Responding to Clinical Psychology Practicum Competencies: An APPIC Perspective

This article offers a commentary by representatives of the Association of Psychology Postdoctoral and Internship Centers (APPIC) on the 2015 article written by Gonsalvez et al. related to the assessment of clinical competencies in clinical psychology practicum students. The four competency “super clusters” derived by Gonsalvez et al. result from a unique empirical hierarchical clustering approach and are sure to add important knowledge to the field. This commentary generalizes from clinical psychology education and training in Australia to the United States, expands from practica to internship and postdoctoral training, and reflects on some relevant APPIC issues and initiatives. Future research is also suggested.     

Comparing the acceptability of a positive psychology intervention versus a cognitive behavioural therapy for clinical depression

There is growing evidence on the efficacy of positive psychology interventions (PPI) to treat clinical disorders. However, very few studies have addressed their acceptability. The present study aimed to analyse 2 key components of acceptability (i.e., client satisfaction and adherence to treatment) of a new PPI programme, the Integrative Positive Psychological Intervention for Depression (IPPI‐D), in comparison to a standard cognitive behavioural therapy (CBT) programme in the treatment of clinical depression. One hundred twenty‐eight women with a DSM‐IV diagnosis of major depression or dysthymia were allocated to a 10‐session IPPI‐D or CBT group intervention condition. Results showed that both interventions were highly acceptable for participants. Attendance rates were high, and there were no significant differences between conditions. However, the IPPI‐D condition showed significantly higher client satisfaction than the CBT condition. Moreover, acceptability did not differ based on participants' severity of symptoms, regardless of condition. These findings encourage further investigations of the applicability of PPI in clinical settings in order to broaden the range of acceptable and suitable therapies for depressed patients. Key Practitioner Message

• This study sheds light on the client satisfaction and adherence to a positive intervention.
• For participants, positive psychology interventions (PPI) may be more satisfactory than CBT as PPI are framed within a positive mental health model and, consequently, may reduce the risk of stigmatization
• Because acceptability of treatments and preferences may affect the efficacy of treatments, this study provides an excellent opportunity to offer professionals more therapeutic options to tailor treatments to clients' needs and expectations

     

A short scale to evaluate supervision and supervisor competence—The SE-SC8

There is an urgent need for instruments to evaluate supervisor competence. The current study describes the development of the SE-SC8, an eight-item version of a previously published Supervision Evaluation and Supervisory Competence scale that has adequate reliability and validity. The current study analysed data from the sample (N = 142) used in the initial validation of the full scale to identify the best set of items for a short scale before testing the scale's psychometric properties in a new study (N = 122). The SE-SC8 demonstrated good reliability and adequate convergent and divergent validity. The SE-SC8 has two overall items respectively measuring supervisor effectiveness and supervision satisfaction and six items that represent supervisory competencies, namely, (1) Openness, Caring and Support, (2) Supervisor's Knowledge and Expertise as Therapist, (3) Supervision Planning and Management, (4) Goal-Directed Supervision, (5) Restorative Competencies, and (6) Insight into and Management of Therapist–Client Dynamics and Reflective Practitioner Competencies. As with other subjective ratings, SE-SC8 scores should be supplemented by other assessments for a holistic appraisal of supervisor competence.     

Systematic evaluation of narrow-sense validity of polygenic risk score for prostate cancer in a Chinese prostate biopsy cohort

The aim of this study was to assess the narrow-sense validity of polygenic risk score (PRS) for prostate cancer (PCa) in a Chinese prostate biopsy cohort. We performed an observational prospective study with 2640 men who underwent prostate biopsy. Germline DNA samples were genotyped and PRS was calculated for each subject using 17 PCa risk-associated genetic variants. Additional GWAS data of the ChinaPCa dataset was also used to compliment the evaluation process. The mean PRS was 1.02 in patients with negative biopsy results, which met the baseline benchmark. The mean PRS was significantly higher in the PCa cases (1.32 vs. 1.02, p = 5.56 × 10⁻¹⁷). Significant dose–response associations between PRS values and odds ratios for PCa were observed. However, the raw calibration slope was 0.524 and the average bias score between the observed risk and uncorrected PRS value was 0.307 in the entire biopsy cohort. After applying a correction factor derived from a training set, the corrected calibration slope improved to 1.002 in a testing set. Similar and satisfied results were also seen in the ChinaPCa dataset and two datasets combined, while the calibration results were inaccurate when the calibration process were performed mutually between two different study populations. In conclusion, assessing the narrow-sense validity of PRS is necessary prior to its clinical implementation for accurate individual risk assessment.     

