Psychotherapy and recovery from schizophrenia: A review of potential applications and need for future study.

Recovery from schizophrenia has been conceptualized to involve not only symptom remission of symptoms and achievement of psychosocial milestones but also subjective changes in how persons appraise their lives and the extent to which they experience themselves as meaningful agents in the world. In this article we review the potential of individual psychotherapy to address these more subjective aspects of recovery. Literature on the effectiveness of psychotherapy for persons with schizophrenia is discussed, and two different paths by which psychotherapy might modify self-experience are described. First, we detail how psychotherapy could be conceptualized and tailored to help persons with schizophrenia to construct richer and fuller narrative accounts of their lives, including their strengths, challenges, losses, and hopes. Second, we explore how psychotherapy could target the capacity for metacognition or thinking about thinking, assisting persons with psychosis to become able to think about themselves and others in a generally more complex and flexible manner. The needs for future research are discussed along with a commentary on how current evidence- and skill-based treatments may contain key elements that could be considered psychotherapeutic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Schizotaxia, schizotypy, and schizophrenia: Paul E. Meehl's blueprint for the experimental psychopathology and genetics of schizophrenia.

Paul E. Meehl proposed a model of the cause and pathogenesis of schizophrenia and related states in the early 1960s (Meehl, 1962), which he later revised in 1990 (Meehl, 1990). His model emphasized a genetically influenced aberration in neural transmission that could eventuate in clinical schizophrenia, nonpsychotic schizotypic states, or apparent normalcy depending on the coexistence of other factors. His model embodied the core ideas of the diathesis-stressor framework that would come to dominate experimental and developmental psychopathology for the next 40 years. The author reviews Meehl's model of schizotaxia, schizotypy, and schizophrenia and reviews and clarifies some frequent misunderstandings of the model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues, problems, and challenges for families coping with breast cancer

There is a scarcity of research that examines the adaptation of the family to breast cancer from the family's perspective. This study analyzed 12 families from the time of diagnosis to 12 months later. Issues, problems, and challenges that partnered families faced during the initial year were identified through five interview points. Frequency of the problems identified and the challenges encountered shifted over time.     

Sertindole, a new atypical antipsychotic for the treatment of schizophrenia

Recent studies have shown that at least some of the functional effects of serotonin (5-HT) on motoneuron excitability are direct and are mediated via postsynaptic 5-HT receptors on motoneurons. To determine the spatial distribution of direct inputs from the serotonin system on the proximal and distal dendrites of individual motoneurons, we examined identified motoneurons in vivo with a combination of immunohistochemical localization of 5-HT-immunoreactive boutons and intracellular staining with horseradish peroxidase. Seventeen intracellularly stained motoneurons from 12 adult cats were analyzed with light microscopy. Quantitative analysis of 5-HT boutons apposed to dendrites of five representative motoneurons that were entirely reconstructed in three dimensions (each from the lumbosacral spinal cord of a different animal) revealed a total of 7,848 contacts (1,570+/-487 contacts/postsynaptic neuron; mean +/- SD) over the dendrites of these cells. Analysis of contacts on the soma of two of these cells, and on the somas of an additional 12 intracellularly stained motoneurons, revealed a wide range of somatic contacts (11-211 contacts/cell) on motoneuron cell bodies, with an average of 52 contacts/cell. These results indicate that the vast majority of 5-HT-immunoreactive boutons are apposed to dendritic branches rather than to the somatic surface of motoneurons. The spatial distribution of contacts essentially matched the distribution of surface membrane area of the postsynaptic neuron, resulting in a relatively uniform density of contacts (<1/100 microm2) on proximal and distal dendrites. Consequently, the frequency of contacts was higher on the proximal dendritic compartments where available membrane area is greater. There was no preferential distribution of contacts to particular dendrites. Light/electron microscopic correlations were performed on 21 boutons that contacted dendrites (n = 7) of three motoneurons from different animals. At the electron microscope level, most appositions (18/21; 85.7%) selected by our light microscopic criteria were confirmed as direct contacts when the 5-HT boutons were examined through serial sections. Synaptic junctions, generally small and symmetric, were positively identified in only a subset of these cases (n = 6; 28.6%), in part due to the obscuring effects of the peroxidase histochemical precipitate present in both pre- and postsynaptic profiles. A few 5-HT boutons (3/21; 14.3%) selected as contacts by our light microscopic criteria were in fact separated from the adjacent labeled dendrites; in two of these three cases, the separation was due to intrusion of very thin glial lamellae (<0.3 microm in cross section). These results indicate that the bulbospinal serotonergic system(s) provide a significant, direct synaptic input to spinal motoneurons that innervate hindlimb muscles. The nature of the modulatory actions exerted by such widespread synaptic inputs will affect all regions of the somatodendritic membrane and will ultimately depend on the nature of the 5-HT receptors present over different parts of the postsynaptic neuron's dendritic tree.     

