Differential diagnosis of steroid-dependent nephrotic syndrome with psychosis: Practical and ethical issues

The present case illustrates practical and ethical issues that can be encountered by clinical psychologists providing consultation services in medical settings. The neuropsychological consultation service was asked to evaluate a 22-year-old male with psychosis, steroid-dependent nephrotic syndrome, and a family history of schizophrenia. MRI revealedmarked cortical atrophy. Clinical findings were consistent with (1) steroid inducedapparent atrophy, which has been shown to be reversible with withdrawal of steroids; (2) uremia secondary to steroid withdrawal; (3) cortical atrophy, found in some schizophrenics; or (4) an atypical, diffuse degenerative disorder. Clinical interview and psychological testing revealed significant thought disorder, prominent delusions, somatic hallucinations, and mood disturbance. Deterioration in social and academic functioning was also present. Except for impaired attention and concentration, neuropsychological evaluation showed no clear evidence of brain-based dysfunction. Further, neuropsychological results effectively ruled out a degenerative process and were not consistent with a steroid effects profile. A conclusive differential diagnosis of steroid induced psychosis versus severe psychopathology would require withdrawal from steroids and antipsychotics. In addition to the practical and ethical issues of withholding antipsychotics, steroid withdrawal would require either dialysis or renal transplant surgery. Decision making regarding dialysis dependency and the possibility of postsurgical psychosis secondary to true psychopathology were salient issues to both the patient and the treatment team.     

Determinants of social perception in a naturalistic setting

Based upon the assumption that personality traits exist more in the eye of the observer than is actually reflected in the actions of the actor, Jones and Nisbett have proposed that a negative relationship exists between familiarity with an actor's behavioral history and the tendency to attribute traits to that individual. An alternative viewpoint is suggested by the present research. Members of a college fraternity attributed more personality traits to themselves than were attributed to them by their fellow members. In addition, the fraternity members tended to offer more dispositional attributions to other members with whom they were more familiar. Furthermore, evidence is presented that is suggestive of the validity of these attributions. It is concluded that the attribution of personality traits provides attributors with information that is both veridical and useful in guiding social interactions.     

Desire for control and reaction to proattitudinal and counterattitudinal arguments

The role of motivation for control in an individual's reaction to persuasive arguments was examined. Subjects scoring either high or low on an individual difference measure of desire for control (DC) were exposed to a position on the Equal Rights Amendment with which they either initially agreed or disagreed. It was found that more often high-DC subjects exposed to a proattitudinal message changed their attitudes in the direction advocated than did low DC subjects. Conversely, more often low-DC subjects exposed to counterattitudinal arguments changed their attitudes in the direction of the advocated position than did high-DC subjects. The findings suggest that a motivation to control events may be operative in some attitude-change situations.     

Attributed intentions and informational selectivity

Three experiments tested the hypothesis that ascribing a specific intention to an actor prior to witnessing his behavior leads an observer to preferentially recall action bearing on the intention. In each case, subjects were exposed to an action sequence which mixed elements appropriate to more than one intention. Recall of action was compared among different observers who were led to attribute different intentions to the same actors. Selective remembering favoring intent-relevant action is demonstrated in all three studies. The second experiment offers evidence that selectivity operates during observation of an actor rather than retrospectively. The third experiment suggests that attributions about intentions are more potent determiners of such selectivity than are characteristics of an actor related to his behavior but not bearing on his intention and indicates that observer characteristics interact with attributed intentions to determine recall. Interpretation of the findings suggests that accurate attribution of intentions can facilitate social exchange by attuning partners to the planned aspects of each other's behavior, while misapprehension of intentions can preclude coordinated interaction by misdirecting attention to irrelevant action or to responses coerced by the observer.     

Prediction of outcome from cognitive-behavioral treatment of irritable bowel syndrome

The presence of a diagnosable Axis I psychiatric disorder predicted significantly (P < 0.001) lower likelihood of significant improvement among 90 irritable bowel syndrome patients given cognitive and behavioral treatments to help the disorder. Other psychological tests, including the MMPI, BDI, STAI, as well as demographic variables, failed to yield significant prediction.     

A pilot study of a Scripture-based trauma healing model for adults in Nicaragua

With the rising attention to global trauma, there is increased interest in utilising effective trauma healing (TH) models, especially those that integrate a spiritual component. This paper examines the effectiveness of a Scripture-based TH model developed by the Trauma Healing Institute utilised in a pilot study with Nicaraguan adults who experienced non-sexualised-related crime, disaster-related trauma, and/or interpersonal violence. An additional focus of this study was on whether increased spiritual well-being would result from this healing model. In this first empirical study on the TH model, initial results indicated that participants (N?=?23) experienced both a reduction in trauma-related symptoms as well as an upward trend in spiritual well-being from pre-test to six-month follow-up. Spearman results also showed an inverse relationship between trauma symptoms and spiritual well-being. Factors that may have impacted results, limitations to this pilot study, and considerations for future studies are discussed.