Genetic risk factors for schizophrenia associate with sleep spindle activity in healthy adolescents

Schizophrenia has been associated with disturbed sleep, even before the onset of the disorder, and also in non‐schizophrenic first‐order relatives. This may point to an underlying genetic influence. Here we examine whether weighted polygenic risk scores (PRS) for schizophrenia are associated with sleep spindle activity in healthy adolescents. Our sample comes from a community‐based cohort of 157 non‐schizophrenic adolescents (57% girls) having both genetic data and an overnight sleep EEG measurement available. Based on a recent genome‐wide association study, we calculated PRS for schizophrenia across the whole genome. We also calculated PRS for the CACNA1l gene region, which has been associated with both schizophrenia and sleep spindle formation. We performed an overnight sleep EEG at the homes of the participants. Stage two sleep spindles were detected using an automated algorithm. Sleep spindle amplitude, duration, intensity and density were measured separately for central and frontal derivations and for fast (13–16 Hz) and slow (10–13 Hz) spindles. PRS for schizophrenia was associated with higher fast spindle amplitude (p = 0.04), density (p = 0.006) and intensity (p = 0.04) at the central derivation, and PRS in the CACNA1l region associated with higher slow spindle amplitude (p = 0.01), duration (p = 0.03) and intensity (p = 0.002) at the central derivation. A positive association between genetic variants for schizophrenia and sleep spindle activity among healthy adolescents supports a view that sleep spindles and schizophrenia share similar genetic pathways. This study suggests that altered sleep spindle activity might serve as an endophenotype of schizophrenia.     

The effect of sleep deprivation on objective and subjective measures of facial appearance

The faces of people who are sleep deprived are perceived by others as looking paler, less healthy and less attractive compared to when well rested. However, there is little research using objective measures to investigate sleep‐loss‐related changes in facial appearance. We aimed to assess the effects of sleep deprivation on skin colour, eye openness, mouth curvature and periorbital darkness using objective measures, as well as to replicate previous findings for subjective ratings. We also investigated the extent to which these facial features predicted ratings of fatigue by others and could be used to classify the sleep condition of the person. Subjects (n = 181) were randomised to one night of total sleep deprivation or a night of normal sleep (8–9 hr in bed). The following day facial photographs were taken and, in a subset (n = 141), skin colour was measured using spectrophotometry. A separate set of participants (n = 63) later rated the photographs in terms of health, paleness and fatigue. The photographs were also digitally analysed with respect to eye openness, mouth curvature and periorbital darkness. The results showed that neither sleep deprivation nor the subjects’ sleepiness was related to differences in any facial variable. Similarly, there was no difference in subjective ratings between the groups. Decreased skin yellowness, less eye openness, downward mouth curvature and periorbital darkness all predicted increased fatigue ratings by others. However, the combination of appearance variables could not be accurately used to classify sleep condition. These findings have implications for both face‐to‐face and computerised visual assessment of sleep loss and fatigue.     

Factors predicting the short‐listing and selection of trainee clinical psychologists: a prospective national cohort study

