Screening for trauma histories,posttraumatic stress disorder (PTSD), and subthreshold PTSD in psychiatric outpatients

The ability of the Structured Clinical Interview for DSM-IV (SCID) posttraumatic stress disorder (PTSD) module's screening question to identify individuals with PTSD or subthreshold PTSD was examined. First, the screen's sensitivity for detecting a trauma history was determined. Second, the incremental validity of a more thorough trauma assessment was examined by determining how many individuals responded negatively to the screen but then were diagnosed with PTSD or subthreshold PTSD. Last, the optimal SCID termination point for assessing subthreshold PTSD was determined. Using a trauma list increased the number of participants reporting a trauma; however, the SCID screen captured almost all individuals who had PTSD or subthreshold PTSD. When one screens for subthreshold PTSD, the SCID can be terminated on failure to meet Criterion B.     

Autism clinical trials: biological and medical issues in patient selection and treatment response

Biomedical measures are critical in the initial patient-screening and -selection phases of a clinical trial in autism and related disorders. These measures can also play an important role in the assessment and characterization of response and can provide an opportunity to study underlying etiologic and pathophysiologic processes. Thus, biomedical measures, including clinical laboratory analyses, metabolic screening, and chromosomal analysis, are used to screen for potential safety-related problems, to decrease biological and genetic heterogeneity, and to define subgroups. Neurobiological measures can be examined as possible predictors, modifiers or surrogates of therapeutic response, and adverse effects. Neurobiological research measures can also be used to study mechanisms and extent of drug action and to perform baseline and longitudinal investigations of possible pathophysiologic alterations. The potential utility and desirability of specific measures are considered and the general approach to choosing measures for incorporation is discussed.     

The role of gender in the clinical presentation of patients with borderline personality disorder

This study examined gender differences in the pattern of comorbid disorders and degree of impairment among outpatients with borderline personality disorder (BPD). A total of 130 outpatients with BPD were assessed for various lifetime impulse-related disorders and post-traumatic stress disorder and for indices of impairment. Compared with women with BPD, men with BPD reported significantly more lifetime substance abuse disorders, antisocial personality and met criteria of intermittent explosive disorder that did not overlap with a diagnosis of BPD. Women with BPD reported significantly more lifetime eating disorders than men with BPD. No gender differences were found in degree of overall impairment. These results suggest that male and female patients with BPD, although equally distressed, present with different lifetime patterns of impulse-related disorders.     

Racial Identity, Parental Support, and Alcohol Use in a Sample of Academically At-Risk African American High School Students

This study examined racial identity and parental support as predictors of alcohol use in a sample of 488 African American adolescents. Two dimensions of racial identity were investigated: (1) racial centrality (i.e., the significance that one places on race in defining oneself) and (2) private regard (i.e., the extent to which one feels positively about Black people). In addition, perceived support from mothers and fathers was examined. Multivariate results showed that private regard and father support were associated with less self-reported alcohol use after partialling out the effects of age and gender. An interaction between the two racial identity dimensions was also found such that private regard was associated with less alcohol use for adolescents who reported that race was a more central part of their identity.     

"Which feels heavier--a pound of lead or a pound of feathers?" A potential perceptual basis of a cognitive riddle

"Which weighs more--a pound of lead or a pound of feathers?" The seemingly naive answer to the familiar riddle is the pound of lead. The correct answer, of course, is that they weigh the same amount. We investigated whether the naive answer to the riddle might have a basis in perception. When blindfolded participants hefted a pound of lead and a pound of feathers each contained in boxes of identical size, shape, and mass, they reported that the box containing the pound of lead felt heavier at a level above chance. Like the size-weight illusion, the naive answer to the riddle may reflect differences in how easily the objects can be controlled by muscular forces and not a perceptual or cognitive error.     

The validity of DSM-IV passive-aggressive (negativistic) personality disorder

Passive-Aggressive (Negativistic) Personality Disorder (NEGPD), listed in Appendix B of the DSM-IV, is not an officially recognized personality disorder. Its future as a discrete disorder is uncertain (Widiger, 2003). Yet, NEGPD occupies a role in some theoretical formulations of personality pathology (Millon & Davis, 1996), and many clinicians believe that passive-aggressive traits are not adequately represented by other PDs (Westen, 1997). In this study, 1158 psychiatric outpatients were assessed for Axis I and Axis II disorders. Thirty-five (3.02%) met criteria for NEGPD. Participants with NEGPD did not differ significantly from those without NEGPD on demographic variables. The internal consistency of the DSM-IV's seven NEGPD items was 0.50. Corrected item- total correlations for the 7 criteria averaged 0.27. Participants with NEGPD had higher rates of lifetime anxiety disorders, and almost 90% had an additional PD. An exploratory factor analysis suggested a two- factor solution that accounted for 43.4% of the variance. The first factor reflected the belief that life is unfair, while the second factor seemed to reflect modes of anger expression. A confirmatory factor analysis showed that the two-factor model fit the data better than a unidimensional model. We discuss implications of these results for the future of the NEGPD diagnosis.     

