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     

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.     

Stress,Coping, and Suicide Risk in Psychiatric Inpatients

The present study investigated the relationship between interpersonal problems, coping styles, and suicide risk. Seventy-one adult psychiatric inpatients completed a suicide risk scale, a measure of interpersonal problems, and a coping scale designed to measure eight coping styles. Patients admitted with a history of suicidal attempts were compared with patients admitted for other reasons. Interpersonal problems were found to be significantly and positively related to suicide risk. The coping style of “suppression” (tendency to avoid threatening or uncomfortable situations) was found to be significantly and positively related to suicide risk [F(2, 68) = 4.54, p < .01]. Several other coping styles were found to be significantly related to suicide risk. These findings are congruent with a “two-stage model of countervailing forces” and have both research and clinical implications.     

Beliefs about God,Psychiatric Symptoms,and Evolutionary Psychiatry

The present study analyzed the association between specific beliefs about God and psychiatric symptoms among a representative sample of 1,306 U.S. adults. Three pairs of beliefs about God served as the independent variables: Close and Loving, Approving and Forgiving, and Creating and Judging. The dependent variables were measures of General Anxiety, Depression, Obsessive-Compulsion, Paranoid Ideation, Social Anxiety, and Somatization. As hypothesized, the strength of participants’ belief in a Close and Loving God had a significant salutary association with overall psychiatric symptomology, and the strength of this association was significantly stronger than that of the other beliefs, which had little association with the psychiatric symptomology. The authors discuss the findings in the context of evolutionary psychiatry, and the relevance of Evolutionary Threat Assessment Systems Theory in research on religious beliefs.     

Social Skills Training for Psychiatric Patients,II

In this second paper on social skills training for psychiatric patients the author critically reviews the controlled clinical outcome studies of social skills training in a number of psychiatric populations: mentally retarded persons, depressed patients, psychiatric outpatients, and psychiatric inpatients. He points out that more research is needed to determine the effectiveness of social skills training, especially for patients with debilitating chronic mental illness.     

Social Skills Training for Psychiatric Patients,I

Deficits in social skills are often seen in psychiatric patients. In particular instances these may be a consequence of the psychiatric illness, a contributing cause to that illness, or a feature of the psychiatric disorder. During the last two decades, systematic training programs in social skills have been developed and evaluated for the amelioration of these deficiencies. The author critically reviews basic concepts and methods in social skills training and the results of treatment in case reports, analogue studies, and single-case experimental decisions.     

Short-Term Psychiatric Treatment

With the increasing prevalence of short-term psychiatric hospitalization, brought about in part by reduced inpatient insurance coverage, decisions must be made concerning both the nature of treatment and who will provide services. The impracticality of traditional rehabilitative services in these settings has serious implications for the future role of occupational therapists in psychiatric health care. It is proposed that necessary modifications to treatment approaches must and can be made without abandoning fundamental theories of practice. Recommendations are made to upgrade the current level of practice via improved communication of information concerning short-term methodologies, to develop long-range plans to strengthen professionalism, and to make greater use of community-based alternatives for the delivery of services no longer practical in short-term treatment settings.     

Childhood Maltreatment,Emotional Response Inhibition,and Suicide in Psychiatric Inpatients

Childhood abuse and/or neglect adversely influences development of neurocognitive systems that regulate affect and behavior. Poor inhibitory control over emotional reactions is thus one potential pathway from maltreatment to suicide. Adult psychiatric inpatients completed the Childhood Trauma Questionnaire and an emotional stop-signal task indexing negative emotional action termination (NEAT): the ability to inhibit ongoing motor reactions to aversive stimuli triggered by negative affect. Clinical interviews assessed suicidal thoughts and behaviors during hospitalization (n = 131) and at follow-up assessments 6 months later (n = 87). Our primary aim was to examine whether maltreatment history and NEAT explain overlapping variance in suicidal behaviors (1) retrospectively and (2) 6 months following hospital discharge. Contrary to prediction, childhood maltreatment was unrelated to history of suicidal behaviors. However, NEAT was consistently associated with prior suicidal acts, even controlling for suicidal ideation and demographic covariates. NEAT similarly contributed to the prediction of post-discharge suicidal behaviors, whereas we found no effect of maltreatment history. The present study suggests that NEAT captures suicide risk independently of childhood maltreatment. Results implicated NEAT impairment specifically, rather than broader response inhibition deficits (e.g., to positive stimuli), in past and future suicidal behaviors. These findings provide preliminary support for NEAT as a behavioral vulnerability marker for suicide, with implications for understanding links between maltreatment history and suicidal acts.     

The Empty Nest, Employment, and Psychiatric Symptoms in College-Educated Women

The relationship of employment status to symptoms was studied in 40 graduates of an Eastern woman's college who had been out of college 35 years and were in their late fifties at the time of the study. All subjects were married women in the "empty nest" stage of life. Women employed full-time were found to have significantly lower symptom scores than women not employed outside the home, with women employed part-time occupying an intermediate position.     

