ICD-11 guidelines for psychotic,mood, anxiety and stress-related disorders in Mexico: Clinical utility and reliability

Background/Objective: The World Health Organization's diagnostic guidelines for ICD-11 mental and behavioural disorders must be tested in clinical settings around the world to ensure that they are clinically useful and genuinely global. The objective is evaluate the inter-rater reliability and clinical utility of ICD-11 guidelines for psychotic, mood, anxiety- and stress-related disorders in Mexican patients. Method: Adult volunteers exhibiting the selected symptoms were referred from the pre-consultation unit of a public psychiatric hospital to an interview by a pair of clinicians, who subsequently assigned independent diagnoses and evaluated the clinical utility of the diagnostic guidelines as applied to each particular case, on the basis of a scale developed for this purpose. Results: 23 clinicians evaluated 153 patients. Kappa scores were strong for psychotic disorders (.83), moderate for stress-related (.77) and mood disorders (.60) and week for anxiety and fear-related disorders (.43). A high proportion of clinicians considered all diagnostic guidelines to be quite to extremely useful as applied to their patients. Conclusions: ICD-11 guidelines for psychotic, stress-related and mood disorders allow adequate inter-rater consistency among Mexican clinicians, who also considered them as clinical useful tools.     

Ethical issues in the clinical application of fMRI: factors affecting the validity and interpretation of activations

The ability of functional magnetic resonance imaging (fMRI) to localize activations in a single patient, along with the safety and widespread availability of this methodology, has lead to an increasing use of fMRI for clinical purposes such as pre-surgical planning. As methodology continues to improve and more experience with fMRI in the clinical setting is acquired, clinical functional neuroimaging will likely have an increasing influence over patient care. Therefore, ethical use of fMRI, as with other medical techniques, requires understanding the factors impacting the interpretation of the methodology. Issues affecting the validity and interpretation of clinical functional neuroimaging, including effects of altered hemodynamic response function, head motion, and structural changes in the brain, are reviewed. The distinction between correlated and necessary activation in a clinical context is discussed. Different types of statistical errors in fMRI analysis are described, along with their consequences to the patient. Finally, for the future of clinical fMRI development, the need for normative patient data, as well as standardized tasks, scan protocols, and data analyses, is discussed.     

Psychologie en première et en troisième personne : de la « psychologie concrète » à la psychologie clinique

This article presents some basic concepts proposed by G. Politzer, articulated around the concept of “tragic life”, in the literary sense of the composition of a complex of events, actions and people, unity and meaning can only be realized in “first person”. In this context, defining the perimeter of legitimacy of clinical psychology, a “fact” specifically psychological necessarily corresponds to an act which takes existence and feel like segment of a human drama, as an effective act of the singular individual. Critics resulting analyzes relate to the abstract and formal perspective of scientific psychology, which considers classes of facts rather than facts, designing them as entities in themselves, the external I they are demonstrations. The explanatory model which necessarily carries out field of concrete psychology since its causalists schemes have lost sight of the act “first person”. And psychologists would not have noticed that “I remove the psychological facts is destroying them.” (G. Politzer). The person, in his psychic dimension, can only be understood from the person, which makes it possible to specify the field of clinical psychology, and more generally, of any clinical approach.     

A randomised controlled trial of cognitive-behaviour therapy for clinical perfectionism: a preliminary study

Perfectionism can be a problem in its own right and it can impede the progress of treatment of Axis I disorders. This study reports on a preliminary randomised controlled trial of cognitive-behaviour therapy (CBT) for "clinical perfectionism". Twenty participants were randomly assigned to either immediate treatment (IT) (n=10) or a wait list (NL) (n=10). Treatment consisted of ten sessions of CBT over eight weeks. Two participants did not complete the follow-up assessments (10%). Fifteen of the original 20 participants (75%) were clinically significantly improved after treatment and the effect size was large (1.8). Treatment gains were maintained at 8-week and 16-week follow-up.     

