bluuebunny/crossref_metadata_2025 huggingface dataset:
Combination Angiotensin‐Receptor Blocker (ARB)/Calcium Channel Blocker With HCTZ vs the Maximal Recommended Dose of an ARB With HCTZ in Patients With Stage 2 Hypertension: The Exforge As Compared to Losartan Treatment in Stage 2 Systolic Hypertension (EXALT) Study
Authors: Wright Richard F. , Duprez Daniel , Purkayastha Das , Samuel Rita , Ferdinand Keith C.
Published: July 2011

J Clin Hypertens (Greenwich). 2011;13:588–597.

This study compared the efficacy and safety of combination angiotensin‐receptor blocker (ARB)/calcium‐channel blocker (CCB) with hydrochlorothiazide (valsartan/amlodipine/HCTZ 160/5/25 mg) vs maximal available combination doses of an ARB with HCTZ (losartan/HCTZ 100/25 mg) in the management of stage 2 hypertension. After 1 to 2 weeks of antihypertensive drug washout, patients with a mean sitting systolic blood pressure (MSSBP) of ≥160 mm Hg and <200 mm Hg were randomized to valsartan/amlodipine 160/5 mg (n=241) or losartan 100 mg (n=247). At week 3, HCTZ 25 mg was added to both treatments. The primary end point, reduction in MSSBP from baseline to week 6, was significantly greater in the valsartan/amlodipine group than in the losartan group (least‐squares [LS] mean change, −31.8 mm Hg vs −26.4 mm Hg; P<.001). Additional reductions occurred after titrating to 320/10/25  mg at week 6 in the valsartan/amlodipine group and switching from losartan/HCTZ to valsartan/amlodipine/HCTZ (week 6, 160/5/25 mg; week 9, 320/10/25 mg) in the losartan group. Achievement of blood pressure <140/90  mm Hg also favored the valsartan/amlodipine group. Dizziness was the only adverse event reported in >5% of patients (5.4% valsartan/amlodipine group, 3.6% losartan group). Moderate doses of an ARB/CCB combination with HCTZ reduced blood pressure more effectively than the maximal dose of an ARB with HCTZ.
Night Pain is not a useful Diagnostic Indicator of Cuff Tear in Patients with Symptoms of Subacromial Impingement
Authors: Arnold Christine S. , Flannery Mark C. , Hearnden Anthony J.
Published: July 2011

Background

Symptoms of shoulder impingement are very common in clinical practice; however, diagnosis of the exact cause of the impingement remains a challenge. Evidence-based guidelines published for physiotherapists state that night pain is particularly associated with rotator cuff tears. This retrospective study aimed to determine whether patients diagnosed with impingement of the shoulder are more likely to report night pain if a tear of the rotator cuff is present.

Methods

The findings at surgery of 873 patients following open or arthroscopic decompression of the shoulder were studied to determine whether a tear of the rotator cuff had been identified. The pre-operative response for each of these patients regarding sleep disturbance as a result of their shoulder pain was cross-matched with the surgical findings.

Results

There was no significant difference between those patients who were found to have a cuff tear and those with an intact rotator cuff and their complaint of night pain.

Discussion

Night pain is a common complaint of patients presenting with impingement of the shoulder. It cannot be used in isolation as a diagnostic predictor for the presence of a rotator cuff tear.
Assessing the Reliability of Shoulder Strength Measurement: Hand-Held versus Fixed Dynamometry
Authors: Beshay Nader , Lam Patrick H. , Murrell George A. C.
Published: July 2011

Background

Reliable measurements of shoulder strength are important in assessing rotator cuff integrity.

Aim

To determine whether a fixed strength assessment device is more reliable than a handheld dynamometer (HHD) when measuring the strength of five shoulder movements (internal rotation, external rotation, abduction, lift-off and adduction).

Methods

We tested 12 asymptomatic and 11 symptomatic shoulders in the intra-rater reliability assessment. For each shoulder tested, the strength of five shoulder movements were recorded three times using HHD and three times using the fixed device by the same examiner. We tested 11 asymptomatic shoulders and 10 symptomatic shoulders in the inter-rater reliability assessment. Each of three examiners tested the shoulder strength of each subjectl once using HHD and once using the fixed device. Intra-class correlation coefficients (ICCs) were calculated to assess reliability of measurements.

Results

Both HHD and the fixed device showed excellent (ICC > 0.80) intra-rater and inter-rater reliability for all movements. The inter-rater reliability of HHD began to decrease as the subject strength increased when testing abduction in the plane of the scapula.

