Multimodal therapy in an inpatient setting

Inpatient Multimodal Therapy (imt) is a residential treatment program, lasting a maximum of 36 weeks, for patients with severe neurotic symptoms. A group of 44 chronic obsessive-compulsive patients and a group of 40 chronic phobic patients were treated in order to assess the outcome and the process of treatment and to identify prognostic factors associated with the effect. At follow-up—on average, eight months after discharge—it was found that 60% had improved, 32% had remained the same, and 8% had deteriorated, indicating that, in general, the treatment was beneficial. That these effects were long-lasting is supported by the fact that, at follow-up, 78% of all patients were no longer receiving treatment, 18% were receiving outpatient or day treatment, and 4% were receiving inpatient treatment. Phobic patients appear to have gained more from the multimodal approach than did obsessive-compulsive patients, as indicated by the fact that the severity of symptoms decreased as they improved in rational thinking, assertiveness, and arousal. By contrast, obsessive-compulsive patients relapsed more than phobic patients did. This was attributed to the fact that the former gained less from the rational-emotive training, denied problems with assertiveness, and did not practice the acquired relaxation skills. It further appeared that a favorable outcome could be induced in patients who (1) expressed relatively mild symptoms in this otherwise severe group, (2) reported relatively few additional complaints, (3) could clearly indicate interpersonal problems, and (4) did not use psychotropic drugs. These prognostic factors are so widespread that not much weight can be ascribed to them. Yet they are useful for indication ofimt until better predictors are found.     

The right to refuse treatment: Paradox,pendulum and the quality of care

This clinical and theoretical overview of the right to refuse treatment will address some of the themes that have dominated this area of interface between psychiatry and the law, and have, perhaps, obscured the real concern of the right to refuse treatment question; i.e., the issue of quality of care. Central themes include factors present in the medicolegal context and recent events, origin of the concept of the right to treatment, the separation of confinement from treatment, and the changing models of vicarious decision making. This review also addresses judicial conceptualizations of treatment, including the concept of quarantine, judicial risk-aversiveness, and judicial fantasies of drug action. Some possible directions for the future are also examined.     

Criminal profiling from crime scene analysis

Since the 1970s, investigative profilers at the FBI's Behavioral Science Unit (now part of the National Center for the Analysis of Violent Crime) have been assisting local, state, and federal agencies in narrowing investigations by providing criminal personality profiles. An attempt is now being made to describe this criminal-profile-generating process. A series of five overlapping stages lead to the sixth stage, or the goal of apprehension of the offender: (1) profiling inputs, (2) decision-process models, (3) crime assessment, (4) the criminal profile, (5) investigation, and (6) apprehension. Two key feedback filters in the process are: (a) achieving congruence with the evidence, with decision models, and with investigation recommendations, and (b) the addition of new evidence.     

The role of spatial-frequency channels in the perception of local and global structure

Adaptation and reaction-time techniques were used to examine the role of different spatial-frequency channels in the perception of local and global structure. Subjects were shown figures consisting of a large C composed of smaller Cs and asked to identify the orientation of either the global C or its local elements. Prior to performing the task subjects were adapted to different spatial frequencies and the effect on subsequent performance was assessed. Two main results were found. First, the adapting frequency that most affected the global task was often lower than that most affecting the local task, suggesting that high and low frequencies independently code the structure of an image. Second, reaction time to global figures was often faster than to local figures at all levels of detectability, again suggesting a role of low-frequency channels in global processing.     

Relationship of parental education,race, and gender to sex role stereotyping in five-year-old kindergartners

This study examined the relationship of parental education, race, and gender to sex-role stereotyping in five-year-old kindergartners. A significant effect for race and parental education level was noted. White children gave more stereotyped responses than did black children, and children whose parents were in the middle- and high-educational levels gave more stereotyped responses than did children whose parents were in the low-educational level. A significant interaction was also found between educational level of parents and race. White children tended to give more stereotyped responses as the educational level of their parents increased; this trend was not evident for black children. No significant differences in stereotyping were noted between the sexes.To whom requests for reprints or information concerning the Bardwell-Sietsema Sex Stereotype Scale should be addressed at Department of Elementary Education, East Texas State University, Commerce, Texas 75428.     

Cognitive and social functioning across adulthood: age or student status differences?

Younger adult students between 19 and 24 years of age (M = 21.3 years), older adult students between 61 and 76 years of age (M = 67.9 years), and older adult nonstudents between 62 and 76 years of age (M = 68.5 years) were assessed for health (self-ratings of physical and mental health), social functioning (self-ratings of physical and mental activity, perceived role activity level, perceived roles, locus of control, and age-norm expectations), and cognitive functioning (Wechsler Adult Intelligence Scale-Revised vocabulary and block design, and paired associate memory). Age differences were observed in self-ratings of health, social roles, intellectual performance, and memory. No student status differences were observed. The results are discussed in terms of plasticity of intellectual function and characteristics of student status in later adulthood.     

How much and how fast: rapid processing of spoken language in later adulthood

Speech processing involves rapid decoding and construction of meaning from a transitory acoustic signal. Because older adults have been found to be slower in performing many cognitive tasks, we hypothesized that they may have difficulty in immediate recall for speech of increasing input rate. Two experiments are reported in which both older and younger participants listened to and immediately recalled sentences that were systematically varied in speech rate and number of propositions. Although recall performance of the older adults showed a disproportionate decline when speech rate was increased, older adults, as well as the younger adults, were able to recall sentences of increasing propositional densities. We also found that the tendency to recall a greater proportion of main ideas than details (the levels effect) was enhanced by increased propositional density, and depressed by increased speech rate and increased age. These results are discussed in terms of an age-related change in the rate at which information can be processed in working memory.     

A guide to family/school interventions for the family therapist

When presented with a behavioral problem or symptom expression that involves two systems, such as a serious school-related problem, the therapist needs to design an approach that will intervene effectively and expeditiously in both systems. This paper offers a guide to stages of problem escalation and therapeutic intervention that is intended to aid the problem-solver's thinking processes in approaching a troubled situation that involves two systems, the school and the home.