Mourning and psychosis: a psychoanalytic perspective

The author attempts to develop some of the basic models and concepts relating to mourning processes in psychotic patients on the assumption that situations of loss and mourning are key moments for psychoanalysis, psychotherapy, and therapeutic approaches in general. Secondly, he reminds us that 'mourning processes in psychotics' are not always 'psychotic mourning processes', that is to say, that they do not necessarily occur within, or give rise to, a psychotic clinical picture. These ideas are illustrated by a number of sessions and vignettes concerning two psychotic patients in psychotherapeutic and psychoanalytic treatment. In theoretical terms, it seems vitally important in this context to combine a relationship-based approach within a framework of special psychoanalytic psychopathology with an updated view of processes of mourning and affective loss. A fundamental requirement at clinical level is to determine the role to be played by psychoanalytically based treatments in combined, integrated or global therapies when working with psychotic patients. For this purpose, the paper ends by outlining a set of principles and objectives for such treatments.     

ABOLISHING AND ESTABLISHING OPERATION ANALYSES OF SOCIAL ATTENTION AS POSITIVE REINFORCEMENT FOR PROBLEM BEHAVIOR

Three participants whose problem behavior was maintained by contingent attention were exposed to 45‐min presessions in which attention was withheld, provided on a fixed‐time (FT) 15‐s schedule, or provided on an FT 120‐s schedule. Following each presession, participants were then tested in a 15‐min session similar to the social attention condition of an analogue functional analysis. The results showed establishing operation conditions increased problem behavior during tests and that abolishing operation conditions decreased problem behavior during tests.     

The state-trait anxiety inventory, trait version: does it really measure anxiety?

To clarify what is actually measured by the trait version of the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970), we conducted a confirmatory factor analysis of various models and evaluated convergent and discriminant validity. The best fit was obtained with both a bifactor model, comprising 2 specific factors plus a general factor, and a 1-construct, 2-method model. The total score and the 2 method subscales of the STAI trait version were more strongly correlated with depression than with anxiety. In the bifactor model with 2 specific factors, the depression subscale showed stronger correlations with measures of depression than with measures of anxiety. The correlation of the hypothetical anxiety subscale with measures of depression was equivalent to or higher than its correlation with measures of anxiety. These results suggest that the questionnaire does not strictly evaluate anxiety but, rather, negative affect.     

Improvement in working memory is not related to increased intelligence scores

The acknowledged high relationship between working memory and intelligence suggests common underlying cognitive mechanisms and, perhaps, shared biological substrates. If this is the case, improvement in working memory by repeated exposure to challenging span tasks might be reflected in increased intelligence scores. Here we report a study in which 288 university undergraduates completed the odd numbered items of four intelligence tests on time 1 and the even numbered items of the same tests one month later (time 2). In between, 173 participants completed three sessions, separated by exactly one week, comprising verbal, numerical, and spatial short-term memory (STM) and working memory (WMC) tasks imposing high processing demands (STM–WMC group). 115 participants also completed three sessions, separated by exactly one week, but comprising verbal, numerical, and spatial simple speed tasks (processing speed, PS, and attention, ATT) with very low processing demands (PS-ATT group). The main finding reveals increased scores from the pre-test to the post-test intelligence session (more than half a standard deviation on average). However, there was no differential improvement on intelligence between the STM-WMC and PS-ATT groups.     

Predictors of healthcare resource use in fibromyalgia

This work identifies which psychosocial, clinical and perceived health status factors predict health-resource use in Fibromyalgia (FM), considering the patients' assistance level. Participants were 315 FM patients from Primary Care (PC: n=101) and Rheumatology Services (RS: n=214). Stepwise regression analysis showed that self-efficacy variables were significant predictors of medication intake in PC, and, along with Illness-focused coping, of the health service use. In RS, perceived health status was the best predictor of medication intake. In any case, Pain intensity significantly predicted the use of health resources. These data offer a new perspective for intervention in these patients, taking into account the level of assistance.     

Quality of life in patients with alcohol dependence disorder with personality disorders: relation to psychological adjustment and craving

The purpose of this study is to determine the self-perceived quality of life of abstinent patients with alcohol dependence disorder during the first month of treatment, and how the presence of personality disorders, psychological adjustment, and the level of craving affect this perception. For this purpose, a sample was used comprising 65 participants with mean age of 43.26 years, of whom 70.8% were male and 29.2% female, with a mean duration of addiction to alcohol consumption of 11.83 years. The results show that quality of life is not related to the duration of abstinence or the course of the addiction. Moreover, the patients who present a personality disorder perceive poorer quality of life in areas such as health status, mood, and social relations. Self-perception of quality of life is affected by psychological adjustment and beliefs about craving. These data should be taken into account when considering quality of life as a measurement of the effectiveness of a treatment for drug addicts with personality disorders.     

Risk and protective factors in adolescents' drug use, and differences by age and sex

Adolescents' drug use has huge social and personal implications, so it is essential to identify risk and protective factors. In this research, the CTCYS was used with 2440 adolescents to detect risk and protective factors for drug use in the community, family, school and peers/individual; differences in risk and protective factors by age and sex; and relationships between risk and protective factors and substance use. Protective factors are high. Risk factors are high in the community, the school and the individual. Older adolescents have more risks and less protection than the youngest; and there are sex differences, because males have less protection and more risks. The risk factors more closely related to drug use are availability of drugs in the community, family attitudes favourable to drug use, family history of antisocial behaviour, early start and use of drugs by friends, perceived risk and attitudes favourable to drug use. In the protective factors, the role played by social skills for alcohol use is important.     

Relationship between perceived health care quality and attitude toward substance abuse treatment

Despite the considerable investment made in recent years in Spain in substance abuse care, treatment adherence remains one of the aspects that determine the effectiveness of programs. Several authors have noted the importance of perceived service quality in this context. This paper is presented with dual purpose of highlighting the role that management of the quality of care for drug addicts has, both as a modulator of users' attitudes and perceptions about the treatment, and as a work philosophy, typical of an organization committed to continuous improvement. Conducting personal interviews with 670 users of drug abuse care services in Galicia and through the application of covariance structure analysis, the close relationship between two factors (perceived quality and attitude toward treatment) was revealed. This research also provides professionals and researchers with a new scale for service evaluation that is short, easy to use and with adequate psychometric properties.