A biopsychosocial approach to liver transplant evaluation in two patients with Wilson's disease

Wilson's disease (WD) is characterized by hepatic, neurological, and/or psychiatric disturbances. In some cases, liver transplantation is indicated. Because psychologists and other health care workers play an increasing role in the evaluation of individuals presenting for transplant, an understanding of the heterogeneous phenotype of WD is important for mental health professionals working in medical settings. This article reviews two cases of patients with WD (one probable, one confirmed) presenting for liver transplantation and a biopsychosocial assessment approach is demonstrated. Patients are presented in terms of medical, psychiatric, and psychosocial history, neuropsychological examination results, and the subsequent indications for liver transplantation. Both patients exhibited neurocognitive and psychiatric symptoms. One patient was determined to be a marginally suitable candidate for transplantation, whereas the other was considered at high risk for negative outcome post-transplant. This article demonstrates the importance of considering phenotypic presentation, neurocognitive function, psychiatric status, and psychosocial circumstances in assessing transplant readiness in patients with WD. A comprehensive and integrative biopsychosocial assessment approach is appropriate for evaluating patients with WD presenting for liver transplantation.     

Motivational systems and preferences for social support strategies

The behavioral inhibition system (BIS), behavioral approach system (BAS), and fight-flight-freeze system (FFFS) are motivational systems that guide people’s behavior. Motivational systems may be relevant to contexts of interpersonal communication, specifically those requiring social support. In these situations, people express preferences for approaching versus avoiding and emotion versus problem-focused comfort. This paper links people’s preferences for supportive strategies with their motivational systems. 335 participants reported their preferences for different strategies of social support and their motivational system orientations. As expected, BAS was associated with preferences for involving, problem-focused support. BIS, BAS, and FFFS were significantly associated with emotion-focused support, and FFFS was negatively associated with comfort that downplays affect. The motivational systems interact when manifesting associations with preferences for support strategies, and the BAS reward responsiveness subscale emerged as the most influential BAS subscale. These results indicate that BIS, BAS, and FFFS influence people’s preferences in contexts of interpersonal communication.     

Psychometric Properties of the Dyadic Parent-Child Interaction Coding System in The Netherlands

Abstract

The current study explored the psychometric properties of a parent-child interaction observation system, the Dyadic Parent-Child Interaction Coding System (DPICS) in the Netherlands. Participants included 31 Dutch mother-child dyads and 86?U.S. mother-child dyads for a community sample (2–7?years; 50% boys). Good one-week test-retest reliability was demonstrated among the Dutch sample. Similarities were found between Dutch and U.S. samples on most interaction codes, but mothers in the U.S. sample used more directive behaviors (e.g., commands) in some situations. Findings suggest that the DPICS is a reliable measure of mother-child interactions in the Dutch population. Cultural issues regarding the use of the DPICS are discussed.     

Mortality Salience and Perceptions of People with AIDS: Understanding the Role of Prejudice

Study 1 examined the perceived association of AIDS and death by showing that thinking about AIDS increased participants'; death-thought accessibility. Hypotheses about the consequences of this association for perceptions of people with AIDS were derived from terror management theory, which proposes that mortality salience increases derogation of those who threaten people's worldviews unless those worldviews oppose prejudice, in which case mortality salience can increase acceptance of people who are otherwise threatening. Consistent with these hypotheses, conservative participants had less favorable impressions (Study 2) and liberal participants had more favorable impressions (Study 3) of a target with AIDS following a death reminder. Study 4 suggested that the decrease in prejudice among liberals following mortality salience was a genuine decrease in prejudice (as indicated by responses to an unobtrusive attitude measure), not just an increase in the desire to appear nonprejudiced. Theoretical and practical implications of these findings are discussed.     

A terror management analysis of self-awareness and anxiety: The hierarchy of terror

Abstract

In this article, we apply terror management theory to the operation of self-awareness processes. According to the theory, self-esteem consists of accepting a cultural conception of reality and believing that one is living up to the standards of value inherent in that conception. The function of self-esteem is to buffer the anxiety that results from the awareness of human vulnerability and mortality that results from our capacity for self-awareness. We argue that self-awareness leads to comparisons with standards, and to behavior aimed at reducing any discrepancies that are detected, because of the potential for existential terror that self-awareness creates. Existential terror is seen as the emotional manifestation of the instinct for self-preservation. Management of this terror is conceptualized as the superordinate goal in a hierarchy of standards through which behavior is regulated. A hierarchical terror management model is proposed. This structure provides a unique analysis of the self-system and its relationship to other attitudes, values, and beliefs. The theory posits several dynamic principles that specify how self-awareness and disruptions determine the movement of conscious attention through various levels of the hierarchy. The implications of this analysis for unresolved theoretical questions about self-awareness processes, unconscius sources of motivation, and clinical problems are discussed.     

