Studies of anticipation in bipolar affective disorder

Anticipation refers to the increase in disease severity or decrease in age of onset in successive generations. The concept evolved from the theories and dogma of degeneration that were pervasive in psychiatry and medicine in the late 19th century and into the early 20th century. The term was set aside with the criticism of geneticist Lionel Penrose, who argued that anticipation was the result of ascertainment biases. The renewed interest in anticipation followed the identification of its molecular genetic basis in the form of unstable trinucleotide repeats. Subsequently, several diseases have been studied clinically for the presence of anticipation. Although anticipation has been identified in many diseases, including bipolar disorder, only diseases showing a pattern of progressive neurodegeneration have been associated with unstable trinucleotide repeats. This review summarizes the research on anticipation in bipolar disorder and other secular trends in the patterns of the illness such as the cohort effect. The changing nature of bipolar disorder is likely to be a result of combined influences from several genes, some of which are likely to be in a state of flux, as well as environmental or cultural forces that converge to give the clinical picture of anticipation.     

Laboratory behavioral measures of impulsivity

Previous research and theory have conceptualized impulsivity as a multifaceted construct that requires multiple modes of measurement for accurate assessment. This article describes a software package that includes four paradigms for measuring multiple and unique aspects of impulsivity. Specifically, four tasks are described: (1) the two choice impulsivity paradigm, (2) the single key impulsivity paradigm, (3) the GoStop impulsivity paradigm, and (4) the time paradigm. These tasks measure processes related to the capacity to tolerate delay for reward, to inhibit an already initiated response, and to estimate the passage of time. These processes have been found to be important to the understanding of impulsive behaviors. The programs are flexible and allow the experimenter to manipulate a number of parameters related to delay-reward contingencies, timing, performance feedback/payment, and data output variables. Manipulation of these parameters makes the paradigms scalable to a wide range of ability levels and appropriate for samples ranging from children to adults. The four paradigms in this software package are available at no cost and can be obtained by contacting the corresponding author.     

Shame Conflicts as Dream Instigators: Wish Fulfillment and the Ego Ideal in Dream Dynamics

Understanding of the instigatory dynamics of the dream is essential to the understanding of the dream as a fulfilled wish. Both the meaning and the function of the dream can be understood only in relation to the instigating disruption that drives the dream into being. It is the instigator of the dream that connects the working of the inner world with events in the external world. The literature on the process of dream instigation is scant, still deriving from Freud's metaphor of "capitalist and entrepreneur." Hidden shame conflicts that react to the dreamer's anticipation of danger of exposure and shame are significant factors in the instigation of the dream. Clinical material in support of this view is presented in the form of a verbatim session that included a dream.     

The Relation Between Coordinated Interpersonal Timing and Maternal Sensitivity in Four-Month-Old Infants

The relation between mother–infant coordinated interpersonal timing, an automated microanalytic measure of dyadic vocal coordination, and maternal sensitivity was explored. Thirty-five mothers and their developmentally normal 4-month-old infants were audio-recorded during a 20-min laboratory vocal interaction session, that was later analyzed for degree of vocal coordination. Maternal Sensitivity ratings (Ainsworth & Bell, 1969) were based on a video-taped 45-min unstructured laboratory interaction period. A significant curvilinear relation between the degree to which mother coordinated her noninterruptive co-occurring speech to that of her infant was found and revealed that mothers highest in sensitivity were characterized by moderate levels of coordination. Examining mother-infant interaction at the specific behavioral level, while incorporating tests of nonlinear trends, may provide important information about the nature of sensitive parenting.     

Euthanasia, assisted suicide, and the philosophical anthropology of Karol Wojtyla.

The lack of consensus in American society regarding the permissibility of assisted suicide and euthanasia is due in large part to a failure to address the nature of the human person involved in the ethical act itself. For Karol Wojtyla, philosopher and Pope, ethical action finds meaning only in an authentic understanding of the person; but it is through acting (actus humanus) alone that the human person reveals himself. Knowing what the person ought to be cannot be divorced from what he ought to do; for Wojtyla, the structure of the ethical "do"--the act itself--comes first. The current paper will focus on four arguments used to justify assisted suicide and euthanasia: (1) the argument from autonomy, (2) the argument from compassion, (3) the argument from the evil of suffering, and (4) the argument from the loss of dignity. It will seek to answer each claim from the perspective of Karol Wojtyla's philosophical anthropology. Much of this will come from his defining work in pure philosophy, The Acting Person (1969). The final part of the paper will suggest some positive solutions to the stalemate over the euthanasia debate, again drawn from Wojtyla's idea of human fufillment through participation with the other, and with the community itself.     

A qualitative analysis of strategies for managing suicide-related events during deployment from the perspective of Army behavioral health providers,chaplains, and leaders

The purpose of this qualitative study was to investigate the use of strategies for managing suicide-related events (SREs; i.e., suicide deaths, suicide attempts, and suicidal ideation with a plan and intent to die) during deployment from the perspective of Army decision makers: behavioral health providers (BHPs), chaplains, and leaders. A total of 76 Army personnel participated in individual interviews or focus groups. Participants identified unit watch, weapon removal, medical evacuations, and debriefings as common strategies used to manage SREs in deployed settings. Many of these strategies were highlighted as short-term solutions only. Participants also underscored the importance of unit cohesion and communication among leaders, BHPs, and chaplains to effectively manage SREs. The need for structured guidelines for successfully managing SREs in deployed settings is discussed.