A pilot randomized trial of metacognitive therapy vs applied relaxation in the treatment of adults with generalized anxiety disorder

Metacognitive Therapy (MCT) and Applied Relaxation (AR) were compared in a pilot treatment trial of generalized anxiety disorder (GAD). Twenty outpatients meeting criteria for DSM-IV-TR GAD were assessed before treatment, after treatment and at 6 m and 12 m follow-up. The patients were randomized and treated individually for 8-12 weekly sessions. There was no drop-out from MCT and 10% at 6 m follow-up from AR. At post-treatment and at both follow-up points MCT was superior to AR. Standardized recovery rates for MCT at post-treatment were 80% on measures of worry and trait-anxiety compared with 10% following AR. At 6 m follow-up recovery rates for MCT were 70% on both measures compared with 10% and 20% for AR. At 12 m follow-up recovery rates for MCT were 80% (worry) and 60% (trait-anxiety) compared with 10% and 20% following AR. The recovery rates for MCT are similar to those obtained in an earlier uncontrolled trial (Wells & King, 2006). The effect sizes and standardized recovery rates for MCT suggest that it is a highly effective treatment.     

The liberty principle and universal health care

A universal entitlement to health care can be grounded in the liberty principle. A detailed examination of Rawls's discussion of health care in Justice as Fairness shows that Rawls himself recognized that illness is a threat to the basic liberties, yet failed to recognize the implications of this fact for health resource allocation. The problem is that one cannot know how to allocate health care dollars until one knows which basic liberties one seeks to protect, and yet one cannot know which basic liberties to protect until one knows how health care dollars will be allocated. The solution is to design the list of basic liberties and the health care system in tandem so as to fit each other, such that every citizen is guaranteed a set of basic liberties and access to the health services needed to secure them.     

Personality traits in patients with narcolepsy

Narcolepsy is a lifelong disorder with the main symptoms of sleep attacks and cataplexy. In this study 49 narcoleptic patients were investigated with a battery of personality inventories, covering the following personality dimensions: anxiety-neuroticism, extraversion and socialization. The results were compared with three groups: normal subject, psychiatric inpatients with anxiety and outpatients with psychosomatic complaints. The main aim was to evaluate a clinical impression of a high degree of extraversion in narcoleptic patients, which according to Eysenck's model could be related to a disturbance in the arousal regulation. Narcoleptic patients had higher anxiety-neuroticism scores than normal individuals, particularly in terms of Somatic Anxiety. They had unexpectedly low scores in some socialization scales, and were contrary to our hypothesis slightly lower in the extraversion variables, than the comparison groups. The high scores in anxiety-neuroticism personality scales may depend on an anxiety-provoking effect of central stimulant drugs and/or a lability of the autonomic regulation associated with the disorder. Further, the strain caused by the narcoleptic symptoms may result in high scores in anxiety-neuroticism scales and low scores in socialization scales, via social-learning mechanisms. However, there may also be a coupling between the genetics of narcolepsy and biologically based personality traits.     

Rorschach indicators of Multiple Personality Disorder.

The increase in reported cases of Multiple Personality Disorder underscores a great need to differentiate clearly this from other psychiatric disorders and from simulation of Multiple Personality Disorder. Two sets of Rorschach signs have been advanced as clinical markers by their developers, namely Barach and also Wagner, Allison, and Wagner. As the Wagner signs are prevalent in much of the research on Rorschach responses in Multiple Personality Disorder, the purpose of the present study was to evaluate these signs using Wagner's administration and the resulting Rorschach protocols of 16 Multiple Personality Disorder patients and 16 psychiatric controls. Analysis indicated that this system was deficient in correctly classifying these 32 protocols. A new marker, the Splitting Response, emerged, however, which was more useful. This response, in combination with at least one Dissociative response, produced an accuracy rate of 94%. These new criteria may be useful aids in the detection of Multiple Personality Disorder from Rorschach protocols. Replication is urged.     

Electrolyte disorders, EEG changes and epileptic seizures in alcohol withdrawal delirium

For 180 patients suffering alcohol-withdrawal induced delirium, electrolytic concentration in the serum of Na, K, Ca, and Mg was determined in the early withdrawal phase, and the electroencephalograms of 95 delirium patients evaluated in respect of local and diffuse changes and epileptic activity, and compared in delirium patients with and without initial seizures. Delirium patients who had initial seizures suffered significantly longer-lasting periods of delirium and significantly more frequent electrolytic changes in the form of hypomagnesemia and hypopotassemia (hypokalemia). There was no significant difference in the EEG changes. A temporary metabolic disorder in the initial phase of the two-phase withdrawal process should be assumed to be the cause of seizures during alcohol withdrawal, and the pathogenetic significance of hypomagnesemia and hypopotassemia should be taken into consideration.     

Learning from successful and failed experience: the moderating role of kind of after-event review

The claim that appropriate "after-event review (AER)" may increase the relative value of drawing lessons from successes, as compared with failures, was examined in the present study. The study was a laboratory experiment in which the effect of type of AER (failure-focused, success-focused, failure- and success-focused, and no AER review) on performance improvement and causal attributions was tested under conditions of earlier success and earlier failure. In general, 2 results were demonstrated: (a) Drawing lessons from successful experience is feasible, and its effectiveness is contingent upon the type of AER. More specifically, after successful events, the most effective review is that of wrong actions, whereas after failed events, any kind of event review (correct or wrong actions) is effective. (b) AERs elicit more internal (as opposed to external) and specific (as opposed to general) attributions. These 2 classifications moderate the effect of AERs on task performance.