Torticollis spasmodicus. A contribution to psychogenesis and psychotherapy

The application of an own psychotherapeutic concept to spasmodic torticollis confirms the assumption that it represents a pantomimic expression interacting with an assumed previous organic damage. An unavowed ambivalence between wishes for support and acknowledgement and feelings of limitation and aggression-by-frustration is reflected in simultaneous spasmodic turnings towards and away with a frequent preponderance of the impulse of anxious-aggressive averting. It directed treatment renders possible stable improvements.     

Effects of massed practice and meprobamate on spasmodic torticollis: an experimental analysis

In recent years a variety of behavioral techniques have been used in the treatment of spasmodic torticollis including negative practice (Agras and Marshall, 1965). faradic aversion (Brierly, 1967). instructions and negative feedback (Bernhardt et al., 1972). and systematic desensitization (Meares. 1973). However, in most of the aforementioned reports the controlling effects of the particular technique over dependent measures (voluntary and/or involuntary evocations of the tic) have not been demonstrated experimentally (see Hersen and Eisler, 1973 for review). In the present single case experimental analysis (Barlow and Hersen. 1973; Hersen and Barlow, 1974). the effects of massed practice (see Yates. 1958) and meprobamate on a subject exhibiting spasmodic torticollis were systematically examined. Following Bernhardt. Hersen and Barlow (1972). treatment efficacy was evaluated by monitoring rate of involuntary torticollis movements per 10-min videotaped recording sessions.     

Heterogeneity of biofeedback training effects in spasmodic torticollis: a single-case approach

Data from 184 biofeedback sessions are presented, in which 10 subjects with spasmodic torticollis had been trained to reduce pathologic activity in the hypertrophied sternocleidomastoid muscle. Each session was conducted as a single case experiment with nine successive trials. Attempts were made to distinguish motor learning processes which can be elicited independently from the biofeedback-condition from the effects of specific biofeedback information. Results showed dramatic decreases of muscle activity under biofeedback. Contrary to expectation, action potentials did not decrease across a course of 14 training sessions. Instead, effects were exhibited in an all-or-none fashion early in the training. Single-case ARIMA intervention analysis has shown that in 59% of the sessions EMG decreases demonstrated under biofeedback could be elicited prior to biofeedback in a condition of instructed control. Case studies revealed complex interactions of instructed control, specific biofeedback effects, unspecific effects of the biofeedback setting, and cognitive processes. Effects obtained within experimental sessions varied highly between subjects. Results are discussed in terms of newer concepts of basal ganglia dysfunction, and conclusions for the use of biofeedback paradigms in torticollis subjects are outlined.     

The effectiveness of behavior modification with spasmodic and congestive dysmenorrhea

Women reporting menstrual discomfort were diagnosed by the Menstrual Symptom Questionnaire as suffering from either spasmodic or congestive dysmenorrhea. Six groups were constructed to form a (congestive vs. spasmodic) × 3 (behavior therapy therapy vs. pseudotreatment vs. waiting list) factorial design. The behavior therapy groups received relaxation combined with premenstrual imagery, and the pseudo-treatment groups engaged in open discussion of personal problems of dysmenorrhea. The Symptom Severity Scale was administered prior to and following treatment as an index of the degree to which menstrual symptoms were experienced. The major finding of clinical significance was that the behavior therapy treatment procedure was highly effective in reducing the reported symptomatology of women suffering from spasmodic dysmenorrhea whereas this approach was not effective in reducing the symptomatology of women suffering from congestive dysmenorrhea. The results are discussed in terms of the need to differentiate type of dysmenorrhea before proceeding with the treatment program herein described.     

Stuttering: a dynamic motor control disorder

The purpose of this review is to determine what neural mechanisms may be dysfunctional in stuttering. Three sources of evidence are reviewed. First, studies of dynamic inter-relationships among brain regions during normal speech and in persons who stutter (PWS) suggest that the timing of neural activity in different regions may be abnormal in PWS. Second, the brain lesions associated with acquired stuttering are reviewed. These indicate that in a high percentage of cases, the primary speech and language regions are not affected but lesions involve other structures, such as the basal ganglia, which may modulate the primary speech and language regions. Third, to characterize the motor control disorder in stuttering, similarities and differences from focal dystonias such as spasmodic dysphonia (SD) and Tourette’s syndrome (TS) are reviewed. This review indicates that the central control abnormalities in stuttering are not due to disturbance in one particular brain region but rather a system dysfunction that interferes with rapid and dynamic speech processing for production.

Educational objectives: The reader will be able to describe: (1) the similarities and differences between stuttering and other speech motor control disorders, (2) which brain lesions are most likely to produce acquired stuttering in adults, and (3) what type of brain abnormality most likely underlies stuttering.     

