Dual diagnosis: Clinical issues in the treatment of substance abuse,and affective,personality, and psychotic disorders

Co-morbidity of alcohol and substance with the spectrum of other psychiatric diagnoses is examined with specific emphasis on diagnostic indicators for anxiety and mood disorders. Diagnostic issues for the chemically dependent person are examined with the context of borderline personality disorder, schizophrenia and other psychiatric disorders. Clinical research related to the dually-diagnosed patient is explored     

Depression and the soul

Clergy are often confronted by challenges in dealing with the depressed congregant. This paper addresses the interface between psychology, psychiatry, and religion in a discussion of two cases. Models are suggested for dealing with the issues raised by the depressed congregant. The paper developed from a symposium on “The Depressed Congregant: Three Pastoral Responses to a Case Vignette” presented at a conference for cleargy onDepression and The Soul, at Temple Sholom in Chicago.     

Promoting Resilience in At-Risk Children

Intervening effectively with youths at risk from early deprivation, family dysfunction, poverty, abuse, and other factors is a major concern for educational and social service policymakers. Current research suggests that a majority of at-risk youths do not experience drastic outcomes, but many exhibit protective factors that buffer them from negative consequences. Longitudinal studies from Hawaii, the continental United States, and Great Britain have identified several personality, familial, and environmental variables that promote resiliency in youths at risk. This article discusses these variables and provides counselors with an assessment technique and strategies to promote a salutogenesis perspective.     

The Assessment of Limb Apraxia: An Investigation of Task Effects and Their Cause

To test the effects of variations in the structure of tasks used to assess limb apraxia, eight tasks—differing in their modes of elicitation (tactile, verbal, visual, imitation) and/or types of movement elicited (transitive, intransitive, meaningless)—were administered to 25 carefully selected subjects with idiomotor limb apraxia. When standardized scores (based on the performance of 10 nonneurologically impaired control subjects) were used to measure the differences between tasks, no clinically significant task effects were found. Additional investigation was made of two causal hypotheses regarding the processes underlying limb apractic performance. The results of factor analyses and a search for double dissociations among individual subjects were consistent with the (severity) hypothesis that differences in task performances (raw scores) reflect degrees of task difficulty; and they failed to support the (disconnection) hypothesis that posits separate and independent neural/mental processes underlying task performances.     

Characteristics and consequences of help-giving practices in contrasting human services programs

Relationships between human services program models and help-giving practices, and between both program models and help-giving practices and help-seeker control appraisals were examined in a study of 107 low socioeconomic background families. Three kinds of human services agencies were included in the study, each of which differed in terms of their implicit and explicit assumptions about the families they served and the roles professionals and families played as part of helping relationships. Results support the hypotheses that (a) a program philosophy that was family centered would be associated with more empowering help-giving practices compared to more professionally centered philosophies and (b) a family-centered program philosophy and empowering help-giving practices would be related to an enhanced sense of personal control over needed supports and resources from a target help-giver.     

Field articulation and working memory

This experiment assessed the proposal that performance differences associated with field independence/field articulation reflect differential efficiency in the use of a limited capacity information-processing system termed working memory. Extreme scores on a group-administered version of the embedded figures test were used to identify subjects “high” and “low” in degree of field articulation. The task required that a subject retain a series of digits for subsequent report while performing a semantic modification of a target phrase. Concurrent information load on working memory was varied in two ways: by increasing memory load from 3 to 6 digits, and by increasing the complexity of the semantic processing required. In low information load conditions no differences were found between high FA and low FA groups. In high information load conditions low FA subjects made more errors in digit recall and took longer to perform the difficult semantic modification.     

Isolating the typicality effect in semantic memory

An experiment was conducted to isolate the typicality effect in the overall categorization process. Subjects were required to indicate whether or not a probe word was a member of one of a variable number of categories held in memory. The typicality of the probe word, with respect to its superordinate category, was varied as was the physical quality of the probe. These manipulations were designed to test predictions drawn from Collins and Loftus (1975) and Anderson and Reder (1974), as well as a prediction based on the well-known effect of semantic context on word perception. A fourth prediction was drawn from a proposed model which postulates successive access of categories and locates the typicality effect in a within-category search stage. Typicality proved to be additive with stimulus quality and set size, but interacted with response type. These results were interpreted as support for the successive-access within-category search model while disconfirming the alternative predictions.     

Suppression and substitution in the treatment of nailbiting

The effectiveness of a package treatment for reducing nailbiting was studied. The package was composed of both positive procedures aimed at teaching adaptive behavior to substitute for nailbiting and negative procedures aimed at advancing skills for suppressing nailbiting. The design of the study permitted an analysis of the contributions of both positive and negative components of the package. Subjects assigned to combined, positive, negative and placebo groups received four weekly treatment sessions, and changes in their nailbiting behavior were compared with untreated controls. As in previous studies, nonspecific factors such as demand and attention to ones nails were found to be important determinants of outcome. In addition, positive procedures were found to be substantially more important than negative procedures in the maintenance of reductions in nailbiting over a 4-month follow-up period.