Spoon distance fading with and without escape extinction as treatment for food refusal

Little is known about the characteristics of meals that serve as motivating operations (MOs) for escape behavior. In the current investigation, we showed that the distance at which a therapist held a spoon from a child's lips served as an MO for escape behavior. Based on these results, we implemented spoon distance fading, compared fading with and without escape extinction (EE), and compared fading plus EE to EE alone. Initially, inappropriate mealtime behavior decreased during fading, but this effect was not maintained as fading progressed. Inappropriate mealtime behavior was lower initially when we combined fading and EE relative to EE alone, but acceptance increased more rapidly with EE than with fading plus EE. These results suggest that a number of mealtime characteristics might function as MOs for escape behavior and that analyses of MOs may be useful for developing treatments for food refusal.     

Neighborhood Environment, Sexual Risk Behaviors and Acquisition of Sexually Transmitted Infections Among Adolescents Diagnosed with Psychological Disorders

The association between neighborhood environment and prevalence of STIs, sexual partner variables and condom use among adolescents with psychological disorders was examined. Cross-sectional data in three urban areas of the US (Southeast, Northeast and Midwest) were obtained from 384 sexually active male and female participants who provided urine samples for laboratory-confirmed testing of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. A total of 15.4% of participants tested positive for one of the three STIs. Results indicated that relative to adolescents living in low risk neighborhood environments, those living in high risk environments were significantly more likely to have a STI and to report having casual partners. Findings suggest that in high risk neighborhoods, STI acquisition may be less dependent on condom use and more dependent on other contextual factors. The importance of expanding public health research to include assessment of neighborhood context as a determinant of sexual risk-taking is emphasized.     

Prevalence of Smoking in Anxiety Disorders Uncomplicated by Comorbid Alcohol or Substance Abuse

This study examined the point prevalence of smoking in patients with anxiety disorders who do not have comorbid alcohol or substance abuse or dependence (ASAD). In a retrospective chart review, the smoking status of 581 patients with anxiety disorders was assessed. Patients, ages 18–65, were seeking treatment for anxiety disorders at an outpatient clinic that specialized in anxiety and related disorders. All participants were interviewed using the Anxiety Disorders Interview Schedule—IV, during which their smoking status was assessed. The prevalence of smoking across all anxiety disorders was 14.8%, which is much lower than found in the general population (23.3%; CDC, 2002) and even lower than previous estimates in individuals with comorbid anxiety and ASAD. Individuals with panic disorder and generalized anxiety disorder had the highest prevalence of smoking, although these rates were still considerably lower than those found in previous studies of smokers with anxiety disorders. Reasons for lower prevalence estimates are discussed.     

Development of the Behavioral Evaluation of Disorders of Sleep Scale

We describe the development, preliminary psychometric properties, and cross-validation of the Behavioral Evaluation of Disorders of Sleep (BEDS: Schreck 1997/1998). Parental reports of problem sleep behavior in elementary school aged children 5 years to 12 years were collected for two samples. With the first sample, an exploratory factor analysis of parental responses (N = 307) resulted in reports of five distinct types of sleep problems: Expressive Sleep Disturbances; Sensitivity to the Environment; Disoriented Awakening; Sleep Facilitators; and Apnea/Bruxism. Four of these factors (Expressive Sleep Disturbances; Sensitivity to the Environment; Disoriented Awakening; and Apnea) were confirmed with the new participant sample (N = 1054). These factors of problem sleep behavior were similar to findings in other studies, with the exception of the exclusion of bedtime behavior problems.     

Screening detoxifying inpatients with substance-related disorders for a major depressive disorder

The Beck Depression Inventory-Fast Screen for Medical Settings (BDI-FS; [Beck, Steer, & Brown, 2000]) and the Mood Module (MM) from the Primary Care Evaluation of Mental Disorders [Spitzer, Williams, Kroenke, Linzer, deGruy, III, Hahn, & Brody, 1995] were used to screen 100 inpatients detoxifying from alcohol, illicit substances, or both for a major depressive disorder (MDD). Receiver operating characteristic (ROC) analyses indicated that both tests were highly and comparably effective in differentiating patients who were and not diagnosed with a MDD; the ROC areas-under-curves for the BDI-FS and MM were, respectively, .87 and .84. A BDI-FS cut-off score of 10 and above had 90% sensitivity and 78% specificity rates, and a MM cut-off score of 7 and above had 90% sensitivity and 72% specificity rates for discriminating patients with and without a MDD. The clinical advantages and disadvantages of both instruments for rapidly screening detoxifying inpatients for clinical depression were discussed.     

