Acting on persecutory delusions: the importance of safety seeking

OBJECTIVE: Acting on delusions is a significant clinical issue. The concept of safety behaviours--actions carried out with the intention of reducing perceived threat--provides a new way of understanding acting on delusions. A study was conducted with the aim of examining the prevalence and correlates of safety behaviours related to persecutory delusions. METHOD: One hundred patients with persecutory delusions were assessed for safety behaviours, acting on delusions, anxiety, depression, and psychotic symptoms. Case note data were collected on instances of serious violence or suicide attempts. RESULTS: Ninety-six patients had used safety behaviours in the last month. Greater use of safety behaviours was associated with higher levels of distress. A history of violence or suicide attempts was associated with greater use of safety behaviours. Safety behaviours were significantly associated with acting on delusions, but not with the negative symptoms of psychosis. CONCLUSION: Safety behaviours are a common form of acting on persecutory delusions. These behaviours have the consequence that they are likely to prevent the processing of disconfirmatory evidence and will therefore contribute to delusion persistence.     

RECURRING THEMES IN THE DEBATE ABOUT EUTHANASIA AND ASSISTED SUICIDE

During the past four decades, the Netherlands played a leading role in the debate about euthanasia and assisted suicide. Despite the claim that other countries would soon follow the Dutch legalization of euthanasia, only Belgium and the American state of Oregon did. In many countries, intense discussions took place. This article discusses some major contributions to the discussion about euthanasia and assisted suicide as written by Nigel Biggar (2004) , Arthur J. Dyck (2002) , Neil M. Gorsuch (2006) , and John Keown (2002) . They share a concern that legalization will undermine a society's respect for the inviolability and sanctity of life. Moreover, the Report of the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill (2005) is analyzed. All studies use ethical, theological, philosophical, and legal sources. All these documents include references to experiences from the Netherlands. In addition, two recent Dutch documents are analyzed which advocate further liberalization of the Dutch euthanasia practice, so as to include infants (Groningen Protocol, NVK 2005 ) and elderly people “suffering from life” (Dijkhuis Report, KNMG 2004 ).     

Identifying Children at Risk of Problematic Development: Latent Clusters Among Childhood Arrestees

The presence of clusters characterized by distinct profiles of individual, family and peer characteristics among childhood arrestees was investigated and cluster membership stability after 2 years was determined. Identification of such clusters in this heterogeneous at-risk group can extend insight into the presence and severity of children’s co-occurring problems and guide intervention and prevention efforts. Latent class analysis (LCA) was used to detect clusters among 308 childhood arrestees (mean age 10.7 years), based on dichotomous dynamic correlates of offending present at the time of first arrest. Correlates in the individual, peer and family domains were assessed at baseline and 2-year follow-up, using standardized instruments. This resulted in identification of a low problem group characterized by few problems across all domains (40.2 %), an externalizing intermediate problem group characterized by mainly externalizing problems on the individual and peer domains (39.4 %), and a pervasive high problem group characterized by numerous problems across all domains (20.4 %). Cluster membership was most stable for the low problem group (71.4 %), followed by the externalizing intermediate problem group (49.5 %). Transition was highest in the pervasive high problem group (63.0 %), with the majority of children progressing to the externalizing intermediate problem group. The identification of such distinct clusters among childhood arrestees, differing in the presence of co-occurring problems, stresses the importance of a first police arrest as an opportunity for early recognition of children in need of care. As problems present at the time of first arrest do not persist in every child, careful periodic monitoring is needed.     

The role of the degree of acquaintance with teachers on students’ interpersonal perceptions of their teacher

Some researchers suggest that the way a teacher is perceived during the first encounter with a classroom group resembles, and therefore is predictive of, later classroom processes as perceived by students. This study investigated the degree to which interpersonal ratings (i.e., control and affiliation), given by secondary school students to teachers unknown to them, are comparable to ratings given by students who are well acquainted with that teacher, by means of a quasi-experimental design. Ratings concerning a teacher students had not met before, based on a 5 min video vignette, were compared to ratings given by students who had been taught by the same teacher for at least a year (N $\,{=}\,$ 489). Students at no acquaintance perceived a teacher’s interpersonal traits in a similar way as students who were familiar with that teacher. It is concluded that students’ early interpersonal perceptions of a teacher largely resemble perceptions formed by students that know this teacher well.     

Beyond Skills and Structure: Justice Dispositions as Antecedents of Young Citizens' Volunteering and Political Participation

Community involvement is usually attributed to opportunity structures and individuals' ability to be involved. Building on psychological justice research, this paper proposes that justice dispositions add to explaining why young citizens become active in their communities or not. Furthermore, it is argued that justice dispositions help to understand why most studies find only moderate relationships between youth volunteering and forms of political involvement. In a sample of 321 young Swiss volunteers, this study shows justice centrality and belief in a just world to predict the extent of volunteering and political participation, even after controlling for civic skills and opportunity structures. However, scrutinising the motivations to volunteer, self‐oriented motivations (enhancement, social, career and understanding) more strongly affected the level of volunteering than motivations related to justice dispositions (political responsibility and social responsibility). These findings have implications for the attraction and retention of volunteers as well as for the politics of volunteering and community development in general. Copyright © 2013 John Wiley & Sons, Ltd.     

