Turning back the clock: A response to Szasz.

Comments on the article by T. S. Szasz (see record 1983-05532-001) in which he discusses the psychiatric will, a legal mechanism to protect persons against involuntary psychiatric interventions. The current author notes that Szasz ignored one central fact--the average length of stay in state mental hospitals is less than one month and the average length of stay in state prisons is measured in months and years. Therefore, if all dangerously mentally ill persons were processed through the criminal justice system, as Szasz recommends, rather than involuntarily hospitalized, the result would be a much longer period of confinement, which does not promote liberty and freedom. How is this humane and progressive? (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life values, resuscitation preferences, and the applicability of living wills in an older population

OBJECTIVES: To determine whether life values are related to resuscitation preferences and living will completion in an older population and to assess beliefs about the applicability of living wills. DESIGN: Individual structured interviews. SETTING: An independent retirement community. PARTICIPANTS: One hundred thirty-two subjects older than 63 years of age. MEASUREMENTS: Resuscitation preferences were elicited in five hypothetical scenarios. Subjects with living wills were asked whether their living will would play a role in the scenarios. Subjects rated the importance of 13 life value statements. RESULTS: The percentage of subjects desiring CPR in each scenario was as follows: current condition (66%); acute illness (33%); terminal disease (8%); functional impairment (8%); and dementia (7%). The percentage of those with a living will who thought their living wills would play a role in the scenarios was as follows: acute illness (84%); terminal disease (93%); functional impairment with intact cognition (66%); and dementia (91%). Factor analysis of the life value statements revealed five meaningful factors: quality of life; capacity/autonomy; family relations; physical comfort; and treatment philosophy. Multiple correlations were found between four of five life value factors and hypothetical resuscitation preferences or the presence of a living will. CONCLUSION: Subjects misinterpreted the applicability of living wills in nonterminal illness scenarios. A relationship between life values and resuscitation preferences was noted, which emphasizes the importance of eliciting and including life values when discussing advance directives.     

Fifteen things you should know about new Maryland laws when making health care decisions

Recent dramatic changes to Maryland law regarding health care decision making for incapacitated patients will have significant impact on the role of physicians in making these decisions. On October 1, 1993, the newly passed Maryland Health Care Decision Act took effect, and revisions to state guardianship laws were implemented. The laws, which Governor Schaefer approved on May 11, 1993, modify existing statutory language pertaining to the four legal tools available for making health care decisions for a person when he or she becomes incapacitated: (1) living wills, (2) substituted consents for medical procedures, (3) health care power of attorney appointments, and (4) guardianship proceedings. This article summarizes 15 important points in these new or revised Maryland laws on health care decision making.     

Should scientists think? Comment on Machado and Silva (2007).

The author has previously claimed that neural activity in a medial frontal brain area represents conscious motor intentions. A. Machado and F. J. Silva (see record 2007-14606-004) attempted to challenge this claim by arguing that such intentions are not necessarily causally effective and must be caused by something else, so that they therefore cannot be the unmoved first movers in action. The author's reply is that he made no such claims about the causal status and origin of conscious intentions. In fact, he has elsewhere presented empirical evidence in support of the idea that intentions are not necessarily causal. But this does not stop researchers from studying the neural basis for the conscious impression that one intends and wills one's actions. One can feel and attend to such intentions, be they causal or not. The author's claim is that there is neural activity in the medial frontal wall that reflects such conscious feelings. Other recent empirical evidence that supports this view is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Seizure disorders presenting with psychiatric symptomatology

Seizure disorders can be mistaken for psychiatric disorders and, the two have a number of poorly understood interrelations. Disruptions of consciousness, motor activity, hallucinations, and abrupt mood and anxiety changes can all be seizure manifestations caused by cortical neuronal discharges. This article presents the classification and proposed psychopathology of seizure disorders. It then reviews the psychiatric conditions that frequently mimic elements of such seizure disorders, giving hints that will allow the clinician to correctly identify seizures that are creating psychiatric presentations. Finally, this article makes clear the situations in which anticonvulsant medications may be of value when nothing else seems to be working.     

Treatment of patients with psychogenic amnesia with the help of therapeutic anamnesis

Psychogenic (dissociative) amnesia is a psychiatric disorder characterised by a sudden loss of memory which is too extensive to be explained by ordinary forgetfulness, but which has no organic disease or explanation. Psychogenic amnesia is categorised among the dissociative disorders in DSM-IV and ICD-10 and begins suddenly, usually after severe psychosocial stress. The prognosis is good with complete recovery, and there is seldom relapse. This article describes a man, 45 years of age, who developed severe depression and amnesia following a very troublesome divorce. He did not talk, he communicated by signs and gestures, and he isolated himself in his mother's home. After being admitted to a psychiatric ward he became anorectic and developed erosive eoesophagitis/gastroduodenitis. Initially he was given perfenazin (Trilafon) 24 mg/day. The psychiatric treatment produced no results for the first three weeks, but the patient gradually recovered when the therapist and the patient recapitulated the conflicts associated with the divorce, using documents from the patient's lawyer as a guide. This method is called "therapeutic anamnesis" and is similar in many ways to psychiatric treatment of post-traumatic stress reactions.     

