Mismanagement of Panic Disorder in Emergency Departments: Contributors, Costs, and Implications for Integrated Models of Care

Panic disorder (PD) is associated with the rapid onset of fear-related symptomatology, often somatic in nature. As a result, individuals with the disorder often fear that they are experiencing a life-threatening emergency and present in hospital emergency departments (EDs). As the operating heuristics of EDs are geared toward identifying organic causes and allow only brief physician–patient contact, the diagnosis of PD is more often than not overlooked. Those with the disorder go on to incur enormous costs as they seek out an explanation for their symptoms. Efforts to alleviate this problem, including increased physician education and the development of screening instruments, have been largely unsuccessful. The continued misidentification and mismanagement of this disorder argues for greater incorporation of mental health professionals into the ED, allowing collaborative efforts that recognize the relationship between physiological and psychological aspects of panic.     

Structure and measurement of depression in youths: applying item response theory to clinical data

Our goals in this article were to use item response theory (IRT) to assess the relation of depressive symptoms to the underlying dimension of depression and to demonstrate how IRT-based measurement strategies can yield more reliable data about depression severity than conventional symptom counts. Participants were 3,403 children and adolescents from 12 contributing clinical and nonclinical samples; all participants had received the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Aged Children. Results revealed that some symptoms reflected higher levels of depression and were more discriminating than others. Furthermore, use of IRT-based information about symptom severity and discriminability in the measurement of depression severity was shown to reduce measurement error and increase measurement fidelity.     

The <Emphasis Type="Italic">Community Supports for Wraparound Inventory</Emphasis>: An Assessment of the Implementation Context for Wraparound

The wraparound process has emerged as perhaps the most frequently implemented comprehensive approach for planning and providing individualized, community-based care for children and adolescents with serious mental health conditions. Providing comprehensive care through the wraparound process necessarily requires a high level of collaboration across organization and agency boundaries. This need for significant inter-agency or “system-level” collaboration creates a complex implementation environment for wraparound. It is therefore not surprising that creating and sustaining a hospitable implementation environment has proven to be extremely challenging. For the people who are responsible for managing the inter-organizational collaboration, it is not easy to evaluate the adequacy of local system-level support for wraparound and to see exactly what kinds of supports are lacking or where system-development efforts should focus. Furthermore, as system-development strategies are put into practice, it can be difficult to assess whether or not meaningful progress is occurring. The Community Supports for Wraparound Inventory (CSWI) was developed to respond to the need for an assessment of the extent to which a community has developed system-level capacity to implement wraparound. This article reports on a study that evaluated the reliability and validity of the CSWI for use in communities implementing wraparound. Findings indicate that the CSWI shows promise as a reliable, valid and useful tool.     

Memory consolidation in both trace and delay fear conditioning is disrupted by intra-amygdala infusion of the protein synthesis inhibitor anisomycin

Memory for delay fear conditioning requires the synthesis of new mRNA and protein in the basolateral amygdala. It is currently unknown whether similar molecular processes in the amygdala are required for the formation of trace fear memory, in which a stimulus-free interval is inserted between the conditional stimulus (CS) and unconditional stimulus (UCS). Here, we show that infusion of the protein synthesis inhibitor anisomycin into the basolateral amygdala disrupts consolidation of both trace and delay fear conditioning. This is the first evidence that protein synthesis in the amygdala is necessary for the formation of both trace and delay fear memory.     

