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PubMed1975

Career decisions in the early postresidency years.

The author notes that the end of the postresidency military obligation necessitates earlier career decision making for the senior psychiatric resident. This problem is seen to be exacerbated by the eclectic nature of most psychiatric training. Issues for residents include the problem of role models and the "senior resident syndrome," the decision of whether to maintain their university affiliation, the role of private practice, questions of clinical maturity, etc. The author believes that programs must be developed to systematically and objectively present to residents the data that now exist regarding multiple career options.

Administrative Personnel↗
PubMed1976

Inspiration of psychotherapists by patients.

Many patients possess such exemplary traits and virtues that their psychotherapists are inspired to emulate them. This process can benefit the clinician and reinforce the therapeutic alliance, rapport, and the spirit of reciprocity; however, it can also arouse responses by the clinician that are therapeutically detrimental. Awareness of this hazard can enable the clinican to avert it and enhance the benefits provided by the patient's outstanding strengths.

Countertransference↗
PubMed1978

Symptom passing in a transvestite father and three sons.

Three sons of a transvestite father engaged in cross-dressing beginning in early adolescence. The literature suggests that observation may play a role in determining the specificity of the symptoms of conflicted sexual identity. These cases of transvestism in offspring are unusual in that the father played an important role in symptom choice and modeling. It is hoped that in future studies of transvestism in the father will be examined in a more intensive way as a figure with whom an active identification process may evolve.

Adolescent↗
PubMed1986

Psychiatric residency, role models, and leadership.

Two hundred fifty ex-fellowship psychiatrists answered a questionnaire on their administrative and other professional experiences during and after residency as part of a study to determine the relationship between psychiatric training experiences and interest in administration. A large majority of subjects had had role models during training. The subjects' interest in administration had grown significantly during residency in the direction of their role models' interest. Postresidency interest in administration was significantly correlated with supervision by a psychiatrist administrator and with the number of hours subjects spent on administrative work.

Administrative Personnel↗
PubMed1988

Clustering of teenage suicides after television news stories about suicides: a reconsideration.

A recent study reported a significant increase in teenage suicides after television newscasts about suicide in the period 1973-1979 and suggested that the increase might have resulted from an imitative effect of television. In the present study, the authors found no significant association between newscasts and subsequent teenage suicides over the period 1973-1984. Although teenage suicides increased after newscasts in 1973-1980, the authors identify reasons why this increase is not consistent with an imitative effect of television. Furthermore, during 1981-1984 teenage suicides decreased after newscasts about suicide; the reversal differs significantly from the association before 1981.

Adolescent↗
PubMed1991

Mass hysteria among student performers: social relationship as a symptom predictor.

OBJECTIVE: In April 1989 an outbreak of illness suddenly afflicted student performers in Santa Monica, Calif., and an extensive investigation revealed no environmental cause. To clarify the details of the epidemic and determine whether mass hysteria occurred, the authors examined physical, psychological, and social factors that might have contributed to the outbreak. METHOD: Participating middle- and high-school performers were surveyed; 93% (N = 519) responded; cases were defined as students who had one or more symptoms during the outbreak. A stepwise logistic regression analysis was used to determine significant predictors of illness. RESULTS: Characteristic features of mass hysteria were present, including preponderance of illness in girls, symptom transmission by sight or sound, presence of hyperventilation, and evidence of psychological or physical stress. Symptomatic and asymptomatic groups differed in frequency of several physical and psychological variables, but observing a friend become sick was the best predictor of the development of symptoms. CONCLUSIONS: These results confirm earlier research demonstrating multiple psychological and physical factors that contribute to such outbreaks, particularly symptom transmission through social networks. Investigators should explore social transmission as an additional characteristic feature of mass hysteria in order to facilitate early identification of future outbreaks.

Achievement↗
PubMed2004

Actors' portrayals of depression to test interrater reliability in clinical trials.

OBJECTIVE: This study determined if actors could portray depressed patients to establish the interrater reliability of raters using the Hamilton Depression Rating Scale (HDRS). METHOD: Actors portrayed depressed patients using scripts derived from HDRS assessments obtained at three points during treatment. Four experienced raters blindly viewed videotapes of two patients and two actors. They guessed if each interviewee was a patient or an actor and rated the certainty of their guesses. For each interview, they also rated the realism of the portrayal and completed the HDRS. RESULTS: Experienced raters could not distinguish actors and patients better than chance and were equally certain of their right and wrong guesses. Actors and patients received high scores on the realism of their portrayals. The HDRS scores of the actor-patient pairs were correlated. CONCLUSIONS: Actors can effectively portray depressed patients. Future studies will determine if actors can accurately portray patients with anxiety and psychosis.

