Divergent ethical perspectives on the duty-to-warn principle with HIV patients

This article presents the case of an HIV-positive client who reported having sexual relations with an unknowing partner. The issue raised is whether the therapist was required to warn the unknowing partner, similar to the Tarasoff mandate that is imposed on therapists. The case is analyzed from an ethical framework similar to that presented by Beauchamp and Childress (1994). Two opinions are presented, each leading to different conclusions about whether the therapist should inform the unknowing partner. It is concluded that although such analysis is valuable in aiding the therapist in his or her decision-making process, no clear professional standard for the management of the problem is evident.     

Why liberals should accept financial incentives for organ procurement

Free market libertarians have long supported incentives to increase organ procurement, but those oriented to justice traditionally have opposed them. This paper presents the reasons why those worried about justice should reconsider financial incentives and tolerate them as a lesser moral evil. After considering concerns about discrimination and coercion and setting them aside, it is suggested that the real moral concern should be manipulation of the neediest. The one offering the incentive (the government) has the resources to eliminate the basic needs that pressure the poor into a willingness to sell. It is unethically manipulative to withhold those resources and then offer payment for organs. Nevertheless, the poor have been left without basic necessities for 20 years since the passage of the prohibition on incentives. As long as the government continues to withhold a decent minimum of welfare, liberals should, with shame, cease opposing financial incentives for organ procurement.     

The Dissociative Factor in Symptom Reports of Rheumatic Patients with and Without Fibromyalgia

The main objective of this study was to investigate the prevalence of dissociation and its relationships to symptom reporting in fibromyalgia (FM) and other rheumatic disorders (non-FM). The participants were 73 women with FM and 85 relatively matched women with other rheumatic disorders. The participants were administered the Dissociative Experiences Scale (DES), the Profile Of Mood States (POMS), and a 50-item medical checklist. The prevalence of dissociation (DES q 25) was significantly higher in FM patients(30.1%) compared to other rheumatic disorders (7.0%). Symptom reporting correlated with measures of dissociation in both patient groups (FM:R = 0.42, p < .001; non-FM:R = 0.44, p < .001), when controlled for age, depression, and anxiety. A regression analysis confirmed the strong linkage between somatic variation and dissociation. The results suggest that dissociation is a problem for a substantial segment of patients with fibromyalgia and that dissociation is related to certain physical symptoms of fibromyalgia. Dissociation offers a different perspective on medically unexplained symptoms and may need to be addressed in future research.     

Development of a short form for the MMPI-2 based on scale elevation congruence

The length of the Minnesota Multiphasic Personality Inventory (MMPI) is often considered a barrier to its use, leading to the development of short forms. Two methods of abbreviating the revised MMPI have now been developed. One agrees poorly with the long form in terms of which scales are elevated. The second ensures perfect congruence in which scales are elevated but requires computer administration. This article describes the development of a short form representing a compromise approach. The short form was derived using 800 psychiatric inpatients and cross-validated with samples of 658 inpatients and 266 outpatients. It is briefer than the computerized short form but does not achieve perfect congruence with the full inventory. It is longer than earlier noncomputerized short forms but demonstrates greater scale elevation congruence with the full inventory and allows estimates of more scales. The short form offers a reasonable alternative when the full inventory is impractical.     

Treatment of bipolar depression

Bipolar disorder is underdiagnosed and often mistaken for unipolar depression. Bipolar patients spend 33% of their time in a state of depression compared to 11% of time spent in a manic state. Duration of time depressed and severity of depression are associated with increased risk for suicide, which occurs in 10% to 20% of bipolar patients. Antidepressants are increasingly being used as adjuncts in the depressed phase of bipolar disorder, although they provide a moderate risk for switch into mania. Lithium and some antiepileptics and atypical antipsychotics have shown antidepressant effects in the treatment of bipolar disorder. Other adjuncts for treatment-refractory patients include monoamine oxidase inhibitors and electroconvulsive therapy.     

