Behavioral assessment of imipramine effects in a depressed child

A 7-year-old boy was diagnosed as suffering from childhood depression by two independent psychiatric evaluators who employed the Research Diagnostic Criteria. Multifaceted behavioral observations were performed on target behaviors which were identified as major problematic areas of functioning related to the child's depression. The behavioral assessment strategy included daily monitoring of on-task and disruptive behavior in the classroom, enuresis, and overall hygienic, social, and compliance behaviors as a means of identifying the specific drug-induced effects of an anti-depressant, imipramine. The assimilation and application of behavioral assessment strategies within child psychiatry have been slow and tenuous. Reasons for the resistance include theoretical differences and misconceptions among psychiatric personnel, who, although open to objective evaluations, may wish to employ nonbehavioral treatments such as pharmacologic agents. The primary purpose of this study was to demonstrate the viability of behavioral assessment as an integral adjunct to pharmacologic treatment in a psychiatric setting as a means of gauging the efficacy of a psychiatric intervention. Issues regarding the role of behavioral assessment in psychiatry and, in particular, pharmacologic interventions with depressed children are examined and discussed.This study was supported, in part, by NIMH Grant MH 30915.     

Confidentiality: a survey in a research hospital

Despite the many justifications for protecting patient confidentiality, we recognize that confidentiality cannot be absolute. Our world of automated information and easy access and storage poses many threats to confidentiality. This paper has described a survey conducted at the NIH Clinical Center to assess the knowledge, attitudes, and behaviors of clinical physicians and nurses about confidentiality of patient information. The survey findings demonstrate the need for reminders and increased awareness about confidentiality in our setting. Most of the survey respondents had a good knowledge of what was expected of them, and they believed that confidentiality was important and maintaining it was their responsibility. Of interest was that in several simulated clinical situations, there was a discrepancy between what respondents indicated they should do and what they thought they would do. The biggest discrepancies appeared in situations that involved overhearing a patient conversation on the elevator, approaching an unfamiliar person who is reading a medical record in the nurses' station, and answering a patient's inquiry about the status of another patient. The findings support the speculation that this difference may be attributed to discomfort or decreased awareness, and not necessarily to lack of knowledge. Results indicate that policies and administrative expectations should be frequently communicated and enforced, and that educational programs that address issues of confidentiality should be provided. The results of this survey have been influential in guiding educational strategies and administrative activities at the clinical center. The clinical center initiated a confidentiality awareness campaign, displaying a new poster every three months in strategic locations and distributing other tangible reminders (such as pens, magnets, and buttons) containing the same confidentiality message.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of Level of Challenge on Pressor and Heart Rate Responses in Type A and B Subjects1

The present study examined the relationship between the Type A coronaryprone behavior pattern and the magnitude of cardiovascular response induced by varying levels of environmental challenge. In a 2 × 2 experimental design, Type A and B (noncoronary-prone) subjects (n= 80) were randomly assigned to either high or low challenge instructional conditions for both the cold pressor (CP) and a choice reaction time task (RT). Overall, across both tasks, Type A subjects responded with greater systolic blood pressure (SBP) and heart rate (HR) elevation than Type B subjects. While these differences between the Types tended to be larger in the high challenge condition, some differences were also observed under low challenge. Component analyses of the Pattern revealed that high hostile/competitive Type A's responded to both low and high challenge instructions in the CP and RT tasks with physiologic elevations comparable to that displayed by globally defined Type A's receiving high challenge instructions. The present findings tentatively suggest that (a) high hostile/competitive Type A's respond to even mild challenge with enhanced physiologic response; (b) globally defined A's tend to evidence the physiologic elevations when specifically challenged; and (c) Type B's show much smaller physiologic reactions to such challenges. Consistent with previous research, comparison of Type A assessment techniques revealed that the Rosenman diagnostic interview was a better predictor of physiologic response than other questionnaire methods. Two hypotheses are advanced and future research recommended regarding possible relationships between environment, behavior, physiology, and disease.     