Discussion

HHD is a reliable method of measuring shoulder strength in the clinical setting. However, when several examiners are testing strength of stronger subjects in abduction of the scapular plane, stabilizing the dynamometer provides more reliable results.
Evolutionary pattern of the regulatory network for flower development: Insights gained from a comparison of two Arabidopsis species
Authors: LIU Yang , GUO Chun‐Ce , XU Gui‐Xia , SHAN Hong‐Yan , KONG Hong‐Zhi
Published: July 2011

Abstract  Previous studies on Arabidopsis thaliana and other model plants have indicated that the development of a flower is controlled by a regulatory network composed of genes and the interactions among them. Studies on the evolution of this network will therefore help understand the genetic basis that underlies flower evolution. In this study, by reviewing the most recent published work, we added 31 genes into the previously proposed regulatory network for flower development. Thus, the number of genes reached 60. We then compared the composition, structure, and evolutionary rate of these genes between A. thaliana and one of its allies, A. lyrata. We found that two genes (FLC and MAF2) show 1: 2 and 2: 2 relationships between the two species, suggesting that they have experienced independent, post‐speciation duplications. Of the remaining 58 genes, 35 (60.3%) have diverged in exon–intron structure and, consequently, code for proteins with different sequence features and functions. Molecular evolutionary analyses further revealed that, although most floral genes have evolved under strong purifying selection, some have evolved under relaxed or changed constraints, as evidenced by the elevation of nonsynonymous substitution rates and/or the presence of positively selected sites. Taken together, these results suggest that the regulatory network for flower development has evolved rather rapidly, with changes in the composition, structure, and functional constraint of genes, as well as the interactions among them, being the most important contributors.
Honokiol attenuates vascular contraction through the inhibition of the RhoA/Rho-kinase signalling pathway in rat aortic rings
Authors: Seok Young Mi , Cho Hae Joung , Cha Byung-Yoon , Woo Je-Tae , Kim In Kyeom
Published: July 2011

Objectives

Honokiol is a small-molecule polyphenol isolated from the species Magnolia obovata. We hypothesized that honokiol attenuated vascular contractions through the inhibition of the RhoA/Rho-kinase signalling pathway.

Methods

Rat aortic rings were denuded of endothelium, mounted in organ baths, and subjected to contraction or relaxation. Phosphorylation of 20 kDa myosin light chains (MLC20), myosin phosphatase targeting subunit 1 (MYPT1) and protein kinase C (PKC)-potentiated inhibitory protein for heterotrimeric myosin light chain phosphatase (MLCP) of 17 kDa (CPI17) were examined by immunoblot. We also measured the amount of guanosine triphosphate RhoA as a marker for RhoA activation.

Key findings

Pretreatment with honokiol dose-dependently inhibited the concentration–response curves in response to sodium fluoride (NaF) or thromboxane A2 agonist U46619. Honokiol decreased the phosphorylation levels of MLC20, MYPT1Thr855 and CPI17Thr38 as well as the activation of RhoA induced by 8.0 mm NaF or 30 nm U46619.

Conclusions

These results demonstrated that honokiol attenuated vascular contraction through the inhibition of the RhoA/Rho-kinase signalling pathway.
A comparison of predictions from peripheral and central theories of emotion
Authors: Linton John C. , Hirt Michael
Published: July 2011

Peripheral and central theories of emotion differ in the role they ascribe to cognitive and physiological variables in arousal. This study compared the responses of quadriplegics and normal controls to sexually arousing stimuli under various conditions of false heart‐rate feedback. The results support a centralist position and the relatively greater importance of cognitive factors in emotional responsiveness.
Clinical responses of A and B practising psychotherapists to schizoid and neurotic patient prototypes
Authors: Goodwin William B. , Geller Jesse D. , Quintan Donald M.
Published: July 2011

Eighty‐three male psychotherapists varying on A‐B type and experience orally responded to tape‐recordings of simulated schizoid and neurotic patients in the privacy of their own offices. Five dimensions of therapist response were studied: accurate empathy, positive social‐emotional reactions, negative social‐emotional reactions, length of response and proportion of declarative statements. Although the simple A‐B interaction effect was not found, significant second‐order interactions were found for both accurate empathy and positive reactions which indicated that the predicted interaction effect tends to be upheld for inexperienced therapists but attenuated or reversed for experienced therapists. A significantly reversed interaction for experienced therapists' response length was also found. Examination of the results from this study and previous studies suggested a revision of the A‐B interaction hypothesis: for inexperienced therapists, As will be more effective with schizoids/schizophrenics than Bs, whereas Bs will surpass As with neurotics; for experienced therapists, however, this interaction will be attenuated or reversed. Speculations about underlying processes in A‐B interaction phenomena were offered.
The patient's view of therapy
Authors: Llewelyn S. P. , Hume W. I.
Published: July 2011

Recent research has suggested an increasing rapprochement between behaviour therapy and psychotherapy, especially in terms of the patient's perceptions. Two hypotheses were tested in this study ‐ (1) that patients would report ‘relationship’ or ‘non‐specific’ factors to be more useful in treatment than behavioural or psychotherapeutic activities, and (2) that there would be no difference between patients who had received behaviour therapy and patients who had received psychotherapy with respect to the rated importance of non‐specific, relationship‐type activities. Forty‐nine patients who had received either behaviour therapy or psychotherapy were asked to complete in retrospect a questionnaire relating to aspects of therapy which they found useful and 37 (76 per cent) completed questionnaires were returned. Both hypotheses were accepted, and the findings are now discussed in relation to the growing realization of the importance of ‘non‐specific’ factors in therapy.
Exhibitionism ‐ A biological hypothesis
Authors: Jones Ivor H. , Frei Dorothy
Published: July 2011

