Comparison of the Hamilton Depression Rating Scale and the Geriatric Depression Scale: detection of depression in dementia patients.

The present longitudinal prospective study compared results from the Geriatric Depression Scale with those from the Hamilton Depression Rating Scale for 30 dementia patients. The criterion measure was presence of depression as indicated by the psychiatric diagnosis. The psychiatrist and physician's assistant made the Hamilton ratings while the psychology staff administered the Geriatric Depression Scale. The two measures were statistically unrelated from Times 1 and 2 (rs = .26 and .41). Eleven (37%) patients were depressed and nine received antidepressant medications. Sensitivity ratings were 82% and 9%, respectively, and specificity ratings were 88% and 92%, respectively. Possible explanations for the success of the Geriatric Depression Scale and lack of success of the Hamilton ratings in detecting depression in this population are discussed.     

The testing of reality from the standpoint of the body self

Traditionally, the body self has been regarded as involved in reality testing principally in the determination of the distinction between the source of a stimulus being internal or external. The body has been closely related to instinctual drives, to urgency, and thus to conflicts that are crucial to normal and pathological development. However, the concept of the body self comprising all the psychic experiencing of body sensation, body functioning, and body image is broader than the body's connection to inner-outer reality testing and id pressures. The findings from childhood observations and from clinical research indicate that at each stage of the child's life, from earliest infancy on, the maturation and development of the body self becomes integrated with the whole group of psychic regulatory activities that contribute to the individual's sense of reality. The development of the body self at each period involves criteria by which some aspect of reality is tested. The subject of this paper has been the developmental pattern of experiences that contribute to the individual's sense of his body in particular and to the sense of reality of the self in general.     

Child abuse and the limits of confidentiality: forewarning practices

Confidentiality is widely considered to be of great importance in psychotherapy. With few exceptions, the breaching of confidentiality is an ethical violation and grounds for litigation. One such exception is the mandated reporting of known or suspected child abuse, representing a legally sanctioned limitation of confidentiality. Because clients generally expect unlimited confidentiality in therapeutic relationships, many therapists have begun to "forewarn" clients as a matter of informed consent. This research report: (a) briefly reviews issues surrounding mandatory reporting and confidentiality as they relate to forewarning, (b) defines and discusses forewarning as contrasted with "informing," (c) examines state statutes, case law and ethical guidelines relevant to forewarning, and (d) presents a survey of 428 mental health providers (MHPs) on their forewarning practices in which 36.9% forewarned all clients, 36.4% informed clients only upon suspicion of abuse, and 20.6% informed only after receiving a disclosure of abuse. The implications of these findings are discussed.     

Efficacy of a Train-the-Trainer Curriculum for Increasing Occupational Therapists’ Mental Health Knowledge

The marked prevalence and under detection of affective disorders including depression in older adults is associated with poor functional outcomes and patient mortality. Although occupational therapists are trained in mental health assessment and intervention, these skills are underutilized in practice. A two-group wait-list control design was used to test a DVD-based educational curriculum to increase knowledge about depression in a sample of occupational therapists. The educational intervention was delivered using a train-the-trainer model. The train-the-trainer model was found to be effective and study results showed that knowledge increased significantly after the DVD training.     

Clinical Utility of the Mattis Dementia Rating Scale in Older,Urban Medical Patients: An Expanded Study

This study investigated the clinical utility of the Mattis Dementia Rating Scale (DRS), using a sample of 138 cognitively intact and 151 cognitively impaired patients at an urban medical center. The 172 young-old patients (ages 60-79) and the 117 older-old patients (ages 80 and above) were predominantly African American elders who had completed significantly less education than had Mattis’s normative samples. Results show that, despite lower mean scores in our sample versus Mattis’s normative samples, the best cut-off score is nearly identical to Mattis’s in the young-old patients, while a lower cut score provided optimal classification for the older-old patients.     

Values,Consciousness, and Language

Two seminal thinkers, Edelman and Damasio, offer neurophysiological models of brain development and functioning that correspond with a contemporary psychoanalytic focus on dynamic experiential intersubjective systems. I describe their respective contributions under three headings derived from Edelman: values, consciousness, and language. I consider the scope of each of these topics as it abuts related psychoanalytic concepts.     

Motivational Systems and Model Scenes with Special References to Bodily Experience

The motivational systems underlying the behavior of recalcitrant and verbally uncommunicative patients are viewed and discussed in terms of emerging self with other. The painful sensations and misperceptions of bodily experience in infancy can reoccur during treatment or have become a habitual way of being in the world. They must be understood and worked through in order to facilitate symbolization and sufficient distance from bodily sensations to allow renewed psychological growth. Five motivational systems are said to aid and express needs such as help in sustaining physiologic requirements, need for attachment, assertion of preferences, development of healthy assertion, and the need for sensual enjoyment. Affective experiences associated with each system in infancy set the pattern for later behavior. It becomes clear that during treatment patients reclaim and begin to understand such “sensation” language. The therapist is then called upon to translate the arising metaphors.

Ten “principles of psychoanalytic technique” are then offered. Every effort is made to comprehend the patient's affective experience, either during recall of experiences or in the present. Of particular interest is the stance of the therapist during such therapeutic encounters. Rather than adopting the traditional position of interpreting the present in terms of the past, empathic attention is given to affect and emotion in the here and now.     

Young Freud's linkage with Persia

Abstract

Sigmund Freud's hands helped to mutilate a volume containing a series of “colored plates” like the one replicated in Figure 1 in the text. As a young adult, his personal library included a fairytale whose German text was entitled Die Träumleiter: Ein Marchen. No one has yet been able to authenticate the author's identity beyond the following imprint: “S. Andreas (1832).” The poetic play centers upon a celestial meeting featuring Shakespeare, Goethe, and Dschami. It has been translated into English (The dream ladder: A fairy tale), but still awaits a psychoanalytically informed exegesis.