Aripiprazole-related tardive dyskinesia

The low prevalence of extrapyramidal symptoms associated with atypical antipsychotics has led to their widespread use during the past decade. Aripiprazole, the newest medication in this class, has been associated with extrapyramidal symptoms (eg, akathisia) and with improvement of tardive dyskinesia (TD), but to date it has not been associated with the development of TD. We report a case of TD associated with the use of aripiprazole 15 mg/day for 18 months for refractory depression. Symptoms of TD resolved within several weeks of discontinuation of aripiprazole.     

From a Distance: Pastoral Care and Theological Education

Abstract. This article is a presentation and discussion of a seminary course on the Corinthian Correspondence. The pedagogical model for this course was structured to parallel the pattern of Paul's pastoral care from a distance as he relates to the Corinthian congregation by personal visits, delegations from and to the congregation, letters from and to the congregation, and unofficial grapevine types of communication. The course was designed for dispersed students to interact with the Corinthian letters, with each other, and with myself as instructor in ways that 1) simulate a first‐century exchange between congregation and apostle and 2) facilitate careful interpretive work on the message of these letters, including their contemporary relevance.     

Cross-fertilization versus transmission: Recommendations for developing a bidirectional approach to psychotherapy dissemination research

Psychotherapy researchers are increasingly engaged in collaborations with clinical practitioners and mental health administrators. Each party brings its own perspectives, values, and agendas to bear in these encounters. Viable research—practice collaborations depend on understanding and negotiating some of the tensions in these relationships. In this article, we discuss the contexts that prevail for various participants in a psychotherapy dissemination study as well as the values, goals, costs, and benefits related to research participation. This article is a collaboration among the researchers, mental health administrators, therapists, and clients involved in an ongoing treatment dissemination study. Our recommendations for research—practice collaborations are based on our experiences and dialogues over the course of this study.     

Rrepresentations of trauma in infancy: Clinical and theoretical implications for the understanding of early memory

Understanding the nature of the infant's internal experience is a crucial prerequisite for delineating the developmental effects of an early trauma. In addition, to the extent that internal representations of a trauma can be traced over time, traumatic experiences present unique opportunities for the study of early memory. This article will describe case vignettes of children who experienced a trauma in the preverbal period and who evidenced forms of memory of their trauma at subsequent points in time. In conjunction with the clinical material, developmental research bearing on the types of early memories described will be discussed. The clinical data, reinforced by research findings, indicate that preverbal children, even in the first year of life, can establish and retain some form of internal representation of a traumatic event over significant periods of time. The specificity and enduring nature of the internal representations suggest that specific therapeutic interventions over and above general comforting will be required if an infant is to maximally recover from a trauma. The clinical findings have relevance for a number of issues currently under debate in the area of infant memory, including the role of reminders in memory retention, the nature of early memory systems, and the development of autobiographical memory. ©2002 Michigan Association for Infant Mental Health.     

Differentiation of Self, Stress, and Emotional Support as Predictors of Psychological Distress

We explored the relations among stress, emotional support, and differentiation of self from the family of origin as predictors of psychological distress in a sample of 200 college students. First, we investigated the discrepant findings of Murdock and Gore (Contemp Fam Ther 23: 319–335, 2004) and Skowron et al. (J Couns Dev 82: 69–78, 2004) regarding the relationships among stress, differentiation, and symptoms (a question of mediation vs. moderation). Second, we examined the role of emotional support in concert with stress and differentiation. When both stressful events and perceived stress were measured, differentiation of self was found to be a significant partial mediator of their effects on psychological distress. Emotional support was also found to partially mediate the relationship between differentiation of self and psychological distress. Differentiation of self partially mediated the relationship between actual and perceived stress, and perceived stress partially mediated the relationship between differentiation of self and psychological distress.