A Short-Term,Family-Oriented,Child and Adolescent Psychiatric Inpatient Treatment Program

We describe a short-term inpatient treatment program whose purpose is to integrate the different interventions in the child, his or her family, and the outpatient professional network. The interaction between the family and the ward is the basic structural element of child psychiatric inpatient treatment. The child, the family, the professional outpatient network, and the ward community together form an extended therapeutic system. Inpatient treatment can be understood as a coevolving process between these systems. The essential feature in our working model is the continuous, daily nursing staff supervision and a focus on interactions in the extended therapeutic system.     

Understandings,Definitions, and Experiences of Clergy in Residential Psychiatric Treatment

The author conducted a qualitative examination of the understandings, definitions, and experiences of forgiveness held by members of the clergy who reported initial or ongoing conflict with the religious superiors who mandated their entry into residential psychiatric treatment because of substance abuse/dependence, sexual misconduct, compulsive behavior disorder, or affective disorders. Participants completed an 8‐item reflection questionnaire constructed for this study. Responses were examined qualitatively to identify trends, commonalities, or differences in the understandings, definitions, and experiences expressed in these responses. The author compared the data collected with definitions presented by previous researchers who have examined forgiveness in other populations.     

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.     

Belief in Life-After-Death,Beliefs About the World,and Psychiatric Symptoms

Data from the 2010 Baylor Religion Survey were analyzed by structural equation modeling (SEM) to test five hypotheses: (1) that religious commitment is positively related to belief in life-after-death; that belief in life-after-death is (2) positively related to belief in an equitable world, and (3) negatively related to belief in a cynical world; (4) that belief in a cynical world has a pernicious association with psychiatric symptoms; and (5) that belief in an equitable world has a salubrious association with psychiatric symptoms. As hypothesized, religious commitment was positively related to belief in life-after-death (β = .74). In turn, belief in life-after-death was negatively associated with belief in a cynical world (β = ?.16) and positively associated with belief in an equitable world (β = .36), as hypothesized. SEM further confirmed that belief in a cynical world had a significant pernicious association with all five classes of psychiatric symptoms (β’s = .11 to .30). Belief in an equitable world had a weaker and less consistent salubrious association with psychiatric symptoms. The results are discussed in the context of ETAS theory.     

Psychological Intervention,Spontaneous Remission,Hopelessness, and Psychiatric Disturbance in Adolescent Parasuicides

A study of 40 Indian adolescent parasuicides in South Africa showed that these subjects have significantly higher levels of hopelessness and psychiatric disturbance than nonsuicidal controls. Approximately half the parasuicides received psychological intervention. Posttesting at 6 months revealed that the treated subjects improved significantly on measures of hopelessness and psychiatric disturbance. The untreated subjects showed no significant reduction in hopelessness although they improved significantly on ratings of psychiatric disturbance. The results are discussed with possible explanations and recommendations.     

Rorschach and TAT Responses of Negro,Mexican-American,and Anglo Psychiatric Patients

The Rorschach and Thematic Apperception Projective Test responses of 75 Anglos, Negroes, and Mexican-American patients on the psychiatric unit of a Veterans Administration General Medical and Surgical Hospital were compared. The subjects were a random sample of non-psychotic male veterans whose ages, educational backgrounds and occupational levels were quite similar.

A number of statistically significant differences were found between the groups, with most distinct differences on the Rorschach appearing on the measures of hostility. The TAT pointed up differences between the Mexican-Americans and the other two groups in themes of family unit, and in their characterization, but more particularly of father-son and mother-son relationships. This TAT finding possibly demonstrates the persistence of Mexican-American cultural values regarding interpersonal. relationships within the family. Results of this study suggest the utility of projective measures in the formulation of culture and personality theories.     

Perfectionism,Stress, Daily Hassles,Hopelessness, and Suicide Potential in Depressed Psychiatric Adolescents

The current study examined dimensions of perfectionism, stress, hopelessness, and suicidality in a sample of adolescent psychiatric patients diagnosed with depression. This study evaluated the unique contribution of perfectionism in predicting suicidality after considering other predictors (i.e., hopelessness, depression) and it also examined the diathesis-stress model of perfectionism and suicide. A sample of 55 adolescents (41 females, mean age = 15.53, 25.5 % ethnic/racial minorities) who were psychiatric patients completed measures including the Child-Adolescent Perfectionism Scale, subjective and objective indices of life stress, daily hassles, depression, hopelessness, suicide ideation, prior attempts and suicide potential. In addition, other informants (i.e., adolescents’ parents) completed a diagnostic interview and an interview assessing major stressful experiences. Socially prescribed perfectionism (i.e., the perception that others require perfection of oneself) predicted concurrent levels of suicide potential and this association with suicide potential held even after controlling for the variances accounted for by depression and hopelessness. Hierarchical regression analyses provided partial support for the diathesis-stress model, that is, socially prescribed perfectionism interacted with daily hassles to predict concurrent suicide potential even after controlling for depression, hopelessness, and prior suicide attempt. Together, these findings suggest that socially prescribed perfectionism acts as a vulnerability factor that is predictive of suicide potential or risk among clinically depressed adolescents.