Total number of MMPI-2 clinical scale elevations predicts premature termination after controlling for intake symptom severity and personality disorder diagnosis

Premature termination of therapy by patients is a common phenomenon that can be deleterious to treatment outcome for patients and also negatively affect therapists, treatment centers, and research programs. Therefore, a method of identifying patients at risk for premature termination could have widespread benefits. This study investigated whether patients’ MMPI-2 profiles, including clinical scale elevations and Negative Treatment Indicator (TRT) scores, could predict premature termination in an outpatient sample, controlling for personality disorder diagnosis and symptom severity at intake. Results indicated that while TRT scores were not incrementally predictive of premature termination, the total number of clinical scale elevations was significantly incrementally predictive of dropout. Clinical implications are discussed.     

Helping and change without traditional therapy: Commonalities and opportunities

The therapeutic elements of four types of helping interactions (friends/family, religion, cinematherapy/bibliotherapy, and self-help groups), and their commonalities with traditional psychotherapy are explored. Empirical findings in these areas are discussed, along with suggestions for process and outcome research. Recommendations for the integration of self-help and paraprofessional counseling with professional therapy are presented.     

Comorbid anxiety and mood disorders among persons with social anxiety disorder.

Axis I comorbidity is associated with greater severity of social anxiety disorder. However, the differential effects of comorbid mood and anxiety disorders on symptom severity or treatment outcome have not been investigated. We evaluated 69 persons with uncomplicated social anxiety disorder, 39 persons with an additional anxiety disorder, and 33 persons with an additional mood disorder (with or without additional anxiety disorders). Those with comorbid mood disorders reported greater duration of social anxiety than those with uncomplicated social anxiety disorder. They were also judged, before and after 12 weeks of cognitive-behavioral group treatment and at follow-up, to be more severely impaired than those with no comorbid diagnosis. In contrast, persons with comorbid anxiety disorders were rated as more impaired than those with no comorbid diagnosis on only a single measure. Type of comorbid diagnosis did not result in differential rates of improvement of social anxiety disorder.     

The Relationship of Pregnancy Status to Job Satisfaction: An Exploratory Analysis

Forty-three women who had worked outside of the home prior to becoming pregnant and had returned to the same place of employment after the birth of their children participated in the study. To do so, they responded to a two-part questionnaire asking about their work lives (e.g., level of job satisfaction before, during, and after their pregnancies) and demographic characteristics (e.g., occupation). The results indicated that their job satisfaction was significantly greater before their pregnancies than either during or after their pregnancies. Job satisfaction during pregnancy had a significant, positive correlation with satisfaction with organizational maternity leave policies. Perceived reactions from women's coworkers and supervisors were also examined. Implications for these findings for organizations are discussed. Limitations of the study, and how they might be rectified in future research, are also addressed.     

Fetal Programming: Prenatal Origins of Health and Illness

ABSTRACT— Research on young animals and humans has demonstrated the critical importance of the fetal stage as a formative period in normal development. However, the significance of these findings has not always been incorporated into our thinking when trying to elucidate the origins of health and disease. It is not only that babies react to the state of the mother and to salient environmental events while still in the uterus. This stimulation and priming seems to be essential for guiding the optimal maturation of the nervous, endocrine, and immune systems. Experiences during prenatal life also program the regulatory set points that will govern physiology in adulthood. During this malleable maturational phase, these biological processes should be viewed as flexible "learning systems" that guide the developmental trajectory toward health or derail it toward pathology. Our studies on infant primates have shown that the competence of their immune responses and the structure and activity of certain brain regions, as well as many aspects of behavior and emotional reactivity, are strongly affected by the pregnancy conditions of their mothers.     

Adolescent Report of Interparental Conflict: The Role of Threat and Self-blame Appraisal on Adaptive Outcome

Research consistently shows that children exposed to interparental conflict are at-risk for experiencing psychopathology. Establishing a link, however, between interparental conflict and maladjustment is not the same as understanding how specific outcomes manifest. Therefore, we examined the relation of interparental conflict and appraisal with adolescent outcome with 169 high school students (ages 14–19 years). Specifically, threat and self-blame appraisals were hypothesized to mediate the relation between interparental conflict and both adaptive and maladaptive outcomes. Results suggest that threat partially mediated the relation between interparental conflict and externalizing problems, interparental conflict and internalizing problems, and interparental conflict and adaptive behaviors. Additionally, self-blame appears to partially mediate the relation between interparental conflict and internalizing problems. Implications of the current findings are discussed.     

不同麻醉方法用于剖宫产手术的利弊分析与临床抉择

本文系统详细的阐述了妊娠期间妇女主要的病理生理变化及其对麻醉的不良影响,指出了剖宫产手术时麻醉处理具有一定的特殊性,并且分析了不同的麻醉方法用于剖宫产手术时所具有的优缺点,最后作者对剖宫产手术时如何合理科学的选择麻醉方法进行了必要的临床思考。     

Implications of naturalistic use of pharmacotherapy in CBT treatment for panic disorder

This study examined naturalistic medication use and cognitive behavioral therapy (CBT) treatment outcomes in 105 patients meeting DSM-IV criteria for panic disorder (PD), assessed by structured clinical interview. The association between pre- and post-treatment use of SSRIs, benzodiazepines (BZs), and any anti-anxiety or anti-depressant (A/D) medication were investigated for three indicators of treatment outcome (PD severity, presence of agoraphobia (AG), anxiety sensitivity) at post-treatment and 6-month follow-up. Controlling for pre-treatment severity, pre-treatment SSRI use was associated with worse outcomes for AG (p=.04) and anxiety sensitivity (p=.047); post-treatment SSRI use was associated with delayed improvements in PD severity (p=.05). Pre-treatment use of A/D was associated with poorer PD severity outcomes (p=.04). Post-treatment use of A/D was associated with higher anxiety sensitivity scores across post-treatment and 6-month follow-up (p=.03). BZ use was not associated with significantly worse outcomes. However, there was a decrease in the number of patients using BZs from pre-treatment to post-treatment (p=.06) and follow-up (p=.006). In conclusion, controlling for pre-treatment severity, pre- and post-treatment use of SSRIs and A/D was associated with poorer outcomes, particularly for PD severity and anxiety sensitivity.     

Improving Service Evaluation in Clinical Genetics: Identifying Effects of Genetic Diseases on Individuals and Families

Outcome measurement in clinical genetics is challenging. Outcome attributes used currently have been developed by service providers or adapted from measures used in other areas of healthcare. Many of the ‘patients’ in clinical genetics are healthy but at risk of developing or transmitting a condition. Usually no pharmacological or surgical treatment is offered, although information-giving is an objective of most consultations. We argue that services should be evaluated on the basis of how well they alleviate the effects of disease, from a patient perspective. This paper describes a qualitative study using seven focus groups with health professionals, patients and patient representatives. Social and emotional effects of genetics diseases were identified. Some differences emerged between the effects identified by health professionals and those identified by patients. These findings will be used to inform the evaluation of existing outcome measures and develop robust measures of outcome for clinical genetics services.