Concerns have frequently been raised about equal opportunities in the short‐listing and selection procedures used by clinical psychology training courses, although little evidence exists. The aim of the study is to identify factors predicting short‐listing and selection to clinical psychology training courses. A prospective study of one national cohort of applicants to UK clinical psychology training (the 2000 entry cohort of 1538 applicants) was carried out. Application forms (n = 1538), references (n = 1538) and postal questionnaires (n = 396) were used to collect demographic, biographical, academic and work experience information. Relationships between these variables and short‐listing or selection to training were examined using univariate odds ratios and effect sizes, and multivariate logistic regressions. Factors most strongly predictive of short‐listing and selection were proxies for academic ability (post‐16 education at school, degree class, involvement in postgraduate education, authoring publications), relevant educational qualifications (a degree eligible for registration into the BPS), relevant vocational experience (a greater number and range of psychology assistant posts), and positive ratings from academic and clinical psychologist experience‐related referees. Short‐listing and selection to clinical psychology training relies on proxy factors related to academic ability, education, vocational experience and ratings from referees. There is little evidence of direct discrimination, although certain subgroups of applicants may be disadvantaged in their opportunities to gain relevant academic qualifications and vocational experience. Copyright © 2004 John Wiley & Sons, Ltd.     

‘This is the last episode’: the association between problematic binge-watching and loneliness,emotion regulation,and sleep-related factors in poor sleepers

Evidence on the relation between binge-watching and sleep quality is still scarce and inconsistent and none has taken into account both the healthy and pathological dimensions of the phenomenon. This study aimed at filling this gap by investigating both aspects in healthy participants with high and low sleep quality. Further, we aimed at identifying sociodemographic, psychological and sleep-related determinants of problematic binge-watching in poor sleepers. We first conducted independent comparisons between good (n = 253) and poor sleepers (n = 209) on different binge-watching symptoms and motives, assessed through ‘Binge-watching Engagement and Symptoms’ and ‘Watching TV Series Motives’ questionnaires, respectively. Then, we focused on the problematic aspects of binge-watching in poor sleepers, investigating the role of emotion regulation, loneliness, and sleep-related factors using hierarchical multiple regressions. Comparisons between the two groups revealed a greater extent of binge-watching behaviour (t = −2.80, p = 0.005) and greater use of this practise to cope with negative emotions (t = −4.17, p < 0.001) in poor sleepers. In addition, hierarchical multiple regressions showed that gender (β = −0.166, p = 0.008), alcohol consumption (β = −0.135, p = 0.035), emotional dysregulation (β = 0.260, p = 0.001; β = 0.298, p < 0.001), feelings of loneliness (β = 0.159, p = 0.029; β = 0.199, p = 0.003), and daytime sleepiness (β = 0.149, p = 0.016) are significant determinants of problematic binge-watching in this population. In addition to showing for the first time the relationship between sleep quality and different aspects of binge-watching, our findings indicate that emotional dysregulation, feelings of loneliness, and daytime sleepiness play a key role in determining problematic binge-watching in poor sleepers, possibly due to the existence of a pathological vicious circle between these factors in poor sleepers.     

Irish clinical and counselling psychologists' experiences and views of mandatory personal therapy during training: A polarisation of ethical concerns

Although there have been some recent changes in Ireland, the practice of mandating personal therapy during training has traditionally differed between counselling and clinical psychologists. Irish psychologists (n = 258: 170 clinical, 88 counselling) took part in a survey study of experiences and views regarding this practice. Counselling psychologists reported higher rates of lifetime and current attendance at personal therapy compared to clinical psychologists, and nearly all had experienced mandated personal therapy compared to a minority of the clinical group. However, the clinical psychologists had a high rate of attendance at personal therapy compared to that reported for their British peers, indicating a high regard for personal therapy amongst Irish clinicians despite the absence of a training mandate. Five factors were found to be independent predictors of agreement with mandating personal therapy during training—lifetime experience of personal therapy, being a counselling psychologist, experience of mandated therapy, being more recently qualified, and longer attendance at personal therapy. Thematic analysis of the psychologists' open responses regarding mandated therapy indicated that the majority believed that personal therapy was an important part of ethical, effective practice, and valuable in enhancing self‐awareness and learning from the client experience. Ethical concerns about a mandate were polarised between the two psychology specialisms, more counselling psychologists emphasising the dangers and questionable efficacy of psychologists practising psychotherapy without personal therapy experience, and more clinical psychologists questioning the efficacy and ethics of imposing a mandate on trainees. Recommendations are made regarding this issue for trainers of both specialisms.     

