The impact of organisational change on professionals working within a Community Mental Health Team (CMHT): a psychodynamic perspective

The aim of this study was to explore the effects of organisational change upon staff working in a Community Mental Health Team (CMHT). A grounded theory methodology was employed to analyse data from eight interviews with a range of staff. Analysis identified one core category and five key categories. ‘Corrosion of good work: an ethos in decline’ represents the core category and refers to the staff members’ sense of demoralisation of their professional values and integrity. The first key category, ‘Cultural change’, refers to staff members’ perception of change within the CMHT, with an increased emphasis on regulation, performance management and proceduralisation. Three further key categories were identified: ‘Caring clinicians and uncaring managers’, ‘Confusion regarding professional roles’ and ‘Disconnecting and isolating’. The fifth key ‘Staff departing and increasing risk for clients’, describes the impact of the working culture. These categories and emerging theory were interpreted through a psychodynamic lens, and identified the need for better management practice, support, training and supervision of staff as the foundations of safe practice.     

Comparison of behavioral intervention and sensory integration therapy on challenging behavior of children with autism

The current study used an AB crossover design to directly compare the effects of sensory integration therapy (SIT) and behavioral intervention (BI) on the challenging behavior of 10 participants with autism spectrum disorder. During the intervention phase, all participants received both treatments. Follow‐up probes were conducted 1 month following intervention for 4 participants implementing the more effective intervention. The results showed that BI successfully reduced challenging behavior to low‐ or near‐zero levels. In contrast, SIT resulted in higher and more variable rates of challenging behavior. One exception was noted for Participant 4 who engaged in a decreased level of challenging behavior during SIT. The findings are discussed in relation to implication for practice and future research.     

The Social Phobia Inventory: validity and reliability in an adolescent community sample

Social anxiety disorder and social anxiety are highly prevalent psychological conditions in youth. Because of the known risks associated with the spectrum of social anxiety in youth, early detection with valid and reliable assessment measures is imperative. Self-report measures have become the most widely used method of assessment for child and adolescent social anxiety. Because research to date on self-report measures of social anxiety disorder in adolescents is limited, the primary objective of the present study was to contribute to the literature by examining the validity and reliability of a new self-report measure, the Social Phobia Inventory (SPIN), in a community sample of adolescents. The SPIN is a 17-item measure purported to assess the full spectrum of social anxiety disorder symptomatology. Previously, psychometric research on the SPIN in adult populations has demonstrated its validity and reliability. In the current psychometric examination, results revealed strong support for the temporal stability, internal consistency, and construct validity of the SPIN, suggesting it is an appropriate screening measure for the assessment of social anxiety disorder in adolescents.     

Feasibility of telecognitive assessment in dementia

Videoconferencing (VC) technology has been used successfully to provide psychiatric services to patients in rural and otherwise underserved settings. VC-based diagnostic interviewing has shown good agreement with conventional face-to-face diagnosis of dementia in several investigations, but extension of this technology to neurocognitive assessment has received little attention. To this end, the authors administered a brief battery of common neuropsychological tests via VC technology (telecognitive) and traditional face-to-face methods to 14 older persons with mild cognitive impairment (MCI) and 19 persons with mild to moderate Alzheimer's disease (AD). Highly similar test scores were obtained when participants were tested in-person or via VC. Telecognitive assessment appears to be a valid means to conduct neuropsychological evaluation of older adults with cognitive impairment. Furthermore, continued development of VC technology has implications for expanding neuropsychological assessment options in under-served populations.     

Amnesic effect of GMP depends on its conversion to guanosine

Extracellular guanine-based purines, namely the nucleotides GTP, GDP, GMP and the nucleoside guanosine, exert important neuroprotective and neuromodulator roles in the central nervous system, which may be related to inhibition of the glutamatergic neurotransmission activity. In this study, we investigated GMP effects on mice inhibitory avoidance performance and the dependence on its conversion to guanosine for such effect, by using the ecto-5'-nucleotidase specific inhibitor AOPCP. We also investigated if this conversion occurs in the central nervous system or peripherally, and if guanosine and GMP affect nociception by the tail-flick test. I.p. GMP or guanosine (7.5 mg/kg) or i.c.v. GMP (480 nmol) pretraining administration was amnesic for the inhibitory avoidance task. I.c.v. AOPCP (1 nmol) administration completely reversed the amnesic effect of i.c.v. GMP, but not of i.p. GMP, indicating that peripheral conversion of GMP to guanosine is probably relevant to this effect. AOPCP alone did not interfere with the performance. Furthermore, tail-flick measurement was unaffected by i.p. GMP and guanosine, suggesting that the amnesic effect of both purines was not due to some antinociceptive effect against the footshock used in the task. All these data together, in accordance to those previously observed in studies involving glutamate uptake and seizures reinforce the idea that guanosine is the specific extracellular guanine-based purines effector and indicate that its conversion occurs not only in the central nervous system but also peripherally.     

