The Use of Psychoeducation for a Patient with Hepatitis C and Psychiatric Illness in Preparation for Antiviral Therapy: A Case Report and Discussion

The standard of care treatment for chronic hepatitis C viral infection (HCV) is a combination of pegylated interferon alfa and ribavirin for 24-48?weeks according to the virus genotype. This therapy is known to have multiple neuropsychiatric side effects. A major concern when evaluating a patient for HCV treatment with a known history of a psychiatric disorder is the risk that the patient's psychiatric disorder will flare or become unmanageable. The possibility of precipitating depression, confusion, mania, psychosis, hallucinations, or suicidal ideation or attempt is frequently an obstacle to treatment. We present the case of a 50?year-old man with HCV and an extensive psychiatric history involving alcoholism, depression, and suicidality who participated in a psychoeducation group to help prepare him for treatment with pegylated interferon alfa/ribavirin therapy. Though the patient derived much benefit from the psychoeducation group, by the time of evaluation for HCV treatment two months after the group ended he had relapsed back into a depressive episode with suicidal thoughts. His acute psychiatric status made him unacceptable for pegylated interferon alfa/ribavirin therapy. Psychoeducation groups show promise for helping patients with chronic medical illness to be ready for and endure intensive medical treatment that has substantial psychiatric side effects. The challenge is to help patients overcome barriers to treatment, particularly psychosocial problems, because available treatments are increasingly effective.     

Age group differences in self-reported aggressive driving perpetration and victimization

Aim

This study examined whether the predictors of self-reported aggressive driving perpetration and victimization vary across age groups.

Method

Based on data from a general-population telephone survey conducted from July 2002 through June 2005, three groups of drivers were examined: 18–34 year-olds (N = 1522), 35–54 year-olds (N = 2726), and 55 years of age or older (N = 1883). For each age group sample, logistic regression analyses examined self-reported aggressive driving perpetration and victimization in the last 12 months by measures of driving exposure, heavy drinking, cannabis use, and drinking-driving, while controlling for demographic factors.

Results

The prevalence of aggressive driving perpetration within the past year was highest for the youngest age group (51%), followed by the middle-aged group (37%), and then the oldest age group (18%). The same pattern of results was found for prevalence of aggressive driving victimization (54%, 47%, and 31%, respectively). Controlling for demographic factors, the predictors of perpetration were generally consistent across the age groups. The logistic regression model for the youngest drivers revealed that those who reported stressful driving, heavy drinking, and cannabis use had significantly increased odds of reporting perpetration of aggressive driving. For middle-aged and older drivers, stressful driving, driving on busy roads, cannabis use, and driving after drinking were associated with perpetration. In addition, increased mileage contributed to perpetration in the oldest group. The findings for victimization by aggressive driving were similar. The logistic regression model for the youngest age group identified stressful driving, cannabis use, and higher annual mileage as being associated with victimization. For the oldest age group, these same variables were significant predictors of victimization, in addition to driving on busy roads. The logistic regression for the middle-aged group identified the same predictors as that of the oldest age group; however, interestingly driving after drinking was found to predict lower victimization among middle-aged drivers.

Conclusions

Although the prevalence of aggressive driving perpetration and victimization declined with age, the factors that contributed to aggressive driving remained generally stable across the lifespan. The results suggest that efforts to reduce aggressive driving among young drivers may prove to be effective for drivers from all age groups.     

Visual threat detection during moderate- and high-intensity exercise

The aim of the study was to assess performance on a visual threat-detection task during concurrently performed vigorous exercise on a cycle ergometer. Thirty (15 female) participants completed a baseline condition of seated rest and then moderate- and high-intensity exercise. Moderate- and high-intensity exercise conditions were completed on the 2nd day in a counterbalanced order. During each exercise condition, participants responded to 3 × 3 picture matrices (256 trials in each condition) that contained discrepant fear-relevant and discrepant fear-irrelevant pictures (?hman, Flykt, & Esteves, 2001). Response accuracy was significantly greater, and reaction time was significantly faster, during moderate- and high-intensity exercise compared with the rest condition (ps < .001). The discrepant fear-relevant matrix type was detected significantly more accurately than a discrepant fear-irrelevant matrix (p < .001). The discrepant fear-relevant matrix was detected significantly faster than all other matrix types (p < .001). These results suggest that exercise at a moderate and high intensity may enhance the efficiency of visual detection of both threatening and nonthreatening targets.     

Eine Quadratur des Kreises

In December 2009 the European Court of Human Rights (ECtHR) found in its judgment in the case of M. v. Germany that the retroactive repeal of the 10-year time limit for the first order of preventive detention violated articles 5 and 7 of the European Convention for the Protection of Human Rights and Fundamental Freedoms (ECHR). It took the German legislator about 1 year to reform the law on preventive detention during which the fate of preventive detainees was debated highly emotionally. Part of this reform is the Law on Therapy and Detention of Mentally Disordered Violent Offenders. It provides the possibility to further detain those persons who would have to be released following the ECtHR judgment. The key element is the very broad criterion ??mental disorder?? which is meant to justify the deprivation of liberty under article 5 § 1 lit. (e) ECHR. However, the attempt to bypass the ECtHR judgment in accordance with the ECHR is unsuccessful: the detention is a violation of article 5 ECHR.     