Anxiety in the workplace: A comprehensive occupational health evaluation of anxiety disorder in public school teachers

The purpose of the study was to systematically assess demographic, occupational, and psychosocial factors associated with Anxiety Disorder in public school teachers. A sample of 3,361 public school teachers was given an online questionnaire, including questions about demographic, occupational, and psychosocial factors. Anxiety Disorder was based on the Patient Health Questionnaire. Univariate analyses and a hierarchical logistic regression were used to determine the key demographic, occupational, and psychosocial factors associated with Anxiety Disorder. Individuals with Anxiety Disorder were significantly more likely to report absenteeism and higher intent to quit (p < .001). The hierarchical logistic regression showed that the factors most associated with the Anxiety Disorder included being Hispanic (p < .01), taught fewer years (p < .05), teaching elementary school (p < .01), higher job involvement (p < .01), higher perceived stress (p < .01), lower physical quality of life (p < .01), major depression (p < .001), and somatization disorder (p < .01). The results from this study identify specific demographic, occupational, and psychosocial factors associated with the presence of anxiety disorder in public school teachers. Future research should examine how implementing changes in the workplace may improve occupational factors such as job control, satisfaction, absenteeism, and intent to quit, which, in turn, may be associated with a reduction in the presence of anxiety disorders.     

Polygenic and environmental determinants of tics in the Avon Longitudinal Study of Parents and Children

Tourette syndrome (TS) is caused by multiple genetic and environmental factors. Yet, little is known about the interplay of these factors in the occurrence of tics. We investigated whether polygenic risk score (PRS) of TS and pregnancy-related factors together enhance the explained variance of tic occurrence in the Avon Longitudinal Study of Parents and Children (N_cases = 612; N_controls = 4,201; 50% male; mean age 13.8 years). We included a cumulative adverse pregnancy risk score, maternal anxiety and depression, and maternal smoking and alcohol use during pregnancy. We investigated possible joint effects of genetic and pregnancy-related risk factors using a multivariable approach, and explored mediation effects between the pregnancy-related risk factors in explaining tic presence. The PRS and the cumulative adverse pregnancy risk score, maternal anxiety, or maternal depression explained significantly more variance of tic presence compared to models including only the PRS. Furthermore, we found that the cumulative adverse pregnancy risk score mediated the association between several pregnancy-related factors (maternal anxiety, depression, and smoking) and tics. The combination of a PRS and pregnancy-related risk factors explained more variance of tics in a general population cohort compared to studying these factors in isolation.     

The clustering and morphology of chondrocytes in normal and mildly degenerate human femoral head cartilage studied by confocal laser scanning microscopy

Chondrocytes are the major cell type present in hyaline cartilage and they play a crucial role in maintaining the mechanical resilience of the tissue through a balance of the synthesis and breakdown of extracellular matrix macromolecules. Histological assessment of cartilage suggests that articular chondrocytes in situ typically occur singly and demonstrate a rounded/elliptical morphology. However, there are suggestions that their grouping and fine shape is more complex and that these change with cartilage degeneration as occurs in osteoarthritis. In the present study we have used confocal laser scanning microscopy and fluorescently labelled in situ human chondrocytes and advanced imaging software to visualise chondrocyte clustering and detailed morphology within grade‐0 (non‐degenerate) and grade‐1 (mildly degenerate) cartilage from human femoral heads. Graded human cartilage explants were incubated with 5‐chloromethylfluorescein diacetate and propidium iodide to identify the morphology and viability, respectively, of in situ chondrocytes within superficial, mid‐ and deep zones. In grade‐0 cartilage, the analysis of confocal microscope images showed that although the majority of chondrocytes were single and morphologically normal, clusters (i.e. three or more chondrocytes within the enclosed lacunar space) were occasionally observed in the superficial zone, and 15–25% of the cell population exhibited at least one cytoplasmic process of ~ 5 μm in length. With degeneration, cluster number increased (~ 50%) but not significantly; however, the number of cells/cluster (P < 0.001) and the percentage of cells forming clusters increased (P = 0.0013). In the superficial zone but not the mid‐ or deep zones, the volume of clusters and average volume of chondrocytes in clusters increased (P < 0.001 and P < 0.05, respectively). The percentage of chondrocytes with processes, the number of processes/cell and the length of processes/cell increased in the superficial zone of grade‐1 cartilage (P = 0.0098, P = 0.02 and P < 0.001, respectively). Processes were categorised based on length (L0 – no cytoplasmic processes; L1 < 5 μm; 5 < L2 ≤ 10 μm; 10 < L3 ≤ 15 μm; L4 > 15 μm). With cartilage degeneration, for chondrocytes in all zones, there was a significant decrease (P = 0.015) in the percentage of chondrocytes with ‘normal’ morphology (i.e. L0), with no change in the percentage of cells with L1 processes; however, there were significant increases in the other categories. In grade‐0 cartilage, chondrocyte clustering and morphological abnormalities occurred and with degeneration these were exacerbated, particularly in the superficial zone. Chondrocyte clustering and abnormal morphology are associated with aberrant matrix metabolism, suggesting that these early changes to chondrocyte properties may be associated with cartilage degeneration.     

