A view from the visitors' gallery

SUMMARY

In this paper, the author describes aspects of his work as a psychoanalytical psychotherapist in a hospital for diseases of the colon and rectum. After reviewing some of the earlier psychoanalytic literature (Freud and Abraham), and more recent theoretical contributions, two cases are described in some detail, which help give a flavour to some of the work. The paper concludes with caveats about the internal and external working environment, which will facilitate or hinder working in particular medical settings.     

Psychometric evaluation of the Drive for Muscularity Scale in a community-based sample of Scottish men participating in an organized sporting event

As the drive for muscularity is an important construct for researchers involved in understanding men's body image, having reliable and valid measures of the construct is essential. This study assessed the Drive for Muscularity Scale (DMS) in a community-based sample of 594 Scottish men participating in an organized running event. Exploratory factor analysis revealed two subscales (Muscularity-oriented body image and Muscularity behavior) as well as a higher-order factor. Both subscales and the total score had acceptable levels of internal consistency, test–retest reliability, and construct validity. These findings provide support for the DMS as a measure of the drive for muscularity in men. It is recommended that, in future, careful consideration is given to the distinction between muscularity attitudes and behavior.     

An event-related brain potential investigation of PTSD and PTSD symptoms in abused children

We tested 186 children ranging in age from 6 years, 10 months to 13 years, 7 months; 174 suffered either physical and/or sexual abuse, and 12 were nonabused children. Abused subjects were grouped in four different ways. The primary grouping was based on whether subjects satisfied the DSM III-R criteria for posttraumatic stress disorder (PTSD). Secondary groupings were based upon the three symptom clusters used to make the PTSD diagnosis (arousal, avaidance, and reexperiencing). In each of these groupings three separate subgroups were formed with approximately 25 percent in the high and low symptom count subgroups and the remaining 50 percent in the middle symptom count subgroup. Subjects listened to four different intensity levels (65, 80, 95, and 102 dB) of a 1 KHz tone, pseudo-randomly ordered, while event-related brain potentials (ERPs) were recorded. Two separate blocks were used, one with short intervals (4±1 sec) between tones and the other with longer intervals (17±2 sec). PTSD subjects presented a greater P2-N2 ERP intensity gradient (i.e., a larger increase in the P2-N2 ERP component as tone intensity increased) than did abused subjects without PTSD. Abused subjects with the highest number of reexperiencing symptoms showed a similar P2-N2 augmenting effect when compared to those with the lowest number of reexperiencing symptoms. Subjects with the highest number of arousal symptoms showed a shallower intensity gradient for the N1-P2 ERP component than did those with fewer arousal symptoms. The results are discussed in relation to previous results reported on adults with PTSD and in terms of CNS processing of stimulus intensity information.     

Death penalty mitigation and cult membership: The case of the Kirtland killings

When cult activities precipitate violence against others, the interface of religious belief and practice, and law becomes complex. Personal and group psychological factors can assume importance not only to explain the crimes, but also in the processing of cases, particularly where a death penalty/mitigation trial is involved. While destructive cult membership has not been accepted in the legal system as a basis for an insanity plea, mitigation from the death penalty or other reduced responsibility outcomes can be justified and was effective in defence of Kirtland cult members. Outcomes in the Kirtland case reflected statutory requirements and procedural operations in complex constellations with roughly proportionate results. The paper details specifics of the case, defense strategies, prosecutorial functions, and religious and psychological underpinnings which led into acts for which neither religious freedom nor psychological disturbance could exempt from Penalty.     

The role of item extremity in the emergence of keying-related factors: an exploration with the life orientation test

Keying-related factors in psychological scales are variously interpreted substantively or as products of violations of the assumptions underlying item keying. The present study investigated whether the extremity of the wording of items may contribute to the emergence of item-keying factors in a commonly used psychological scale. Respondents (N = 277) completed the Life Orientation Test (M. F. Scheier & C. S. Carver, 1985) in either its original or modified, more moderately worded form. Results indicate that the interaction of item extremity and item keying significantly affected subscale means and, more important, that the more moderately worded scale was substantially more unidimensional. Results are explained partially through the association of lesser and greater extremity with the tendency for some respondents to agree or disagree with items irrespective of keying direction. These results, although demonstrated in only 1 scale, have potential relevance to any scale comprising positive and negative items.     

Baby Triple P: A Randomized Controlled Trial Testing the Efficacy in First-Time Parent Couples

Journal of Child and Family Studies - In a randomized controlled trial, we tested the efficacy of Baby Triple P in a community sample of first-time parent couples. The intervention was developed to...     

Service and Medication Use and Their Effects on Arrest Rates Among Children with Emotional Disturbances Before Disenrollment from Medicaid

In this study we examine two assumptions that underlie the hypothesis that the outcomes of children with emotional disturbances are negatively affected by the loss of access to mental health services during their transitions to adulthood. The first is that children access mental health services during the pre-transition years, and the second is that these services are effective in reducing poor outcomes. We tested these assumptions using children who lost Medicaid enrollment between their 18th and 20th birthdays in Florida’s Medicaid program using arrests as the outcome. All children with an emotional disturbance received at least one outpatient service. However, while the mean days of service per month were 3, more than half the children received less than one day of service. Fifty-six percent of children received some psychotherapeutic medication treatment. Children with ADHD had the highest number of days of medication per month in both univariate and multivariate analysis. In multivariate analysis, children with disruptive behavior disorders had significantly more days per month of outpatient services than children with any other diagnoses except anxiety disorders. Medication days but not outpatient service days were negatively associated with arrests. Post hoc analysis suggested that children with ADHD who had high medication days had significantly fewer arrests than children with disruptive behavior disorders. This was not the case for children with ADHD and low medication days. Children with ADHD and high medication use may be most at risk of increases in arrests after Medicaid disenrollment as many will lose access to a service that was associated with fewer arrests. Findings suggest the need for reform of the children’s mental health system.     

Extreme Values of Maternal Serum Analytes in Second Trimester Screening: Looking Beyond Trisomy and NTD’s

Second trimester maternal serum screening can identify high risk pregnancies and fetuses at risk for birth defects (in addition to those in the standard interpretation). The purpose of this study was to quantify such risks to improve counseling. We compared outcomes of 692 pregnancies that had abnormal levels of at least one analyte with a cohort of 713 pregnancies with normal analytes. Increased risks include: demise with high AFP and low uE3; intrauterine growth restriction with high AFP, high and low hCG, and low uE3; placental abnormalities with high AFP; fetal stress with high AFP and high hCG. Birth defects are increased with high AFP, high hCG, and low hCG. When two or more analytes are abnormal, 46% have a poor outcome. Abnormal levels of maternal serum analytes provide information in addition to the risks for neural tube defects, Down syndrome, and trisomy 18. This information is important for counseling and pregnancy management.