Metacognition of emotional face recognition

While humans are adept at recognizing emotional states conveyed by facial expressions, the current literature suggests that they lack accurate metacognitions about their performance in this domain. This finding comes from global trait-based questionnaires that assess the extent to which an individual perceives him or herself as empathic, as compared to other people. Those who rate themselves as empathically accurate are no better than others at recognizing emotions. Metacognition of emotion recognition can also be assessed using relative measures that evaluate how well a person thinks s/he has understood the emotion in a particular facial display as compared to other displays. While this is the most common method of metacognitive assessment of people's judgments of learning or their feelings of knowing, this kind of metacognition--"relative meta-accuracy"--has not been studied within the domain of emotion. As well as asking for global metacognitive judgments, we asked people to provide relative, trial-by-trial prospective and retrospective judgments concerning whether they would be right or wrong in recognizing the expressions conveyed in particular facial displays. Our question was: Do people know when they will be correct in knowing what expression is conveyed, and do they know when they do not know? Although we, like others, found that global meta-accuracy was unpredictive of performance, relative meta-accuracy, given by the correlation between participants' trial-by-trial metacognitive judgments and performance on each item, were highly accurate both on the Mind in the Eyes task (Experiment 1) and on the Ekman Emotional Expression Multimorph task (in Experiment 2).     

Category norm data and relationships with lexical frequency and typicality within verb semantic categories

The aim of the present study was to expand the scope of category norm and typicality data to include verbs for use when investigating semantic memory in fields such as linguistics, psychology, and aphasiology. Two experiments were conducted. In the first, participants were asked to list verbs within 10 semantic categories (e.g. breaking, cleaning, cooking, etc.) and 10 noun categories (e.g. animals, fruit, tools, etc.). In the second experiment, participants were asked to rate the typicality of verbs within 8 of the previously investigated verb categories. Although participants listed fewer verbs in verb categories than nouns in noun categories, the overall patterns with regard to correlation analyses between production frequency, mean rank of responses, lexical frequency, and typicality were consistent with those observed in noun categories. These patterns are also consistent with those observed in previous research. Potential similarities and differences between nouns and verbs, as well as future applications of such data, are discussed.     

A Clinical Model in Action in Intensive Residential Treatment: Meeting the Needs of Adolescent Boys who have Experienced Domestic Violence

The Habitat Program at Wood’s Homes, Calgary, Alberta, is an eight bed residential treatment program for conduct-disordered youth who have been exposed or subjected to high levels of violence in their family home. The program was based on the assumption that working effectively with such youth requires consideration of the background experiences of family violence, yet traditional treatment models often ignore or minimize the importance of these experiences. We present a clinical model which incorporates aspects of milieu treatment, relationship-based daily interventions and elements of Jenkins’ invitational approach to working with men and boys who use violence as well as Wade’s response-based approach to counseling with victims and perpetrators of violence. The model also incorporates ideas based on Maruna’s research into recidivism and excuse-making. The purpose of the model is twofold: to be broad enough to structure an overall treatment strategy based on the assumption that successful treatment results from the cumulative effect of many interactions over time, and to be specific enough to guide staff in developing strategies for specific situations that typically arise in daily interaction with the youth. We use a case example format to illustrate how staff has utilized the model to engage youth in exploring both their experiences of violence in the family home and in developing new ways of thinking and talking about behavioural choices.     

Multiculturalism as a dimension of school climate: the impact on the academic achievement of Asian American and Hispanic youth

Multiculturalism constitutes an important element of school climate, but the relation between perceived multiculturalism and academic achievement has not been widely studied. This study examined the influence of students' perceptions of school support for multiculturalism on academic achievement among 280 Asian American and Hispanic youth, including ethnic identity and ethnocultural empathy as potential mediators. Results of structural equation modeling revealed that perceived multiculturalism was significantly positively related to ethnocultural empathy for Asian Americans and Hispanics, and that ethnocultural empathy, in turn, was predictive of academic achievement for Hispanics only. Results of bootstrapping to test for mediation effects revealed ethnocultural empathy to be a salient mediator for Hispanic youth. Although ethnic identity did not mediate the link between multiculturalism and academic achievement, ethnic identity was significantly predictive of achievement for Hispanics. On the whole, these findings suggest that fostering a school climate supportive of multiculturalism may improve empathy toward ethnic out-groups. Furthermore, schools that promote compassion and tolerance for diverse ethnic groups may achieve better academic outcomes among Hispanic youth.