Against relativism

Recent years have brought relativistic accounts of knowledge, first-person belief, and future contingents to prominence. I discuss these views, distinguish non-trivial from trivial forms of relativism, and then argue against relativism in all of its substantive varieties.     

Community-Engaged Neighborhood Revitalization and Empowerment: Busy Streets Theory in Action

Busy streets theory predicts that engaging residents in physical revitalization of neighborhoods will facilitate community empowerment through the development of sense of community, social cohesion, collective efficacy, social capital, and behavioral action. Establishing safe environments fosters positive street activity, which reinforces neighborhood social relationships. A community-engaged approach to crime prevention through environmental design (CE-CPTED) is one promising approach to creating busy streets because it engages residents in collaborative interactions to promote safer environments. Yet, few researchers have studied how CE-CPTED may be associated with busy streets. We interviewed 18 residents and stakeholders implementing CE-CPTED in Flint, Michigan. We studied three neighborhoods with different levels of resident control over CE-CPTED. Participants described how CE-CPTED implementation affected their neighborhood. Participants from all three neighborhoods reported that CE-CPTED was associated with positive street activity, sense of community, and collective efficacy. Participants from neighborhoods with higher resident control of CE-CPTED reported more social capital and behavioral action than those from neighborhoods with less resident control. Our findings support busy streets theory: Community engagement in neighborhood improvement enhanced community empowerment. CE-CPTED that combines physical revitalization with resident engagement and control creates a potent synergy for promoting safe and healthy neighborhoods.     

Reviews: Books and Films

TO REDEEM ONE PERSON IS TO REDEEM THE WORLD: THE LIFE OF FRIEDA FROMM-REICHMANN. By Gail A. Hornstein. 390 pp. New York: The Free Press, 2000. $35. THE GUIDE TO PASTORAL COUNSELING AND CARE. Edited by Gary Ahlskog and Harry Sands. 415 pp. Madison, CT: International Universities Press and Psychosocial Press, 2000. $60. THE ART OF DYING: A JUNGIAN VIEW OF PATIENTS' DRAWINGS. By Yvonne Barnhouse Williams. 209 pp. Springfield, IL: Charles C. Thomas, 1999. $24.95. LITTLE SAINT. By Hannah Green. New York: Random House, 2000. $25.95. BODY AND SOUL: HUMAN NATURE AND THE CRISIS IN ETHICS. By J.P. Moreland and Scott B. Rae. 350 pp. InterVarsity Press, 2000. $22.99. MUHAMMAD AND THE RISE OF ISLAM: THE CREATION OF GROUP IDENTITY. By Subhash C. Inamdar, M.D. 266 pp. Madison, Ct: International Universities Press and Psychosocial Press, 2001. $40. MANAGING MANAGED CARE: SECRETS FROM A FORMER CASE MANAGER. By Susan Frager. 276 pp. New York: John Wiley and Sons, 2000. $45. THE DISABLED GOD: TOWARD A LIBERATORY THEOLOGY OF DISABILITY. By Nancy L. Eiesland. 139 pp. Nashville: Abingdon Press, 1994. $15. A LIFE COMPLETE. By Sallierae Henderson. 222 pp. New York: Scribner, 2000. $24. BIOENGAGEMENT: MAKING A CHRISTIAN DIFFERENCE IN BIOETHICS TODAY. Edited by Nigel Cameron, Scott Daniel and Barbara White. 265 pp. Grand Rapids, MI: Wm.B.Eerdmans, 2000. $22. CALLED INTO HEALING: RECLAIMING OUR JUDEO-CHRISTIAN LEGACY OF HEALING TOUCH. By Linda L. Smith. 244 pp. Arvada, CO: HTSM Press, 2000. $22.95. SURVEYING THE RELIGIOUS LANDSCAPE: TRENDS IN U.S. BELIEFS. By George Gallup, Jr. and D. Michael Lindsay. 171 pp. Harrisburg, PA: Morehouse Publishing, 1999. $17.95. The Straight Story. Snow Falling On Cedars