Recollective Experience During Recognition of Emotional Words in Clinical Depression

Earlier work has shown that free recall tasks produce a robust mood-congruent memory effect in depression, whereas recognition tasks produce heterogeneous results. This study aimed to further investigate recognition memory for positive, negative and neutral words in depressed patients and matched comparison participants with the Remember/Know/Guess procedure for assessing recollection and familiarity. No mood-congruent memory bias effect was detected in discrimination abilities. However, depressed patients recollected (more Remember responses) more negative than positive or neutral words, whereas comparison participants recollected more positive than neutral words. No mood-congruent pattern was evidenced for Know responses. However, the depressed patients responded to fewer words overall with Know responses than the comparison participants. These results suggest that the mood-congruent memory pattern in depressed patients is related to conscious recollection rather than to familiarity. Attentional biases toward negative words and elaboration processes and/or encoding in reference to the self may contribute to these findings.     

The Findings of a Cochrane Meta-Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice

The association between depressive symptoms and distressed intimate relationships supported the assumption that couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. This issue was addressed by a Cochrane meta-analysis assessing the evidence from clinical trials of couple therapy for depression in comparison with individual psychotherapy, drug therapy, and no/minimal intervention, including fourteen studies with 651 participants. No study was found free of bias and the quality of the evidence was low, with major problems of small sample sizes, missing outcome data, selective reporting, lack of information on random sequence generation and allocation concealment, recruitment of people not representative of clinical practice, and allegiance bias. The meta-analysis showed that both couple therapy and individual psychotherapy improved depressive symptoms at end of treatment and after 6 months or longer, with moderate effect sizes, without any difference between the two treatments. Couple therapy was more effective in reducing couple distress. This effect was larger in studies with distressed couples only and should be considered as relevant in its own right. Couple therapy is a viable option for the treatment of a depressed partner, especially in discordant couples. Future research should address several issues left open to provide a sound empirical foundation for clinical practice.     

Clinical interventions and prevention for Asian American children and families: Current status and needed research

The current status of clinical interventions and prevention for Asian American children and/or adolescents and their families was assessed through a review of the literature on conceptual frameworks, cultural variables and related issues, and empirical studies. Five proposed approaches to treatment or prevention were examined. Some factors that might account for the slow progress of treatment research in this area were also discussed. These included conceptual and methodological issues; the paucity of data on psychopathology in this population; their low service-utilization rates; and societal images, values, and needs. Some needed directions for future research are suggested.     

What do these clinical trial results mean? How product efficacy judgments are affected by data partitioning,framing, and quantification

Organizations often present data related to clinical trials, and other product efficacy information, in partitioned or aggregated formats, as successes or failures, and as frequencies or percentages. We examine how such different data presentation formats might interact to influence product efficacy judgments. The results of five experiments indicate that partitioned (vs. aggregated) frequency data affect judgments regarding perceived product efficacy and these effects are moderated by data frames (success vs. failure) and quantification (frequencies vs. percentages). Specifically, success-framed, partitioned, frequency data enhance product efficacy judgments and choice, while failure-framed, partitioned, frequency data have the opposite effects. However, these effects get attenuated when data are aggregated or presented as percentages.     

Issues in Publicly Subsidized Long Term Care Systems and Implications for the Religous Sector

Given the increasing numbers of elderly in need of long term care services and the harsh reality of finite resources, new models are required which define those elderly persons who should remain eligible for publicly subsidized long term care. If, in fact, a method is established for serving only a limited number of older persons, i.e., the truly vulnerable elderly, by way of the public system of long term care, a large constituency of older Americans will be left to exist on the margins. The church as an informal care system may appropriately assume the role of ensuring that the available public funds are used wisely and that service gaps inevitably left bewteen the increasing number of older persons and shrinking public support are bridged. In addition, the church must assist in improving all long term services by contributing to public policy formation.