Twenty‐four male genital exhibitionists were interviewed in detail and followed up for periods of from 1 to 5 years. Biographical, attitudinal and behavioural data obtained from them were examined with a view to providing information about the aetiology of this behaviour. The evidence presented and discussed is consistent with the hypothesis that exhibiting represents the expression of an innate disposition. Exhibitionism is found to be widespread and patterned in form, to have a driven quality and to coexist with a variety of personality types. This hypothesis is further developed by discussion of anthropological and ethological data.
Orality and smoking
Authors: Howe Michael , Summerfield Angela B.
Published: July 2011

This study was designed to investigate the relation of orality and smoking, smoking motivation and anticipatory pleasure in smoking. Ninety‐seven male and female subjects completed questionnaires designed to elicit information about their motivation and behaviour. Results indicated that difficulty in stopping smoking was positively related to three non‐nutriment oral preoccupations. Smoking for psychological as opposed to social reasons was positively related to two non‐nutriment oral preoccupations. Anticipation of pleasure in smoking before becoming a smoker was negatively related to nutriment orality, positively related to smoking because of a craving, and, for females only, positively to one type of non‐nutriment orality. The results are discussed in relation to the role of oral ingestion and the reaction of the central nervous system to the drug.
Agoraphobic women married to abnormally jealous men
Authors: Hafner R. Julian
Published: July 2011

Of 36 married female agoraphobics treated by the author over a period of 3 years, seven were married to men who displayed abnormal jealousy. In all these cases the husbands‘ jealousy adversely influenced their wives’ response to treatment, and improvement in wives was associated with increased morbidity in their husbands.
The specificity of schizophrenic thought disorder
Authors: Harrison Anne , Phillips J. P. N.
Published: July 2011

Bannister and Salmon (1966), in a repertory grid study, reported that ‘thought‐disordered schizophrenics lost significantly more reliability and social agreement when shifted from object to people construing than normals’. This conclusion is of doubtful validity, since the between‐grids variable, people vs. objects, was confounded with at least five other variables of possible relevance, three of which have been found by subsequent workers (McPherson & Buckley, 1970; Williams, 1971; Heather, 1976) to affect performance on grids. The main aim of the present experiment was to determine the effects of as many as possible of these variables. The subsidiary aim was to replicate, or otherwise, the findings of Frith & Lillie (1972) and Haynes & Phillips (1973) that the effective discriminator between thought‐disordered schizophrenics and other groups on repertory grid tests is not intensity of relationship between constructs but pure (element or internal) consistency.

Six grids involving all feasible combinations of rating familiar and unfamiliar people and objects on psychological and physical constructs were administered to 10 thought‐disordered schizophrenics, 10 non‐thought‐disordered schizophrenics and 10 normals. As regards the main aim of the experiment it was found that there was no significant grids x diagnoses interaction on pure consistency, but that there was one on intensity, even with pure consistency partialled out. Taking previous work into consideration, it appears that this effect is weak, inconsistent from experiment to experiment, and anomalous in the present study. As regards the subsidiary aim, the findings of the two previous experiments cited above were confirmed. The discrepant results of McPherson et al. (1973) are considered, and it is noted that they held only for a subsample of the schizophrenic group in that experiment, the results for the total sample of schizophrenics, manics and depressives not being inconsistent with those of other experiments.

The theoretical and practical implications of these and previous findings are indicated.
Therapist A‐B score and treatment outcome with psychiatric in patients: A table of random numbers
Authors: Young Rhodes C. , Glick Ira D. , Hargreaves William A. , Braff David , Drues Joan
Published: July 2011

The study evaluated the relationship between therapist personality and treatment success for 141 schizophrenics and 94 non‐schizophrenics randomly assigned to short or long hospitalization. The 47 therapists were self‐rated on the Whitehorn‐Betz A‐B scale in both the original and the Campbell versions. Outcome was assessed on the Health‐Sickness Rating Scale and the Psychiatric Evaluation Form at discharge and at 1 and 2 year follow‐up. The hypothesis of greater success for A‐type therapists with schizophrenics was not confirmed, nor were alternative relationships evident in the data.
The relation of guilt and other feelings to the diagnosis of depression
Authors: Shapiro M. B.
Published: July 2011

This paper reports a re‐evaluation of seven sets of findings appearing in the research literature. The findings were derived from questionnaire studies of feelings of guilt and other feelings in diagnosed depressives and other psychiatric groups. The publications did not provide sufficient information to evaluate important inconsistencies in the findings. However, an examination of the structure and content of the questionnaires which were used made it possible to account for the discrepancies. There were three main conclusions. The first was that the only way to minimize the ambiguity of questionnaire responses was to avoid the use of multiple‐item scales and only to use single‐item questions which were constructed as simply as possible. The second was that depressives were not much different from other people in the degree of outwardly and inwardly directed hostility. The third was that, while guilt feelings, with certain provisos, tended to be associated with the diagnosis of depression, other feelings appeared to be both more prominent in and more strongly associated with depression. These feelings consisted of increments in feelings of loss, in the most general sense of the word, and decrements in general positive pleasant feelings.
Effects of anxiety on attitudes ‐ A semantic differential study
Authors: Gentil Maria L. Felix , Lader Malcolm
Published: July 2011

