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 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The standards for ECT recommended by an APA task force report and those embodied in federal court orders and state statutes and regulations are compared. The authors conclude that there is serious boundary and role confusion owing to progressive intrusion of state authority into areas traditionally held to lie in the domain of medical judgment and clinical care. In spite of comprehensive safeguards promulgated by the psychiatric community, overregulation by legislatures and courts is commonplace, interposing law between physicians and patients and resulting in delays or denials of service while failing to resolve critical legal issues involving competence and consent.
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PMID:Medical, judicial, and statutory regulation of ECT in the United States. 649 78

The recent introduction of the diagnostic category developmental coordination disorder (DCD) (American Psychiatric Association [APA], 1987, 1994), has generated confusion among researchers and clinicians in many fields, including occupational therapy. Although the diagnostic criteria appear to be similar to those used to define clumsy children, children with developmental dyspraxia, or children with sensory integrative dysfunction, we are left with the question: Are children who receive the diagnosis of DCD the same as those who receive the other diagnoses, a subgroup, or an entirely distinct group of children? This article will examine the theoretical and empirical literature and use the results to support the thesis that these terms are not interchangeable and yet are not being used in the literature in a way that clearly defines each subgroup of children. Clear definitions and characteristic features need to be identified and associated with each term to guide occupational therapy assessment and intervention and clinical research.
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PMID:Developmental dyspraxia by any other name: are they all just clumsy children? 757 32

Considered in this special section on the working alliance is the current role and place of the construct in psychotherapy theory, research, practice, and training. This overview briefly summarizes the six articles included in the volume and highlights a number of issues relevant to the working alliance, such as the ubiquity of the alliance in psychotherapy today, conceptual confusion about the construct, measurement problems, and the importance of reworking existing clinical theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
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PMID:The working alliance in psychotherapy: An overview of the invited papers in the special section. 2212 1

Section 7.3 of the Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry (the so-called Goldwater Rule) provides guidance on the ethics of making psychiatric comments about public figures who have not been interviewed and have not given consent. I argue that the wording of Section 7.3 is ambiguous, and I document disagreement over the scope of the rule and consider the implications of this disagreement. If one reads Section 7.3 narrowly, as banning media comments without interview and consent, but allowing such comments in institutional settings, then the general principle articulated in the text and often repeated in the media begins to appear insubstantial. If one reads Section 7.3 broadly, then the work of psychiatrists in the courts, in government agencies such as the Central Intelligence Agency, in insurance companies, and in the academy becomes ethically problematic. I trace the American Psychiatric Association's own interpretation of Section 7.3 and conclude that the APA has advocated a narrow reading. I assert the need for an integrated theory of psychiatric ethics for settings where interview and consent are absent. Such a theory, articulating why comments in institutional settings are ethical, but comments to media are not, may reduce public confusion and provide a basis for revising Section 7.3.
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PMID:Interpreting the Goldwater Rule. 2861 66

This study aimed to explore children's experiences and memories of the pediatric intensive care unit (PICU) and identify the relative importance of premorbid, trauma, and cognitive/affective variables associated with acute posttraumatic stress symptoms (PTSS). Participants were 95 children aged 6-16 years admitted to the PICU and their parents. Children completed questionnaires and an interview assessing PTSS, peritrauma affect, and their memory of the admission 3 weeks following discharge. Medical data were extracted from patient charts. Premorbid and demographic data were provided by parent questionnaire. Most children remembered some aspects of their admission. Younger age, admission for traumatic injury (rather than non-injury-related reasons), and cognitive/affective factors including confusion, peritrauma panic, and sensory memory quality were associated with acute PTSS. Age and traumatic injury accounted for 18% of the variance in PTSS (p < .01). The addition of cognitive/affective variables increased the explained variance to 38% (p < .001). Child age did not moderate the effect of cognitive/affective variables on PTSS. This study demonstrates that objective indicators of disease severity do not adequately explain the high prevalence of PTSS in children following PICU admission. It also suggests that subjective, cognitive factors such as the way children process and remember a PICU admission are very important in the onset of PTSS. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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PMID:Cognitive/affective factors are associated with children's acute posttraumatic stress following pediatric intensive care. 2973 70

The Medical Consultation Experience Questionnaire (MCEQ) is a new, brief self-report instrument that can be used with both adult patients and parents of child patients to assess two dimensions of people's experiences interacting with medical practitioners: Alliance and Confusion. In contrast with existing measures, the MCEQ was expected to provide good discrimination across a full range of experience levels and to assess two distinct dimensions of experience with good factor validity. It was developed in a series of 7 preliminary studies (with 758 participants) and tested in 3 subsequent validation studies, which are the focus of the present report. Study 1 was an Internet sample of 199 parents of child patients, Study 2 was a hospital sample of 173 parents of child surgery patients, and Study 3 was an Internet sample of 204 adult patients. A confirmatory factor analysis specifying strict measurement invariance across the 3 groups produced a good fit. An item response theory analysis suggested that scales on the MCEQ provide good discrimination across a wide range of experience levels. The new scales measuring Alliance and Confusion each had a distinct pattern of convergent validity associations with criterion variables regarding alternate measures of consultation experience, treatment context, and patient-reported perception, behavior, and affect. Results support the validity of the MCEQ and suggest that Alliance and Confusion are two distinct and informative dimensions of medical consultation experience. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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PMID:Medical Consultation Experience Questionnaire: Assessing perceived alliance and experienced confusion during medical consultations. 2987 15

