Private-sector care for chronically mentally ill individuals. The more things change, the more they stay the same

Two profit-making industries, nursing homes and board-and-care homes, care for about one million chronic mental patients. This care is primarily custodial and probably not very different from the care patients received in the public sector prior to deinstitutionalization. Moreover, certain characteristics of privately owned facilities encourage poor patient care so as to maximize profit. The problem could be ameliorated if chronic mental patients were strong and informed consumers or if the public sector strongly regulated proprietary care. However, neither of these two conditions now hold. Perhaps the apparent difficulties in significantly improving care for chronically mentally ill individuals despite seemingly major changes in policy reflect a fundamental problem in overall social policy--a reluctance to care for chronically indigent individuals of all kinds.     

The Social Phobia and Anxiety Inventory: concurrent validity with a clinic sample

The Social Phobia and Anxiety Inventory (SPAI) is an empirically derived self-report inventory developed as a specific measure of social phobia. The current investigation included two studies. The first examined the correlation of the SPAI with daily social behavior of a clinic sample of social phobics. The results indicated that the SPAI provides a reasonable indication of the distress experienced during daily social encounters in three dimensions: behavior, cognitions, and overall distress. The second study examined the validity of the SPAI with reference to the somatic response and avoidance behavior of social phobics. The results indicated that the somatic items of the SPAI are related to the somatic response of social phobics and that performance on the SPAI is associated with avoidance behavior in an anxiety-producing task.     

Testing between the TRACE model and the fuzzy logical model of speech perception

The TRACE model of speech perception (McClelland & Elman, 1986) is contrasted with a fuzzy logical model of perception (FLMP) (Oden & Massaro, 1978). The central question is how the models account for the influence of multiple sources of information on perceptual judgment. Although the two models can make somewhat similar predictions, the assumptions underlying the models are fundamentally different. The TRACE model is built around the concept of interactive activation, whereas the FLMP is structured in terms of the integration of independent sources of information. The models are tested against test results of an experiment involving the independent manipulation of bottom-up and top-down sources of information. Using a signal detection framework, sensitivity and bias measures of performance can be computed. The TRACE model predicts that top-down influences from the word level influence sensitivity at the phoneme level, whereas the FLMP does not. The empirical results of a study involving the influence of phonological context and segmental information on the perceptual recognition of a speech segment are best described without any assumed changes in sensitivity. To date, not only is a mechanism of interactive activation not necessary to describe speech perception, it is shown to be wrong when instantiated in the TRACE model.     

The composition of imaginal transformations

Three experiments examine the performance of composite imaginal spatial transformations using tasks in which people perform pairs of distinct imaginal transformations either in close succession or simultaneously. The principal aim of the investigation is to determine, for both modes of composition, whether imaginal transformations combine interactively or noninteractively to determine the temporal course of imaging performance. Specifically, does the time to imagine a given composite transformation reflect the independent contributions of its component transformations, or do component transformations have different effects within different composites? Results obtained under a number of distinct task conditions are most consistent with the proposal of noninteractive composition. However, the temporal effects of particular imaginal transformations are neither consistent nor readily predictable across different task conditions. Implications of these results for analogue-spatial models, task demand, and procedural accounts of imaging are discussed.     

Effect of depression on processing interactions in group psychotherapy

Two studies were conducted to investigate the possibility of individual differences in the ability of inpatients to process interactions in group psychotherapy. The first was a pilot study conducted on groups of major depressive patients and matched normal subjects. Subjects were asked to give process comments after viewing simulations of typical group therapy interactions. These comments were later rated on the extent to which they reflected process qualities and accuracy. These data led to a more rigorous and extensive study that included more appropriate control groups as well as measures of potential confounding factors, such as simulation realism, verbal ability, and interaction comprehension. Results indicated that major depressives suffer from deficits in the ability to process group interactions, relative to three types of control groups, including normals. These differences in processing were not significantly positively correlated with any of the potential confounding factors. The implications for understanding interactional processing and group psychotherapy are discussed.     

