Preventive group psychotherapy for at-risk infants and their mothers

There is increased evidence that infants who receive poor quality social stimulation from their primary caregiver are at risk for later developmental difficulties. This paper describes a preventive intervention for mother-infant dyads exhibiting impaired patterns of social interaction. An impaired relationship with the primary caregiver has been found to be associated with social and emotional deficits in early childhood as well as with significant psychopathology in adulthood. The intervention consisted of group treatment of mothers and their infants. Each group session has 4 subsections which, together, were directed towards improving the mothers' ability to relate in a stimulating and nurturant manner to their children. Types of intervention included didactic instruction, modeling, and interpretation of the infant's behavior. Qualitative data suggested that the group intervention has positive effects on the mother-infant dyads.     

In Vivo Hippocampal Acetylcholine Release During Exposure to Acute Stress

Hippocampal extracellular acetylcholine (ACh) and choline levels were evaluated using in vivo microdialysis in male Fischer 344 rats before, during, and following an 80-min exposure to two different stress conditions. Measurements were taken in rats restrained and immersed in a water bath containing either 37 degreesC (normothermic-restraint) or 20 degreesC (cold-restraint) water. Results were compared to normothermic-freely-moving rats. Cold-restrained rats displayed decreased ACh levels during cold exposure relative to both normothermic-restrained and normothermic-freely-moving rats. By the end of the cold exposure period and following removal from cold, ACh levels had returned to near-baseline values. Normothermic-restrained rats had levels similar to those of normothermic-freely-moving rats, except for a marked increase in ACh following removal from restraint. Cold-restrained rats displayed a gradual elevation in choline levels during cold stress, followed by a gradual decline after stress termination, whereas both normothermic-restrained and normothermic-freely-moving rats displayed gradual decreases during the microdialysis session. These findings demonstrate that central cholinergic neurotransmission can be altered by the application of, and removal from, acute stressors. In addition, the results suggest a possible relationship between the magnitudes of both the stressor and its cholinergic consequences.     

Psychosocial knowledge and allopathic medicine: Points of convergence and departure

The past 15 years have witnessed a call for allopathic medicine to incorporate psychosocial perspectives into education and clinical practice. While a biopsychosocial perspective has influenced academic medicine in areas such as primary care and psychiatry, its direct impact on clinical medicine has been questionable. One barrier to the incorporation of psychosocial information into medicine which has only recently received attention has been different cultural assumptions which govern medicine versus the social-behavioral sciences. These assumptions are examined in the context of four issues: knowledge paradigms, models of education, acculturation of psychosocial knowledge into medicine, and patient autonomy. This cultural analysis provides a vantage point for understanding similarities as well as points of divergence between psychosocial and biomedical knowledge and practice.     

Attention-Deficit Hyperactivity Disorder: The Medicalization of Misbehavior

During the past decade, there has been an increase in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). This syndrome, typically diagnosed in childhood, is characterized by inattention, hyperactive motor behavior, and distractibility. Current prevalence rates obtained in various countries generally exceed the 3–5% reported by DSM-IV. Reasons for increased ADHD prevalence include changes in diagnostic standards, overlap between ADHD and other externalizing disorders, nonspecific behavioral criteria, and the rapid effects of stimulant medication on cognitive functioning. However, social, cultural, and economic factors may also contribute to increased diagnosis. ADHD has become a common topic in the lay media. Popular discussions of ADHD may serve as a metaphoric expression of social anxieties, particularly with respect to children. At the same time, ADHD has rapidly become incorporated into a medical model, with emphasis on pharmacological treatment. Reductions in mental health and educational services, as well as economic pressures of managed care, may also contribute to medicalization of behavioral problems. Collaboration between psychologists and primary care physicians can lead to more accurate diagnosis and appropriate treatment of ADHD and related disorders.     

The community competence scale in the placement of the deinstitutionalized mentally ill

Little systematic research has been directed towards the determination of appropriate residential placements for deinstitutionalized psychiatric patients. A previous study suggested that the Community Competence Scale (CCS), a 124-item multiscale instrument, had potential utility for community placement decisions. In the present study, the CCS was administered to 52 deinstitutionalized patients placed in an urban boarding home, a rural boarding home, and urban apartments. No significant differences on the CCS occurred attributable to urban vs. rural setting; accordingly, the urban and rural boarding home groups were combined. The CCS discriminated between patients placed in boarding home and apartment settings after variability between the groups associated with age and diagnosis had been removed. The CCS discriminated more effectively between the groups than did prior hospitalization, subsequent rehospitalization, or the Social Competence Scale (SCS). The CCS was significantly positively correlated with the SCS and significantly negatively correlated with previous hospitalization and age.     

The family-of-origin framework: A model for clinical training

Family-of-origin work is defined as a person's attempt to examine and/or change the patterns of interaction that occur in the family in which s/he was raised. This article outlines a model of family-of-origin work that is used in the clinical psychology training program at St. Louis University. The family therapy literature, particularly the work of Bowen, provides its theoretical underpinnings. An integral part of family-of-origin presentations is the genogram, or visual depiction of a family tree. Many ethical issues arise from the use of family-of-origin work within the context of clinical training, including confidentiality, responsibility, informed consent, values, and the boundaries of the supervisory relationship.     

Why families are not like swamps,solar systems,or thermostats: Some limits of systems theory as applied to family therapy

Family systems theory presents an answer to the riddles of mental disorder and human functioning that stands in marked contrast to other prevailing views based on linearity and traditional science. At this stage of its development, the family systems view does not provide an internally coherent, predictive, or unifying theory about humans and their problems. Further, it tends to both undercontextualize and overcontextualize behavior, substitutes blaming the family for blaming the victim, reifies and anthropomorhizes the systems metaphor, dismisses such concepts as power and responsibility, and discourages research. As one theoretical and clinical perspective among many, however, it can be helpful and eye-opening.Based on a paper presented at the Forty-fifth Annual Conference of the American Association for Marriage and Family Therapy, Chicago, 1987.     

Anorexic eating attitudes and behaviors of male and female college students

This study examined gender differences in eating attitudes and behaviors in a sample of 471 undergraduate college students. The prevalence of symptomatology indicative of anorexia was determined using the Eating Attitudes Test (EAT-26). In addition, the family climate, parent-child dynamics, and self-concept of students with and without maladaptive eating attitudes and behaviors were compared, and the relationship between eating attitudes/behaviors and current psychological distress was examined. Anorexic symptomatology was found for 20% of the females and 10% of the males. In general, students without symptomatic attitudes and behaviors had a more positive self-concept and reported less psychological distress than did those with eating disturbances. The findings suggest that eating problems may be more prevalent among males than previously estimated.