The psychiatrist

This short story concerns a court-appointed psychiatrist who must evaluate the sanity of a young woman who killed her eight-month-old daughter. The woman tells of her pain and helplessness at being unable to comfort her infant daughter, who speaks of her own mortality with terrible dread! The story attempts to convey something of the experience of the professional working on the borderline of the real and the unreal, the possible and the impossible, tragedy and absurdity and having to make decisions that have major life consequences.     

Duty to Re-Contact: A Study of Families at Risk for Fragile X

DNA testing for Fragile X syndrome is now routinely available through a large number of diagnostic laboratories. We have surveyed individuals from British Columbia Fragile X families identified prior to the availability of DNA testing for FMR1 to determine if they are subsequently receiving information about DNA testing. Of the 78 individuals first seen before the cloning of the FMR1 gene, 39 (50%) had not been seen in the clinic to discuss DNA testing. We initiated a contact program with these 39 patients to determine their interest in DNA testing. Contact was made with 28 individuals, 20 of whom stated interest in testing either for themselves or for a relative. Patient opinions about DNA testing were assessed through questionnaires. In those individuals who stated an interest in DNA testing, the most common reason for wishing testing was to provide information to children or grandchildren. The most common disadvantages of testing indicated by this group were that they had finished their families and that they felt the test would not have a direct impact. The most common reasons individuals were not interested in DNA testing were that there were no family members appropriate to test and that the respondent had completed his or her family. DNA testing has been performed for 13 of the 28 (46%) contacted individuals and/or at least one relative. In view of the high level of interest for testing in families who had not been seen since the cloning of the FMR1 gene, we feel that FMR1 screening programs should include actively contacting previously seen individuals.     

Experiential Group Psychotherapy Supervision

Following a review of various traditional models of supervising group therapy, an experiential model of supervising group in a group setting is presented. The model stresses the group aspect of the supervisory process, encourages group interaction, here-and-now responses and associations, and employs concepts from both object relations and group-as-a-whole theory to understand what is taking place. The model's premise is that case material presented in a supervision group stimulates parallel material in supervisees, which is then used to elucidate what has taken place in the therapy group being presented. Excerpts from one supervisory group are used to illustrate major features of the model.     

What care should be covered?

The answer to the question of what health care services should be covered by a managed care plan is straightforward; the plan should cover whatever the consumer is willing to pay for. From the plan's perspective, the consumer is the payer, that is, the employer who negotiates the plan; not the individual patient whose personal preferences and interests may be quite different. Since managed care organizations contract with payers to arrange for health care services within a defined set of benefits, there is a broader question as well: Within the benefits chosen by the payer, what actually is covered? Criteria for determining "medical necessity," which managed care plans frequently use as the basis for coverage, are discussed.     

An epidemiological study on work and family stress among Chinese in Hong Kong

Hong Kong, with a population of over six million in a modern city, has been shown to be a very stressful place to live in. However, epidemiological data from a big-scale study in this regard are lacking. The present territory-wide survey, from a sample representative of the general population, was aimed to investigate the work and family stress of Chinese adults in the community with respect to the impact on their psychological well-being. The psychosocial context was considered as an important source of stress. The results showed that coping with work demands and rearing children were reported as the highest stress responses. Moreover, workers in Hong Kong took an instrumental attitude, i.e., one emphasizing material rewards, in order to reduce the job stress arising from interpersonal conflicts in the workplace.     

TEACHING CHILDREN TO SPELL: DECREASING CONSONANT CLUSTER ERRORS BY ELIMINATING SELECTIVE STIMULUS CONTROL

Six elementary-aged children were taught to spell words containing initial consonant clusters (CCs). They were trained to select printed words in response to the corresponding spoken words using computerized matching-to-sample procedures. After each training session, they were tested for spelling with a constructed-response transfer test. Based on previous selective stimulus control research, we hypothesized that only the first letter of an initial CC might control spelling when CC spelling errors are made. Thus, a critical-difference matching-to-sample training condition that required the children to respond to both letters of the CC to be correct was compared to a multiple-difference training condition that required the children to respond to only one letter of the pair. Results showed that children made fewer errors during the multiple-difference training condition than during the critical-difference training condition. On the constructed-response transfer tests, however, more overall errors and CC errors were made in the multiple-difference condition than in the critical-difference condition, and the words trained in the multiple-difference condition required more training sessions to reach criterion. All children improved their spelling of novel CC words by the completion of training. If normal classroom or home reading was to be supplemented by computer tasks of the kind used here, some spelling problems could be circumvented without costly intervention by a teacher or a special trainer.     

An examination of the relationship between race,skin color and a series of autonomic nervous system measures

In the total population of 75 subjects, the skin albedo correlated significantly with skin resistance, a relationship which was not maintained when the total population was separated into its component subgroups of whites, blacks and Indians. The Indians, “anthropologically Caucasians” but skin color more akin to the blacks, exhibited mean skin reflectance and skin resistance intermediate to that obtained in the black and white groups respectively. Other differences and significant correlations between the autonomic functions in the three groups indicated a higher level of sympathetic tone in the Indians, although this could be attributed to the older age of this group. It was suggested from the results that skin color rather than race has a greater influence on skin resistance.