Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders

The reliability of current and lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) anxiety and mood disorders was examined in 362 outpatients who underwent 2 independent administrations of the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). Good to excellent reliability was obtained for the majority of DSM-IV categories. For many disorders, a common source of unreliability was disagreements on whether constituent symptoms were sufficient in number, severity, or duration to meet. DSM-IV diagnostic criteria. These analyses also highlighted potential boundary problems for some disorders (e.g., generalized anxiety disorder and major depressive disorder). Analyses of ADIS-IV-L clinical ratings (0-8 scales) indicated favorable interrater agreement for the dimensional features of DSM-IV anxiety and mood disorders. The findings are discussed in regard to their implications for the classification of emotional disorders.     

Directed Convergence in Stable Percept Acquisition

We view a perceptual capacity as a nondeductive inference, represented as a function from a set of premises to a set of conclusions. The application of the function to a single premise to produce a single conclusion is called a "percept" or "instantaneous percept." We define a stable percept as a convergent sequence of instantaneous percepts. Assuming that the sets of premises and conclusions are metric spaces, we introduce a strategy for acquiring stable percepts, called directed convergence. We consider probabilistic inferences, where the premise and conclusion sets are spaces of probability measures, and in this context we study Bayesian probabilistic/recursive inference. In this type of Bayesian inference the premises are probability measures, and the prior as well as the posterior is updated nontrivially at each iteration. This type of Bayesian inference is distinguished from classical Bayesian statistical inference where the prior remains fixed, and the posterior evolves by conditioning on successively more punctual premises. We indicate how the directed convergence procedure may be implemented in the context of Bayesian probabilistic/recursive inference. We discuss how the L(infinity) metric can be used to give numerical control of this type of Bayesian directed convergence. Copyright 2001 Academic Press.     

Forum: Teaching With,Against, and To Faith

These three articles deal with the issue of faith in the classroom – whether one should teach “to,” “for,” or “against” faith. While their institutional settings and experiences are different, the authors all contend that more serious reflection needs to be given to the matter of how religious commitment plays out in our diverse pedagogical settings. The initial article by Carolyn Medine surveys the current climate regarding student spirituality in the classroom, the broader governmental concerns, and, the tensions that inform the choices available to a professor. Todd Penner's essay analyzes faith‐as‐ideology in the undergraduate classroom, and Marjorie Lehman's contribution analyzes how the issue manifests differently in Jewish Studies.     

DECIDE: a Decision Support Tool to Facilitate Parents’ Choices Regarding Genome-Wide Sequencing

We describe the rationale, development, and usability testing for an integrated e-learning tool and decision aid for parents facing decisions about genome-wide sequencing (GWS) for their children with a suspected genetic condition. The online tool, DECIDE, is designed to provide decision-support and to promote high quality decisions about undergoing GWS with or without return of optional incidental finding results. DECIDE works by integrating educational material with decision aids. Users may tailor their learning by controlling both the amount of information and its format – text and diagrams and/or short videos. The decision aid guides users to weigh the importance of various relevant factors in their own lives and circumstances. After considering the pros and cons of GWS and return of incidental findings, DECIDE summarizes the user’s responses and apparent preferred choices. In a usability study of 16 parents who had already chosen GWS after conventional genetic counselling, all participants found DECIDE to be helpful. Many would have been satisfied to use it alone to guide their GWS decisions, but most would prefer to have the option of consulting a health care professional as well to aid their decision. Further testing is necessary to establish the effectiveness of using DECIDE as an adjunct to or instead of conventional pre-test genetic counselling for clinical genome-wide sequencing.     

How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians’ Practice

Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semi-structured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they felt unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians’ minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that it encompasses more than information provision. It is important to increase physicians’ awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.     

The effects of a short-term mindfulness meditation intervention on coping flexibility

Background and objectives: Mindfulness meditation (MM) training promotes health and well-being. One potential mechanistic link between MM and health may be coping flexibility, (e.g., the ability to monitor and modify coping strategies based on situational needs and strategy effectiveness). We hypothesized that MM training would increase coping flexibility and also explored whether gains in coping flexibility continued to increase after training, or whether they were maintained or lost with time.

Methods and design: One hundred thirteen students (71 female, M_age?=?18.97) were randomly assigned to a waitlist control or MM condition. Participants in the MM condition were trained by a certified MM instructor and given guided recordings for one-week of at-home practice. Participants provided reports of coping flexibility over a three-week span.

Results: Results from multilevel modeling indicated that MM increased coping flexibility among those in the MM condition and among those who spent relatively more time meditating. Results further suggested that the gains in coping flexibility that were evident at post-test were not only maintained but increased in the two weeks after the intervention.

Conclusions: This study provides preliminary support for the assertion that MM increases the ability to monitor and modify coping strategies during times of stress.