Cerebral laterality and depression: differences in perceptual asymmetry among diagnostic subtypes

Examined the influence of diagnostic subtype of depression on perceptual asymmetry for dichotic listening and visual tachistoscopic tasks. A total of 65 unmedicated patients with major depressive disorders and 30 normal controls were tested on a verbal and nonverbal task in each modality. Patients diagnosed according to the DSM-III with melancholia had abnormal perceptual asymmetry for dichotic nonsense syllable and complex tone tasks. In contrast, patients having a nonmelancholic "atypical depression" (reactivity of mood with preserved pleasure capacity and associated features) did not differ from normal controls on these tasks, but had an increased incidence of left handedness. Bipolar depression (history of hypomania) differed from unipolar depression in showing abnormal perceptual asymmetry for a tachistoscopic dot enumeration task. Alterations of perceptual asymmetry in melancholia and bipolar depression were consistent with hypothesized right hemisphere dysfunction.     

Family Functioning of Male Alcoholics and Their Female Partners during Periods of Drinking and Abstinence

Family functioning of 20 alcoholic male veterans and their female partners was assessed in relation to drinking (wet) and abstinent (dry) intervals. Repeated measures analyses performed on the McMaster Family Assessment Device (FAD) indicated that on all 7 scales of the FAD, alcoholics and their mates perceived family functioning to be better during dry than wet periods. In contrast to their alcoholic mates, female partners gave healthier ratings to all FAD scales except Roles in the dry condition and Affective Involvement in the wet condition. According to published cutoff scores for healthy and unhealthy family functioning, alcoholics as a group viewed their wet and dry family functioning as unhealthy, although the female group regarded the family's dry Problem Solving and Behavioral Control as healthy. These findings suggest that the family functioning of alcohol-involved couples is biphasic, oscillating between drinking and abstinent periods.     

Residential density and psychological health: the mediating effects of social support

People report excessive, unwanted social interactions, insufficient privacy, and are observed to be more socially withdrawn under crowded living conditions. If people socially withdraw from one another as a way to cope with crowding, this could lead to an unintended side effect of breakdowns in socially supportive relationships. A breakdown in socially supportive relationships could, in turn, account for some of the pathological consequences of chronic, high density living conditions. An empirical study of 175 male heads of household among inner city residents in India suggests that the adverse effects of residential crowding on psychological health are mediated by a breakdown of social support systems. The study also points to the value of examining social support as an endogenous variable in the stress and health process.     

Cardiovascular reactivity and interpersonal influence: active coping in a social context

Previous studies have demonstrated that effortful attempts to secure positive outcomes or avoid negative outcomes produce significant increases in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Although these effects of active coping on cardiovascular reactivity are central in current psychosomatic theories, virtually all of the research to date has used impersonal, asocial tasks. Our two studies examined the cardiovascular effects of effortful attempts to influence other people. In Study 1, male subjects attempting to influence the opinions of their discussion partner to improve their own chances of winning money displayed significantly greater SBP, DBP, and HR reactivity. In Study 2, we obtained similar effects on SBP and DBP reactivity in men and women, while both preparing an influence attempt and making that attempt. Furthermore, reactivity levels were larger as the magnitude of incentive for successful persuasion increased. Implications of this interpersonal equivalent of active coping for the development of cardiovascular disease are discussed.     

Psychological test signs of borderline personality disorder: a review of the empirical literature

Recent empirical work aimed at identifying test signs of borderline personality disorder is reviewed. The review focuses on commonly employed clinical tests, including the Wechsler Adult Intelligence Scale (WAIS), the Rorschach, and the Minnesota Multiphasic Personality Inventory (MMPI). Possible test signs are considered in relation to their sensitivity to and specificity for the diagnosis and in relation to the criteria of DSM-III, which define the disorder. Although consistent patterns of potentially useful test signs have begun to appear, methodological difficulties have hampered any subsequent development of clinically useful indices. Greater attention to sample size and its composition and definition as well as demonstrations of adequate reliability and predictive utility are required for further development of these signs.