Multimodal therapy in an inpatient setting

Inpatient Multimodal Therapy (imt) is a residential treatment program, lasting a maximum of 36 weeks, for patients with severe neurotic symptoms. A group of 44 chronic obsessive-compulsive patients and a group of 40 chronic phobic patients were treated in order to assess the outcome and the process of treatment and to identify prognostic factors associated with the effect. At follow-up—on average, eight months after discharge—it was found that 60% had improved, 32% had remained the same, and 8% had deteriorated, indicating that, in general, the treatment was beneficial. That these effects were long-lasting is supported by the fact that, at follow-up, 78% of all patients were no longer receiving treatment, 18% were receiving outpatient or day treatment, and 4% were receiving inpatient treatment. Phobic patients appear to have gained more from the multimodal approach than did obsessive-compulsive patients, as indicated by the fact that the severity of symptoms decreased as they improved in rational thinking, assertiveness, and arousal. By contrast, obsessive-compulsive patients relapsed more than phobic patients did. This was attributed to the fact that the former gained less from the rational-emotive training, denied problems with assertiveness, and did not practice the acquired relaxation skills. It further appeared that a favorable outcome could be induced in patients who (1) expressed relatively mild symptoms in this otherwise severe group, (2) reported relatively few additional complaints, (3) could clearly indicate interpersonal problems, and (4) did not use psychotropic drugs. These prognostic factors are so widespread that not much weight can be ascribed to them. Yet they are useful for indication ofimt until better predictors are found.     

The right to refuse treatment: Paradox,pendulum and the quality of care

This clinical and theoretical overview of the right to refuse treatment will address some of the themes that have dominated this area of interface between psychiatry and the law, and have, perhaps, obscured the real concern of the right to refuse treatment question; i.e., the issue of quality of care. Central themes include factors present in the medicolegal context and recent events, origin of the concept of the right to treatment, the separation of confinement from treatment, and the changing models of vicarious decision making. This review also addresses judicial conceptualizations of treatment, including the concept of quarantine, judicial risk-aversiveness, and judicial fantasies of drug action. Some possible directions for the future are also examined.     

The process of scapegoating in a neonatal nurses' group

This paper reviews the literature on scapegoating, elaborating on the underlying mechanisms before describing the process of scapegoating as it occurred in a neonatal nurse support group. Illustrative vignettes are used to discuss how scapegoating was used by group members to avoid painful feelings arising from their care of extremely ill infants. Group process is related to the stages of the group's development as feelings were addressed more directly and the need to use scapegoating as a defense decreased.     

The accommodative response to subthreshold blur and to perceptual fading during the Troxler phenomenon

A study is reported which shows that accommodation can be stimulated by a blur stimulus which is below the threshold for visual perception. It is also shown that perceptual fading of the target, caused by stabilization of the retinal image (Troxler phenomenon), can eliminate the accommodative response causing it to default to its resting level. The first finding suggests a way in which the visual system can filter the percept of blur out of our conscious awareness and still effectively utilize the blur as a steady-state error for the accommodative control system. The second finding is consistent with a locus for the Troxler phenomenon in the early afferent part of the visual pathway, ie the retinal ganglion cells.     

The role of spatial-frequency channels in the perception of local and global structure

Adaptation and reaction-time techniques were used to examine the role of different spatial-frequency channels in the perception of local and global structure. Subjects were shown figures consisting of a large C composed of smaller Cs and asked to identify the orientation of either the global C or its local elements. Prior to performing the task subjects were adapted to different spatial frequencies and the effect on subsequent performance was assessed. Two main results were found. First, the adapting frequency that most affected the global task was often lower than that most affecting the local task, suggesting that high and low frequencies independently code the structure of an image. Second, reaction time to global figures was often faster than to local figures at all levels of detectability, again suggesting a role of low-frequency channels in global processing.     

Static depiction of movement

A number of pictorial devices were compared in order to assess their relative effectiveness in depicting events. Effectiveness, as measured by a rating task, did not seem to be a function of the classification of a device as natural or metaphorical. Rather, it depended on whether a given device highlighted a distinctive aspect of a particular event (running, jumping, or moving), or simply modified the event. This observation was buttressed by the existence in a forced-choice task of a category boundary for depictions of running (pictures with a certain device were seen as running, those without it were not) but not for moving or jumping. Even preschool children displayed some understanding of metaphorical devices. They chose figures with those devices as running faster than the experimental standard. Results are discussed in the context of Kennedy's characterization of pictorial metaphors and Gibson's framework for understanding the relationship between pictorial and environmental information.     

Modification of preschool sex-typed behaviors by participation in adult-structured activities

Earlier studies have shown the girls spend more time than boys in activities that are highly structured by adults. Structured activities may encourage feminine sex-typed behaviors such as compliance to adults; low-structure activities may encourage masculine sex-typed behaviors such as independence and assertiveness. In the present study the effects of high or low levels of adult structuring on children's social behavior during preschool free-play activities were tested in a field experiment carried out during an entire semester in one preschool classroom. For the first 15 minutes of free play, children were assigned to high- or low-structure activities. As predicted, when children were in high-structure activities, they exhibited high rates of bids for recognition and compliance to adults; in low-structure activities, they exhibited peer-directed leadership, bids for recognition, and compliance. There were no generalized effects of these treatments on their subsequent free choice of activities or social behavior. The study demonstrates powerful effects of naturally occurring variations in children's play activities on sex-typed social behaviors.     

San Diego suicide study: comparison of gay to straight males

Previous large studies of completed suicides have not considered sexual orientation in their data analyses. In this study, data from the known homosexual subpopulation (13 males, aged 21-42) in a series of 283 suicides were examined. They were compared with all other aged male suicides 21-42 (n = 106). Both groups showed considerable substance abuse plus a variety of other psychiatric diagnoses. Both also had a high frequency of relationship difficulties near the time of death. Gays who committed suicide did not have a history of more police trouble and were no more likely to be living alone than the comparison group. They did not have more prior suicide attempts or previous psychiatric treatment. We conclude that, among the factors examined here, there appears to be little difference between gay and heterosexual male suicides.     

Cognitive and social functioning across adulthood: age or student status differences?

Younger adult students between 19 and 24 years of age (M = 21.3 years), older adult students between 61 and 76 years of age (M = 67.9 years), and older adult nonstudents between 62 and 76 years of age (M = 68.5 years) were assessed for health (self-ratings of physical and mental health), social functioning (self-ratings of physical and mental activity, perceived role activity level, perceived roles, locus of control, and age-norm expectations), and cognitive functioning (Wechsler Adult Intelligence Scale-Revised vocabulary and block design, and paired associate memory). Age differences were observed in self-ratings of health, social roles, intellectual performance, and memory. No student status differences were observed. The results are discussed in terms of plasticity of intellectual function and characteristics of student status in later adulthood.