Metacognitive beliefs across the continuum of psychosis: comparisons between patients with psychotic disorders, patients at ultra-high risk and non-patients

BACKGROUND: Recent models of emotional disorders and psychosis implicate metacognitive beliefs in the development and maintenance of psychological distress. We predicted that patients with established psychotic disorders and those meeting at risk mental state (ARMS) criteria (and, thus, at increased risk of developing psychosis) would show higher levels of metacognitive beliefs than non-patient controls. Furthermore, we predicted that patients with psychosis would show higher levels of such beliefs than the at risk group. METHOD: The Metacognitions Questionnaire was administered to 73 patients with psychotic disorders, 43 ARMS patients and 188 non-patients. RESULTS: As predicted, patients with psychotic diagnoses and those at risk scored higher on metacognitive belief dimensions than non-patients. Patients with psychosis showed higher positive metacognitive beliefs than the at risk patients, indicating a greater range of unhelpful metacognitions overall, when compared to non-patients. CONCLUSIONS: These findings are consistent with metacognitive conceptualisations of psychological disorders. The implications of these findings for clinical practice are discussed.     

A Pilot Study to Assess the Feasibility of a Multicenter Cluster Randomized Trial for the Management of Asymptomatic Persons with a Thrombophilia

There is controversy whether asymptomatic first-degree relatives (FDRs) of patients with venous thromboembolism (VTE) and thrombophilia should be screened, followed, and prescribed prophylaxis during risk periods. We recruited consecutive probands with idiopathic VTE and thrombophilia from our thrombosis clinics. Those FDRs with thrombophilia were randomized in family clusters to receive one-time verbal counseling and no organized follow-up or counseling, educational material, reminder aids and follow-up. Only 203 of 1,129 FDRs were eligible and consented. Dropouts were common; 1 FDR (1.7%) developed VTE. VTE risk, ability to treat and prevent were underestimated by the participants. Patients with VTE and thrombophilia and their FDRs are often not interested in thrombophilia testing. Despite education to inform their knowledge, interest and follow-up were less than ideal. The question of the best educational approach in these patients remains unanswered. The value of testing and following asymptomatic carriers of probands with VTE and thrombophilia remains unknown.     

REJOINDER: WHITHER MARITAL THERAPY?

It is apparent that Gurman and Kniskern have greatly revised their original position in response to our critique. We believe that their revised position is more fully consonant with the available empirical evidence, although certain areas of disagreement between us are still evident. Overall, we believe that this dialogue has generated some promising lines for future research and clinical practice.     

Primary Prevention Mental Health Programs: The Future is Exciting

Current outcome research on primary prevention mental health programs is encouraging and the future is exciting. Data continue to accumulate regarding the efficacy of preventive intervention. Exemplary programs can prevent multiple problems across different outcome domains suggesting the need for collaboration among preventionists across disciplines and research areas. The commentators on our review (Durlak and Wells, 1997) offered many useful suggestions to improve the next generation of research. Most recommendations fall broadly under the rubric of increasing the precision of theory, design, and program evaluation. If current recommendations for improving future research are followed, the next reviewers of primary prevention mental health programs for children and adolescents will have a more complete and useful database for analysis.     

The family-of-origin framework: A model for clinical training

Family-of-origin work is defined as a person's attempt to examine and/or change the patterns of interaction that occur in the family in which s/he was raised. This article outlines a model of family-of-origin work that is used in the clinical psychology training program at St. Louis University. The family therapy literature, particularly the work of Bowen, provides its theoretical underpinnings. An integral part of family-of-origin presentations is the genogram, or visual depiction of a family tree. Many ethical issues arise from the use of family-of-origin work within the context of clinical training, including confidentiality, responsibility, informed consent, values, and the boundaries of the supervisory relationship.     

A feature analysis of stuttered phonemes

Stuttered and nonstuttered phonemes of 20 adult males were analyzed for distinctive feature patterns using the Chomsky-Halle system. The features (+ consonantal), (- voice), (+ continuant), and (- strident) occured significantly more often in stuttering than in nonstuttering instances. Results suggest that adult stuttering is most likely to occur when the primary sites of tension and discoordination are lingual and laryngeal and when the speaker must shift from (- voice) to (+ voice).