Many veterans do not engage in needed mental health care. To address this problem, we need to understand these patients' experiences from the very start of their care, which includes the assessment and diagnosis process and the communication of that diagnosis to the patient. The patient's reaction to this process can set the tone for the patient's relationship with the mental health system and his or her therapist, yet therapists often receive little training in how to most effectively provide a diagnosis to patients. Prior research has examined emotional reactions to receiving a psychotic spectrum diagnosis, which sometimes included both positive and negative reactions, but to the authors' knowledge, no work has examined reactions to receiving a posttraumatic stress disorder (PTSD) diagnosis. This qualitative study expands upon that work by examining common reactions to receipt of a PTSD diagnosis among low treatment-engaging veterans, changes in that reaction over the first few weeks postdiagnosis, and differences among reactions across veterans who initiate versus refuse evidence-based psychotherapy. Among 50 participants, self-reported reactions were categorized as positive, neutral, and negative. Positive reactions included validation, hope, and proactivity; neutral reactions included confusion, uncertainty, and acceptance; and negative reactions included shock, denial, and fear of stigma. We discuss recommendations for therapists in providing diagnoses in a patient-centered, cognitive-behavioral therapy-consistent way, to maximize the chances of engaging patients into mental health care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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PMID:A qualitative study of veterans' mixed emotional reactions to receiving a PTSD diagnosis. 3005 19

Facial expressions of emotion include both muscular and color modulations that contribute to the accurate perception of emotion. However, some emotion categories share common facial-muscular features during the dynamic expressive sequence, which can lead to confusion and misidentification. The current research posits that a potential social function of facial-color expression lies in its ability to disambiguate confusing facial-muscular emotion expressions. In Experiment 1, participants were asked to rate and categorize confusing emotion expressions (i.e., mixed anger-disgust) that varied in facial color (i.e., CIELAB a*, red-green axis). The results showed that changes in facial color facilitated the disambiguation of the confusing emotion expressions for both ratings and categorizations. In Experiment 2, participants were asked to change the color on faces with either disgust, confusing, or anger expressions, to match the emotion being expressed. The results showed that participants differentially used color information to make the faces maximally expressive. Additionally, participants in Experiment 2 consistently applied facial color changes regardless of disambiguating information provided by either explicit instructions or validated expressions. The findings from the current research support a social functional account of facial color in the communication of emotion; facial color makes a unique contribution to emotion expression, independent of facial musculature. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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PMID:Face color facilitates the disambiguation of confusing emotion expressions: Toward a social functional account of face color in emotion communication. 3008 74

Recent research has shown systematic patterns of confusions between digits of the hands and feet. The present study addressed whether such confusions arise from early somatosensory maps or higher level body representations. As the glabrous and hairy skin of the hands and feet have distinct representations in somatosensory cortex, an effect arising from early somatotopic maps may show distinct patterns on each skin surface. In contrast, if the effect arises from higher level body representations which represent the digits as volumetric units, similar patterns should be apparent regardless of which side of the digit is touched. We obtained confusion matrices showing the pattern of mislocalization on the glabrous and hairy skin surfaces of the toes (Experiment 1) and fingers (Experiment 2). Our results replicated the characteristic pattern of mislocalizations found on the glabrous skin reported in previous studies. Critically, these effects were highly similar on the hairy skin surface of both the toes and fingers. Despite the pattern of mislocalizations being highly stereotyped across participants, there were consistent individual differences in the pattern of confusions across the two skin surfaces. These results suggest that mislocalizations occur at the level of individual digits, consistent with their resulting from higher level body representations. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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PMID:Tactile confusions of the fingers and toes. 3009 37

Patients with borderline personality disorder (BPD) display disturbances in self and other understanding, which is also evident when they narrate events from their own and significant others' lives. In a recent study, we found that patients described both their own and their parents' life stories as more negative and with fewer themes of agency and communion fulfillment. Hence, we examined whether 12 months of psychotherapy would change how patients described their own and their parents' life stories. At baseline, 30 BPD patients and 30 matched control participants described and answered questions about their personal and their parents' life stories. At follow-up, 23 patients and 23 control participants repeated the same procedure after patients had completed 12 months of psychotherapy. At both baseline and follow-up, the life stories were coded for complexity and themes of agency, communion, communion fulfillment, and self-other confusion. BPD patients' personal life stories increased significantly in agency from baseline to follow-up compared with the control group, whereas other aspects of personal and parents' life stories did not change significantly after therapy. Development of agency through the reconstruction of personal life stories may be a crucial mechanism in psychotherapy with BPD patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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PMID:Patients with borderline personality disorder show increased agency in life stories after 12 months of psychotherapy. 3011 86


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