Multimodal therapy in an inpatient setting

Inpatient Multimodal Therapy (imt) is a residential treatment program, lasting a maximum of 36 weeks, for patients with severe neurotic symptoms. A group of 44 chronic obsessive-compulsive patients and a group of 40 chronic phobic patients were treated in order to assess the outcome and the process of treatment and to identify prognostic factors associated with the effect. At follow-up—on average, eight months after discharge—it was found that 60% had improved, 32% had remained the same, and 8% had deteriorated, indicating that, in general, the treatment was beneficial. That these effects were long-lasting is supported by the fact that, at follow-up, 78% of all patients were no longer receiving treatment, 18% were receiving outpatient or day treatment, and 4% were receiving inpatient treatment. Phobic patients appear to have gained more from the multimodal approach than did obsessive-compulsive patients, as indicated by the fact that the severity of symptoms decreased as they improved in rational thinking, assertiveness, and arousal. By contrast, obsessive-compulsive patients relapsed more than phobic patients did. This was attributed to the fact that the former gained less from the rational-emotive training, denied problems with assertiveness, and did not practice the acquired relaxation skills. It further appeared that a favorable outcome could be induced in patients who (1) expressed relatively mild symptoms in this otherwise severe group, (2) reported relatively few additional complaints, (3) could clearly indicate interpersonal problems, and (4) did not use psychotropic drugs. These prognostic factors are so widespread that not much weight can be ascribed to them. Yet they are useful for indication ofimt until better predictors are found.     

The right to refuse treatment: Paradox,pendulum and the quality of care

This clinical and theoretical overview of the right to refuse treatment will address some of the themes that have dominated this area of interface between psychiatry and the law, and have, perhaps, obscured the real concern of the right to refuse treatment question; i.e., the issue of quality of care. Central themes include factors present in the medicolegal context and recent events, origin of the concept of the right to treatment, the separation of confinement from treatment, and the changing models of vicarious decision making. This review also addresses judicial conceptualizations of treatment, including the concept of quarantine, judicial risk-aversiveness, and judicial fantasies of drug action. Some possible directions for the future are also examined.     

Single-gender group psychotherapy: A “women's group” for adolescent inpatients

This paper describes an attempt at forming and conducting a unique single-gender psychotherapy group with severely disturbed female adolescents on a long-term, psychotherapeutically oriented co-ed inpatient unit. The focus of this group was assisting the female patients in negotiating the tasks and conflicts specific to their gender and developmental stage. The therapeutic approach and the role of female coleaders are described, emphasizing particular modifications made to meet the needs of this group. Clinical examples are offered to high-light salient group themes of identity formation and separation and individuation. Finally, group therapeutic factors specifically enhanced by single gender membership are discussed and observations regarding the group/milieu interface are explored.     

The role of spatial-frequency channels in the perception of local and global structure

Adaptation and reaction-time techniques were used to examine the role of different spatial-frequency channels in the perception of local and global structure. Subjects were shown figures consisting of a large C composed of smaller Cs and asked to identify the orientation of either the global C or its local elements. Prior to performing the task subjects were adapted to different spatial frequencies and the effect on subsequent performance was assessed. Two main results were found. First, the adapting frequency that most affected the global task was often lower than that most affecting the local task, suggesting that high and low frequencies independently code the structure of an image. Second, reaction time to global figures was often faster than to local figures at all levels of detectability, again suggesting a role of low-frequency channels in global processing.     

Sex difference trends in completed suicide

The recent suicide literature increasingly has contained statements suggesting that the differences in completed suicide between the sexes are lessening. A compilation of official suicide data for 1933-1980 verifies such a trend from the 1950s through 1971. However, increased differences (as measured by the ratio of male to female rates) were consistently observed from 1971 to 1980. These trends were found for data for the nation, for whites and nonwhites, for numbers of suicides, for crude rates, and for age-adjusted rates. Decreased sex differences were obtained for those 35-44, 45-54, 55-64, and for 65+ years of age, but increased sex differences were observed for those aged 15-24 and 25-34. Possible explanations for these findings are presented.     

Cognitive and social functioning across adulthood: age or student status differences?

Younger adult students between 19 and 24 years of age (M = 21.3 years), older adult students between 61 and 76 years of age (M = 67.9 years), and older adult nonstudents between 62 and 76 years of age (M = 68.5 years) were assessed for health (self-ratings of physical and mental health), social functioning (self-ratings of physical and mental activity, perceived role activity level, perceived roles, locus of control, and age-norm expectations), and cognitive functioning (Wechsler Adult Intelligence Scale-Revised vocabulary and block design, and paired associate memory). Age differences were observed in self-ratings of health, social roles, intellectual performance, and memory. No student status differences were observed. The results are discussed in terms of plasticity of intellectual function and characteristics of student status in later adulthood.     

Reserve capacity of the elderly in aging-sensitive tests of fluid intelligence: replication and extension

Fluid intelligence belongs to that cluster of intellectual abilities evincing aging loss. To examine further the range of intellectual reserve available to aging individuals and the question of replicability in a new cultural and laboratory setting, 204 healthy older adults (mean age = 72 years; range = 60-86) participated in a short-term longitudinal training study. For experimental subjects, 10 sessions consisted of cognitive training involving two subability tests (Figural Relations, Induction) of fluid intelligence. The pattern of outcomes replicates and expands on earlier studies. Older adults have the reserve to evince substantial increases in levels of performance in fluid intelligence tests. Transfer of training, however, is narrow in scope. Training also increases accuracy of performance and the ability to solve more difficult test items. Difficulty level was estimated in a separate study, with a comparable sample of N = 112 elderly adults. Future research is suggested to examine whether intellectual reserve extends to near-maximum levels of performance.     

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