The future of behavior therapy.

Predicts the future of behavior therapy, focusing on theoretical development, therapeutic techniques, and empirical research. The importance of cognitive and affective processes in behavior change will attract increasing attention. Already one of the most widely adopted approaches, behavior therapy will be used to treat an expanded range of psychiatric disorders and health problems. Research will focus on comparative outcome studies and provide probes for investigating the nature of specific disorders and the mechanisms of therapeutic change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On Carson's comment re diagnostic testing.

Comments on Robert Carson's article titled The status of diagnostic testing (see record 2005-07925-004). The article focuses on the importance of psychodiagnostic testing states very clearly and consistently a position shared by many in our profession, but one which is predicated on a number of assumptions which--as value judgments--lack empirical validity and, in fact, serve to engender and perpetuate interprofessional rivalry, professional mediocrity, and scientific stagnation. This writer does not deny the right to hold to and express value judgments per se; rather, he wishes to suggest alternatives to those underlying Carson's argument. Three assumptions are implied in the latter: (a) the "tripartite organization" of professions, i.e., psychiatry, clinical psychology, and psychiatric social work, constitutes a satisfactory state of affairs and should endure; (b) unique contributions to the service endeavor must arise from each profession and will obtain in the case of psychology via the psychodiagnostic enterprise; and (c) the service function (treatment?) is implemented, facilitated, or benefited as a result of the psychodiagnostic activity (testing) of psychologists. The commenter responds to the assumptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychiatric will: Is the cure worse than the illness?

Points out legal difficulties concerning T. S. Szasz's (see record 1983-05532-001) proposal of a "psychiatric will," similar to a "living will," to resolve the conflict between involuntary hospitalization vs the right to treatment of individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Psychophysiologic medicine.

Reviews the book, Psychophysiologic medicine by Eugene Ziskind (see record 1954-08809-000). Here is a book written for the general medical practitioner that will interest psychologists more by its purpose than by its content. Its premise is that one-third of the patients seeking medical aid have symptoms solely or primarily due to psychogenic pathology and another third combine psychogenic with physiogenic pathology. The requirement for psychodiagnosis and psychotherapy in the treatment of general medical disorders is clear indeed. The book consists of four parts. The first one provides background and orientation to the problem. The second part is concerned with diagnostic and psychotherapeutic technique. The third part consists of a review of familial and other social factors in psychopathology, plus a general treatment of psychiatric syndromes and common psychiatric emergencies with which the physician may be confronted. The fourth part includes a useful review of contemporary schools of psychiatric thought. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

St. John's Wort (Hypericum Perforatum): Practical considerations based on the evidence.

Reviews the available data on hypericum perforatum, an herbal remedy known as St. John's wort commonly used for psychological and psychiatric symptoms, such as anxiety, depression, cognitive dulling, and insomnia. Specifically, data regarding hypericum's efficacy, tolerability, and potential for interactions is examined. It is hoped that this review will allow clinicians to draw their own conclusions regarding this herb and provide them with information for educating and guiding discussions with patients. It is noted that the ethical, legal, and practice issues related to psychologists recommending—or even discussing—the use of herbal preparations remain complex, and that psychologists should be aware that this is not a risk-free area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychiatric will: A new mechanism for protecting persons against "psychosis" and psychiatry.

After a brief review of the traditional justifications for and objections to involuntary psychiatric interventions, a new legal mechanism accommodating the interests of both supporters and opponents of such interventions is proposed. Fashioned after the model of the last will and the living will, the psychiatric will provides a mechanism whereby individuals could plan, while rational and sane, for how they wish to be treated in the future, should others consider them to be irrational or insane. Individuals who dread the power of psychosis and desire protection from it by embracing, in case of "need," the use of involuntary psychiatric interventions could execute a psychiatric will in keeping with their beliefs. Individuals who dread the power of psychiatry and desire protection from it by rejecting, regardless of "need," the use of involuntary psychiatric interventions could execute a psychiatric will in keeping with their beliefs. Thus, no one who believes in psychiatric protectionism would be deprived of its alleged benefits, while no one who disbelieves in it would be subjected to its policies and practices against his or her will. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Repeated method operations in recurrent urinary incontinence (author''s transl)

The author thinks that psychiatric examination (asked by the judge) can be a therapeutic act: the first. The expert should not think he is a therapeutic man, nor should he say he is, but he must create by his intervention the circumstances that are necessary for a therapy.     

The biopsychosocial model and chronic fatigue syndrome

Comments on the article of L. A. Jason et al (see record 199705605-007) on the diagnosing of chronic fatigue syndrome (CFS) and its comorbidity with psychiatric disorders. The present author points out that one of the most consistent research findings is the inconsistency and failure to replicate reports of pathophysiology in CFS. However, it is suggested, it is unlikely that either psychiatric disorder alone or physiological factors alone will sufficiently explain CFS. It is argued that ultimately, a biopsychosocial model should prove the most constructive way of conceptualizing this illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Enhancing marital intimacy through facilitating cognitive self-disclosure.