Clinical Psychologists in the 2010s: 50 Years of the APA Division of Clinical Psychology

The American Psychological Association's Division of Clinical Psychology constitutes one of the oldest, largest, and most active organizations of clinical psychologists in the world. For 50 years, beginning with E. Lowell Kelly in 1960, researchers have chronicled the evolution of its membership and the transformation of clinical psychology in the United States. In this article, we highlight the continuity and change in clinical psychologists’ demographics, educations, theories, employment, activities, and satisfactions over a 50‐year span. Results from the most recent, 2010 study (N = 588, 46% return rate) are summarized in both contemporary and historical contexts. Among the prominent trends are steady increases in the proportion of female and ethnic minority psychologists, the rise of Psy.D. graduates, the domination of the cognitive orientation, a relative decline in psychological assessment in general and projective testing in particular, the ascendancy of independent practice, and a pattern of high career satisfaction.     

Identification of Novel Craniofacial Regulatory Domains Located far Upstream of SOX9 and Disrupted in Pierre Robin Sequence

Mutations in the coding sequence of SOX9 cause campomelic dysplasia (CD), a disorder of skeletal development associated with 46,XY disorders of sex development (DSDs). Translocations, deletions, and duplications within a ～2 Mb region upstream of SOX9 can recapitulate the CD–DSD phenotype fully or partially, suggesting the existence of an unusually large cis‐regulatory control region. Pierre Robin sequence (PRS) is a craniofacial disorder that is frequently an endophenotype of CD and a locus for isolated PRS at ～1.2–1.5 Mb upstream of SOX9 has been previously reported. The craniofacial regulatory potential within this locus, and within the greater genomic domain surrounding SOX9, remains poorly defined. We report two novel deletions upstream of SOX9 in families with PRS, allowing refinement of the regions harboring candidate craniofacial regulatory elements. In parallel, ChIP‐Seq for p300 binding sites in mouse craniofacial tissue led to the identification of several novel craniofacial enhancers at the SOX9 locus, which were validated in transgenic reporter mice and zebrafish. Notably, some of the functionally validated elements fall within the PRS deletions. These studies suggest that multiple noncoding elements contribute to the craniofacial regulation of SOX9 expression, and that their disruption results in PRS.     

Uptake of polygenic risk information among women at increased risk of breast cancer

Polygenic risk scores (PRSs) are increasingly being implemented to assess breast cancer risk. This study aimed to assess and determine factors associated with uptake of PRS among women at increased risk of breast cancer for whom genetic testing to date had been uninformative. Participants were recruited from the Variants in Practice study from which breast cancer PRS had been calculated. Four hundred women were notified by letter of the availability of their PRS and invited to complete a self-administered survey comprising several validated scales. Considering non-participants, uptake of PRS was between 61.8% and 42.1%. Multivariate logistic regression identified that women were more likely to receive their PRS if they reported greater benefits (odds ratio [OR] = 1.17, P = .011) and fewer barriers to receiving their PRS (OR = 0.80, P = .007), had completed higher level education (OR = 3.32, P = .004), and did not have daughters (0.29, P = .006). Uptake of breast cancer PRS varied according to several testing- and patient-related factors. Knowledge of these factors will facilitate the implementation of polygenic testing in clinical practice and support informed decision making by patients.     