Eighteen female out‐patients suffering from chronic anxiety states and 25 normal women matched for age filled in an anxiety inventory and completed semantic differential forms on 21 concepts grouped into four areas: characters, locations, human interactions and abstractions. Each concept was rated on 15 scales grouped into four types: evaluation, activity‐potency, sex evaluation and danger. The normal subjects were divided into high anxiety and low anxiety subgroups on the basis of their trait anxiety scores.

Anxious patients rated themselves with lower self‐esteem and confidence. They reacted with apprehension to unfamiliar locations and perceived danger in other people. Sexual activity and the human body were viewed negatively. Anxious patients' apprehensions were particularly raised by vague abstractions.
Are there different types of neurotic depression?
Authors: Roy Alec
Published: July 2011

The classification of depression remains controversial (Kendell, 1976). Overall et al. (1966) used the Brief Psychiatric Rating Scale (BPRS), a computer classification procedure and derived three depressed groups: anxious, hostile and retarded depressives. Paykel (1971, 1972) reported four groups derived from a multivariate cluster analysis: psychotic depressives and ‘… three groups, anxious, hostile and young depressives with personality disorder, from the diversity of patients subsumed under neurotic depression’. Amongst 85 women treated with amitriptyline ‘this typology predicted outcome significantly’. This paper presents the results of a cluster analysis of a group of 60 female out‐patient neurotic depressives.
Modification of deviant sexual behaviour: The need for a comprehensive approach
Authors: Crawford David A.
Published: July 2011

This paper gives four main lines of evidence to support the view that it is too simple to view sexual deviance as a problem of deviant arousal only. Firstly, clinical experience leaves the clear impression that sex offenders are not stable, well‐adjusted men with a sexual arousal problem, but have difficulties in many areas of their lives. Secondly, research on human sexuality has resulted in a greater appreciation of the complexities of sexual behaviour. It is inconsistent to accept that ‘normal’ sexual behaviour is complex and varied but maintain that deviant sexual behaviour is just an inappropriate penile response. Thirdly, treatment studies aimed at modifying homosexual behaviour have found that changes in heterosexual measures are the most important. This suggests that for sex offenders most attention should be paid to increasing non‐deviant arousal and interests. Fourthly, studies of sex offenders have consistently reported that they experience a wide variety of problems. It is unrealistic to consider the problem of deviant sexual behaviour in isolation from these other problems.

It follows that comprehensive treatment programmes will be necessary, covering such problems as sexual dysfunction, anxiety, deficient social skills, inadequate sexual knowledge, poor self‐control, lack of non‐deviant sexual arousal as well as the presence of deviant sexual arousal.
A method of structured brief psychotherapy
Authors: Rosen B.
Published: July 2011

Structured brief psychotherapy is a method of organizing treatment along problem‐solving lines. The features of this method are the selection of problem areas, the translation of insight into specific activity, the structuring of psychodynamics and a concentration on termination events. The method is illustrated by clinical examples.
Problems in a ‘creative marriage’ following the birth of the first child ‐ An account of a conjoint marital therapy
Authors: Clementel Cecilia , Crockatt Philip
Published: July 2011

This description of the marital therapy of a couple treated conjointly by the authors illustrates the profound effects of the couple's childhood experiences of their respective parents' relationships on their own subsequent marriage. The precipitating effect of the birth of the child in the marriage in awakening dormant unconscious conflicts stemming from these early experiences also emerges in the history of the couple and in the material of the therapeutic sessions.
Verbal conditioning of affect responses of process and reactive schizophrenics in a clinical interview situation
Authors: Pansa Monika
Published: July 2011

Sixteen process and 16 reactive schizophrenic out‐patients were compared on a verbal conditioning task in an alternating conditioning‐extinction design, using verbal and non‐verbal positive social reinforcement to influence the emission of self‐referred affect statements. It was found that process subjects failed to condition during the time periods used, while reactives demonstrated a significant trials effect showing trends consistent with those hypothesized from the type of design used. This differential conditionability between groups was shown not to be a function of diagnosis, sex, motivation, severity of illness, medication, hospitalization history, or general speech output. It was concluded that the degree of social responsiveness manifested in the premorbid history of the two groups is also operative in behaviour during the psychotic period, specifically, in responsiveness to positive social reinforcers in a verbal conditioning task.
The dietary chaos syndrome: A useful new term?
Authors: Palmer Robert L.
Published: July 2011