Opportunities for and challenges of computerisation

Information technology offers many potential advantages over paper for the storage and retrieval of patients' data. Enthusiasts predict that soon all records will be stored and viewed on computer, but others are more sceptical. The failure of some computer-based records may be due to poor information design. This paper explores how computers broaden the range of design options but points out that more attention to design is required for computer-based than for paper-based records.     

Environmental challenges for the iron- and steelmaking process

Abstract

The challenge to major process industries like the steel industry is to achieve satisfactory environmental performance in a cost-effective manner. Three case studies describe recent work by Corus UK to develop novel approaches for reducing emissions in a sustainable manner: the development of novel end-of-pipe technology for the abatement of pollutants; the use of process-integrated techniques to suppress dioxin emissions; and the use of knowledge-based expert systems to enhance the operation of a waste gas cleaning system.     

Gentic risk for schizophrenia, birthweight, and cerebral ventricular enlargement.

Recent work by Silverton, Finello, Mednick, and F. Schulsinger (1985) indicates a relation between low birthweight and cerebral ventricular enlargement, as assessed in adulthood, in a group of subjects at risk for schizophrenia. In the present study, we examined the role of low birthweight in ventricular enlargement and tested the hypothesis that low birth weight interacts with a genetic predisposition for schizophrenia in its association with enlarged ventricles. This study reports on 34 subjects of the Danish high-risk-for-schizophrenia prospective study. Birthweight, paternal schizophrenia spectrum disorder (PSSD), and an interaction term for these two variables were analyzed in a regression with ventricle-to-brain ratio (VBR) as the dependent variable. As in Silverton et al. (1985), birthweight significantly contributed to the variance in VBR. Although PSSD did not significantly contribute to the variance in VBR, there was a significant interaction effect of birthweight and PSSD on VBR. Results were discussed in terms of a diathesis-stress model of schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lyme disease, Rocky Mountain spotted fever, ehrlichiosis: emerging and established challenges for the clinician

OBJECTIVE: The goal of this review is to facilitate the management of patients with tick-associated diseases. This article will discuss the epidemiology, clinical diagnosis, and antimicrobial therapy of Lyme disease, Rocky Mountain spotted fever, and ehrlichiosis. DATA SOURCES: References are limited to the English language and extend back to the beginning of the twentieth century. The human and veterinary literature were reviewed. Sources include computerized databases and bibliographies of recent articles and books. STUDY SELECTION: Papers were selected on the basis of their timeliness, explanation of important findings by major investigators, extrapolation of clinical data from large patient populations, and clarification of controversial issues. Approximately 50% of the articles initially reviewed are included in the bibliography. RESULTS: Standardization of laboratory testing for Lyme disease should facilitate more accurate diagnosis in the future. Clinical diagnosis of Rocky Mountain spotted fever and ehrlichiosis prior to laboratory confirmation is necessary in order to ensure timely institution of antimicrobial therapy. CONCLUSIONS: Knowledge of endemic regions and seasonal cycles of vectors, varying clinical presentations of disease and appropriate utilization of the laboratory are critical for the appropriate diagnosis and management of patients with tick-associated diseases.     

Intrafamilial interactive behavior, parental communication deviance, and risk for schizophrenia.

Examined the empirical question of whether families high in communication deviance (CD) assessed from parental projective test data show direct interaction patterns similar to those found in families with offspring diagnosed as schizophrenic. Three parameters of interactive functioning were examined—focus of communication, role structure, and nonverbal affective attitude. The data base was a 5-min, face-to-face videotaped interaction between parents and their disturbed, nonpsychotic adolescent in 47 families. Only families with high CD parents failed to focus communication on the discussion topic and to share topic-related feelings. High CD families were more likely to exhibit role structures in which the mother was active, either alone or in combination with the father. Low CD families were characterized by father activity. High CD parents showed avoidance and rigidity in their nonverbal affective attitude to the child; low CD parents were nonavoidant and relaxed. The relationships among the measures of communication deviance, type of adolescent symptomatology, interactive measures, and risk for schizophrenia are discussed. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology, the stalwart profession, faces new challenges and opportunities.

Psychology emerged as a profession following World War II, seemingly out of nowhere and against all odds, through the sheer grit and determination of its early clinical psychology doctoral pioneers, who recognized the economic importance of licensure and third-party reimbursement. After 2 or 3 decades of prosperity in which psychology became the nation's preeminent psychotherapy profession, professional psychologists ignored warnings of impending managed care and the biomedical revolution and have suffered an unfortunate decline in income. Once again healthcare is confronted with double-digit inflation, and draconian reimbursement measures are being put into place that will impact psychological practice. Practicing psychologists need to heed these harbingers and deflect their negative effects while taking advantage of their potential opportunities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression, schizophrenia, and social attraction.

