Rethinking a universal framework in the psychiatric symptom-disorder relationship

Research on disparities in health and services should include a critical examination of how social, cultural, and contextual factors affect the connection between symptoms and psychiatric disorders. Systematic differences in this connection by these factors will mean that clinicians using a universalist approach to disorders may make more diagnostic errors for certain patients (e.g., ethnic minorities, the poor). Based on the literature on normative clinical decision-making, this study tests for whether the effect of specific psychiatric disorders on key symptoms is the same for certain groups of the population. The data come from the National Comorbidity Survey. Conditional probabilities of disorders and symptoms, the elements feeding into clinical decision-making, are calculated and tested for equivalence across various racial/ethnic, educational, income, and gender groups. We find some significant differences in the relation of key symptoms to disorders across groups. These findings should encourage testing relativistic frameworks in diagnostic nosology as a step to improve clinical decision-making and reduce diagnostic and treatment disparities in mental health services.     

Making space for racial dialogue: our experience in a marriage and family therapy training program

Marriage and family therapy (MFT) training programs need to create opportunities for all students to develop cultural competency by raising their racial awareness and sensitivity. Likewise, therapists of color need to be offered space in MFT programs to voice their experiences and venues for their voices to be heard. This article reports on the efforts within a master's level, accredited MFT training program to create space, through participatory action research, for the unique experiences of therapists of color and White therapists who are deeply committed to racial sensitivity.     

The "experimenting agency". The California Youth Authority Research Division

During the 1960s and 1970s, the California Youth Authority embarked on a series of randomized field trials to test interventions for juvenile and young adult offenders. This article examines the institutional and political reasons why rigorous tests were adopted for such interventions as the Community Treatment Program. It also describes the effect these trials had on the agency and on California justice, as well as how the experimental method eventually became less often used in the Youth Authority. The authors explore some general reasons why this happened.     

Emotional closeness with perpetrators and amnesia for child sexual abuse

Over the past decade, a contentious debate regarding delayed memories of childhood sexual abuse (CSA) has existed. In order to address this debate, 240 female participants completed questions about CSA, the Dissociative Experience Scale (Bernstein & Putnam, 1986), Perceived Emotional Closeness with Perpetrator Scale (Schultz, Passmore, & Yoder, 2000), and the Gudjonsson Suggestibility Scale 2 (GSS 2) (Gudjonsson, 1987). Eighty-two (36%) reported CSA and 37% of these indicated memory disturbances for the CSA. Participants reporting memory disturbances also reported significantly higher numbers of perpetrators, chemical abuse in their families, and closer relationships with the perpetrator(s) than participants reporting no memory disturbances. Implications for clinicians working with clients reporting CSA are discussed.     

Alzheimer's disease,neuropeptides, neuropeptidase,and amyloid-beta peptide metabolism

Amyloid-beta peptide (Abeta), the pathogenic agent of Alzheimer's disease (AD), is a physiological metabolite in the brain. We have focused our attention and effort on elucidating the unresolved aspect of Abeta metabolism: proteolytic degradation. Among a number of Abeta-degrading enzyme candidates, we used a novel in vivo paradigm to identify a member of the neutral endopeptidase family, neprilysin, as the major Abeta catabolic enzyme. Neprilysin deficiency results in defects in the metabolism of endogenous Abeta 40 and 42 in a gene dose-dependent manner. Our observations suggest that even partial down-regulation of neprilysin activity, which could be caused by aging, can contribute to AD development by promoting Abeta accumulation. Moreover, we discuss the fact that an aging-dependent decline of neprilysin activity, which leads to elevation of Abeta concentrations in the brain, is a natural process that precedes AD pathology. In this Perspective, we hypothesize that neprilysin down-regulation has a role in sporadic AD (SAD) pathogenesis, and we propose that this knowledge be used for developing preventive and therapeutic strategies through use of a G protein-coupled receptor (GPCR).     