Performance and Private Speech of Children with Attention-Deficit/Hyperactivity Disorder While Taking the Tower of Hanoi Test: Effects of Depth of Search,Diagnostic Subtype,and Methylphenidate

We administered the Tower of Hanoi to demographically comparable samples of control participants (n = 34) and children with the Combined (n = 22) and Inattentive subtypes (n = 19) of Attention-Deficit/Hyperactivity Disorder (ADHD). Controls excelled over children with the Inattentive subtype, who outperformed patients with the Combined subtype. These results replicated findings of greater executive deficits in the Combined than in the Inattentive type of ADHD. Double-blind administration of methylphenidate improved task performance only for patients with the Inattentive subtype. In a drug-free Baseline session, children with both subtypes of ADHD made more private verbalizations than controls, particularly when failing puzzles. In later sessions, regardless of drug condition, the inattentive sample exhibited a smaller increase in self-regulatory utterances under failure. In contrast, the combined sample decreased self-regulatory verbalizations under failure only under methylphenidate. The results support some differences between the two subtypes of ADHD in executive functioning and in their response to stimulant therapy. Portions of these results were submitted as part of H. Theresa Chang's PhD dissertation (Chang, 2000) and Helena Kopecky's unpublished master's research, both conducted at the University of Rochester and supervised by Rafael Klorman.     

Observed classroom behavior of children with ADHD: relationship to gender and comorbidity

Examined hypothesized gender and comorbidity differences in the observed classroom behavior of children with attention deficit hyperactivity disorder (ADHD). The behavior of 403 boys and 99 girls with ADHD, ages 7–10, was compared (a) to observed, sex-specific classroom behavior norms, (b) by sex, and (c) by comorbid subgroups. Boys and girls with ADHD deviated significantly from classroom norms on 15/16 and 13/16 categories, respectively. Compared to comparison girls, girls with ADHD had relatively high rates of verbal aggression to children. Boys with ADHD engaged in more rule-breaking and externalizing behaviors than did girls with ADHD, but the sexes did not differ on more neutral, unobtrusive behaviors. The sex differences are consistent with notions of why girls with ADHD are identified and referred later than boys. Contrary to hypothesis, the presence of comorbid anxiety disorder (ANX) was not associated with behavioral suppression; yet, as hypothesized, children with a comorbid disruptive behavior disorder (DBD) had higher rates of rule-breaking, and impulsive and aggressive behavior, than did children with ADHD alone and those with ADHD+ANX. Elevated rates of ADHD behaviors were also observed in children with comorbid DBD, indicating that these behaviors are truly present and suggesting that reports of higher ADHD ratings in this subgroup are not simply a consequence of negative halo effects and rater biases.     

Parent Cognitions as Predictors of Child Treatment Response in Attention-Deficit/Hyperactivity Disorder

Using a subsample of 105 children and their parents (100 mothers, 57 fathers) from the Multimodal Treatment Study of Children with ADHD (the MTA), the value of parents' baseline cognitions as predictors of children's treatment outcome at 14 months was examined. Measures of parents' cognitions about themselves, their ADHD children, and their parenting, as well as a self-report measure of dysfunctional discipline were included. Both mothers' and fathers' self-reported use of dysfunctional discipline predicted worse child treatment outcome. Low self-esteem in mothers, low parenting efficacy in fathers, and fathers' attributions of noncompliance to their ADHD child's insufficient effort and bad mood also were associated with worse child treatment outcome. All of these predictive relations were obtained even after MTA treatment effects had been taken into account. Secondary analyses indicated that mothers had a more external locus of control, lower self-esteem, lower parenting efficacy, and a greater tendency to attribute noncompliance to their ADHD child's bad mood than did fathers.     

Estimation in the three-state markov learning model

The problem of estimation of the parameters of the Bower three-state learning model is discussed for three forms of the model. In the simplest case, a minimum variance unbiased estimator is found and is presented with its asymptotic distribution theory and with a method of obtaining approximate confidence intervals. In the other cases, methods are discussed for obtaining the maximum likelihood estimators at least approximately. All estimation techniques are illustrated by application to a set of data obtained by Theios.This research was supported by the Office of Naval Research Contract Nonr-225(17), (NR 171-034).     

Assessing Adult Attachment Across Different Contexts: Validation of the Portuguese Version of the Experiences in Close Relationships–Relationship Structures Questionnaire

The Experiences in Close Relationships–Relationship Structures questionnaire (ECR–RS) is one of the most recent measures of adult attachment. This instrument provides a contextual assessment of attachment-related anxiety and avoidance by measuring these dimensions in various close relationships (mother, father, partner, friend). To further explore its psychometric properties and cross-cultural adequacy, this study presents the validation of the ECR–RS in a sample of Portuguese community individuals (N = 236). The Portuguese version showed adequate reliability and construct validity. The original 2-factor structure was confirmed through confirmatory factor analysis. The ECR–RS is a psychometrically robust measure of attachment, representing an important advance in the measurement of adult attachment.