Care For Pastors: Learning From Clergy and Their Spouses

Pastors and their spouses face unique challenges because of the nature of pastoral work, and yet most manage these challenges successfully. Five studies are presented which help distinguish between intrapersonal, family, and community forms of care. Pastors rely heavily on intrapersonal forms of coping such as spiritual devotion, hobbies, exercise, and taking time away from work. The marriage relationship is also quite important for most clergy and spouses. Relationships outside the immediate family are not commonly identified as coping resources. Implications are discussed.     

The preservation of verb subcategory knowledge in a spoken language comprehension deficit

Patient WBN has a lexical-semantic deficit resulting in impaired performance on language comprehension tasks that require access to verb meanings in both single-word and sentence contexts. However, WBN shows no such comprehension impairment with respect to lexical syntax. Specifically, he performs without error on comprehension tasks that rely on knowledge of lexical-specific verb subcategory requirements. This performance pattern supports theories of lexical representation and processing in which lexical syntactic information may be encoded and retrieved independently from lexical semantic information.     

Myth and Legend in Family Therapy: Maintaining the Distinction Between the Sacred and Secular in Family Process

Family therapy has blurred the distinction between the sacred (myth) and the secular (legend) with resultant ethical implications, and has also created problematic cross-cultural considerations with its use of “myth.” The objectives of this paper are (a) to briefly introduce the evolution of the concept of “myth” in folklore; (b) to identify specific problems resulting from the current utilization of the term “myth” by family therapists; and (c) to demonstrate how appropriate usage of the concepts “myth” and “legend” from folklore theory radically decreases the confusion created in comparison to the present reliance on the term “myth” alone. Kimberly Ann Holle, MS, MSW, LSW, LCDC -III, CADC, graduated from the College of Social Work, The Ohio State University, in June, 2005. Ms. Holle now resides in Columbus, Georgia, USA (kimmers.1212@aol.com).     

Contextual Competence: Multiple Manifestations Among Urban Adolescents

The authors develop and validate multidimensional and contextual profiles of competence among low-income, urban, middle adolescents (N = 560). The assessment of contextual competence was based on youth self-reports of involvement, performance, and relationship quality in the peer, school, athletic, employment, religious, and cultural contexts. A principal components analysis of these engagement indices revealed the six expected components with the addition of a component labeled self-in-context. To identify holistic, multidimensional profiles of contextual competence, scores along the seven domains were cluster analyzed. Nine clusters emerged, each representing a distinct constellation of youth experience. Profiles were associated with demographic variables and youth adjustment. Profiles reflecting high engagement in two or more contexts predicted higher self-esteem and lower depression. In contrast, profiles marked by high engagement in the contexts of athletics or employment predicted more serious delinquency. The authors discuss the implications of these findings for future research and intervention.     

Assessment of gestational age and neuromaturation

Neuromaturation is the functional development of the central nervous system (CNS). It is by its very nature a dynamic process, a continuous interaction between the genome and first the intrauterine environment, then the extrauterine environment. Understanding neuromaturation and being able to measure it is fundamental to infant neurodevelopmental assessment. Fetal and preterm neuromaturation has become easier to observe with the advent of prenatal ultrasonography and neonatal intensive care units. A number of measures of degree of fetal maturation have been developed and used to estimate gestational age (GA) at birth. The most reliable measures of GA are prenatal measures, especially from the first trimester. Postnatal GA measurements tend to be least accurate at the extremes of gestation, that is, in extremely preterm and post-term infants. Observations of measures of neuromaturation in infants born to mothers with pregnancy complications, including intrauterine growth restriction, multiple gestation, and chronic hypertension, have led to the discovery that stressed pregnancies may accelerate fetal pulmonary and CNS maturation. This acceleration of neuromaturation does not occur before 30 weeks' gestation and has a cost with respect to cognitive limitations manifested in childhood. The ability to measure fetal and preterm neuromaturation provides an assessment of neurodevelopmental progress that can be used to reassure parents or identify at risk infants who would benefit from limited comprehensive follow-up and early intervention services. In addition, measures of neuromaturation have the potential to provide insight into mechanisms of CNS injury and recovery, much-needed early feedback in intervention or treatment trials and a measure of early CNS function for research into the relationships between CNS structure and function.     

