Primary care physicians attitude toward diagnosis and treatment of late-life depression

Underdiagnosis and undertreatment of late-life depression is common, especially in primary care settings. To help assess whether physicians attitude and confidence in diagnosing and managing depression serve as barriers to care, a total of 176 physicians employed in 18 primary care groups were administered surveys to assess attitudes towards diagnosis, treatment, and management of depression in elderly patients, (individuals over 65 years of age). Logistic regression was performed to assess the association of physician characteristics on attitudes. Nearly all of the physicians surveyed felt that depression in the elderly was a primary care problem, and 41% reported late-life depression as the most common problem seen in older patients. Physicians were confident in their ability to diagnose and manage depression, yet 45% had no medical education on depression in the previous three years. Physicians confidence in their ability to diagnose, treat, and manage depression, and their reported adequacy of training, do not appear to correspond to the amount of continuing medical education in depression, suggesting that physician overconfidence may potentially be serving as a barrier to care.     

Goal specificity and learning with a hypermedia program

Problem solving research has found that a nonspecific goal (NSG) leads to better learning than a specific goal (SG). This effect can be understood in terms of dual-space search theories of problem solving. To apply the theory, we studied goal specificity effects with a hypermedia program in which participants had to learn about the outbreak of World War 1, either with the goal to find twenty dates (i.e., SG) or with the goal to explain the reasons for the war (i.e., NSG). As expected, compared to the SG-group, the NSG-group correctly answered more factual questions about the text during the task, spent more time on average per page, and more often looked for extra information. In a final questionnaire with factual and inferential questions, the NSG-group still performed better than the SG-group. The NSG-group may also show better transfer of what they had learnt to a new situation.     

Relations of Tripartite Dimensions of Emotion to Childhood Anxiety and Mood Disorders

This study examined preliminary higher-order models relating tripartite dimensions of emotion to severity of anxiety and depressive disorders in 100 clinically referred children and adolescents. In light of the accumulating support for multifactor models of vulnerability and negative emotion in children, the present investigation was designed to establish preliminary estimates of the structure and magnitude of the relations of three emotion factors with dimensions of social anxiety, depression, panic, generalized anxiety, obsessions/compulsions, and separation anxiety. Results were consistent with structures that minimally specified two higher-order emotion factors, yet only some parameter estimates were consistent with theory regarding the tripartite model. Problems with the measurement of tripartite factors and possibilities for further research are outlined.     

Metapsychiatry and the Elusive Truth of Being

The legacy of the spiritual teachings of Dr. Thomas Hora (a training analyst at Blanton-Peale), known as Metapsychiatry, is introduced and its approach to and definition of a variety of spiritual terms and ideas is explained. The primacy of the distinction between reality and experience is presented, and the tools for discerning the difference, the two intelligent questions, are described. Brief clarifications of the nature of God, illusion, suffering, love, meditation, and enlightenment are offered, and the meaning of the elusiveness of the truth of being is identified.     

Covert face recognition in neurologically intact participants

Prosopagnosic patients may maintain some ability to recognize familiar faces, although they remain unaware of this ability. This phenomenon – called covert face recognition – was investigated in neurologically intact participants, using priming techniques. Participants were quicker to indicate that a target-name was familiar when the preceding prime-face belonged to the same person compared with an unrelated familiar person. This was observed both when prime-faces could be recognized overtly and when they were presented too briefly to be recognized overtly (Exps. 1 and 2). Thus, covert face recognition was observed in neurologically intact participants. In Exp. 3, participants were quicker to recognize a familiar face when that person's face had been seen previously, but only when it had been recognized overtly on the first encounter. These results are interpreted within the framework of an interactive activation model of face recognition. Received: 21 September 1998 / Accepted: 2 March 1999     

Body checking and avoidance and the core features of eating disorders among obese men and women seeking bariatric surgery

This study examined two aspects of body checking and avoidance, and their relations to the core psychopathology of eating disorders (EDs), in severely obese men and women seeking bariatric surgery. A consecutive series of 260 (44 male and 216 female) gastric bypass candidates were administered measures to assess body checking and avoidance, binge eating, restraint, and overevaluation of weight and shape. The majority of patients reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations were observed between checking and restraint, and between avoidance and binge eating. Both checking and avoidance behaviors were significantly associated with overevaluation of weight and shape. The positive associations between each of the two behaviors (body checking and avoidance) with overevaluation of weight/shape remained significant even after controlling for the effects of avoidance on body checking and vice versa. Stepwise multiple regression analyses revealed that binge eating, body checking, and avoidance behaviors made significant unique contributions and jointly accounted for 22-25% of the variance in overevaluation of weight and shape, respectively. This study documents the presence of eating disorder psychopathology among severely obese patients seeking bariatric surgery. The findings support the view that body checking and avoidance behaviors are manifestations of overevaluation of weight and shape and disordered eating.     

Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample

This study examined the psychometric properties of the Revised Child Anxiety and Depression Scale (RCADS) in a clinical sample of 513 youth referred for mental health assessment at a university clinic. Internal consistency and factor analysis provided support for the factorial validity of the RCADS. Convergent and discriminant validity tests against both clinical interview and self-report criteria also suggested favorable properties of the RCADS. In comparative tests with traditional measures of anxiety and depression, the RCADS generally showed greater correspondence to specific diagnostic syndromes. Clinical cutoffs are reported for the purposes of future clinical and research applications.     

Clinical status of at-risk individuals 5 years later: further validation of the psychometric high-risk strategy

The authors hypothesized that at-risk individuals identified on the basis of their Chapman scale scores would be diagnosed with schizophrenia-spectrum disorders at follow-up. In the present study, the authors interviewed 135 young adults approximately 5 years following their initial assessment. The at-risk groups included high scorers on the Perceptual Aberration and/or Magical Ideation Scales (n=59) and high scorers on the revised Social Anhedonia Scale (n=32). The control participants (n=44) scored below 0.5 SD of the same-sex group means on all the scales. At the follow-up, the groups differed in terms of their likelihood of having a schizophrenia-spectrum diagnosis, Chi2(2)=9.79, p<.01. The at-risk groups reported more frequent and severe psychotic-like experiences relative to the control group. These findings support the predictive validity of the Chapman psychosis-proneness scales and may enhance the power of early detection efforts.     

The impact of enhanced incentives on vocational rehabilitation outcomes for dually diagnosed veterans

This study evaluated the efficacy of adding contingency management techniques to vocational rehabilitation (VR) to improve treatment outcome as measured by entry into competitive employment. Nineteen dually diagnosed veterans who entered VR in the Veterans' Administration's compensated work therapy (CWT) program were randomly assigned to CWT (n = 8) or to CWT with enhanced incentives (n = 11). Over the first 16 weeks of rehabilitation, those in the incentives condition could earn up to dollar 1,006 in cash for meeting two sets of clinical goals: (a) remaining abstinent from drugs and alcohol and (b) taking steps to obtain and maintain a competitive job. Results indicate that relative to participants in the CWT-only group, those in the incentives condition engaged in more job-search activities, were more likely to remain abstinent from drugs and alcohol, were more likely to obtain competitive employment, and earned an average of 68% more in wages. These results suggest that rehabilitation outcomes may be enhanced by restructuring traditional work-for-pay contingencies to include direct financial rewards for meeting clinical goals.