Racial bias and the MCMI

We studied the scores obtained on the Millon Clinical Multiaxial Inventory (MCMI) by Black and White male psychiatric inpatients to determine the presence or absence of racial bias. In predicting psychopathology for the two races, comparisons of MCMI performance indicated significant differences for all diagnoses except the personality disorders. The subjects were then matched into two groups of 209 patients each, according to DSM-III psychiatric diagnoses. The data were analyzed at the item, scale, and structural levels. At the item level, application of the Mantel-Haenszel Procedure revealed that 45 of the 175 items of the inventory were answered significantly different by the two racial groups. Because this number was higher than what could be expected by chance, the finding suggested possible deficiencies in terms of the culture-fairness of the items used in the test. At the scale level, an analysis of variance (ANOVA) demonstrated that the scores obtained by the Black and White groups were significantly different in 9 of the 20 scales (Histrionic, Narcissistic, Antisocial, Paraphrenia, Hypomania, Dysthymia, Alcohol Abuse, Drug Abuse, and Psychotic Delusion). With the exception of the Dysthymic scale, all of the differences were in the direction of the Blacks obtaining a higher score than the Whites. At the structural level, however, a principal components factor analysis performed on each group resulted in factor structures that looked identical.     

Evidence for preserved emotional memory in normal older persons

Emotion has been shown to have a modulatory effect on declarative memory. Normal aging is associated with a decline in declarative memory, but whether aging might affect the influence of emotion on memory has not been established. To investigate this, we administered a task that provides a detailed assessment of emotional memory to 80 neurologically normal adults ranging in age from 35 to 85 years. Across ages, memory performance was found to be modulated by the emotional significance of stimuli in a comparable manner (improved memory for gist, compromised memory for visual detail), despite an overall decline in memory performance with increasing age. The results raise the interesting possibility that aging has a differential effect on hippocampal versus amygdala function.     

Impaired emotional declarative memory following unilateral amygdala damage

Case studies of patients with bilateral amygdala damage and functional imaging studies of normal individuals have demonstrated that the amygdala plays a critical role in encoding emotionally arousing stimuli into long-term declarative memory. However, several issues remain poorly understood: the separate roles of left and right amygdala, the time course over which the amygdala participates in memory consolidation, and the type of knowledge structures it helps consolidate. We investigated these questions in eight subjects with unilateral amygdala damage, using several different measures. For comparison, our main task used stimuli identical to those used previously to investigate emotional declarative memory in patients with bilateral amygdala damage. Contrasts with both brain-damaged and normal control groups showed that subjects with left amygdala damage were impaired in their memory for emotional stimuli, despite entirely normal memory for neutral stimuli (because of a number of caveats, the findings from subjects with right amygdala damage were less clear). Follow-up experiments suggested that the normal facilitation of memory for emotional stimuli may develop over an extended time course (>30 min), consistent with prior findings, and that the specific impairment we report may depend in part on the lexical nature of the task used (written questionnaire). We stress the complex and temporally extended nature of memory consolidation and suggest that the amygdala may influence specific components of this process.     

Behavioral interventions may prolong remission in patients with inflammatory bowel disease

Inflammatory Bowel Diseases (IBDs) are chronic, relapsing and remitting gastrointestinal conditions with no known cure. Previous studies have linked behavioral factors, including stress and medication adherence, to relapse.

Purpose

We sought to determine the effect of participation in a behavioral self-management program on incidence of flare within 12 months following behavioral intervention when compared to the natural history of flare incidence prior to program participation.

Results

Results from a 2-level regression model indicated that those participants in the treatment group were 57% less likely to flare in the following 12 months (compared to 18% in the control group). The decline in “flare odds” was about 2 times greater in treatment versus controls (OR = 0.52, t(34) = 2.07, p < 0.05). Office visits, ER visits, and disease severity (all p < 0.05) were identified as moderators of flare risk.

Conclusions

We have demonstrated 1) a statistical model estimating the likelihood of flare rates in the 12 months following a behavioral intervention for IBD (compared to a control condition), and 2) that the introduction of a behavioral intervention can alter the natural course of a chronic, relapsing and remitting gastrointestinal condition such as IBD.     

Trajectory of risky decision making for potential gains and losses from ages 5 to 85

The ability to make advantageous decisions in the face of uncertainty is an essential human skill, yet the development of such abilities over the lifespan is still not well understood. In the current study, from childhood through older adulthood, we tracked the developmental trajectory of risk taking for gains and losses, and expected value (EV) sensitivity in risky choices. In the gain domain, risk‐taking decreased consistently across the lifespan. In the loss domain, risk‐taking was relatively constant across ages, a result we attribute to the pervasiveness of loss aversion. EV sensitivity showed an inverted‐U‐shaped function, increasing from childhood to adulthood but then decreasing for the elderly, which occurred for both risky gains and risky losses. This finding is consistent with neuropsychological and neuroanatomical evidence concerning the role of the frontal lobe in decision making, which is relatively late to develop during childhood but may degrade earlier in the later years. Copyright © 2010 John Wiley & Sons, Ltd.     

Interpersonal Assessment in Counseling and Psychotherapy

This article provides a review of some of the major instruments, methodologies, and strategies available to assess clients' interpersonal functioning. The focus is on instruments that provide characterizations of clients' and counselors' overt interpersonal behavior and covert reactions translated onto interpersonal circle models. A suggested interpersonal assessment battery is presented, and how the information obtained from this battery can be applied to assist in conceptualization and treatment efforts is described.     

Clinical Trials Infrastructure as a Quality Improvement Intervention in Low- and Middle-Income Countries

Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a “trial effect,” however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure—the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research—may function as a quality improvement lever, improving the quality of care and outcomes of all patients within an institution or region independent of their individual participation in trials. We further contend that this “infrastructure effect” can yield particular benefits for patients in low- and middle-income countries (LMICs). The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development.     

Verbal and Nonverbal Emotional Memory Following Unilateral Amygdala Damage

The amygdala is involved in the normal facilitation of memory by emotion, but the separate contributions of the left and right amygdala to memory for verbal or nonverbal emotional material have not been investigated. Fourteen patients with damage to the medial temporal lobe including the amygdala (seven left, seven right), 18 brain-damaged, and 36 normal controls were exposed to emotional and neutral pictures accompanied by verbal narratives. Memory for both narratives and pictures was assessed with a free recall test 24 h later. Subjects with left amygdala damage failed to show the normally robust enhancement of memory for verbal and nonverbal emotional stimuli. The group with right amygdala damage showed the normal pattern of facilitation of memory by emotion for both verbal and nonverbal stimuli despite an overall reduction in memory performance. Furthermore, subjects with left amygdala damage were disproportionately impaired on memory for emotional narratives as compared with memory for emotional pictures. The latter finding offers partial support for a lateralized and material-specific pattern of the amygdala's contribution to emotional memory.