When the West Meets the East: Cultural Clash and Its Impacts on Anomie in a Sample of Chinese Adolescents

ABSTRACT

Criminological studies conducted in China have highlighted the important role of Chinese culture and anomie theory in explaining crime patterns and delinquency among adolescents. None of the studies, however, have empirically tested the relationship between cultural attachment and anomie. The purpose of this study is to examine the influence of ethnic identity associated with cultural attachment on anomie in the Chinese social setting. Specifically, the effects of both attachment to conventional Chinese culture and attachment to Western popular culture (WPC) were examined; the interaction between the two may shed some important light on how culture and cultural conflict can lead to anomie among Chinese adolescents. The data analyzed were collected from a sample of more than 6,500 middle school students. Structural equation modeling was employed to test the hypothesized relationships. The study found that attachment to traditional Chinese cultural values, especially showing respect to conventional figures/values, reduces anomie among adolescents. In contrast, attraction to WPC and being socially labeled as a big fan of WPC elevate the levels of anomie reported by the students. Reflections on cultural conflict and relevant policy implications are provided in the “Discussions and conclusions” section.     

A behavioral medicine intervention as an adjunctive treatment for HIV-related illness

Abstract

This investigation assessed the efficacy of a behavioral medicine intervention in the adjunctive treatment of symptomatic HIV seropositive men. Twenty-six, well coping, seropositive gay males were randomly assigned to either a treatment group or a waiting list control group. The treatment group received eight weeks of training in thermal biofeedback, guided imagery and hypnosis Significant results (p < 0.05) indicated that HIV-related symptoms (fever, fatigue, pain, headache, nausea and insomnia) decreased and that vigor and hardiness increased. No significant changes were found in absolute numbers of CD4 cells, tension-anxiety or depression.     

Incidence of Specific Absolute Neurocognitive Impairment in Globally Intact Children with Histories of Early Severe Deprivation

Postnatal deprivation is associated with neurocognitive delay/dysfunction. Although “catch up” in global cognition following adoption has been reported, this study examined the incidence of specific absolute impairment in adopted children with intact global cognitive functioning. Eighty-five children (38 males, mean age = 112.8, SD = 30.3 months; range 61–209 months) raised from birth in orphanages underwent comprehensive neuropsychological evaluation. Fifty-four were deemed globally intact (IQ > 85). Of those deemed globally intact, 46% evidenced absolute impairment in at least one domain of functioning. Duration of stay in the orphanage was directly associated with incidence of impairment and number of domains affected. A substantial proportion of participants evidenced persistent, absolute impairment in one or more domains of neurocognitive function despite integrity of basic intellectual functions.     

Aggressive behavior: A comprehensive review of its neurochemical mechanisms and management

Aggression is a deliberate series of actions that lead to harm, injury, or destruction of another organism, and is the most common factor promoting violent crimes. Beyond being the immediate cause of physical injury, aggressive behavior also produces profound long term emotional disabilities in its victims. When outburst of aggression is comorbid with DSM-IV-defined neuropsychiatric disorders, the offenders are usually given psychiatric care; however, when they appear normal or healthy, their most likely fate is punishment by the law. This punitive approach often increases aggression, thereby promoting the propensity for violent crimes. Antipsychotics are the drugs commonly used for treatment of aggression and violent outbursts. However, the uses of these drugs have serious side effects of catalepsy or impairment of sensorimotor performance. They also affect the defense or flight capabilities of organisms, which further limit their usefulness in aggression. Thus, there is a critical need to search for agents that can selectively reduce aggression without affecting other behaviors or causing any serious unwanted side effects. This review focuses on the types, neurochemical bases, and animal models of aggression, with a comprehensive appraisal of the pharmacological approach to the treatment of the disorder.     

Mothering Children with Schizophrenia in a Village Setting: A Multiple Case Study

This study reports on the experiences of mothers (n=8) raising children with schizophrenia in a rural South African village. The mothers were individually interviewed at their homes, using in-depth, phenomenological methods. Data were thematically analysed. Mothers of children with schizophrenia indicated that they are facing the following challenges on their process of caregiving: mothers' emotional reactions, blaming witchcraft, dealing with the children's violence and destructiveness, poverty and unemployment, financial support, isolation and social support, effects of schizophrenia on the mother-child relationship, and the loss that mothers go through.