Family Functioning and Mental Illness: A Comparison of Psychiatric and Nonclinical Families

The primary objective of the present investigation was to examine adaptive functioning in the families of patients with a wide range of psychiatric disorders. Seven dimensions of family functioning, as measured by the Family Assessment Device (FAD), were compared across families of patients with a schizophrenia spectrum disorder (n = 61 ), bipolar disorder (n = 60 ), major depression (n = 111 ), anxiety disorder (n = 15 ), eating disorder (n = 26 ), substance abuse disorder (n = 48 ), and adjustment disorder (n = 46 ). Families in each psychiatric group were also compared to a control group of nonclinical families (N = 353 ). Results indicated that regardless of specific diagnosis, having a family member in an acute phase of a psychiatric illness was a risk factor for poor family functioning compared to the functioning of control families. However, with few exceptions, the type of the patient's psychiatric illness did not predict significant differences in family functioning. Thus, having a family member with a psychiatric illness is a general stressor for families, and family interventions should be considered for most patients who require a psychiatric hospitalization for either the onset of, or an acute exacerbation of, any psychiatric disorder.     

The Development of a Clinical Rating Scale the McMaster Model of Family Functioning

This article describes the development and validation of the McMaster Clinical Rating Scale (MCRS). The MCRS is a 7-item scale designed to be completed by a trained rater after completion of an in-depth interview of the family. We present data from four new studies and review previously published articles concerning the reliability, validity, and clinical utility of the MCRS. Adequate interrater reliability and rater stability were obtained. The MCRS was found to correlate significantly with the self-report Family Assessment Device and to discriminate between families in different phases of a depressive disorder.     

A Whiff of Reality: Empirical Evidence Concerning the Effects of Pleasant Fragrances on Work-Related Behavior1

Two studies were conducted to investigate the potential effects on workrelated behavior of one environmental variable: pleasant fragrances. In Study 1, participants performed a word construction task under low or high stress while in the presence or absence of pleasant fragrances. Performance was significantly enhanced by fragrance in both stress conditions. In addition, exposure to pleasant fragrances significantly increased performance on an additional task (decoding written messages) completed by participants following exposure to stress. In Study 2, both exposure to pleasant fragrances and receipt of a small gift increased performance on the same word construction task used in Study 1. In addition, fragrance and a gift increased participants' willingness to engage in both immediate and delayed helping. Together, the results of these studies offer support for the view that pleasant fragrances can influence work-related behavior, and that such effects may be mediated, at least in part, by increments in positive affect.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.     

Neuropsychological Features of Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is the epitome of a subcortical dementia process. Due to its relative rarity, there is only a small literature on the neuropsychological consequences of PSP. The findings to date demonstrate that PSP patients have dramatically slowed information processing and motor execution, rapid forgetting, problems in orienting attentional resources, and difficulty in planning and shifting conceptual sets. The pattern and severity of these deficits are unique to PSP and suggest that the study of PSP patients can provide a special insight into brain-behavior relations.     

Quantitative measurement of observed workload in the analysis of aircrew performance

A methodology for the quantitative evaluation of observed workload was proposed. The model was designed to provide point estimations of observed workload at any time during the performance of a set of tasks. The model was also designed to provide information about the task-scheduling strategies used to complete a set of tasks. The proposed model was then tested with data from a full mission flight simulation. The model predictions correlated significantly with expert ratings of workload management made during the flight simulation. The model was also able to distinguish between low- and high-performing aircrews when performance was based on the number of errors made during flight simulations.     

Reply to William R. Ferrell’s paper “A model for realism of confidence judgments: Implications for underconfidence in sensory discrimination”

Ferrell’s decision-variable partition model and our subjective distance model belong to the same family of Thurstonial models. The subjective distance model is limited to sensory discrimination with the method of constant stimuli and rooted in such notions as discriminal dispersion and sense distance. Ferrell’s model is intended to be wider in scope and to apply to both cognitive and sensory tasks. Both models need supplementary assumptions to predict calibration phenomena. The point of departure for us is the fact that the model predicts under-confidence under “guessing” and the empirical finding that people are about 100% correct when they report “absolutely certain.” Ferrell makes assumptions about cutoffs on the decision variable. The respondent is assumed to adjust or not adjust cutoffs according to “cues to difficulty.” We disagree with Ferrell’s claim that the hard-easy effect is explained by the respondent’s failure to adjust cutoffs sufficiently when there is a change in level of difficulty, and argue that this amounts to little more than a translation of the hard-easy effect into the lingua of Ferrell’s decision-variable partition model. Our argument is that the hard-easy effect is a consequence of the post hoc division of items according to solution probability. In addition, error variance may contribute to regression effects that enlarge the hard-easy effect. Finally, in contrast to Ferrell’s position, we regard inference (cognitive uncertainty) and discrimination (sensory uncertainty) as different psychological processes. An understanding of calibration in these two areas requires separate models.     

Discrimination of Facial Identity and Facial Affect by Temporal and Frontal Lobectomy Patients

The purpose of this study was to determine the extent to which lobectomy affects ability to discriminate facial identity or facial expression. Fifteen right temporal, 15 left temporal, 5 right frontal, and 4 left frontal lobectomy patients, pair-matched for age, sex, and education to normal control subjects, participated in this study. Tasks included a Facial Identity Matching Task and a Facial Affect Matching task. The lobectomized patients as a whole were significantly impaired on both tasks (22% decrement in performance). The patients made twice as many errors resulting from perseveration of response-set of the first condition (identity or emotion matching) into the second condition. The site of lobectomy did not influence general performance on any one task or selective performance on any subset of affective categories. It was concluded that all four brain regions play a significant and equal role in face processing, and that circuits more specifically dedicated to visual face processing, which are responsible for hemispheric dominance affects and affect/identity dissociations, are probably located more posteriorly in the brain. Finally, it was concluded that perseveration of acquired habit may, under specific conditions, characterize temporal lobe dysfunction just as much as frontal lobe dysfunction.     

Managed mental health care and professional compensation

Managed care and organized systems of care are restructuring the delivery of care in the United States. As care is reorganized, physician practice styles, autonomy, and compensation are undergoing profound changes. To successfully integrate physicians into the new managed systems of care, their organizational relationship to and their compensation within these systems must be carefully considered. This paper first explores physician motivation as it is related to compensation. The paper then describes a variety of emerging organizational designs aimed at aligning the interests of physicians and hospitals. The author considers fully integrated, physician-hospital organizations with target income compensation arrangements to be most suitable to the collective success of professionals and organized systems of care. The paper concludes with a discussion of the many dilemmas and challenges posed by the intertwining of managed care, organized networks of care, and professional compensation.