Treatment-resistant depression: A systematic review of systematic reviews

The objective of this research study was to assess pharmacological, somatic and/or psychological treatments in adults with a diagnosis of major depressive disorder who have not responded to at least one course of antidepressant medication. We conducted a systematic review to identify systematic scientific reviews and meta-analyses on treatment-resistant depression (TRD) published until February 2012. Of the sixty studies selected, sixteen met the inclusion criteria and were therefore included in the review. We considered eight main themes, including the definition of TRD, long-term results, and different treatment strategies, including so-called somatic therapies. Based on the review, the definition of TRD should be standardized in order to achieve a shared conceptualization of this disorder. This would allow a better understanding among clinicians and researchers in the field, promoting a homogeneous research methodology and thus leading to more reliable and comparable results. This essential conceptual clarification would also have a positive impact on patients with TRD, their families, and social and health systems.     

Constructing We‐ness: A Communal Coping Intervention for Couples Facing Chronic Illness

Communal coping occurs when relationship partners view a stressful health problem as “ours,” rather than yours or mine, and take collaborative action to deal with it. Although research employing linguistic (we‐talk) and other measures of communal coping demonstrates relevance to a variety of chronic illnesses, the literature offers little about how clinicians can actively promote we‐ness and teamwork to help patients and their partners achieve the health benefits this appears to confer. This paper highlights clinical and supporting scientific features of a narrative intervention designed to foster communal coping by couples in which one partner has a chronic illness. The illustrative illness is diabetes, but with modification the protocol is suitable for other chronic conditions as well. Grounded in systemic and narrative models of problem maintenance and change, the communal coping intervention represents a distillation of research and clinical experience with family consultation over several decades. In contrast to more directive and educational approaches, the intervention consists entirely of questions, with no direct suggestions or instruction about how patients, partners, or couples should change. These questions comprise 8 sequential modules (Coping Challenges, Trajectory and Focus, Illness as External Invader, You as a Couple, Past Teamwork in Overcoming Adversity, Present and Future Teamwork, Obstacles to Teamwork, and Wrap‐Up), described here in manual‐like detail.     

Apego al lugar,identidad de lugar,sentido de comunidad y participación en un contexto de renovación urbana

Resumen

Este artículo se centra en la participación de vecinos en los asuntos locales (actividades en el barrio, implicación en entidades locales, pertenencia a grupos vecinales) para explicar los vínculos socioespaciales (apego al lugar, identidad de lugar y sentido de comunidad) que ocurren a nivel de barrio. La relación de la participación con el apego al lugar y el sentido de comunidad es explorada en barrios en los que se está llevando a cabo un proceso participativo de regeneración urbana inserto en el programa “Quiero mi barrio” promovido por el Ministerio de Vivienda y Urbanismo chileno. Se seleccionaron cinco barrios (Valparaíso e Illapel, Chile), en los que se aplicaron escalas de apego al lugar, identidad de lugar, sentido de comunidad y participación a una muestra de 995 personas. Los resultados muestran que la participación local está relacionada con el apego al lugar a través del sentido de comunidad.     

Principios para construir una batería de tests informatizados

Resumen

Desde hace unos años, el programa LAMP (Learning Abilities Measurement Program, Programa de Medida de las Capacidades necesarias para Aprender) viene desarrollando una batería comprehensiva de capacidades de aplicación informatizada. A partir de esta experiencia, se discuten los siguientes principios: uso de una taxonomía para seleccionar pruebas, medir nuevas capacidades, mezclar pruebas intra e inter-sujetos, usar items facetados en cada prueba, adaptar las instrucciones a los entornos informáticos, controlar el balance rapidez-precisión, proporcionar feed-back, que el ordenador corrija las pruebas y cuestiones relacionadas con la valoración.     

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis

As evidence‐based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural‐strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off‐model, nonsystemic formulations/interventions). Of these, “failure to think in threes” appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.     

