relationship with the patients and by coming in contact with their needs and disturbance from a position of responsibility. Such fears are accompanied by phantasies and are related to specific defence mechanisms.     

The cognitive-behavioural treatment of low self-esteem in psychotic patients: a pilot study

Low self esteem in individuals with a psychotic disorder is common and may be related to poorer clinical outcomes. However, there has been little research on devising treatment methods to improve self-esteem either generally or in psychotic patients in particular. The aims of this study were to evaluate the efficacy of a simple cognitive behavioural intervention to improve self esteem in psychotic patients who scored poorly on a self-esteem measure. This pilot study was a randomised control trial with a convenience sample of chronic psychotic inpatients. The cognitive behavioural self-esteem intervention, as an adjunct to treatment as usual (TAU), was compared to TAU alone in patients with psychosis. The individual self-esteem intervention as described by Tarrier (The use of coping strategies and self-regulation in the treatment of psychosis. (2001)) consisted of working with participants to elicit positive self-attributes and then identify specific behavioural examples to provide evidence of this attribute. Emphasis was given to any consequential change in the patient's belief that they had the attribute. The results indicated that this cognitive behavioural treatment for self-esteem used as an adjunct treatment in psychosis, resulted in clinical benefits in terms of increased self-esteem, decreased psychotic symptomatology and improved social functioning. These benefits were largely maintained at 3-month follow-up.     

Cancer Family History Reporting: Impact of Method and Psychosocial Factors

Family history is one the greatest risk factors for disease and one of the most important informational tools in medical genetics for the purpose of diagnosis, risk assessment, prevention and treatment. However, research is needed on the comparability of different methods of cancer family history assessment and the influence of psychosocial factors in family history reports. The purpose of this study was to determine if individuals had discrepancies between written and interview reports of cancer family history and the role of psychosocial factors in these discrepancies. Oncology patients (n=104) were administered a survey to assess psychosocial factors (i.e., information-seeking, worry, perceived risk, and health literacy) and were asked to provide family history in a written and an interview form. Randomization determined which form individuals received first. No differences in the amount of missing data or the amount of unspecified data were noted between the written and interview method. Psychosocial factors did not differentiate between those who had discrepancies in family history reports and those who did not have discrepancies in family history reports; although there was a trend for those with lower literacy and those who were blunters to be more discrepant on type of cancer diagnosis. In sum, this preliminary study indicates that written and interview methods of family history assessment for first degree relatives may be used interchangeably. The ability to use written methods will facilitate collection of basic family history information in the oncology clinic.     

Prototypical profiles of the Brief Psychiatric Rating Scale

Three prototypical profiles of the Brief Psychiatric Rating Scale (BPRS; Overall & Gorham, 1962) were isolated using a Q-type factor-analytic strategy with a sample of homeless men with mental illness (N=165). The 3 profiles--depressed, actively psychotic, and withdrawn--were used to study changes in BPRS profiles over time in a control group and a group that received assertive community treatment (ACT). Over2 time periods (inception to 12 months and 12-24 months), the 2 groups did not differ in terms of changes in profile shape, but they did differ in terms of changes in profile elevation. The ACT group evidenced a decrease in symptom severity during the last 12 months, whereas the control group showed an increase. Although changes in profile shape in both groups did occur, there was a significant tendency for the shape of the BPRS profiles to remain stable from the inception of the study to the 12-month assessment and from that time to the 24-month assessment. We describe the uses of these prototypical profiles and discuss the applicability of this analytical approach to other assessment instruments.     

Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders

In a randomized clinical trial, multisystemic family preservation was shown to significantly reduce rates of criminal activity and incarceration in a sample of 84 serious juvenile offenders and their multi-need families. In the current study, archival records were searched for re-arrest an average of 2.4 years post-referral. Survival analysis showed that youths who received multisystemic family preservation were less likely to be re-arrested than were youths who had received usual services. Such results represent the first controlled demonstration that family preservation, when delivered via a clearly specified treatment model, has lasting effects with serious juvenile offenders. Implications for family preservation and juvenile justice research are discussed.     

Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality

Family caregivers of persons with schizophrenia and other psychotic disorders experience high levels of burden. Although a number of patient and caregiver predictors of burden have been identified, little research has investigated the contributions of patient depression, suicidal ideation, and substance abuse. In addition, family psychoeducation interventions have reduced patient symptoms, as well as inpatient treatment utilization; however, it is not known whether or not these interventions reduce family burden. This study investigated predictors of family burden and tested to what degree multiple family group treatment (MFGT), relative to a standard care condition, was associated with reduced family burden. Participants were 90 outpatients with a diagnosis of schizophrenia or other psychotic disorders, and their caregivers who were enrolled in a 2 year psychoeducation intervention. The best set of predictors of burden, identified by stepwise linear regression, was young patient age, awareness of patient's suicidal ideation, and family resources. These variables accounted for 32% of the total variance in burden. Findings suggest that caregiver's awareness of patient's suicidal ideation, not patient's report of suicidal ideation; and that patient age, not duration of the illness, were significant independent predictors of burden. When compared to a standard-care condition over 2 years, MFGT did not reduce family caregiver burden. Discussions focus on the relationship between burden and its predictors, and possible reasons why MFGT did not decrease burden. Modifications are proposed that may increase the impact of MFGT.     

