Bayesian Hierarchical Classes Analysis

Hierarchical classes models are models for N-way N-mode data that represent the association among the N modes and simultaneously yield, for each mode, a hierarchical classification of its elements. In this paper we present a stochastic extension of the hierarchical classes model for two-way two-mode binary data. In line with the original model, the new probabilistic extension still represents both the association among the two modes and the hierarchical classifications. A fully Bayesian method for fitting the new model is presented and evaluated in a simulation study. Furthermore, we propose tools for model selection and model checking based on Bayes factors and posterior predictive checks. We illustrate the advantages of the new approach with applications in the domain of the psychology of choice and psychiatric diagnosis. Iwin Leenen is now at the Instituto Mexicano de Investigación de Familia y Población (IMIFAP), Mexico. The research reported in this paper was partially supported by the Spanish Ministerio de Educación y Ciencia (programa Ramón y Cajal) and by the Research Council of K.U.Leuven (PDM/99/037, GOA/2000/02, and GOA/2005/04). The authors are grateful to Johannes Berkhof for fruitful discussions.     

权力、知识和精神病学主题——福柯的视角

精神病学领域有关权力因素的讨论日渐增多,法国哲学家福柯对权力和知识的含义及其关系进行了讨论,同时也对当代精神病学领域的相关的主题,如精神疾病、精神病院、诊断、治疗等,提出了批判性的思考,指出了其中隐含的权力因素及其历史性、文化性构成,有助于我们重新理解精神病的主题,更加关注人文因素的强大作用     

错误相关负波（ERN）在精神病理学研究中的应用

错误相关负波（error-related negativity, ERN）是由行为错误诱发的一种脑电波成分,最大峰值在错误反应之后的50ms左右,偶极子源定位于前扣带回（anterior cingulate cortex, ACC）附近。错误加工（error processing）的经典研究范式中出现的ERN成分可能反映了ACC具有错误检测、冲突监控、强化学习、情绪动机等功能。大量研究表明过度的和不足的错误相关脑活动（hyperactive and hypoactive error processing）可能分别与精神病理学的内化性和外化性障碍（internalizing and externalizing disorders）相关联。内化性和外化性障碍的内表型（endophenotype）的研究,还存在许多值得进一步探索的问题。     

Self-esteem and interpersonal functioning in psychiatric outpatients

This study explored associations between self-esteem and interpersonal functioning in a one-year clinic cohort of psychiatric outpatients ( n = 338). At intake, patients completed questionnaires measuring self-esteem, interpersonal problems, interpersonal style, and general symptomatic distress. They were also diagnosed according to the ICD-10. Interpersonal behaviour was measured along the agency and communion dimensions of the Inventory of Interpersonal Problems – Circumplex [IIP-C]. The results show that lower self-esteem was associated with higher levels of interpersonal problems in general. Further, lower self-esteem was first and foremost linked to frustrated agentic motives, as measured by the IIP-C. Hence, the study concludes that fostering patient agency should be considered as an important goal in psychotherapy. Furthermore, the analyses revealed an interaction effect of agency and communion on self-esteem, indicating a need for balancing the two motive dimensions. Finally, some questions are raised concerning the interpretation of the IIP-C subscales in general.     

Psychiatric disorders and the use of mental health services among children involved in bullying

This study had two aims: to evaluate the relationship between bullying and psychiatric disorders and to study the probability of using mental health services among children involved in bully/victim problems. The data consisted of interviews with 423 parents and 420 children. Diagnostic measures were based on the Isle of Wight Interview. Children involved in bullying as bullies, bully‐victims, and victims were compared with other children. Children involved in bully/victim problems were more prone to have psychiatric disorders than noninvolved children. The probability of being disturbed was highest among male bullies, followed by male bully‐victims and female victims (9.5‐fold, 7.9‐fold, and 4.3‐fold, respectively) compared with noninvolved same‐sex children. The most common diagnoses among children involved in bully/victim problems were attention deficit disorder, oppositional/conduct disorder, and depression. Furthermore, children involved in bully/victim problems were more likely to have used mental health services at some time during their lives and also during the previous 3 months. Special attention should be paid to children’s mental health when dealing with bullying problems at school. Referral pathways to mental health services and factors affecting the referral processes among children should be further studied. Aggr. Behav. 27:102–110, 2001. © 2001 Wiley‐Liss, Inc.     