Following typical primary anorexia nervosa some subjects enter a state characterized by disordered eating behaviour and emotional instability whilst remaining at or above a normal weight. Other subjects may reach a similar position without having been in a state of anorexia nervosa. Surprisingly the state seems to lack a satisfactory name. The term ‘Dietary chaos syndrome’ is proposed.
Intersubject agreement concerning relationships between the positive and negative poles of constructs in repertory grid tests
Authors: Adams‐Webber J.
Published: July 2011

Previous research indicates that there is more intersubject agreement concerning patterns of correlations between constructs than concerning how specific elements are rated on each construct. In this study, Canadian undergraduates (15 women, 15 men) rank‐ordered eight photographs of strangers separately on the basis of the positive and negative poles of six constructs. The results indicated that there is more consensus concerning specific patterns of relationships between the positive poles of constructs than concerning those between their negative poles. Some implications of this finding for repertory grid assessment and research were discussed.
The modification of personality disturbance in a therapeutic community for drug abusers
Authors: Kennard David , Wilson Stephen
Published: July 2011

Two personality questionnaires, the MMPI and 16PF, were administered routinely to drug abusers admitted to a newly established hierarchical type of therapeutic community. Questionnaires were repeated at 6 and 12 months with those residents who remained. Comparison of the results with other studies suggests that drug abusers admitted to different treatment centres display a recognizable pattern of personality disturbance, characterized by a combination of neurotic, psychopathic and psychotic elements and an unusual degree of willingness to admit to socially undesirable traits. Twenty‐five per cent of residents stayed longer than 6 months. They showed a significant reduction in measured personality disturbance, and at 1 year anxiety was the only outstanding indication of disturbance. The relationship between these results, possible sources of bias and other indices of behaviour change is discussed.
An analysis of individual treatment on a token economy for chronic schizophrenic patients
Authors: Butler Richard J.
Published: July 2011

Fifty‐one individually designed treatment programmes carried out over a 22 month period on a token economy ward for 12 female chronic schizophrenic patients were analysed. Level of withdrawal was found to be a critical factor in patients’ response, both in terms of the rate and extent of improvement during the treatment stage, and presence or absence of deterioration during ‘weaning’ and follow up. No difference in response between type of behavioural problem and methods of treatment or weaning were found.
Contrasting resources in disturbed and non‐disturbed family systems
Authors: Steger Carmen , Kotler Tamara
Published: July 2011

Previous research has shown that problems in family functioning and psychological disturbances in children are closely related. To increase understanding of this complex interaction the present review sets out to make explicit certain aspects of the relationship between child psychopathology and the quality of family life.

The usefulness of the concept of resources for analysing major aspects of family functioning (contextual, intra‐familial and extra‐familial) is discussed within a systems framework and is then applied to a wide range of empirical studies which relate important features of family functioning to disturbed behaviour in children.

It is found that interpersonal conflict in the lives of parents before marriage may severely constrain their own psychological development. When the psychological effects of such early disadvantage are amplified by marital conflict other family members are also affected. The notion of resources requires such disabilities to be assessed as well as directing attention to non‐family interactions which offer compensating supports.
Mental hospital experience, classroom instruction and change in conceptions and attitudes towards mental illness
Authors: Jaffe Yoram , Maoz Benjamin , Avram Lilian
Published: July 2011

Changes in conceptions and attitudes towards mental illness and the mentally ill were investigated in Israel. Questionnaires were presented to 69 student nurses, assessing stereotyped image, authoritarianism, social restrictiveness, benevolence, mental hygiene ideology and interpersonal aetiology before and after psychiatric affiliation in two kinds of mental hospitals, or before and after classroom instruction only. The findings lend cultural generality to previous observations and demonstrate that:

(a) classroom instruction is ineffective as an agent of change;

(b) practical experience involving personal confrontation with mental patients in a progressive psychiatric hospital, which contradicts the stereotyped image of mental patients and inculcates positive attitudes towards them, results in a change to a more professional scientific orientation and a more humane, accepting and liberal attitude;

(c) under hospital conditions which support the stereotyped conception and authoritarian restrictive attitudes, the confrontation will result in preservation, even consolidation and strengthening, of the stereotyped image and undesirable attitudes towards mental patients.

The findings were discussed and the implications for training programmes were drawn.
Towards a conceptual framework of psychotherapy: A personal view
Authors: Aveline Mark
Published: July 2011

A conceptual view of psychotherapy is put forward for discussion and debate. The view is a personal one based upon experience of life and the practice of psychotherapy over a 10 year period. Harmony between the therapist's personality, the process of therapy and the nature of good human relationships is important. Therapy is seen as a practical discipline and a creative art in which the focus should be upon the patient's existence now and what it could be tomorrow.
Capgras: Case study and reappraisal of psychopathology
Authors: Dally Peter , Gomez Joan
Published: July 2011

A case of the Capgras phenomenon in a man of 58, arising during the course of a depressive illness, is described. Physical, electroencephalographic and psychometric investigations gave no sign of organic disease, and recovery was complete. Factors leading to the development of a depressive psychosis and its particular manifestation in the Capgras delusion are traced in detail. The psychopathology of the condition and the implications for treatment are discussed.
Questions of supply and demand in dynamic psychotherapy
Authors: Tyson Robert L. , Reder Peter
Published: July 2011