Delusions and decision-making style: use of the Need for Closure Scale

Clinicians and researchers have suggested that rapidity in belief formation, due to having a high 'need for closure' (NFC), may contribute to the acceptance of delusional explanations. The aim of the study is to determine whether NFC has such a direct link with delusions. A secondary aim is to examine if NFC is related to the delusion-associated reasoning process of 'jumping to conclusions'. One hundred and eighty-seven patients with psychosis, recruited for a treatment trial of psychological therapy (the PRP trial), completed the Need for Closure Scale (NFCS), symptom measures, and probabilistic reasoning tasks. The NFCS was considered in terms of its two dimensions: a desire for simple structure and a preference for quick, decisive answers. The individuals with psychosis reported being poor at making quick, decisive answers but required a greater need for simple structure. NFC was associated with levels of anxiety and depression. There were weak links between NFC and both positive and negative symptoms of psychosis, but these were explained by differences in affect. NFCS scores were unrelated to jumping to conclusions. Contrary to the argument that NFC is directly linked to delusions, individuals with delusions actually perceive themselves as indecisive. There was no evidence that NFC-at least as assessed by the NFCS-could be a proximal cause of delusions. Any potential effect on psychotic symptom presentation is indirect, mediated through affect. The use of the NFCS on its own in the study of psychotic symptoms cannot be recommended.     

Perceptions of Familial Risk in those Seeking a Genetic Risk Assessment for Alzheimer’s Disease

Perceived risk is a complex concept that influences the genetic counseling process and can affect client coping and behavior. Although the association between family history and risk perception is well recognized in the literature, no studies have explored this relationship specifically in those seeking genetic susceptibility testing for a common chronic condition. REVEAL is a randomized trial assessing the impact of APOE disclosure and genetic risk assessment for Alzheimer’s disease (AD). Using baseline REVEAL data, we hypothesized that there would be a significant association between the degree of AD family history and risk perception of AD, and that this relationship would be stronger in those who believed that genetics is a very important AD risk factor. In our sample of 293 participants, we found that a higher self-perceived risk of AD was associated with strength of family history of AD (p < 0.001), belief in genetics as an important AD risk factor (p < 0.001), being female (p < 0.001) and being Caucasian (p = 0.02). These results are the first to demonstrate the association between family history and risk perception in persons volunteering for genetic susceptibility testing for a common complex disease.     

Improving L2 Reading Comprehension through Emotionalized Dynamic Assessment Procedures

The paper reports a study on an emotionally-loaded dynamic assessment procedure used with Iranian EFL learners. It focuses on the effect of using emotional intelligence characteristics (based on Goleman’s framework) as a tool for motivating learners while performing reading tasks. The study with 50 intermediate learners aged 12–15 used three modalities: a control group, which was taught under institute’s normal procedures; a comparison group, which received dynamic assessment (DA); and an experimental group, which received emotionalized dynamic assessment (EDA) procedures, in the form of an intervention focusing on characteristics of Goleman’s emotional intelligence framework with the express purpose of inducing them to work with their emotions. Results showed that applying EDA procedures to reading assessment tasks made a difference in learners’ level of performance in comparison to those who went through pure DA procedures who in turn performed significantly better than those who did not received DA in any form.     

Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: pilot results

Cognitive behavior therapy (CBT) has been demonstrated in a number of randomized controlled trials to be efficacious as an adjunctive treatment for psychotic disorders. Emerging evidence suggests the usefulness of CBT interventions that incorporate acceptance/mindfulness-based approaches for this population. The current study extended previous research by Bach and Hayes (2002. The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139) using Acceptance and Commitment Therapy (ACT) in the treatment of psychosis. Psychiatric inpatients with psychotic symptoms were randomly assigned to enhanced treatment as usual (ETAU) or ETAU plus individual sessions of ACT. At discharge from the hospital, results suggested short-term advantages in the ACT group in affective symptoms, overall improvement, social impairment, and distress associated with hallucinations. In addition, more participants in the ACT condition reached clinically significant symptom improvement at discharge. Although 4-month rehospitalization rates were lower in the ACT group, these differences did not reach statistical significance. Decreases in the believability of hallucinations during treatment were observed only in the ACT condition, and change in believability was strongly associated with change in distress after controlling for change in the frequency of hallucinations. Results are interpreted as largely consistent with the findings of Bach and Hayes and warrant further investigations with larger samples.     

Reactions to Receiving Assumptive Help: The Moderating Effects of Group Membership and Perceived Need for Help1

The present study examined how group membership and need for help, variables that can operate independently or in combination, can affect reactions to receiving help. Arab participants (n = 164) received or did not receive help from an in‐group member (Arab helper) or from an out‐group high‐status member (Jewish helper) when the task was described as easy or difficult, or when no information was given. As predicted, Arab participants who received assistance from a Jewish helper or received assistance on an easy task showed more negative reactions than did those who received assistance from an Arab helper or on a difficult task. The theoretical implications for disentangling intergroup and interpersonal influences on reactions to receiving help are considered.