Repeated-measures contrasts for "multiple-pattern" hypotheses

Contrast analysis of repeated-measures data generally focuses on hypotheses when only 1 pattern of results is of theoretical interest. This article articulates a framework for contrast analysis in repeated-measures contexts in which researchers have hypotheses relevant to 1 potential pattern or multiple potential patterns of results. For example, a researcher might ask whether participants exhibit a pattern of (a) immediate symptom reduction or (b) delayed symptom reduction. Alternatively, the researcher might ask whether 2 or more groups exhibit 2 or more patterns to differing degrees. Building on the familiar logic and computational procedures for 1-pattern hypotheses, the authors present a contrast analysis framework that integrates analysis of 1-pattern and multiple-pattern hypotheses and accommodates 1 group or multiple groups of participants.     

New lessons from knockout mice: The role of serotonin during development and its possible contribution to the origins of neuropsychiatric disorders

Serotonin (5-HT) modulates numerous processes in the central nervous system that are relevant to neuropsychiatric function and dysfunction. It exerts significant effects on anxiety, mood, impulsivity, sleep, ingestive behavior, reward systems, and psychosis. Serotonergic dysfunction has been implicated in several psychiatric conditions but efforts to more clearly understand the mechanisms of this influence have been hampered by the complexity of this system at the receptor level. There are at least 14 distinct receptors that mediate the effects of 5-HT as well as several enzymes that control its synthesis and metabolism. Pharmacologic agents that target specific receptors have provided clues regarding the function of these receptors in the human brain. 5-HT is also an important modulator of neural development and several groups have employed a genetic strategy relevant to behavior. Several inactivation mutations of specific 5-HT receptors have been generated producing interesting behavioral phenotypes related to anxiety, depression, drug abuse, psychosis, and cognition. In many cases, knockout mice have been used to confirm what has already been suspected based on pharmacologic studies. In other instances, mutations have demonstrated new functions of serotonergic genes in development and behavior.     

r equivalent: A simple effect size indicator

The purpose of this article is to propose a simple effect size estimate (obtained from the sample size, N, and a p value) that can be used (a) in meta-analytic research where only sample sizes and p values have been reported by the original investigator, (b) where no generally accepted effect size estimate exists, or (c) where directly computed effect size estimates are likely to be misleading. This effect size estimate is called r(equivalent) because it equals the sample point-biserial correlation between the treatment indicator and an exactly normally distributed outcome in a two-treatment experiment with N/2 units in each group and the obtained p value. As part of placing r(equivalent) into a broader context, the authors also address limitations of r(equivalent).     

Stress within a bicultural context for adolescents of Mexican descent

Folkman and Lazarus's theory of stress and coping was used to develop a measure assessing the perceived stress within a bicultural context. Middle school students of Mexican descent (N = 881) reported their perceived stress from intergenerational acculturation gaps, within-group discrimination, out-group discrimination, and monolingual stress. Although immigrant youths reported more total number of stressors, U.S.-born youths reported more stress from needing better Spanish and impact of parents' culture. Immigrant youths reported more stress from needing better English in school. Higher stress was associated with more depressive symptoms for both U.S.-born and immigrant youths. Although this study has identified some elements of stress, it has not identified positive coping mechanisms of the bicultural context for Latino youths.     

The effects of depression on the emotional responses of Spanish-speaking Latinas

Emotional responses (physiology, self-report, and facial expression) of 12 depressed and 10 nondepressed Spanish-speaking Latinas during sad and amusing film clips of human and animal content were compared. Depressed Latinas demonstrated less electrodermal reactivity across all the film clips and displayed fewer social smiles during the amusing-human film clip than nondepressed Latinas. No differences emerged for cardiovascular measures, reports of emotion, or facial expressions of happiness and negative emotion. Observed differences in electrodermal reactivity are similar to results from previous studies of Anglo Americans, suggesting that reduced electrodermal activity may be linked to depression across cultures. The findings also suggest that, for Latinas, depression may selectively alter expressions that serve interpersonal functions.