Identifying meaning and perceived level of satisfaction within the context of work

OBJECTIVE: The primary objectives of this study were to identify sources of meaning for individuals within the context of a work environment, and to compare varied sources of meaning for individuals with high and low work satisfaction levels. METHOD: Participants were chosen based on satisfaction levels in employment, full-time employment status within an organization for at least one year, and diversity in the work setting. Data were gathered through a series of interviews and observations of the participants' workplaces. A comparative analysis of transcribed interviews was conducted by the researchers and with an expert occupational therapy faculty panel. From these analyses, the researchers developed work narratives for a mechanical engineer, a high school teacher, an employee of mechanical services, and a career service counselor. RESULTS: Emerging themes from the work narratives indicated that the various meanings employees found in work had an effect on their perceived levels of job satisfaction. Participants conveyed that organization identification, financial benefits, independent decision-making, reciprocal respect, opportunities for creativity, and maintaining significant relationships outside of work enhanced meaning and satisfaction. CONCLUSIONS: The worker role is a significant source of an individual's identity, meaning, and satisfaction in life. Professionals in various fields can work with employers to develop meaningful work environments for increased job satisfaction, greater motivation for work, increased productivity, and decreased employee turnover.     

Empirically supported ethical research practice: the costs and benefits of research from the participants' view

Researchers and institutional review boards are routinely called upon to evaluate the cost-benefit status of proposed research protocols that involve human participants. Often these assessments are based on subjective judgments in the absence of empirical data. This reliance on subjective judgments is of particular concern for studies involving clinical samples where unfounded assumptions may adversely affect research progress or clinical outcomes. The Reactions to Research Participation Questionnaire (RRPQ) was designed to address this shortcoming and to help promote ethical decision making about research practice. The present study describes development of the RRPQ and presents a series of exploratory and confirmatory analyses investigating its structure. Based on these findings, a revised version of the instrument and suggestions for future research are presented. This approach provides a foundation for scientifically informed protection of human subjects.     

Psychiatric inpatients' experience of nursing observation. A United Kingdom perspective

1. Nursing observation is a key component of psychiatric inpatient nursing care. 2. Patients' experiences of being observed are strongly influenced by the attitudes and behaviors of the observing nurses. 3. Patients prefer to be observed by nurses they know and who talk to them.     

Maximizing learning outcomes by videotaping nursing students' interactions with a standardized patient

1. Videotaping is a beneficial instructional methodology to help undergraduate students develop awareness of their strengths and opportunities for growth in therapeutic interactional skills. 2. Educational interventions with undergraduate students provide an opportunity to involve doctoral students in vital instruction, research, and knowledge dissemination through publication and presentation. 3. Allowing novice nurses to view their interactional skills with a simulated patient can reduce the anxiety they experience in first therapeutic encounters with assigned patients. 4. Continuous quality improvement in educational methodology is dependent on listening carefully to students who have invaluable feedback to offer and making appropriate correction as indicated.     

Health maintenance behaviors of individuals with severe and persistent mental illness in a state prison

The purpose of this grounded theory study is to define health and health-seeking behaviors of incarcerated individuals experiencing severe and persistent mental illness (SPMI) in a state prison. The strategies used to prevent loss of control and maintain health in the prison environment were examined. Nineteen incarcerated individuals with SPMI were interviewed in a state prison. Constant comparative analysis of the data revealed that while establishing a "fit" with the core variable "loss of control" and its identified properties, differences were found in the enactment of health maintenance behaviors related to properties in the prison environment. Several of these behaviors are inconsistent with behaviors expected of individuals in a community day treatment center and reflect a need for bridging programs to facilitate entry into the "free" world. Correctional nurses and mental health providers in this system can advocate for incarcerated individuals with SPMI by developing programs that provide cost-effective intermediate care and collaborating with community health systems for continuity of care. The findings related to alcohol and drug abuse among incarcerated individuals with SPMI challenges mental health providers in both correctional facilities and community-based programs to generate appropriate and effective substance abuse treatment programs for these individuals.