Out‐patient psychotherapy resources are severely limited in the face of a considerable mental health problem in the community. A review is made of the literature pertinent to the attempt to estimate the number of patients who receive, or might benefit from receiving, dynamic psychotherapy in the National Health Service. Among the many variables involved, problems of definition and the interests and opinions of general practitioners and hospital psychiatrists are prominent. Implications for the planning of psychotherapy training and service programmes are discussed.
Aspects of the patient intake process in a psychotherapy clinic
Authors: Tyson Robert L. , Reder Peter
Published: July 2011

Recent interest in psychotherapy services in the National Health Service has raised questions regarding the availability of existing psychotherapy facilities. In attempting to answer some of these questions, a study was made of aspects of the referral and assessment segments of the intake process of 180 patients referred in 1975 to the Paddington Centre for Psychotherapy Adult Out‐patient Department. Of this group, 137 were referred for individual psychoanalytically orientated psychotherapy, 82 of whom were offered assessment interviews, 45 offered treatment and 40 actually began treatment during the study period. An additional seven patients originally assessed for group therapy were offered and began individual treatment. Some characteristics of the referral population, the referring agencies, the effects of a waiting list, and the phenomenon of dropouts are discussed and compared with findings from other Centres.
The reasons people give for taking overdoses: A further inquiry
Authors: Bancroft John , Hawton Keith , Simkin Sue , Kingston Breda , Cumming Clyde , Whitwell David
Published: July 2011

A representative sample of 41 cases of self‐poisoning was studied in depth. In each case ‘reasons’ for taking the overdose, both stated spontaneously and chosen from a presented list, were recorded. The commonest spontaneous reason was the ‘wish to die’. Nearly one‐third indicated some non‐suicidal purpose early in the interview and consistently denied suicidal intent subsequently.

Apart from suicidal intent, reasons chosen from the list bore little resemblance to reasons that had been offered earlier in the interview and are therefore of uncertain relevance.

Three psychiatric judges attributed reasons for each case based on common‐sense criteria. Several reasons were seldom or never chosen by them; four were chosen frequently with good agreement, i.e. communicating hostility, influencing others, relieving a state of mind and suicidal intent. The first two were the most frequently chosen, attributed to 71 per cent and 54 per cent of cases respectively. They were the reasons chosen least frequently by the self‐poisoners themselves.

Of 23 (56 per cent) subjects indicating suicidal intent, 12 (29 per cent) were judged to be suicidal by psychiatrists. These were not clearly distinguishable on the basis of their original interviews, except that those judged suicidal tended to indicate suicidal intent early in the interviews.

The clinical and research implications of these findings are discussed.
A misconception concerning the meaning of ‘disease’
Authors: Birch James
Published: July 2011

‘I only wanted to see what the garden was like, your Majesty ‐’

‘That's right,’ said the Queen, patting her on the head, which Alice didn't like at all; ‘though, when you say “garden”, I've seen gardens, compared with which this would be a wilderness.’

Alice didn't dare to argue the point, but went on: ‘‐ and I thought I'd try and find my way to the top of that hill.’

‘When you say “hill”,’ the Queen interrupted, ‘I could show you hills, in comparison with which you'd call that a valley.’

‘No, I shouldn't,’ said Alice, surprised into contradicting her at last: ‘a hill can't be a valley, you know. That would be nonsense ‐’

Through the Looking Glass and What Alice Found There (Lewis Carroll)
Transitional space in psychotherapy and theatre
Authors: Pedder Jonathan R.
Published: July 2011

Winnicott (1971 a) emphasized the importance of transitional space in play and psychotherapy, and hinted at its relevance in other areas of cultural experience. This paper compares and complements Winnicott's ideas with those of other writers and especially with the point of view of the theatre director. Both psychotherapy and theatre require a special frame or boundary; they both demand toleration of paradox and willing suspension of disbelief; and both involve repetition and re‐enactment in the presence of the other.
The border between the paranoid‐schizoid and the depressive positions in the borderline patient
Authors: Steiner John
Published: July 2011

In this paper some of the mental mechanisms deployed by borderline patients are described and illustrated with clinical material. It is suggested that the term borderline has three distinct but related meanings. First, it refers to a clinical category of patients, borderline between neurosis and psychosis who, while not frankly psychotic, tend to use psychotic mechanisms. Second, it refers to a metaphor representing the subjective experience of these patients who are unable to find a permanent identity but feel themselves sitting on the fence between a variety of different identities in a borderline position. Third, it can refer to a theoretical formulation of the level of development at which these patients function. I propose that in terms of mental mechanisms, they function as if on the border between the paranoid‐schizoid and depressive positions as outlined by Melanie Klein. Some of the consequences of the failure to experience and work through depressive anxieties are discussed.
Clinical judgement and clinical training
Authors: Watts Fraser N.
Published: July 2011