心理障碍的文化建构--健康心理学发展中的新趋向

西方心理学发展过程中的文化转向使得文化在心理障碍建构中的作用日益突出,主要表现为:象征功能、建构功能、指导功能和唤起功能。相应地,文化对于心理障碍的建构主要通过文化基础的主观经验、悲伤惯用语、诊断、治疗和结果来进行。此种建构方式将促使心理障碍的诊断和治疗走出传统的疾病中心治疗范式,更加关注人文因素的强大作用。     

The Paradigm Shift to True Collaboration with Families

Target four of the National Agenda for Achieving Better Outcomes for Children and Youth with Serious Emotional Disturbance focuses on collaborating with families to improve service delivery and results for their children. Moving toward this goal has necessitated the continuation of a paradigm shift that brought out this target as an important one in the first place, and that has highlighted the difference between family-focused and family-driven approaches. We discuss the history of the paradigm shift, the progress that has been made toward this goal of making families full collaborative partners in the care of their children, the elements and examples of effective systems of care, and the distance still to traverse toward fully realizing the goal of this strategic target.     

The concept of psychical trauma: A bridge in interdisciplinary space1

The concept of trauma currently occupies a central position in interdisciplinary dialogue. Using the concept of psychical trauma as a bridge, the author attempts an interdisciplinary dialogue with psychiatry, biology and neuroscience. Beginning with the concept of psychical trauma in Freud, the author reviews the evolution of Freud's thinking, and links it with the ideas of Ferenczi and post‐Freudian psychoanalytical authors. From a different framework, he considers the present state of research on post‐traumatic stress disorder in current psychiatric nosography and attempts an interdisciplinary approximation to the concept of psychical trauma. Interesting ideas like the traumatic situation, trauma spectrum and psychopathological spectrum emerge, which enable a better understanding of the concept of psychical trauma through its relatedness, as a bridge connecting a broad psychopathological range extending from normality to psychosis. The ensuing possible relative loss of nosographical rigour is more than compensated by the resulting increased understanding and enlarged therapeutic possibilities. In the second part of the paper, the author attempts a dialogue with neuroscience, taking into account new advances in current research on emotion and memory, and making them compatible with the psychoanalytical concept of trauma. In this sense, the paper underlines the importance of emotion and crucially of memory, regarded as a fundamental axis of the subject explored in this paper. Here a substantial distinction which is pertinent for analytical work appears: declarative memories versus non‐declarative or procedural memories. In a concluding discussion the author argues that, taking into account the implications of these current notions regarding a number of theoretical and technical aspects, psychoanalysis currently holds a privileged position, both in its potential for prevention and regarding the treatment of patients, in so far as, through interdisciplinary dialogue, psychoanalysis can be receptive to and be enriched by the contributions of other disciplines, just as it enriches them with its own contributions.     

西方关于自闭症研究的新进展——与心理理论的关系研究

自闭症是一种罕见的身体机能失调的综合病症。本文阐述了西方关于自闭症研究的新进展,其中分别介绍了自闭症的重要症状、自闭症起因的理论假设以及自闭症与心理理论的关系研究。在阐述的过程中强调了心理理论的缺失是自闭症产生的重要原因。     

CHRM3基因与孤独症谱系障碍

孤独症谱系障碍是一类具有遗传基础的儿童发展障碍疾病。近些年, 研究者们从分子病理学层面发现中枢胆碱能神经系统异常与孤独症患者认知和行为异常存在相关性。尸检研究、临床案例、动物模型研究均发现毒蕈碱型(M型)乙酰胆碱受体异常和孤独症的发生有着密切的关系。在以小鼠为模型的行为学研究中, 编码毒蕈碱型乙酰胆碱受体Ⅲ亚型的CHRM3基因突变会导致小鼠出现认知障碍、刻板行为等孤独症样表现。深入了解CHRM3基因的功能将能够帮助研究者进一步解释孤独症的相关行为特征, 为孤独症儿童教育方案的制定提供新的思路和方法。