Cultural Influences on Perceptions of Health, Illness, and Disability: A Review and Focus on Autism

This conceptual paper considers the role of culture in shaping family, professional, and community understanding of developmental disabilities and their treatments. The meanings of health, illness, and disability vary greatly across cultures and across time. We use Bronfenbrenner’s ecological model to provide a theoretical framework for examining disability, with special attention to autism spectrum disorders. Cultural beliefs about the cause of a disorder influence families’ decision-making about what treatments to use and what outcomes to expect. Autism provides an example that is especially challenging, as there is no agreed-upon cause. Also, an overwhelming array of treatments is available in the West for autism, including behavioral, cognitive, pharmaceutical, sensory, relational, vitamin, and diet therapies. Other cultures contribute additional views on cause (e.g., Karma, Allah’s will) and treatments (e.g., acupuncture, herbal medicines, Ayurveda). We suggest how a broad cultural view can help us understand treatments and the treatment delivery system of a nation and a culture. For the best course of care, professionals need to understand and respect families’ views of autism and work toward mutually agreeable treatments that may involve a combination of biomedical and cultural practices. Although a family-focused, open teamwork model that aims to acknowledge the context of the child, take into consideration the strengths and limitations of the child and the family, and introduce appropriate, sustainable, and sensitive interventions is regarded as best practice in the United States, it will take sensitive work to find out whether it will suit other cultural groups across the world.     

Interprofessional Education: Preparing Psychologists for Success in Integrated Primary Care

Rapidly occurring changes in the healthcare arena mean time is of the essence for psychology to formalize a strategic plan for training in primary care settings. The current article articulates factors affecting models of integrated care in Academic Health Centers (AHCs) and describes ways to identify and utilize resources at AHCs to develop interprofessional educational and clinical integrated care opportunities. The paper asserts that interprofessional educational experiences between psychology and other healthcare providers are vital to insure professionals value one another’s disciplines in health care reform endeavors, most notably the patient-centered initiatives. The paper highlights ways to create shared values and common goals between primary care providers and psychologists, which are needed for trainee internalization of integrated care precepts. A developmental perspective to training from pre-doctoral, internship and postdoctoral levels for psychologists in integrated care is described. Lastly, a call to action is given for the field to develop more opportunities for psychology trainees to receive education and training within practica, internships and postdoctoral fellowships in primary care settings to address the reality that most patients seek their mental health treatment in primary care settings.     

Gadd45b knockout mice exhibit selective deficits in hippocampus-dependent long-term memory

Growth arrest and DNA damage-inducible β (Gadd45b) has been shown to be involved in DNA demethylation and may be important for cognitive processes. Gadd45b is abnormally expressed in subjects with autism and psychosis, two disorders associated with cognitive deficits. Furthermore, several high-throughput screens have identified Gadd45b as a candidate plasticity-related gene. However, a direct demonstration of a link between Gadd45b and memory has not been established. The current studies first determined whether expression of the Gadd45 family of genes was affected by contextual fear conditioning. Gadd45b, and to a lesser extent Gadd45g, were up-regulated in the hippocampus following contextual fear conditioning, whereas Gadd45a was not. Next, Gadd45b knockout mice were tested for contextual and cued fear conditioning. Gadd45b knockout mice exhibited a significant deficit in long-term contextual fear conditioning; however, they displayed normal levels of short-term contextual fear conditioning. No differences between Gadd45b knockout and wild-type mice were observed in cued fear conditioning. Because cued fear conditioning is hippocampus independent, while contextual fear conditioning is hippocampus dependent, the current studies suggest that Gadd45b may be important for long-term hippocampus-dependent memory storage. Therefore, Gadd45b may be a novel therapeutic target for the cognitive deficits associated with many neurodevelopmental, neurological, and psychiatric disorders.     