The literature indicates that clinical judgement may sometimes be adversely affected by clinical training. It is suggested that this reflects qualitative changes in the modes of clinical listening, modes of inference, and relative weights given to stereotypic and individual information. A theoretical discussion of this issue focuses mainly on the hypothesis that training leads to relatively high‐risk strategies of judgement, and on the construct validity of analytic and non‐analytic judgement. It is suggested that clinical training needs to give separate attention to the use of objective ‘low‐risk’ and of more intuitive styles of clinical judgement, and to consider the judicious combination of these. Practical approaches to both kinds of training are discussed.
The analysis of a repertory grid
Authors: Shaw Mildred L. G.
Published: July 2011

The problems of repertory grid analysis fall into two main groups: (i) general scaling problems; (ii) specific methods of the simplification of the grid data. Some problems of psychological scaling are considered including ‘ranking’ versus ‘rating’, equal interval assumption, and comparison of constructs. The grid analysis methods of principal component analysis, multidimensional scaling and cluster analysis are described briefly, whilst a hand‐sorting cluster‐type method is demonstrated. Methods for processing pairs and groups of grids are also considered.
Transient paranoia and the ‘gift’ in terminal illness
Authors: Moss Donald
Published: July 2011

A case report of a transient paranoia in a man with a terminal illness is presented with three basic aims: (1) to highlight the delicate nature of the treatment of the gravely ill and to illustrate what may have been an iatrogenic panic; (2) to examine the development of the symptoms in such a way as to suggest a theoretical synthesis of the views of Kurt Eissler and those of D. W. Winnicott; (3) to illustrate the dramatic effect of a brief, dynamically informed intervention.
A predictive study of post‐partum depression: Some predisposing characteristics
Authors: Hayworth J. , Little B. C. , Carter S. Bonham , Raptopoulos P. , Priest R. G. , Sandler M.
Published: July 2011

Postnatal depression was investigated by the antenatal screening of a sample of women for factors that might be predictive of later disturbance. The women were assessed when they were 36 weeks pregnant on anxiety, hostility, and locus of control. Predictions were tested by assessing depression 6 weeks after birth. Both high anxiety and high hostility were positively associated with postnatal depression. Intropunitiveness was not significantly related to subsequent depression. The most depressed women were those who had been the more extrapunitive as well as the more hostile.

Women who perceived themselves as less in control of their lives were likely to rate high on depression postnatally, as were younger women. There were indications that some women may have been experiencing depression before the birth. Depression was not significantly associated with parity, gravidity, race, social class or marital status.
The use of psychotherapy with in‐patients
Authors: Whitwell David
Published: July 2011

Some form of psychotherapy is now often attempted with psychiatric in‐patients, even though most discussion of the subject is concerned with out‐patients. This study looks at how a group of junior doctors used psychotherapy with 38 patients who were routinely admitted to an acute admission ward. Information was gathered from the doctors at the beginning of the treatment, during its course, and at the time the patient was discharged. Three distinct patterns emerged. One group of patients were seen as candidates for psychotherapy and definite progress seemed to be made. A second group were seen as candidates for psychotherapy but somehow no progress was made. A third group of patients were never seen as candidates for psychotherapy. These groups are looked at in some detail and the implications are discussed.
Video‐feedback and personal attribution in anorexic, depressed and normal viewers
Authors: Biggs Simon J. , Rosen Bernard , Summerfield Angela B.
Published: July 2011

Video‐feedback has been shown to be particularly influential in changing bodily awareness and causal attribution by confronting participants with a concrete ‘public’ self‐image. Body‐image disturbance and denial are major aspects of patients suffering with anorexia nervosa. It was predicted that video‐feedback should alter these attitudes in this group and result in a more realistic self‐appraisal. Anorexics respond to video‐feedback with a reduction in self‐esteem whereas normal controls displayed an increase in self‐esteem and depressed patients perceived themselves negatively both before and after video‐feedback. It is concluded that video‐feedback may prove to be a useful technique in the treatment of body‐image disturbance in anorexic patients.
‘Possession’ in psychiatric patients in Britain
Authors: Whitwell F. D. , Barker M. G.
Published: July 2011

Various different types of explanation that have been offered for so‐called possession states are reviewed. Patients continue to be seen who believe that they are possessed. A group of 16 such patients are described. The relative contributions of individual and cultural factors are discussed. It is concluded that in this group of patients, while cultural factors may exert a pathoplastic influence, the main causes of disturbance lie within the individual.
Active development of the positive introject in severely disturbed patients
Authors: Donnelly Charles
Published: July 2011

We describe the structure of the positive introject functionally as the ability to calm oneself. In elucidating the essential action involved in this function we focus on a certain kind of fantasying which allows a person to re‐experience a way of thinking about and feeling toward oneself that has occurred in the relation with a therapist and that was experienced as calming.

Three clinical vignettes are presented. The same psychological event is occurring in each one. However, the mode varies from consciously to preconsciously to unconsciously. In the first two modes the process is made clear and the patient is enabled to practise the action until the function becomes reliably available. In the unconscious mode, which seems to be required in certain cases where the patient's internal actions are predominantly aggressive, the process is not made explicit to the patient. Nevertheless the function can develop adequately given enough time and care in titrating positive experiences.