Reviews the book, Enhancing marital intimacy through facilitating cognitive self-disclosure by Edward M. Waring (see record 1988-97051-000). In this book Dr. Waring presents his approach to marital therapy, which he calls cognitive family therapy. The central thesis of the book is as follows: A lack of intimacy in family relationships is associated with emotional and psychosomatic symptoms. An important determinant of intimacy, perhaps the most important, is self-disclosure. The author suggests that facilitating self-disclosure is the easiest and most direct technique for enhancing intimacy. The emphasis on cognitive, as opposed to emotional, self-disclosure is the crucial and innovative aspect of the author's approach to treatment. After completing this book, one is left with one idea that there may be some couples with psychiatric problems who benefit more from the exchange of information about each other than from the expression of personal emotions. This is an interesting notion, and one hopes that the author will publish more definitive conceptual and empirical work on this idea. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician-assisted suicide in psychiatry: developments in The Netherlands

Physician-assisted suicide can now be officially and legally carried out for psychiatric patients in The Netherlands who request it, provided that criteria are met. The authors describe two recent cases of psychiatric patients whose suicides were assisted by their psychiatrist. They critically examine the guidelines for physician-assisted suicide in psychiatry. The criteria address the decision of the patient to be assisted with suicide, which must be voluntary and well considered, and the patient's desire to die, which must endure over time. The patient's suffering must be unacceptable, and the disorder incurable. The authors conclude that important aspects of psychiatric practice are not addressed in the guidelines, which were originally developed for use in somatic medicine. The assessment of treatment prognosis in psychiatry is not accurate enough to allow a final decision about incurability. Boundaries of the psychiatric therapeutic relationship are violated in physician-assisted suicide. The therapist's inability to objectively assess the patient's wish to die is overlooked. Because the general public will continue to ask for clarity on the issue of euthanasia and physician-assisted suicide, the authors believe that an open discussion of both ethical and professional issues is the best option.     

Simple-minded questions and twirling stools.

This reply to Ullman includes the following points: (a) The 2 variables he implicates as spuriously producing the relationships found between the social atmosphere and effectiveness of hospitals, namely, percentage of personnel responding and percentage of psychiatric beds, yield relationships with the criteria which are either O or opposite in sign from what he supposes. When these are allowed for, the relationships we posit increase. (b) Hospital size and staff/patient ratio undoubtedly bear on effectiveness, but do so through their effects on staff attitude. (c) Ullman is mistaken in his belief that psychiatrists' means on Opinions about Mental Illness Scale (OMI) authoritarianism and social restrictiveness are unrelated to hospital effectiveness. In fact, psychiatrists' means are more highly correlated (-.38 to -.66) than are those of representative staff samples (-.35 to -.44). These additional analyses strengthen the conclusion Ullman questions: "Authoritarian-restrictive hospital atmospheres are bad for patients." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selecting a time-series strategy.

Tests of hypotheses implying a longitudinal association between or among time series have become increasingly common in the psychological literature. These tests, however, vary greatly in analytic approach and, therefore, focus attention on methodological rather than on substantive issues. The present authors contend that the lack of methodological convergence is due to the fact that time-series analyses have historically evolved to meet forecasting rather than hypothesis testing needs. A scheme is presented by which researchers can choose among time-series methods to test various classes of hypotheses. The scheme is derived from experimental logic and should help psychologists converge on time-series conventions that will allow attention to focus on substance rather than method. Empirical applications of the scheme are illustrated with several examples of psychiatric admissions series. (54 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic theories and the validation of psychiatric diagnoses: Implications for the study of children of schizophrenics.

Argues that the success of prospective methods for studying the development of schizophrenia in those few offspring of schizophrenics who also become schizophrenic (high-risk method) depends on using valid diagnostic criteria for selecting the parent probands. Data from a high-risk study in which the affected parents were diagnosed by 5 clinicians are used to illustrate how different diagnostic standards affect the comparison of high-risk samples and control samples of children of other psychiatric patients. Publicly reporting careful assessments of affected parents will also facilitate comparisons among different high-risk samples and will allow estimates of the risks for individuals within each high-risk sample. Genetic theory and empirical data suggest that children with severely affected parents and children with many affected relatives will have the highest risks, while samples of children with only 1 mildly affected parent may have risks that approach the population base rates. Genetic theory further suggests that some children of validly diagnosed schizophrenics will have no genetic risk for schizophrenia, and some of those who do have the genetic predisposition will enjoy a lifetime of adequate mental health even without intervention, thus confounding the effort of high-risk research to validate indicators of the high-risk genotype with follow-up status. High-risk researchers are cautioned against premature implementation of intervention strategies based on unvalidated indicators of the risks to individuals. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)