J. C. Coyne (see PA, Vol 56:02455 and 61:1146) has shown that after interacting with depressed patients, Ss report feeling depressed themselves and rejecting toward the depressed person. In the present study, measures (e.g., Mood Adjective Check List, Interpersonal Check List) were obtained from 216 undergraduates who listened to tapes of interviews with either hospitalized depressive, hospitalized schizophrenics, or normal hospital staff. Results show that schizophrenics aroused dysphoric feelings similar although not identical to those feelings aroused by depressives, and in the case of males they were equally rejected. In addition, the schizophrenics and, to a lesser extent, the depressives were seen as weak, submissive, and less capable of offering a positive relationship. Modifications of the Coyne position are suggested. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advances and challenges for the expanded programme on immunization

Over 3 million deaths from measles, neonatal tetanus and pertussis are prevented by vaccination each year. In the Americas, poliomyelitis has been eliminated, and measles is close to elimination. Globally, reported poliomyelitis incidence has declined by over 80% since 1988. Strategies have evolved from strengthening routine childhood immunization services, to establishing disease surveillance and defining specific activities for disease control and elimination. Efforts to ensure the supply and quality of vaccines are underway. New vaccines against major pathogens will be licensed soon. Some of these will be used for groups other than mothers and infants, requiring re-definition of the 'EPI target groups'. Despite global successes, in 1995, six of the world's most populous developing countries reported coverage levels below 70% and coverage is below 50% in several African countries. Immunization programmes will need to be tailored to the level of economic and health systems development of a country. Industrialized countries must offer sustained support to expand immunization programmes in ways that strengthen health systems in developing countries.     

Convergences and challenges in the search for consistency.

Reviews critiques of traditional trait and psychodynamic approaches of the 1960's, outlining trends in research and discussing directions most suitable for further study. One line of research investigated how psychological situations and the specific mental representations of rewards in the delay of gratification paradigm systematically influence the developing child's ability to defer immediate gratification for larger delayed consequences. The nature of the competence basic for this ability in relation to coherence over time and cross-situational discriminativeness in self-control is discussed. In related directions, analyses of naturally occurring social behavior reveal links between the temporal stability of prototypic behavioral features and the perception of consistency in personality. Global, situation-free consistencies are neither expected nor obtained: Discriminative facility rather than rigidity characterizes adaptive behavior. Consideration of the competency requirements of situations in relation to the competency levels of the persons in them allows some specific predictability of relative behavioral consistency from situation to situation. (60 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pivotal role for glutamate in the pathogenesis of schizophrenia, and its cognitive dysfunction

PURPOSE: To compare the outcome for patients with squamous cell carcinoma of cervical lymph nodes metastatic from an unknown primary site who were irradiated to both sides of the neck and potential mucosal sites with opposed photon beams, and for those irradiated to the ipsilateral side of the neck alone with an electron beam. METHODS AND MATERIALS: Fifty-two patients with squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary site were irradiated by two different methods. Thirty-six were irradiated with a bilateral technique (BT), i.e., to both sides of the neck, including the naso-oro-hypopharyngeal mucosa, and 16 were irradiated with an electron beam (EB) to the ipsilateral side of the neck alone. Twenty patients of the BT group and 11 of the EB group had cervical lymph node dissections, and the remaining 21 patients had lymph node biopsies, prior to radiotherapy. RESULTS: Tumor control in the ipsilateral side of the neck did not differ for either radiation technique, but was significantly higher after lymph node dissection than after biopsy (90 vs. 48%; p = 0.0004). Control of subclinical metastases in the contralateral cervical lymph nodes was higher for patients irradiated with BT than for patients irradiated with EB (86 vs. 56%; p = 0.03). The occult primary was later discovered in 8% of the patients in the BT group and 44% of the EB group (p = 0.0005). The disease-free survival rate at 5 years for patients who had lymph node dissection prior to irradiation was 61%, and was 37% for those who had biopsy (p = 0.05). Only 20% of patients who subsequently developed an occult primary were salvaged and survived for 5 years after salvage treatment. CONCLUSION: Bilateral neck and mucosal irradiation is superior to ipsilateral neck irradiation in preventing contralateral cervical lymph node metastases and the subsequent appearance of an occult primary cancer. Both techniques combined with cervical lymph node dissection were equally effective in controlling the ipsilateral neck disease.     

Helicobacter pylori: challenges for the paediatrician

During the last 15 years, a great body of knowledge about Helicobacter pylori has been accumulated. Much, however, remains to be studied, particularly in relation to children. The vast majority of infections occur in childhood. It is towards children that any widespread screening, prevention or treatment strategies would need to be aimed. In this annotation, we discuss the epidemiology, symptomatology, diagnosis and treatment of H. pylori in children.     

Complementary/alternative medicine: Ethical, professional, and practical challenges for psychologists.

Do your clients talk about using various complementary/alternative medicine (CAM) approaches to deal with their problems? Are you aware of the research on these approaches and their possible effect on health? Many popular CAM approaches are described, and the background and efficacy literature on several of them is reviewed and discussed. Ethical, legal, and practical issues for psychologists are discussed. Data from a preliminary survey of members of the American Psychological Association (N=202) on their knowledge and use of CAM are reported. A majority held favorable opinions of the potential legitimacy of alternative modalities, but many correctly assumed that state laws are ambiguous on this matter. This information may help the practicing psychologist respond more effectively when clients talk about their CAM interests and practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)