THE MANAGEMENT OF DEPRESSION – ANALYTIC,ANTIDEPRESSANTS OR BOTH?

Patients with depression cover the spectrum, in terms of severity of psychopathology, between those receptive to analytic psychotherapy and those that require treatment with medication. In this paper, the author demonstrates how an analytic framework of understanding has a place in the latter group, and can aid general psychiatrists in relation to their depressed patients. It will be demonstrated, with clinical illustrations, how analytic thinking can help to make sense of many of the symptoms of depression, including early-morning wakening, diurnal mood variation, agoraphobia and hypochondriasis. It is also important to help the supportive relative with their countertransference experiences, when their partner is undergoing a depressive episode. Finally, the notion of a pathological ego-destructive superego taking over the driving-seat in depression is explored. The need to unseat it and replace it with a more mature superego provides an overall framework of approach to the treatment of depression.     

Pygmalion in the genes? On the potentially negative impacts of polygenic scores for educational attainment

Social Psychology of Education - Polygenic scores for educational attainment and related variables, such as IQ and “mathematical ability” are now readily available via...     

Multisystemic Therapy and Functional Family Therapy Compared on their Effectiveness Using the Propensity Score Method

Multisystemic Therapy (MST) and Functional Family Therapy (FFT) have overlapping target populations and treatment goals. In this study, these interventions were compared on their effectiveness using a quasi-experimental design. Between October, 2009 and June, 2014, outcome data were collected from 697 adolescents (mean age 15.3 (SD 1.48), 61.9% male) assigned to either MST or FFT (422 MST; 275 FFT). Data were gathered during Routine Outcome Monitoring. The primary outcome was externalizing problem behavior (Child Behavior Checklist and Youth Self Report). Secondary outcomes were the proportion of adolescents living at home, engaged in school or work, and who lacked police contact during treatment. Because of the non-random assignment, a propensity score method was used to control for observed pre-treatment differences. Because the risk-need-responsivity (RNR) model guided treatment assignment, effectiveness was also estimated in youth with and without a court order as an indicator of their risk level. Looking at the whole sample, no difference in effect was found with regard to externalizing problems. For adolescents without a court order, effects on externalizing problems were larger after MST. Because many more adolescents with a court order were assigned to MST compared to FFT, the propensity score method could not balance the treatment groups in this subsample. In conclusion, few differences between MST and FFT were found. In line with the RNR model, higher risk adolescents were assigned to the more intensive treatment, namely MST. In the group with lower risk adolescents, this more intensive treatment was more effective in reducing externalizing problems.     

Reactions in Psychotherapy

The Pollyanna Principle states that people process pleasant information more accurately and efficiently than less pleasant information. This study examined whether different measures of Pollyanna tendencies are correlated with each other. Fourteen measures of Pollyannaism were derived for 133 students. The results showed that subjects who rated themselves as optimistic or happy also showed Pollyannaism on other measures of happiness, believed that the events in their lives were pleasant, gave themselves positive ratings on personality characteristics, recalled pleasant words more often than unpleasant words, supplied more free associations to pleasant stimuli than to unpleasant stimuli, listed pleasant items first, and judged that pleasant words were more frequent in the English language.     

Recognizing Specialized Terminology Presented Through Different Modes

In the present study, the authors examined how previous experience and modes of presenting information affect the recognition of terms in new, specialized terminologies. The specialized terminology used was related to orienteering. Orienteering concepts representing features found in the woods may be communicated verbally (as definitions or words) or symbolically. There were 225 participants (101 reported no orienteering experience and 122 reported varying amounts of orienteering experience; 2 did not respond to that question) who tried to identify which of 5 entities was an orienteering definition, word, or symbol. Those with orienteering experience found that recognizing the specialized terminology was significantly easier than for those without experience. Recognizing symbols was significantly more difficult than recognizing definitions or words, particularly for non-orienteers. Performance of the orienteers was similar for the three modes. Within the orienteering group, the number of years of experience and usual course difficulty attempted were significant predictors of overall test success. Applications to training of both low-level specialized terminology (e.g., used in algebra), and higher level terminology (e.g., used in computer science) are discussed.     

Puerperal psychosis: Vulnerability and aftermath

The puerperium is a particularly vulnerable time for a depressive psychotic breakdown, with important consequences for both mother and child. While general psychiatric experience helps in the overall management, psychoanalytic insights help towards understanding the central psychopathology. Illustrative case-studies are presented.

Based on hospital admission rates, puerperal psychosis is regarded as a rare condition (one in 500 deliveries). In this paper, evidence is given to suggest that puerperal psychosis is a far commoner condition (three in 100 deliveries), and that many less-severe cases remain undetected and untreated in the community. It is argued that understanding interventions in these cases can be therapeutic for the mother, as well as having major implications for the baby's development.