Metaphors for retirement: Unshackled from schedules

This study uses metaphor analysis to examine the meanings of retirement for a group of 35 retired Canadian executives and managers. Our analysis identified eight metaphors relating to the meanings of retirement. The findings provide us with a range of insights into the experience of retirement, from loss of purpose and identity to liberation from the constraints of work to retirement being constructed as a new beginning or renaissance. Based on the accounts given by each manager, metaphors were collated and compared across retirees to reveal four distinct configurations that conceptualize retirement as exploring new horizons, searching for meaning, contributing on your own terms and putting your feet up. We discuss the implications of these metaphor configurations for understanding the consumer and producer-oriented meanings of retirement and challenge dominant career constructions of retirement as disengagement and decline. Our findings reveal that retirement appears to be better understood by incorporating future-focused and agentic forms that contribute to different types of identity work in retirement.     

Thought dismissability in obsessive-compulsive disorder versus panic disorder

This study sought to better understand the persistence of obsessive-compulsive disorder (OCD) by studying the dismissability of obsessional thoughts in individuals with OCD relative to the dismissability of panic-relevant thoughts in individuals with panic disorder with or without agoraphobia (PD/A). Individuals with a principal diagnosis of OCD (n = 25) or PD/A (n = 25) completed a thought replacement task in which they replaced a primary obsession (target thought for the OCD group) or a primary panic-relevant thought (target thought for the PD/A group), with a neutral thought, signaling when the target thought occurred and when the neutral thought was in mind. The OCD group had more target thoughts and appraised the recurrence of the target thought more negatively. Whereas mood state did not change in the PD/A group, it declined in the OCD group, and this change was predicted by negative appraisal of target thought recurrences, but not amount of time thinking the target thought. These findings suggest that in vivo appraisal of the recurrence of obsessions may be a unique, key mechanism in the persistence of OCD and that the identification and exploration of appraisal of thought recurrences may be an especially important target in its treatment.     

Can I trust you? Negative affective priming influences social judgments in schizophrenia

Successful social interactions rely on the ability to make accurate judgments based on social cues as well as the ability to control the influence of internal or external affective information on those judgments. Prior research suggests that individuals with schizophrenia misinterpret social stimuli and this misinterpretation contributes to impaired social functioning. We tested the hypothesis that for people with schizophrenia, social judgments are abnormally influenced by affective information. Twenty-three patients with schizophrenia and 35 healthy control participants rated the trustworthiness of faces following the presentation of neutral, negative (threat-related), or positive affective primes. Results showed that all participants rated faces following negative affective primes as less trustworthy than faces following neutral or positive primes. Importantly, this effect was significantly more pronounced for participants with schizophrenia, suggesting that schizophrenia may be characterized by an exaggerated influence of negative affective information on social judgment. Furthermore, the extent that the negative affective prime influenced trustworthiness judgments was significantly associated with patients' severity of positive symptoms, particularly feelings of persecution. These findings suggest that for people with schizophrenia, negative affective information contributes to an interpretive bias, consistent with paranoid ideation, when judging the trustworthiness of others. This bias may contribute to social impairments in schizophrenia.     

Relationships Between Married Couples’ Self-Differentiation/Individuation and Gottman’s Model of Marital Interactions

One hundred sixty-nine couples completed measures of Bowen’s concept of differentiation/individuation (including emotional reactivity to parents and triangulation into parental disputes), and Gottman’s concepts related to current marital dynamics (e.g., flooding, marital satisfaction/adjustment). The results of canonical correlations run separately for males and females supported hypothesized relationships between differentiation and flooding and satisfaction. Gender differences are discussed as well as implications for counseling/therapy.     

Evidenzbasierte Psychotherapie der Depression

Depressive disorders are among the most frequent reasons for utilizing the health care system. Despite the availability of efficacious treatments and further advances throughout the last years, there is still a need for improving diagnostic and therapeutic procedures. A promising approach is the implementation of evidence- and consensus-based guidelines. The German “Nationale VersorgungsLeitlinie Unipolare Depression” are evidence- and consensus-based clinical practise guidelines for patients with unipolar depression. All relevant stakeholders have been involved in its development and have passed the final version at the end of 2009 to foster compliance throughout. The available evidence allows the derivation of differentiated treatment recommendations, also with regard to concomitant antidepressant medication or as alternative treatment options. In acute therapy watchful waiting over 14 days is recommended for mild depression and psychotherapy after persistence of symptoms. In cases of moderate depression, psychotherapy and pharmacotherapy are equally recommended, in cases of severe depression a combination of both is recommended.     

On Minimizing Guessing Effects on Multiple‐Choice Items: Superiority of a two solutions and three distractors item format to a one solution and five distractors item format

Multiple‐choice response formats are troublesome, as an item is often scored as solved simply because the examinee may be lucky at guessing the correct option. Instead of pertinent Item Response Theory models, which take guessing effects into account, this paper considers a psycho‐technological approach to re‐conceptualizing multiple‐choice response formats. The free‐response format is compared with two different multiple‐choice formats: a traditional format with a single correct response option and five distractors (‘1 of 6’), and another with five response options, three of them being distractors and two of them being correct (‘2 of 5’). For the latter format, an item is scored as mastered only if both correct response options and none of the distractors are marked. After the exclusion of a few items, the Rasch model analyses revealed appropriate fit for 188 items altogether. The resulting item‐difficulty parameters were used for comparison. The multiple‐choice format ‘1 of 6’ differs significantly from the multiple‐choice format ‘2 of 5’, while the latter does not differ significantly from the free‐response format. The lower difficulty of items ‘1 of 6’ suggests guessing effects.