Intergenerational associations linking identity styles and processes in adolescents and their parents

Identity formation is a lifelong task, yet much research focuses on adolescence and emerging adulthood. Little is known about whether parents' identities are related to their adolescent children's identities. The present studies were designed to examine intergenerational associations. Specifically, we focused on identity styles (Study 1 with 191 mother–adolescent and 170 father–adolescent dyads) and exploration and commitment processes (Study 2 with 230 mother–adolescent and 214 father–adolescent dyads). In Study 1, the information-oriented and normative styles, especially among mothers, were positively associated with these same styles among adolescents. Fathers' use of the normative and diffuse-avoidant style was positively associated with adolescents' use of these same styles. In Study 2, parental identification with commitment was positively associated with adolescent commitment making and negatively with adolescent ruminative exploration. Maternal exploration in depth was positively associated with adolescent exploration in depth and ruminative exploration. In sum, parents may function as role models for adolescent identity formation, although longitudinal research is needed to support more authoritative claims.     

Jumping to conclusions, a lack of belief flexibility and delusional conviction in psychosis: a longitudinal investigation of the structure, frequency, and relatedness of reasoning biases

Two reasoning biases, jumping to conclusions (JTC) and belief inflexibility, have been found to be associated with delusions. We examined these biases and their relationship with delusional conviction in a longitudinal cohort of people with schizophrenia-spectrum psychosis. We hypothesized that JTC, lack of belief flexibility, and delusional conviction would form distinct factors, and that JTC and lack of belief flexibility would predict less change in delusional conviction over time. Two hundred seventy-three patients with delusions were assessed over twelve months of a treatment trial (Garety et al., 2008). Forty-one percent of the sample had 100% conviction in their delusions, 50% showed a JTC bias, and 50%-75% showed a lack of belief flexibility. Delusional conviction, JTC, and belief flexibility formed distinct factors although conviction was negatively correlated with belief flexibility. Conviction declined slightly over the year in this established psychosis group, whereas the reasoning biases were stable. There was little evidence that reasoning predicted the slight decline in conviction. The degree to which people believe their delusions, their ability to think that they may be mistaken and to consider alternative explanations, and their hastiness in decision making are three distinct processes although belief flexibility and conviction are related. In this established psychosis sample, reasoning biases changed little in response to medication or psychological therapy. Required now is examination of these processes in psychosis groups where there is greater change in delusion conviction, as well as tests of the effects on delusions when these reasoning biases are specifically targeted.     

Understanding AIDS preventive behavior with casual and primary partners in homosexual men: The theory of planned behavior and the information-motivation-behavioral-skills model

Abstract

This study examined whether components from the Information-Motivation-Behavioral-Skills Model, in particular information, added explanatory power to factors derived from the Theory of Planned Behavior with respect to predicting AIDS-preventive behaviors among gay men. Participants were recruited from a longstanding cohort study in Amsterdam. Multivariate regression analyses showed that concepts from the Theory of Planned Behavior could account adequately for intentions to use condoms with casual as well as with steady partners. Actual behavior was best predicted by past behavior. In addition, structural equation modeling demonstrated that the causal paths as posited by Theory of Planned Behavior had a good fit to the data. From the presented findings implications for preventive interventions can be drawn. Specifically, interventions to increase condom use with casual partners need to focus at improving perceived behavioral control regarding this behavior, for instance through skills training. Interventions aimed at safer sex within steady relationships should take into account that the HIV-status of the individual and his partner plays an important role in the occurrence of unprotected anal sex in a romantic dyad.     

Development of an eight-subtest short form of the WISC-IV and evaluation of its clinical utility in children with traumatic brain injury

This study evaluated the degree to which an 8-subtest short form of the Wechsler Intelligence Scale for Children—Fourth Edition would yield acceptable estimates of the long-form Full-Scale IQ index while clarifying the underlying factor structure in a sample of 100 children and adolescents with traumatic brain injury. The short-form Full-Scale IQ had sufficient (i.e., at least two thirds) nonerror covariance with its full-length counterpart. In addition, a sufficient proportion (i.e., > 80%) of these short-form estimates fell within the 90% confidence interval of the respective full-length scores. Importantly, the elimination of 2 subtests, and in particular the Picture Concepts subtest, resulted in a factor structure where each remaining subtest was fairly specifically associated with its intended scale. It is concluded that this short form can be used clinically in children with traumatic brain injury without sacrificing reliability and with more straightforward interpretability at the level of the factor index scores.     

Un ensayo controlado de intervención social en familias de pacientes esquizofrénicos

RESUMEN

En este estudio se expone un ensayo controlado de intervención social en familias de pacientes esquizofrénicos con alto riesgo de recaída. Los pacientes se seleccionaron por tener mucho contacto con familiares con alta emoción expresada. Todos los pacientes mantuvieron su tratamiento con medicamentos neurolépticos. Una mitad de las veinticuatro familias se asignaron al azar a cuidados rutinarios de pacientes externos, mientras que la otra mitad recibió un paquete de intervenciones sociales. Éste comprendía un programa de educación acerca de la esquizofrenia, un grupo para los parientes y sesiones familiares para parientes y pacientes. La tasa de recaída en el grupo de control fue de cincuenta por ciento comparada con el nueve por ciento del grupo experimental (P = 0.04). Los objetivos establecidos en las intervenciones terapéuticas se alcanzaron en el setenta y tres por ciento de las familias experimentales, en las cuales no hubo pacientes con recaídas. Los resultados evidencian el papel causal de la emoción expresada de los familiares en la recaída de pacientes esquizofrénicos, así como de la efectividad terapéutica de la intervención social combinada con el tratamiento farmacológico.