Treatment‐as‐Usual for Couples: Trajectories Before and After Beginning Couple Therapy

Couple therapy has been shown to be a meaningful way to improve couples’ relationships. However, less information is known about couples’ functioning prior to entering treatment in community settings, as well as how their relationship functioning changes from initiating therapy onward. This study examined 87 couples who began community‐based couple therapy during a longitudinal study of couples in the military. The couples were assessed six times over the course of 3 years, including time points before and after starting couple therapy. Using an interrupted‐time series design, we examined trajectories across the start of couple therapy in relationship satisfaction, divorce proneness, and negative communication. The results demonstrated that couples’ relationship satisfaction was declining and both divorce proneness and negative communication were increasing prior to entering couple therapy. After starting couple therapy, couples’ functioning on all three variables leveled off but did not show further change, but previous experience in relationship education moderated these effects. Specifically, those who were assigned to the relationship education program (vs. control) demonstrated greater reductions in divorce proneness and greater increases marital satisfaction after starting therapy; however, they also started more distressed.     

OLD TEXTS,NEW MASKS: A CRITICAL REVIEW OF MISREADING EVOLUTION ONTO HISTORICAL ISLAMIC TEXTS

With the increasing interest in Islam and evolution, some Islamic thinkers have vehemently rejected evolution, while others have eagerly embraced it. However, those seeking to embrace evolution sometimes err in their interpretation of historical writings. Indeed, there are texts written by famous historical scholars of Islam who seem to suggest that humans have evolved from lower forms of species. These include Ibn Khaldūn, Jalāl ad‐Dīn Rūmī, al‐Jāhiz, and The Brethren of Purity (Ikhwān al Safā). Although this may be true, such readings are a mistaken interpretation of the aforementioned authors who are actually referring to some form of the scalae naturae (the Great Chain of Being). This reference to the Great Chain of Being is unknown to some contemporary readers who mistakenly believe these writers to be discussing an evolutionary or a proto‐evolutionary theory. This article demonstrates how and why these historical records do not actually represent any notion of evolution as it is currently understood, in the hope of avoiding any further erroneous claims that seem to be proliferating among modern thinkers.     

Effects of male postpartum depression on father–infant interaction: The mediating role of face processing

It is estimated that postpartum depression affects up to 25% of men. Despite such high prevalence, the majority of studies on postpartum depression are focused on mothers, and the role of paternal depression and its effects on infant development have been overlooked by researchers and clinicians. The present study aimed to fill this gap by investigating the effect of paternal postpartum depression on father–infant interactions. In addition, we examined whether differences in face recognition mediated the effects of paternal postpartum depression on father–infant interactions. A total of 61 father–infant dyads (17 postpartum depression, 44 controls) took part in the study. Results revealed that compared to controls, fathers with postpartum depression had a worse pattern of interaction with their infants on measures of responsiveness, mood, and sensitivity; they also had greater difficulty in recognizing happy adult faces, but greater facility in recognizing sad adult faces. Depressed fathers attributed greater intensities to sad adult and infant faces. The tendency to attribute greater intensity to sad adult faces was confirmed as a partial mediator of the effect of paternal postpartum depression on measures of father responsiveness and as a full mediator of the effects of paternal depression on father sensitivity. Clinical implications and suggestions for further studies are discussed.     

Commands as Divine Attributes

Theories of ethics that attempt to incorporate divine speech or commands as necessary elements in the construction of moral obligations are often viewed as vulnerable to a challenge based on the so‐called Euthyphro dilemma. According to this challenge, opponents of theistic ethics suppose that divine speech either informs one of a preexisting set of values and obligations, which makes it inconsequential, or is entirely arbitrary, which makes it irrational. This essay analyzes some of the debates on the nature of divine commands in eleventh‐century works of Islamic jurisprudence (u?ūl al‐fiqh). I show that Mu?tazilī jurisprudents advanced the view that divine commands were actions performed in time that had concrete manifestations, while Ash?arīs argued that divine speech in general, and commands in particular, were eternal divine attributes. After exposing certain weaknesses in the Euthyphro‐inspired objections to theistic ethics, I argue that the Ash?arī idea of commands as divine attributes is a promising move for scholars interested in defending a divine command view of moral obligation.