Factors associated with Borderline pathology in school-age children

The Diagnostic Interview for Borderlines as revised (DIB-R) for use with children and chart review was completed using the records of 54 children, ages 6 to 12 years, who had been admitted to a public psychiatric hospital. Based on the results of the DIB-R, the children were grouped as borderline and nonborderline. The two groups were then compared with regard to 52 independent variables which have historically been associated with the borderline diagnosis. Stepwise logistic regression was used to identify the cluster of diagnostic and independent variables which best discriminated the borderline subjects. Self-destructive behavior, irritable affect, anhedonia, and an externalizing disorder diagnosis at the time of admission accounted for 95.4% of the borderline children. These findings are in contrast to previous studies which have found an assortment of neuropsychological and/or neurological deficits and stressed the importance of a tendency toward psychotic regression on psychological testing as discriminative variables. The authors underscore the idea that borderline pathology may represent a spectrum of disorders and the need for a more specific psychiatric nosology in describing and diagnosing these children.     

Development and preliminary validation of the Concise Neuropsychological Screening Inventory (CNSI): A clinical tool for use in psychiatric settings

We describe the development and preliminary validation of the Concise Neuropsychological Screening Inventory (CNSI), designed to afford clinical psychologists working in psychiatric settings a simple, rapid, and objective assessment of 10 vital left- and right-hemisphere brain functions: (1) Receptive and Expressive Language, (2) Orientation, (3) Attention/Concentration/Immediate Memory, (4) Recent Auditory and Visual Memory, (5) Remote Memory, (6) Motor/Sensory/Tactile Functioning, (7) Visual/Spatial/Motor Integration, (8) Academic Functioning, (9) Intellectual Processes, and (10) Judgment and Reasoning. Preliminary findings suggest that the CNSI can discriminate patients diagnosed with organic mental syndrome from patients with various psychiatric disorders, including chronic schizophrenia (i.e., specificity in screening). Moreover, with regard to predicting neuropsychological differences among various diagnostic groups, the CNSI is superior to some of the most commonly employed tests by psychologists in psychiatric settings (e.g., WAIS-R Digit Span, Digit Symbol, and Bender-Gestalt).     

Crisis Assessment and Psychiatric Hospitalization of Children and Adolescents in State Custody

We investigated the clinical characteristics and placement decisions among a group of children who were wards of the state and had been evaluated for a crisis assessment. The sample consisted of 383 children and adolescents (ages 2-20 years) who were wards of the Illinois Department of Children and Family Services (DCFS). This study retrospectively reviewed the symptoms, risk factors, functioning and co-morbid variables, and placement or system characteristics of these children using a structured assessment tool, the Childhood Severity of Psychiatric Illness (CSPI). Results indicated that risk behaviors as rated on the CSPI, including suicidality, dangerousness, and runaway tendency, were significant predictors of psychiatric hospitalization. The importance of more widespread usage of standardized assessment tools in evaluating children's mental health needs is discussed.     

Perceived stress,life events,dysfunctional attitudes,and depression in adolescent psychiatric inpatients

Hewitt, Flett, and Mosher (1992) examined the factor structure of the Perceived Stress Scale (PSS) and its relation to depression in adult psychiatric patients. This study sought to replicate and extend their findings, using a sample of 203 adolescent psychiatric inpatients. All patients admitted to the adolescent unit in a psychiatric hospital over a 3-year period were administered the PSS, as well as measures of depression, life events, dysfunctional attitudes, and intellectual abilities. Consistent with Hewittet al., two factors were found in the PSS, reflecting perceived distress and perceived coping ability. Regression analyses indicated that, for males, both factors account for independent variance in depression, whereas for females, only the distress factor is related to depression. In addition, for both male and female, dysfunctional attitudes account for significant variance in depression in addition to PSS, but negative life events do not. None of the variables were related to intellectual abilities. Implications for clinical assessment and intervention are discussed.     

DISCRIMINATIVE CONTROL OF THERAPISTS' PERFORMANCE1

In order to examine therapists' discriminative responding to normal and idiosyncratic patient responses, naive subjects were presented with a simulated “patient” for treatment. The subjects were made to believe they were reinforcing normal verbalizations emitted by this patient In fact, they were listening to a tape on which normal and idiosyncratic verbalizations had been recorded. Different probabilities of normal and idiosyncratic “patient” verbalizations could be presented to the subjects by means of a digital programming unit. In one of a number of conditions, the subjects' accurate reinforcing responses were followed by an increased probability of the patient's normal verbalizations. Accurate reinforcing responses emitted by the subjects were brought under the control of normal and idiosyncratic patient responses, by use of contingent feedback, change in patient responding, and monetary reinforcers. When the patient's normal verbalizations increased in probability, so did the subjects' accurate reinforcing responses following the patient's normal verbalizations, and to a lesser degree, the subjects' inaccurate reinforcing responses following the patient's idiosyncratic verbalizations. When the patient's idiosyncratic verbalizations increased in probability, the subjects' accurate and inaccurate reinforcing responses decreased in probability. The clinical implications of these tendencies are discussed.