Clinical Trials as Topic↗
PubMed2002

Applications of errorless learning for improving work performance in persons with schizophrenia.

OBJECTIVE: Until recently, few training methods used in the psychosocial rehabilitation of persons with schizophrenia have taken into account the neurocognitive deficits common to this illness. The present study tested a training method called errorless learning (which theoretically compensates for neurocognitive impairments) for efficacy at teaching entry-level job tasks to persons with serious and persistent mental illness. METHOD: Sixty-five unemployed, clinically stable outpatients with schizophrenia or schizoaffective disorder were randomly assigned to training by means of either errorless learning or conventional instruction for two entry-level job tasks (index card filing and toilet tank assembly). Training was conducted in small groups of four subjects for 90-120 minutes in a simulated workshop. Efficacy-as measured by accuracy, speed, and overall productivity-was assessed immediately after training and at a 3-month follow-up evaluation. RESULTS: Significant group differences in accuracy that favored errorless learning were found on both job tasks. In terms of productivity, the errorless learning group was superior to the conventional instruction group on the card filing task, and differences for the tank assembly task approached significance. There were no significant group differences in speed. Both groups showed significant drops in accuracy and productivity on the tank assembly task from immediately after training to the 3-month follow-up evaluation; performance levels were more stable for both groups on the card filing task. CONCLUSIONS: Errorless learning appears to be a useful training method for establishing introductory high levels of performance in the work rehabilitation of persons with schizophrenia. Future studies may wish to test its long-term durability by embedding it within supported employment programs.

Adult↗
PubMedDate not supplied

The media and suicide.

OBJECTIVE: The authors aim to inform readers of the theory that when newspapers, film, and television describe suicidal deaths, additional suicides may result by virtue of contagion or copy-cat effects; to review data that support and refute this theory; to present some promising and recommended ways to prevent copy-cat suicide; and to cite news-media examples of both particularly bad and good reporting. METHODS: A review of the literature on media-related suicide was conducted, which included reviewing materials published in scientific journals and data published by the U.S. Public Health Service, Centers for Disease Control, and materials from private, not-for-profit agencies. RESULTS: Data support an increased number of suicides resulting from media accounts of suicide that romanticize or dramatize the description of suicidal deaths. Specific guidelines for the media that may be able to decrease these additional deaths have been devised. CONCLUSION: Psychiatrists should be familiar with the harm that may result from improper reporting of suicide in the media since they may be called upon by reporters or family members following the suicide of one of their patients or following the suicide of a newsworthy person. Following the media guidelines available may prevent such contagion effects from occurring.

Humans↗
PubMed1977

Psychotherapy supervision: the problem of conflicting values.

Psychotherapy supervision offers an opportunity for examination of value differences between therapist and patient and therapist and supervisor. Effects of availability of female supervisors are discussed in relation to these value differences affecting referrals, therapeutic goals, assessment of psychopathology, termination, and supervision of cojoint therapy. Advocacy and ombudsman function of the female supervisor in a training program are emphasized.

Attitude of Health Personnel↗
PubMed1983

Cognitive and affective features in childhood psychosis.

This paper has explored the relationship between affect and cognition in normal, borderline, and psychotic child cases. In contrast to the normal child, an orderly unfolding of cognitive structures appears to be absent, or present only in part for the more severely disturbed child population. The aberrant delays presented by these children reveal a structure of cognition in which heterogeneous levels of thought coexist without reorganization into any known structure of totality. We hypothesize that an interactive relationship exists between these cognitive deficits, and the children's failure to achieve an integrated and differentiated self. We further speculate as a point of dysjunction the failure to coordinate the secondary schemata. This cognitive integration is coincident with the affective shift from passive to active, and a significant moment in the child's emerging individuation. In this latter process, active imitations of the mother play an extremely important role. As the beginning coordination of states and their transformations seemingly do not occur, active limitations do not function in usually expected ways, nor do they prepare the way for the later transition to partial identifications. It is these later internalizations which enable the child to sustain both more separate functioning and a sense of his own identity. The psychotic child appears to be enmeshed at the level of whole, merging identifications; that is, imitation of the other persists, and with it the fantasy of either being the other or not being.

Affect↗