Child,Adolescent and Adult Psychiatric Disorders in Africa: Implications for Psychological Interventions

The authors start by critically discussing some core features of Western psychiatric diagnosis, and present the cultural formulation as one approach to ensure that the cultural aspects of the diagnostic process are addressed, followed by a summary of what is known about the causes of psychiatric disorder. Five arguments are presented that provide support for the importance of psychiatric disorders in Africa: prevalence rates are high; psychiatric disorder is associated with a considerable burden from disability; in most cases, adults with psychiatric disorders experienced the onset of their disorder in childhood or youth; psychiatric disorders are strongly associated with medical conditions; and effective interventions exist for the majority of people suffering from psychiatric disorders. Against this background, current mental health services in Africa are reviewed. Finally, some suggestions are provided for how those providing psychological interventions can contribute to addressing the challenges posed by psychiatric disorders in Africa.     

Use of a common software system for collaborative clinical research on attentional processes in schizophrenia and ADHD

MacArthur Network III, consisting of five nodes (locations) and over 100 investigators, was formed in 1983 to conduct collaborative clinical research on risk and protective factors associated with psychiatric disorders. The common measurement of attentional dysfunction associated with two specific disorders (schizophrenia and attention deficit-hyperactivity disorder) was a goal of a subgroup of 11 Network III investigators. In this paper, the experiences with five approaches for implementing common protocols on laboratory computers for collaborative clinical research are described. The reasons for selecting the approach provided by Schneider’s (1988) MEL system are presented and discussed.     

Clinical,Studies in Psychiatry by H. S. Sullivan

A structured group therapy approach for psychiatric inpatients is presented. After reviewing the literature indicating that insight-oriented approaches are not effective with severely disturbed patients, the data supporting an interpersonal, cognitive, problem-solving approach with such patients is reviewed. A rationale for combining this cognitive problem-solving approach and Yalom's interpersonal approach with psychiatric inpatients is then presented. This structured group therapy approach, called the problem-solving support group (PSSG) is discussed, defining the nature and composition, screening procedures, methods, and techniques of the PSSG. Its use with psychiatric patients is illustrated by therapy protocols depicting the nature of the therapeutic interactions during the group, while also demonstrating what the group appears to be accomplishing for its members.     

EVALUATING PSYCHIATRIC TREATMENT METHODS THROUGH CLINICAL TRIALS RESEARCH

The author presents a design for single subject/clinical trial research that is applicable for occupational therapists working in a psychiatric treatment facility. The potential factors that can affect outcome are analyzed in terms of the treatment framework, patient characteristics, environmental factors, and therapist skills. Experimental control of external factors affecting behavioral change are analyzed and a protocol for designing a study in psychiatric occupational therapy is presented as a method of generating research.     

Emotional damages due to wrongful death—what are they worth?

A rational methodology based on economic and psychiatric theory is presented to quantify the dollar amount of emotional damages for a wrongful death. The scope and the issue of admissibility of such hedonic damage testimony are considered. Anew scale, the Loss of Enjoyment of Life—Severity Scale (LEL-SS), is introduced and its development is traced. The clinical evaluation of the emotional consequences of a wrongful death go beyond bereavement, encompassing depression and the more global construct of loss of enjoyment of life. To illustrate a clinical evaluation, the case of a mother in the wrongful death of her child is presented, and the dollar amount for emotional damages is calculated. To justify the hopes that this methodology will help settle cases more frequently without the need for trial, reasons are given why both plaintiffs and defendants should be interested in this approach.     

Violence,research, and non-identity in the psychiatric clinic

Violence in psychiatric clinics has been a consistent problem since the birth of modern psychiatry. In this paper, I examine current efforts to understand and reduce both violence and coercive responses to violence in psychiatry, arguing that these efforts are destined to fall short. By and large, scholarship on psychiatric violence reduction has focused on identifying discrete factors that are statistically associated with violence, such as patient demographics and clinical qualities, in an effort to quantify risk and predict violent acts before they happen. Using the work of Horkheimer and Adorno, I characterize the theoretical orientation of such efforts as identity thinking. I then argue that these approaches lead to epistemic imperceptiveness and a subtle form of conceptual restraint on patients. I suggest a reorientation in psychiatric research, away from identity thinking and toward a more productive and just approach to the problem of violence in psychiatric clinics.     

Torticollis spasmodicus and addiction

From a random sample of 49 patients suffering from torticollis spasmodicus and dependence on alcohol or medicaments, 6 have been selected and are discussed with i view to findings possible mutual influences between the disorders. In particular, premorbid accentuation of personality presented itself as a potential risk factor leading to both tortocollis and alcoholism. In various cases, the patient makes use of alcohol for self-treatment of extrapyramidal-motor symptoms. But such phenomenological developments are preceded by varied constellations of conditions, that have to be taken into account in the treatment.     

A family assessment based on the Social Relations Model

One purpose of family assessment is to formulate hypotheses that can guide clinical interventions. Family assessment is based on models about family functioning. In this paper the Social Relations Model ( Kenny and La Voie, 1984 ; SRM) is presented as such a model about family dynamics. Moreover, SRM provides statistical tools to underpin empirical hypotheses about family functioning. An SRM family assessment of a family with a child in child psychiatric care exemplifies the possibilities and limitations of this SRM approach to family assessment. The subject of the family assessment is family members' sense of influence in their family relationships.     

