Seeing through The Bell Jar: Investigating Linguistic Patterns of Psychological Disorder

As a means of conveying difficult personal experiences, illness narratives and their analysis have the potential to increase awareness of patients' lives and circumstances. Becoming sensitised to the linguistic texture of narrative offers readers a means of increasing narrative understanding. Using the fictional narrative of The Bell Jar, this paper outlines a novel method for exploring the language of illness narratives. Corpus stylistics provides new insights into narrative texture and demonstrates the importance of recurrent linguistic features in shaping meaning. The paper concludes by proposing the application of a similar methodology to non-fictional illness narratives in therapeutic contexts.     

Patient role orientations,doctor-patient fit,and visit satisfaction

Abstract

Two studies were conducted using the Patient-Practitioner Orientation Scale (PPOS), an instrument that measures the role orientations of patients. In the first, 297 students responded to a pool of 61 items concerning their attitudes about doctor-patient relationships (e.g., about power-sharing and the importance of physicians' supportiveness). The scale was reduced, and associations between PPOS scores and gender, race, country of origin as well as Health Locus of Control were found. In Study 2, 90 additional students filled out the PPOS, read two doctor-patient scenarios, and rated their satisfaction as if they had been the patient. In one, the physician exhibited a controlling style, and in the other a more open style. As predicted, patient-centered physicians generated higher satisfaction, and patients were most satisfied with a physician whose style matched their own role orientation. These studies suggest the potential usefulness of the PPOS as an indicator of patient attitudes and doctor-patient fit, and as an predictor of visit satisfaction.     

Assessment of cognitive domains during treatment with OROS methylphenidate in adolescents with ADHD

Aim: To psychometrically assess cognitive domains in adolescents with ADHD during long-term open treatment with robust dosing of extended-release methylphenidate (OROS MPH).

Methods: Data were derived from a prospective clinical study of adolescent ADHD, employing the Cambridge Neuropsychological Test Automated Battery (CANTAB), before and after up to one year of treatment with OROS MPH. In the absence of placebo control, a similar age and gender group of youth without ADHD served as comparators.

Results: During the course of treatment with OROS MPH, ADHD youth’s performance significantly improved across multiple CANTAB tasks, including spatial working memory, rapid visual processing, verbal recognition memory, set shifting, and inhibition/vigilance. ADHD subjects’ scores in several CANTAB tasks, including spatial working memory, planning, and set shifting, were significantly more impaired at baseline compared to the non-ADHD comparison group; these significant differences were no longer seen at endpoint.

Conclusions: Statistically significant improvements in multiple cognitive domains were observed in a sample of adolescents with ADHD over the course of 12 months of robust treatment with extended-release methylphenidate. Rigorous, monitored stimulant treatment may be associated with objectively determined cognitive benefits; however, practice effects in this open trial cannot be ruled out. Further study on this important topic is warranted.     

The influence of interfaces on the formation of bubbles in He-ion-irradiated Cu/Mo nanolayers

The role of immiscible Cu/Mo interfaces on the formation of helium (He) bubbles in ion-irradiated Cu/Mo 5?nm multilayers is examined. Interfaces significantly enhance the critical He concentration above which bubbles, approximately 1?nm in diameter, are detected via through-focus imaging in a transmission electron microscope. He-to-vacancy ratio affects the formation and distribution of He bubbles. The diameter of He bubbles in Cu appears to be slightly larger than that in Mo.     

A divergence formulation of the surface reproducibility condition during kinematic evolution

Abstract

Considerations of the self-similar reproducibility criterion for the steady-state evolution of the morphology of surfaces during erosion or growth allow a new formulation of this condition in terms of the divergence of the velocity of surface points along characteristic contours. The analogy of this formulation with that for the surface free-energy vector describing thermodynamic equilibrium is demonstrated.     

An evaluation of a partial training program in psychiatric residency on the later practice of marital and family therapy

Abstract

This paper reports on the results of a survey of psychiatrists and residents who received marital and family therapy training during their second year of residency. The data indicate that such training has an immediate positive effect on practice and is carried forward into later practice. Practicing psychiatrists trained in marital and family therapy during residency report spending 25% of their caseloads in marital and family therapy which was seen as producing positive change in patients. In line with previous training, practicing psychiatrists define the unit of treatment as more than an identified patient and treat marital and family therapy cases themselves or refer to others for such therapy. Variations in practice and techniques raise questions regarding the structure and content of marital and family therapy training in psychiatry residency programs and point out the importance of such training in the later practice of psychiatry.     

Perceived Responder Legitimacy and Group Identification Predict Cooperation and Compliance in a Mass Decontamination Field Exercise

Emergency responders' failure to communicate effectively during decontamination following a chemical or biological incident has been associated with increased public anxiety and reduced public compliance. In this study we applied the social identity approach to evaluating a field exercise that involved mass decontamination. Questionnaires were collected from 115 volunteers, who participated in the exercise as simulated casualties. Volunteers' perceptions of effective responder communication predicted increased self-reported compliance with decontamination, mediated by perceived responder legitimacy and identification with other group members. Developing effective communication strategies using a social psychology perspective could improve the way in which incidents are managed.     

Reviews

Gorbachev, Glasnost and The Gospel by Michael Bourdeaux. Hodder and Stoughton, 1990. 226 pp. Hardback, £13.95. Paperback, £8.99.

The Lutheran Church and the East German State: Political Conflict and Change under Ulbricht andHonecker by Robert F. Goeckel. Cornell University Press, 1990. 328 pp.

With God, For the People by Laszlo Tokes with David Porter. London: Hodder and Stoughton, 1990. Paperback, 226 pp., £3.50.

In the Eye of the Romanian Storm by Felix Corley and John Eibner. Old Tappan, New Jersey: Fleming H. Revell Company, 1990. Paperback, 272 pp., $6.95.     

Negotiating for Improved Reimbursement for Dialectical Behavior Therapy: A Successful Project

Dialectical Behavior Therapy (DBT) is an evidence-based treatment for borderline personality disorder that has been widely disseminated to many outpatient treatment settings. Many practitioners depend on third-party payers to fund treatment delivery. DBT requires additional clinical services not often included in outpatient therapy, including a weekly skills group led by 2 clinicians, and the requirement for clinicians to attend weekly consultation team and provide intersession contact for coaching. Standard outpatient insurance rates for individual and group sessions do not provide adequate reimbursement for the additional services of DBT. This paper describes how 2 DBT team leaders collaborated to obtain improved reimbursement for their programs. The 2 teams met with insurers, educated them about DBT, and showed outcomes from their programs to achieve large increases in reimbursement rates. The paper includes client outcome data from both programs.