Social support and the course of bipolar disorder

The current study prospectively examined the impact of social support on symptom severity and recovery from episodes in bipolar disorder, both as a direct influence and as a buffer of life events. Fifty-nine individuals with Bipolar I disorder were followed longitudinally with monthly symptom severity interviews. Social support was measured by the Interpersonal Support Evaluation List and the Interview Schedule for Social Interaction, and life events were assessed using the Life Events and Difficulties Schedule. Individuals with low social support took longer to recover from episodes and were more symptomatic across a 6-month follow-up. Results suggest a polarity-specific effect, in that social support influences depression but not mania. Discussion focuses on theoretical implications of a series of polarity-specific findings within the field.     

When days are numbered: calendar structure and the development of calendar processing in English and Chinese.

Unlike English, Chinese uses a numerical system for naming months and days. This study explored whether this difference in naming affects the development of simple calendar calculation. Eight- and 10-year-old children as well as undergraduates in China and the United States were asked to name the day or month that comes a specified time before or after a given day or month. In each age group Chinese speakers primarily used calculation based on calendar names to solve these tasks, while English speakers primarily resorted to reciting the names. The magnitude of these differences was substantial; on difficult tasks Chinese fourth graders performed at speeds comparable to those of English-speaking adults. Implications for models of how linguistic structure affects cognition are discussed.     

Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees

This paper examines with a somewhat critical eye the primary role that psychotherapy and other clinic-based services currently play in addressing the mental health needs of political refugees in the industrialized countries. Two factors are considered which suggest that refugee mental health needs might be better served by complementing clinic-based treatments with a variety of community-based interventions. The first factor concerns the pervasiveness of psychological distress within refugee communities, coupled with the reluctance of many refugees to utilize formal psychological and psychiatric services. This calls into question both the adequacy and appropriateness of clinical-based services as cornerstones of our response to the mental health needs of refugees. More precisely, it suggests the need to complement such services with a variety of culturally grounded, community-based strategies that do not require attendance in formal mental health settings. Second, recent findings have shown consistently that a considerable amount of the distress reported by refugees is related not to prior exposure to violent events, but to a constellation of exile-related stressors such as the loss of one's community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles. It is suggested that while psychotherapy can play an important adjunctive role in helping people confront these exile-related stressors, they may most effectively be addressed through targeted community-based interventions. Examples of such community-based approaches are briefly described, and suggestions are offered for community-level strategies that might be explored. The paper concludes by emphasizing the complementary nature of clinical and community-based programs, and by suggesting that psychotherapy might best be conceptualized as one component of a more comprehensive approach to addressing the mental health needs of refugee communities.     

Trauma Accommodation and Anniversary Reactions in Children

Anniversary reactions in traumatized children have been well recognized in the literature. Examined herein are temporal issues in the mourning process often realized by traumatized children. The case study of Laura is presented as a clinical illustration of problems in trauma accommodation that include anniversary reactions in children. Anniversary reactions in children are more common than is generally recognized in clinical practice. Such reactions are more likely to be found among children who exhibit persistent, repetitive, but insufficient efforts of trauma mastery through their incomplete grief and inadequate mourning process. Clinical issues are discussed.     

How the moralization of issues grants social legitimacy to act on one's attitudes

Actions that do not have as their goal the advancement or protection of one's material interests are often seen as illegitimate. Four studies suggested that moral values can legitimate action in the absence of material interest. The more participants linked sociopolitical issues to moral values, the more comfortable they felt advocating on behalf of those issues and the less confused they were by others' advocacy (Studies 1 and 2). Crime victims were perceived as being more entitled to claim special privileges when the crime had violated their personal moral values (Studies 3 and 4). These effects were strongest when the legitimacy to act could not already be derived from one's material interests, suggesting that moral values and material interest can represent interchangeable justifications for behavior. No support was found for the possibility that attitude strength explained these effects. The power of moralization to disinhibit action is discussed.     

Uptake of Cardiac Screening and Genetic Testing Among Hypertrophic and Dilated Cardiomyopathy Families

Cardiomyopathy is a genetically and clinically heterogeneous, life threatening disease which affects people of all ages. Recent guidelines provide recommendations for cardiac screening and genetic testing in at-risk relatives, but the uptake and impact of these measures in the United States is unknown. This is a single institution retrospective study that characterizes the uptake of cardiac screening and genetic testing for relatives of a cohort of 57 probands with hypertrophic (HCM) and dilated cardiomyopathy (DCM) who underwent both clinical evaluation and genetic testing. Cardiac screening was indicated for 302 relatives. One hundred and seventy-three (57 %) completed cardiac screening. Forty of the 57 probands were mutation positive and genetic testing was indicated for 213 relatives. Eighty-four (39 %) completed genetic testing. The uptake of cardiac surveillance was greater than the uptake of genetic testing (p?<?0.0001) among relatives of mutation positive probands. Within the group of at-risk, asymptomatic relatives of probands, cardiac screening and genetic testing were positive in 25 % and 40 % of cases, respectively. These data demonstrate the important role and utility of cascade cardiac screening and genetic testing in the care of patients and families with HCM or DCM. The approach to cardiac screening and genetic testing should be family-specific and requires expertise in the genetics of cardiomyopathy.     

Reasonable Partiality Towards Compatriots

Ethical theories normally make room both for global duties to human beings everywhere and special duties to those we are attached to in some way. Such a split-level view requires us to specify the kind of attachment that can ground special duties, and to explain the comparative force of the two kinds of duties in cases of conflict. Special duties are generated within groups that are intrinsically valuable and not inherently unjust, where the duties can be shown to be integral to relationships within the group. Since nations can be shown to meet these conditions, acknowledging special obligations towards compatriots is justified. However for such partiality to be reasonable, it must be balanced against recognition of duties of global justice. These duties include duties to respect human rights and duties of fairness towards non-nationals. Weighing such duties against domestic duties of social justice is not a simple task, and the outcome should depend on the precise specification of the duty at stake. In particular, the duty to respect human rights fragments into four sub-duties whose force when set against local duties is markedly different.