Best clinical practice with ziprasidone IM: update after 2 years of experience

Acute agitation is a common psychiatric emergency often treated with intramuscular (i.m.) medication when rapid control is necessary or the patient refuses to take an oral agent. Conventional i.m. antipsychotics are associated with side effects, particularly movement disorders, that may alarm patients and render them unreceptive to taking these medications again. Ziprasidone (Geodon) is the first second-generation, or atypical, antipsychotic to become available in an i.m. formulation. Ziprasidone IM was approved by the Food and Drug Administration in 2002 for the treatment of agitation in patients with schizophrenia. In October 2004, a roundtable panel of physicians with extensive experience in the management of acutely agitated patients met to review the first 2 years of experience with this agent. This monograph, a product of that meeting, discusses clinical experience to date with ziprasidone IM and offers recommendations on its use in various settings. In clinical trials, patients treated with ziprasidone IM demonstrated significant and rapid (within 15-30 minutes) reduction in agitation and improvement in psychotic symptoms, agitation, and hostility to an extent greater than or equal to that attained with haloperidol i.m. Tolerability of ziprasidone IM was superior to that of haloperidol IM, with a lower burden of movement disorders. Clinical trials have also shown that ziprasidone IM can be administered with benzodiazepines without adverse consequences. Transition from i.m. to oral ziprasidone has been well tolerated, with maintenance of symptom control. The most common adverse events associated with ziprasidone IM were insomnia, headache, and dizziness in fixed-dose trials and insomnia and hypertension in flexible-dose trials. No consistent pattern of escalating incidence of adverse events with escalating ziprasidone doses has been observed. Changes in QTc interval associated with ziprasidone at peak serum concentrations are modest and comparable to those seen with haloperidol IM. Results of randomized clinical trials of ziprasidone IM have been corroborated in studies in real-world treatment settings involving patients with extreme agitation or a recent history of alcohol or substance abuse. In these circumstances, clinically significant improvement was seen within 30 minutes of ziprasidone IM administration, without regard to the suspected underlying etiology of agitation. Agents with a good safety/tolerability profile, such as ziprasidone IM, may be more cost effective long term than older agents, due to reduced incidence of acute adverse effects (eg, acute dystonia) that often require extended periods of observation. Additional trials of ziprasidone IM in agitated patients in a variety of clinical setting are warranted to generate comparative risk/benefit data with conventional agents and other second-generation antipsychotics.     

Manipulation of study trials in recognition memory

Two experiments were performed for the purpose of ascertaining the effects of two processes in recognition memory: the Ss’ actual viewing time of verbal material and the E’s feedback. Recognition-memory performance was found to be superior for an Ednduced feedback over the S’s own “subjective, ” induced feedback (query loops), even though the time for total rehearsal was kept constant for each condition. The actual viewing time was not found to be a critical factor. Several hypotheses are advanced to account for this result.     

The Prediction of Future Outcomes Among OASI Referrals Using NMZ Scores

Using samples from Iowa OASI sub-populations, the relationships between NMZ scores and the criteria of acceptance for services by the Iowa DVR as well as future rehabilitation of clients were examined. The results suggest that (a) the relationship of NMZ scores to the acceptance criterion is low; (b) the relationship of NMZ scores to the more ultimate criterion of client rehabilitation is moderate, and, here, empirical weights appear to work better than the intuitive weights assigned in the original development of NMZ scores; (c) through empirical weighting, the variable of age was revealed as most important in predicting such criteria.     

Studies on sensory feedback: III the effects of display gain on tracking performance

Instrumentation is described which permits study of the effects of different forms of visual feedback display on the patterns of fine movement obtained from the extended human index finger when the subject is attempting to keep his finger at a fixed point in space. The task is a compensatory tracking task in which the only source of input to the system is the subject's own finger movement. The effects of increasing the gain (or amplification) of a proportional error signal on the pattern of finger movement was studied. Gains of 1, 2, 4, 10, 20 and 40 were studied with a group of 24 subjects. Increasing the gain of a proportional error signal resulted in a marked improvement in the ability of subjects to maintain their extended finger at a fixed point in space. As the gain of the error signal was increased, the subject's high-amplitude, low frequency errors were reduced, and there was a progressive appearance of high-frequency activity of low-amplitude, more accurately centred about the reference position in space. A total off-target area measure (integrated absolute error) showed marked decrease in scores as the amplification of the error signal was increased from 1 through 10. Beyond this gain there was no appreciable additional improvement in motor control, however no degradation of control was noted to characterize the group performance.

Exploratory studies were undertaken to permit comparison of the effects of increasing the gain of a proportional visual display with the effects of increasing the gain of non-proportional visual and auditory displays. An increase in the dominant-energy frequency was noted as the error signal gain was increased, independent of whether a proportional visual, or non-proportional visual or auditory display was used. This observation suggests that common mechanisms mediate the processing of the gain parameters of feedback displays, in some measure independent of the display form or the sensory modality used for presentation.