Personality Disorders and Treatment: A Therapeutic Conundrum

Of challenge to developmental psychologists and mental health practitioners is the importance of temperament, the intractable nature of personality, the complex psychodynamics of personality disorders, the fragile features of the therapeutic alliance, and the selection of appropriate therapy techniques. The intent of this article is to provide specific information pertinent to understanding personality disorders and to offer recommendations for effective treatment strategies.     

Anxiety as a Predictor and Outcome Variable in the Multimodal Treatment Study of Children with ADHD (MTA)

Initial moderator analyses in the Multimodal Treatment Study of Children with ADHD (MTA) suggested that child anxiety ascertained by parent report on the Diagnostic Interview Schedule for Children 2.3 (DISC Anxiety) differentially moderated the outcome of treatment. Left unanswered were questions regarding the nature of DISC Anxiety, the impact of comorbid conduct problems on the moderating effect of DISC Anxiety, and the clinical significance of DISC Anxiety as a moderator of treatment outcome. Thirty-three percent of MTA subjects met DSM-III-R criteria for an anxiety disorder excluding simple phobias. Of these, two-thirds also met DSM-III-R criteria for comorbid oppositional-defiant or conduct disorder whereas one-third did not, yielding an odds ratio of approximately two for DISC Anxiety, given conduct problems. In this context, exploratory analyses of baseline data suggest that DISC Anxiety may reflect parental attributions regarding child negative affectivity and associated behavior problems (unlike fearfulness), particularly in the area of social interactions, another core component of anxiety that is more typically associated with phobic symptoms. Analyses using hierarchical linear modeling (HLM) indicate that the moderating effect of DISC Anxiety continues to favor the inclusion of psychosocial treatment for anxious ADHD children irrespective of the presence or absence of comorbid conduct problems. This effect, which is clinically meaningful, is confined primarily to parent-reported outcomes involving disruptive behavior, internalizing symptoms, and inattention; and is generally stronger for combined than unimodal treatment. Contravening earlier studies, no adverse effect of anxiety on medication response for core ADHD or other outcomes in anxious or nonanxious ADHD children was demonstrated. When treating ADHD, it is important to search for comorbid anxiety and negative affectivity and to adjust treatment strategies accordingly.     

Retrograde amnesia for visual memories after hippocampal damage in rats

It is generally believed that the hippocampus is not required for simple discrimination learning. However, a small number of studies have shown that hippocampus damage impairs retention of a previously learned visual discrimination task. We propose that, although simple discrimination learning may proceed in the absence of the hippocampus, it plays an important role in this type of learning when it is intact. In order to test the role of the hippocampus in simple discrimination learning, we performed a series of experiments utilizing a two-choice picture discrimination task. Our experiments confirm that rats readily learn simple two-choice picture discriminations after hippocampus damage. However, if such discriminations are first learned while the hippocampus is intact, subsequent hippocampus damage causes severe retrograde amnesia for the discriminations. Furthermore, retrograde amnesia for simple picture discriminations was equally severe when the interval between training and damage was 1 d or 60 d; remote picture memories are not spared. Similarly, the rule or schema underlying a recently or remotely acquired picture discrimination learning set was lost after hippocampus damage. The severity of retrograde amnesia for simple picture discriminations is negatively correlated with the volume of spared hippocampus tissue. Thus, the hippocampus plays an essential role in long-term memories supporting simple picture discriminations.     

Generative Neo‐Cyberculture in the Modern Seminary

Four faculty discuss how their institution's launching of a program to implement instructional technology across the campus influenced their teaching and broadened their understanding of student learning. Examples of their first attempts at online projects for classes in homiletics and ecclesiology are described.     

Decreasing scoring errors on Wechsler Scale Vocabulary, Comprehension, and Similarities subtests: a preliminary study

Studies of graduate students learning to administer the Wechsler scales have generally shown that training is not associated with the development of scoring proficiency. Many studies report on the reduction of aggregated administration and scoring errors, a strategy that does not highlight the reduction of errors on subtests identified as most prone to error. This study evaluated the development of scoring proficiency specifically on the Wechsler (WISC-IV and WAIS-III) Vocabulary, Comprehension, and Similarities subtests during training by comparing a set of 'early test administrations' to 'later test administrations.' Twelve graduate students enrolled in an intelligence-testing course participated in the study. Scoring errors (e.g., incorrect point assignment) were evaluated on the students' actual practice administration test protocols. Errors on all three subtests declined significantly when scoring errors on 'early' sets of Wechsler scales were compared to those made on 'later' sets. However, correcting these subtest scoring errors did not cause significant changes in subtest scaled scores. Implications for clinical instruction and future research are discussed.     

‘Bound in a nutshell’: Thoughts on complexity,reductionism, and ‘infinite space’1

Pluralism is the hallmark of 21st century psychoanalytic discourse. Nevertheless, an unpleasant byproduct of pluralism is a tendency in some quarters to retreat into orthodoxy, stemming from a perceived need to shore up theoretical boundaries in the service of differentiating one theory from another. The delineation of borders places us at a risk of losing sight of the fact that genuine psychoanalytic thinking is fundamentally non‐reductionistic. Moreover, the core psychoanalytic notion of overdetermination, which Freud never abandoned throughout his career, has recently been neglected as authors argue in their communications that one point of view is better than another. Both analysts and their patients secretly are drawn to simple formulations that eschew complexity. The need to remain open to the ‘infinite space’ of meaning, motive, and causation should be a hallmark of clinical psychoanalytic practice. The author considers the implications for technique, and provides case material to illustrate some of the challenges inherent in approaching psychoanalytic work as a complex phenomenon.