Identifying illness perception schemata and their association with depression and quality of life in cardiac patients

The purpose of this paper is to identify groups of cardiac patients who share similar perceptions about their illness and to examine the relationships between these schemata and psychosocial outcomes such as quality of life and depression. A total of 190 cardiac patients with diagnoses of myocardial infarction, stable angina pectoris or chronic heart failure, completed a battery of psychosocial questionnaires within four weeks of their admission to hospital. These included the Brief Illness Perceptions Questionnaire (BIPQ), Beck Depression Inventory II (BDI II) and The MacNew Health-related Quality of Life instrument (MacNew). BIPQ items were subjected to latent class analysis (LCA) and the resulting groups were compared according to their BDI II and MacNew scores. LCA identified a five-class model of illness perception which comprised the following: (1) Consequence focused and mild emotional impact, n?=?55, 29%; (2) Low illness perceptions and low emotional impact, n?=?45, 24%; (3) Control focused and mild emotional impact, n?=?10, 5%; (4) Consequence focused and high emotional impact, n?=?60, 32%; and (5) Consequence focused and severe emotional impact, n?=?20, 10%. Gender and diagnosis did not appear to reflect class membership except that class 2 had a significantly higher proportion of AMI patients than did class 5. There were numerous significant differences between classes in regards to depression and health-related quality of life. Notably, classes 4 and 5 are distinguished by relatively high BDI II scores and low MacNew scores. Identifying classes of cardiac patients based on their illness perception schemata, in hospital or shortly afterwards, may identify those at risk of developing depressive symptoms and poor quality of life.     

The structure of temperament in preschoolers: a two-stage factor analytic approach

The structure of temperament traits in young children has been the subject of extensive debate, with separate models proposing different trait dimensions. This research has relied almost exclusively on parent-report measures. The present study used an alternative approach, a laboratory observational measure, to explore the structure of temperament in preschoolers. A 2-stage factor analytic approach, exploratory factor analyses (n = 274) followed by confirmatory factor analyses (n = 276), was used. We retrieved an adequately fitting model that consisted of 5 dimensions: Sociability, Positive Affect/Interest, Dysphoria, Fear/Inhibition, and Constraint versus Impulsivity. This solution overlaps with, but is also distinct from, the major models derived from parent-report measures.     

Similarity-based interference in a working memory numerical updating task: age-related differences between younger and older adults

Similarity among representations held simultaneously in working memory (WM) is a factor which increases interference and hinders performance. The aim of the current study was to investigate age-related differences between younger and older adults in a working memory numerical updating task, in which the similarity between information held in WM was manipulated. Results showed a higher susceptibility of older adults to similarity-based interference when accuracy, and not response times, was considered. It was concluded that older adults' WM difficulties appear to be due to the availability of stored information, which, in turn, might be related to the ability to generate distinctive representations and to the process of binding such representations to their context when similar information has to be processed in WM.     

Panic-Focused Psychodynamic Psychotherapy–Extended Range

Panic-Focused Psychodynamic Psychotherapy (PFPP) is a 24-session, twice-weekly treatment that has been manualized and has demonstrated efficacy in a randomized controlled trial in the treatment of panic disorder. The treatment has recently been extended to address additional DSM-IV anxiety disorders and Cluster C personality traits and disorders. The manualized approach identifies a set of dynamisms that contribute to panic onset and persistence involving intrapsychic conflicts about separation, autonomy, anger, and guilt. The treatment aims at increasing patients' recognition and understanding of these dynamics through exploration of the meaning and circumstances of their panic attacks, related intrapsychic dynamics, developmental factors, and the transference. The termination of treatment is particularly important in working through conflicts surrounding separation and autonomy. This article describes the formulation and psychotherapeutic approach in greater depth, and a case example is provided. We then provide a summary of the research on this treatment.     

Female Passion and the Matrix of Mother,Daughter, and Body: Vicissitudes of the Maternal Transference in the Working Through of Sexual Inhibitions

The maternal object is rarely seen as a girl's source of identification as a vibrant, sexually desirous woman. In this paper, I propose that the mother's capacity both to convey her own pride and pleasure in her female body, its sexual and procreative capacities, and to confer the privilege of passion on her daughter is requisite for a girl's full, pleasurable possession of her body and sexuality. Using observations from two analyses, I explore ways in which transformations of the negative transference manifestations of thwarted maternal sexuality and its pernicious expressions within the mother–daughter relationship paralleled recovery of a fuller capacity for sexual pleasure and agency. To offer clinical pathways toward development of female analysands' capacities for feminine pride and sexual passion, theories must allow for adaptive resolution of oedipal-period conflicts—resolution that can lead to a mature mutuality between mother and daughter.