Homelessness and dual diagnosis.

People who are dually diagnosed with severe mental illness and substance use disorders constitute 10%-20% of homeless persons. They are a heterogeneous and extremely vulnerable subgroup with complex, poorly understood needs. In this article recent research on the epidemiology, subject characteristics, and service needs of the dually diagnosed homeless population is reviewed. Also, the range of evolving approaches to providing social services, housing, and mental health and substance-abuse treatments; the relevant system issues and legal issues; and problems with current research, as well as future research directions, are discussed. The importance of the distinction between providing appropriate living environments and mental health treatments emerges throughout.     

Group psychotherapy in chronic psychiatric outpatients: a Toronto model.

Seventy to 80 chronic psychiatric patients are treated in an aftercare clinic with a goal of tertiary preventive care. The major component of the treatment approach is reality-oriented group psychotherapy with an emphasis on interpersonal relationships. Attention to three factors in group psychotherapy with this population of patients has facilitated our work and outcome. These are the concept of the core group, diagnostic heterogeneity, and staff structure.     

Emergent themes and roles in short-term loss groups

Clinical observations regarding themes and roles that are characteristic of short-term, psychoanalytically oriented therapy groups for loss patients are presented. They reflect aspects of both the therapy and the patients. Themes refer to the content of a recurrent conflict in the group. They include trust, survivor guilt, mortality, and termination. Roles refer to a set of patient behaviors that represent a shared conflict. They include the apparition, monk, professor, professional nurturer, emotional conductor, and cruise director. Challenges that the themes and roles present to the therapist and clinical guidelines for addressing them are offered. Awareness of characteristic themes and roles and possible therapist responses are regarded as important parts of the preparation and training of therapists who plan to conduct short-term loss groups.     

A theory of visual interpolation in object perception

We describe a new theory explaining the perception of partly occluded objects and illusory figures, from both static and kinematic information, in a unified framework. Three ideas guide our approach. First, perception of partly occluded objects, perception of illusory figures, and some other object perception phenomena derive from a single boundary interpolation process. These phenomena differ only in respects that are not part of the unit formation process, such as the depth placement of units formed. Second, unit formation from static and kinematic information can be treated in the same general framework. Third, spatial and spatiotemporal discontinuities in the boundaries of optically projected areas are fundamental to the unit formation process. Consistent with these ideas, we develop a detailed theory of unit formation that accounts for most cases of boundary perception in the absence of local physical specification. According to this theory, discontinuities in the first derivative of projected edges are initiating conditions for unit formation. A formal notion of relatability is defined, specifying which physically given edges leading into discontinuities can be connected to others by interpolated edges. Intuitively, relatability requires that two edges be connectable by a smooth, monotonic curve. The roots of the discontinuity and relatability notions in ecological constraints on object perception are discussed. Finally, we elaborate our approach by discussing related issues, some new phenomena, connections to other approaches, and issues for future research.     

Coping within couples: adjustment two years after forced geographic relocation

Is our understanding of how individuals adjust to stressful life events increased when we analyze their adjustment in ways that recognize that these individuals are also married couples? The data used to answer this question came from a unique “natural experiment” occasioned by the forced evacuation of the Israeli settlement of Ophira under the terms of the Camp David Accords. We found that the adjustment of individuals within couples became more similar across the relocation, that is, couples adapted as a “family system.” This occurred because the coping skills of one member of the couple “drove” the adjustment of both partners.     

Sleep physiology and psychological aspects of the fibrositis (fibromyalgia) syndrome

Fibrositis (fibromyalgia) patients were compared with normal controls in terms of electrophysiology (EEG), self-report indicants of awakening, quality of sleep, behaviourally signalled awakenings, and Symptom Check List 90R (SCL-90R) scores. The results differentiated fibrositis patients from normal controls in terms of SCL-90R scores, with fibrositis patients showing significantly more psychopathology. Fibrositis patients had more alpha EEG sleep and less REM and Stage 1 sleep. They were better able to recall their behaviourally signalled awakenings the following morning and reported qualitatively less satisfying sleep than the normal controls. The alpha EEG sleep anomaly may reflect a vigilant arousal state during nocturnal sleep and result in the daytime experience of unrefreshing sleep, psychologic distress, that re-enforces the perpetuation of the sleep-related symptoms.     

Assertiveness, social support, and psychological adjustment following spinal cord injury.

Tested predictions that assertiveness and social support would be significantly predictive of psychological adjustment. Furthermore, it was anticipated that assertiveness and certain types of social relationships would differentially interact to predict adjustment, since positive and negative effects of both variables have been noted in prior research. Trained raters interviewed 156 persons receiving either in-patient or out-patient care for cord injuries and administered measures of assertiveness, social support, depression and psychosocial impairment. Persons who reported a keen sense of responsibility for the welfare of another reported more depression and impairment. Persons reporting higher levels of support facilitating social integration and reassuring personal worth were less depressed. Several significant interactions between assertiveness and different social support relationships revealed beneficial and deleterious effects on depressive behavior and impairment secondary to the disability. Results are discussed as they advance theoretical understanding of the effects of assertiveness and social support. Implications for discriminate cue learning in assertion training for persons with physical disability are proposed.     

Anxiety induced by cardiac perceptions in patients with panic attacks: a field study

In panic disorder bodily sensations appear to play an important role as a trigger for anxiety. In our psychophysiological model of panic attacks we postulate the following vicious circle: individuals with panic attacks perceive even quite small increases in heart rate and interpret these changes as being catastrophic. This elicits anxiety and a further increase in heart rate. To evaluate this model we conducted a field study of 28 subjects with panic attacks and 20 healthy controls. A 24 hr ambulatory ECG was recorded and the subjects were instructed to report any cardiac perceptions during this period and to rate the anxiety elicited by these perceptions. The incidence of cardiac perceptions was about the same in both groups, but only subjects with panic attacks reported anxiety associated with such perceptions. Analysis of the ECGs revealed that in both groups heart rate accelerations preceded cardiac perceptions. Following cardiac perceptions, the healthy controls showed a heart rate deceleration, whereas the subjects with panic attacks had a further acceleration. This heart rate increase after cardiac perceptions was positively related to the level of anxiety elicited by the perceptions. These results provide clear evidence in support of the vicious circle model of panic attacks.