Stereotype threat and group differences in test performance: a question of measurement invariance

Studies into the effects of stereotype threat (ST) on test performance have shed new light on race and sex differences in achievement and intelligence test scores. In this article, the authors relate ST theory to the psychometric concept of measurement invariance and show that ST effects may be viewed as a source of measurement bias. As such, ST effects are detectable by means of multi-group confirmatory factor analysis. This enables research into the generalizability of ST effects to real-life or high-stakes testing. The modeling approach is described in detail and applied to 3 experiments in which the amount of ST for minorities and women was manipulated. Results indicate that ST results in measurement bias of intelligence and mathematics tests.     

Assessing Suicidal Potential by Time Perspective*

ABSTRACT: The clinical assessment of the high risk suicidal person continues to be a major challenge for diagnosticians. Based on the parameter of time as a major differentiating variable, a semiprojective psychological technique—the Time Questionnaire (TQ)—has been developed. The present study reports findings elaborating and extending a pilot study using the TQ. The TQ consistently and significantly differentiates suicidal high risk patients from both nonclinical controls and from such clinical comparison groups as nonsuicidal psychiatric patients and suicidal low risk patients. Such factors as race, patient status, and psychiatric diagnosis were controlled and found to have no significant effect on results. Age was found to affect results only in the population 65 and over. Reliability and normative data based on an N of over 500 persons are also presented.     

Schizophrenia: refining the phenotype, resolving endophenotypes

The conceptual history of the diagnosis of schizophrenia is reviewed and the current definition of the illness is examined (e.g. DSM-IV). A dimensional alternative to the traditional categorical model of diagnosis is discussed with a specific emphasis on the four dimensions of psychopathology represented by reality distortion (hallucinations, delusions), disorganization (positive formal thought disorder, bizarre behavior), negative symptoms (flattened affect, avolition, alogia, asociality), and premorbid social functioning. Also discussed is the development of structured psychiatric interviews that emerged from the clinical/research context that gave rise to explicit (i.e. operational) diagnostic criteria for schizophrenia. The general methodological approach used to detect valid endophenotypes for schizophrenia liability--i.e. indicators of liability not visible to the unaided naked eye--as well as their potential diagnostic and research utility is presented in overview. The rationale for linking such indicators to schizophrenia liability, which is conceptualized as a latent construct, is also reviewed. Future directions in the development and refinement of the diagnostic approach to schizophrenia and schizophrenia liability are highlighted.     

Therapeutic Assessment With Child Inpatients

Growing evidence supports Therapeutic Assessment (TA), a collaborative and therapeutic approach to psychological assessment, as an effective method for enhancing motivation for and engagement with psychotherapy across a variety of clinical populations and treatment settings. However, to date there are no known studies assessing the use of TA in child psychiatric inpatient settings. This article briefly reviews the structure of child and family TA, enumerates the challenges and risks associated with short-term inpatient stays, and proposes a path for integrating TA into these units as a way to enhance the quality of care and reduce the risk of rapid rehospitalization. The authors provide three case examples from a child psychiatric inpatient unit, each using a modified version of TA and each integrating assessments into brief family interventions. The authors conclude with suggestions for best practice for child psychiatric inpatient TAs.     

Examining the Three-Step Theory (3ST) of Suicide in a Prospective Study of Adult Psychiatric Inpatients

This study examined the validity and predictive utility of the three-step theory (3ST) of suicide in psychiatric patients. Participants were 190 consecutively admitted adult psychiatric inpatients (53% female, 60% White, ages 18–73) assessed at three time points: baseline, 4 weeks later (n = 112), and 3 months postdischarge (n = 102). Results were broadly supportive of the 3ST. First, at baseline, an interactive model of pain and hopelessness accounted for substantial variability in suicidal desire, even when controlling for depression and lifetime ideation. This result replicated in different genders and age ranges (i.e., 18–32 and 33–73). Further, pain and hopelessness were robust predictors of suicidal desire weeks and months into the future. Second, among those with pain and hopelessness, lower connectedness, as well as the extent to which pain exceeds connectedness, were robust predictors of higher suicidal desire. Last, a baseline measure of practical capability for suicide predicted suicide attempts both retrospectively and prospectively, even when controlling for lifetime ideation—however, dispositional and acquired contributors to capability were less predictive. Results support the validity and predictive utility of the 3ST, and suggest that the theory may have utility for guiding risk assessment and intervention.     

Using empirical data to inform the ethical evaluation of placebo controlled trials

There has been considerable debate about the ethical acceptability of using placebo-controls in clinical research. Although this debate has been rich in rhetoric, considering that much of this research is predicated upon the assumption that data from this research is vital to clinical decision-making, it is ironic that researchers have introduced little data into these discussions. Using some published research concerning the use of placebo-controls in clinical research in hypertension and psychiatric drug trials, I suggest some ways that such data might be incorporated into the ethical analysis concerning placebo use in clinical trials. This approach promises to be important for enhancing conceptual and scientific understanding as well as public policy decision-making. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.