The requirement that patients assume the role of agent in developing particular functions may well be one of the important ingredients that helps them break out of chronicity. For the requirement represents the bridge from a passive, dependent mode typically associated with chronicity, to an active responsible mode associated with healthier functioning.
Differences between physical and psychological constructs in repertory grids
Authors: Adams‐Webber J.
Published: July 2011

It was hypothesized on the basis of previous findings (Adams‐Webber, 1977) that the meanings of the negative poles of constructs are more differentiated than are those of their positive poles. Forty subjects (20 females, 20 males) each completed a series of four repertory grid tests based successively on the positive poles of psychological constructs (e.g. happy); negative poles of psychological constructs (e.g. sad); positive poles of physical constructs (e.g. physically strong); and negative poles of physical constructs (e.g. physically weak). As predicted, there was significantly more differentiation (statistical independence) among the negative poles of psychological constructs than among their positive counterparts; however, this relationship was exactly reversed in the case of physical constructs. These results are discussed in relation to the notion that the logical extensions of the negative poles of physical constructs, and possibly those of the positive poles of psychological constructs, converge upon a common reference point.
Freud's penis—baby equation: Exploratory tests of a controversial theory
Authors: Greenberg Roger P. , Fisher Seymour
Published: July 2011

Freud developed the controversial idea that pregnancy has phallic significance for women. He theorized that one aspect of the natural development of femininity involves the substitution of the wish for a baby in place of a desire for a penis. Two exploratory studies are described testing whether there is a link between pregnancy and phallic imagery as Freud's theory indicates. Study I supported such a link by showing that a group of women produced significantly more phallic imagery, on an inkblot measure, during pregnancy than they produced in the non‐pregnant state. The pregnant women also produced significantly more phallic imagery than did a control group of non‐pregnant women. Study II supported a ‘penis‐baby’ link by showing that a group of women increased significantly in their phallic imagery under the impact of a subliminal pregnancy message while no increase occurred in a group of women receiving a subliminal message dealing with being penetrated. Alternative explanations for the findings are explored and issues are discussed in terms of other empirical findings related to Freud's ideas. The results suggest that Freud's speculations concerning pregnancy deserve further attention.
The relevance of early parental experiences to adult dependency, hypochondriasis and utilization of primary physicians
Authors: Parker Gordon , Lipscombe Penny
Published: July 2011

The possible relationships between early parental experiences and three adult characteristics regarded as having a care‐eliciting component (dependency, hypochondriasis and utilization of health care services) were examined in a study of 100 consecutive patients attending their general practitioner. Assessment of presumed ongoing fundamental parental characteristics was made, together with assessment of parental response to childhood illness in the subjects. Those scoring highest on each of the three dimensions under examination remembered one or both of their parents as highly likely to call a doctor in response to childhood illness in the subjects. Dependent subjects scored their fathers in such a way as to suggest an intense paternal involvement in their child. Those who scored high on hypochondriasis scored their fathers as highly overprotective and their mothers as highly caring. When ill they scored both parents as evidencing more sympathy, and their mothers as more likely to call the doctor, than parents of remaining subjects.
Using discriminant function analysis with clinical, demographic and historical variables to diagnose schizophrenia
Authors: Newmark Charles S. , Jones M. Tazewell , McKee Daphne C. , Simpson Mariett , Boren Richard B. , Prillaman Kathy
Published: July 2011

An effort was made to formalize the critical clinical, demographic and historical features of schizophrenia through the development of a reliable assessement questionnaire. The criterion diagnosis was established via traditional hospital procedures and was substantiated by psychometric measures. Raters with comparable diagnostic experience were familiarized with each of the clinical, demographic and historical features before evaluating the presence or absence in a sample of both psychiatric in‐patients and out‐patients. A structured, standardized interview was used to reduce inconsistency and oversight due to variability in interviewing techniques and coverage of psychopathology. Using the coefficients of the discriminative functions of five major symptoms (loose associations, autism, loss of ego boundaries, emotional blunting, delusions) and two demographic and historical features (family history of mental illness, poor social relations) correctly classified 98 per cent of the total sample of 253 patients. A subsequent investigation demonstrated the utility and generalizability of the proposed system. The assets and liabilities of using such an approach are discussed.
Phenomenological psychology and schizophrenia as explored by Erwin Strauss
Authors: Korer Jacqueline R.
Published: July 2011

This paper is concerned with an attempt to return to the earliest principles of the phenomenological method by exploring the psychology of Erwin Strauss, with particular reference to his studies of schizophrenia. Strauss's analysis of the peculiarly subjective relationship between the schizophrenic and the no‐longer‐neutral outside world is particularly investigated with specific reference to the physiognomic quality of everyday experience. It is suggested that the existential categories utilized in this method can offer an additional perspective in the attempt to explore the world of the schizophrenic; particularly in understanding his idiosyncratic fears and his autistic I‐world interpretation.