Tardive dyskinesia and malpractice

Tardive dyskinesia is a potentially irreversible disorder of involuntary movement which may result from the prolonged use of neuroleptic medication in some patients. Its increase in prevalence in recent years has been accompanied by increased apprehension in the medical community regarding malpractice litigation. Following an update of current knowledge about tardive dyskinesia, several legal aspects of tardive dyskinesia are reviewed, including negligence, breach of contract, fraud, strict liability and informed consent. Despite considerable criticism of the doctrine of informed consent, it is suggested that it constitutes an inherent and indispensable component of long-term psychiatric treatment, where tardive dyskinesia is at issue.     

Comorbidity between and within childhood externalizing and internalizing disorders: reflections and directions

The term and concept of lcomorbidity has been mired in controversy, although there is little question that the existence of covariation among psychiatric diagnoses poses significant challenges to current models of psychiatric classification and diagnosis. The papers in this Special Section underscore a number of important issues relevant to the comorbidity between and within childhood externalizing and internalizing disorders, and illustrate both methodological and substantive reasons for such comorbidity. Weiss, Susser, and Catron's distinction among common, broad-band specific, and narrow-band specific features provides a helpful framework for understanding the comorbidity of childhood externalizing and internalizing disorders (B, Weiss, K. Susser, & T. Catron, 1998). Hierarchical models of psychopathology help to dissolve the distinction between splitters and lumpers and point to variables that may elucidate the etiology of externalizing and internalizing disorders.     

Cloninger's Temperament and Character Inventory Correlates with Personality Characteristics of Organ Donation Advocates

Temperament and Character Inventory (TCI) and background questionnaire data were collected from a sample of men and women organ donation advocates (N = 362) as part of a national study to investigate their personality characteristics, temperaments, and attitudes about organ donation advocacy. Goals included identifying unique traits for advocates, and response consistency between the TCI and questionnaire. The TCI results included high scores on Cooperativeness and Self-Directedness, and low on Harm Avoidance dimensions. The questionnaire results indicated that most advocates were White, married, college-educated females, who typically spent less than 2 hr with potential donor families, were satisfied with life and job, and believed they would be in a donation position 2 years from the time surveyed. TCI and questionnaire measures were correlated for Self-Transcendence and Spirituality, Helpfulness and Job Satisfaction, and Compassion and Identification variables.     

Stress and Coping: A Comparison of Self-Report Measures of Functioning in Families of Young Children with Cerebral Palsy or No Medical Diagnosis

We analyzed data from 87 mothers of children ages 15 to 44 months with cerebral palsy (CP) or no diagnosis, who completed the Dyadic Adjustment Scale, Parenting Stress Index, Support Functions Scale, and Inventory of Social Support. Principal components analysis of the 15 subscales from the 5 measures revealed few cross-measure loadings. Mothers of children with CP (severe or mild) reported higher levels of parenting stress than did mothers of controls. However, cluster analysis of self-report measures yielded a 5-cluster solution, with no diagnostic group differences across clusters. That is, there were no overall differences in self-reported family functioning according to presence or severity of the child's disability. The results are discussed in terms of the organization of family systems and their relationship to child diagnosis. Clinical implications for assessing and working with families are noted.     

Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions

Fifty-five insomniacs, 60 years or above, participated in a behavioral treatment program, comparing two interventions (sleep hygiene+stimulus control vs sleep hygiene+relaxation tape). Half of the subjects were randomized to a waiting-list condition prior to treatment. No significant changes were observed during the waiting-list period. During the treatment period however, the subjects improved on several sleep parameters, and treatment gains were maintained at a 6-month follow-up. The effects of treatment were greater for nocturnal measures (e.g. sleep onset latency and total sleep time) as compared to daytime measures (e.g. life satisfaction, daytime alertness) and not-targeted behavior (medication use). There were no differences in treatment effects for the two interventions.     

Tooth color: effects on judgments of attractiveness and age

Tooth whitening has become a very popular procedure. Advertisements for whitening products imply that whiter teeth are more attractive than yellower teeth. We tested this idea empirically by manipulating the tooth color of pictures of male and female targets. Participants' ratings of attractiveness were not influenced by tooth color. Exp. 2 yielded a negative correlation between attractiveness and age ratings: targets judged to be older were rated as less attractive. Unless whiter teeth help in some other way, e.g., improved self-esteem or confidence, it seems that tooth whitening procedures or products are not associated with increased attractiveness to others.     

Idealization and psychoanalytic learning

Idealization is an intrinsic part of psychological maturation, but it is also a potential barrier to psychoanalytic learning, and must to some degree be outgrown if an analyst is to develop a natural authority and individual style. Unrecognized idealizations stifle analysts' engagement in the transferences of their patients, and so compromise the ability to freely experience and analyze them. Attention to real life and the lessons it teaches counterbalances the tendency to idealize and encourages lifelong psychoanalytic growth.     

Factorial validity of the Conners' Parent Rating Scale-revised: short form with psychiatric outpatients

To assess the factorial validity of the 27-item Conners' Parent Rating Scale-Revised: Short Form (CPRS-R:S; Conners, 1997), 100 (50%) male and 100 (50%) female psychiatric outpatients between 5 and 16 years old were rated by a parent. A confirmatory factor analysis of the 18 item ratings from the CPRS-R:S Oppositional, Cognitive Problems, and Hyperactivity scales provided only tentative support for scoring these scales as Conners (1997) recommended. However, an exploratory principal-axis factor analysis with all 27 item ratings found 2 dimensions: 1 dimension was composed of the 6 items in the Oppositional scale, and other dimension contained the remaining 21 items. An attention deficit hyperactivity disorder (ADHD) Total Symptoms scale was constructed by summing the ratings for these 21 symptom ratings, and this scale was found to be as effective as the Hyperactivity scale was in discriminating between youth who were and were not eventually diagnosed with an ADHD. We discuss the results as providing an alternate way of scoring the CPRS-R:S to screen for an ADHD in child and adolescent psychiatric outpatients.