Polymorphisms in Dopamine Transporter (<Emphasis Type="Italic">SLC6A3</Emphasis>) are Associated with Stimulant Effects of <Emphasis Type="Italic">d</Emphasis>-Amphetamine: An Exploratory Pharmacogenetic Study Using Healthy Volunteers

Individuals vary in their subjective responses to stimulant drugs, and these differences are believed to be partially genetic in origin. We evaluated associations between mood, cognitive and cardiovascular responses to d-amphetamine and four polymorphisms in the dopamine transporter (SLC6A3): rs460000, rs3756450, rs37022 and rs6869645. Healthy Caucasian male and female volunteers (N = 152) participated in a double-blind, crossover design study in which they received placebo, 10 and 20 mg of d-amphetamine. We measured self-reported rating of mood, performance on the Digit Symbol Substitution Task, blood pressure and heart rate. Individuals with the C/C genotype at rs460000 (N = 83) reported approximately twofold higher ratings of stimulation and euphoria relative to the A/A+A/C (N = 69) genotype group, at both the 10 and 20 mg doses. No other responses or SNPs showed significant effects. rs460000 is in perfect LD with rs463379 (CEU: D′ = 1; r ² = 1), which was not studied here, but has been associated with etiology of Attention Deficit Hyperactivity Disorder (ADHD). These findings suggest a pleiotropic effect of this polymorphic locus on both ADHD and sensitivity to the subjective effects of amphetamine.     

Positive Clinical Psychology: A new vision and strategy for integrated research and practice

This review argues for the development of a Positive Clinical Psychology, which has an integrated and equally weighted focus on both positive and negative functioning in all areas of research and practice. Positive characteristics (such as gratitude, flexibility, and positive emotions) can uniquely predict disorder beyond the predictive power of the presence of negative characteristics, and buffer the impact of negative life events, potentially preventing the development of disorder. Increased study of these characteristics can rapidly expand the knowledge base of clinical psychology and utilize the promising new interventions to treat disorder through promoting the positive. Further, positive and negative characteristics cannot logically be studied or changed in isolation as (a) they interact to predict clinical outcomes, (b) characteristics are neither “positive” or “negative”, with outcomes depending on specific situation and concomitant goals and motivations, and (c) positive and negative well-being often exist on the same continuum. Responding to criticisms of the Positive Psychology movement, we do not suggest the study of positive functioning as a separate field of clinical psychology, but rather that clinical psychology itself changes to become a more integrative discipline. An agenda for research and practice is proposed including reconceptualizing well-being, forming stronger collaborations with allied disciplines, rigorously evaluating the new positive interventions, and considering a role for clinical psychologists in promoting well-being as well as treating distress.     

Evaluation of the Numeric Rating Scale for perception of effort during isometric elbow flexion exercise

The aim of the study was to examine the reliability and validity of the numerical rating scale (0-10 NRS) for rating perception of effort during isometric elbow flexion in healthy people. 33 individuals (32 ± 8 years) participated in the study. Three re-test measurements within one session and three weekly sessions were undertaken to determine the reliability of the scale. The sensitivity of the scale following 10 min isometric fatiguing exercise of the elbow flexors as well as the correlation of the effort with the electromyographic (EMG) activity of the flexor muscles were tested. Perception of effort was tested during isometric elbow flexion at 10, 30, 50, 70, 90, and 100% MVC. The 0-10 NRS demonstrated an excellent test–retest reliability [intra class correlation (ICC) = 0.99 between measurements taken within a session and 0.96 between 3 consecutive weekly sessions]. Exploratory curve fitting for the relationship between effort ratings and voluntary force, and underlying EMG showed that both are best described by power functions (y = ax ^b ). There were also strong correlations (range 0.89–0.95) between effort ratings and EMG recordings of all flexor muscles supporting the concurrent criterion validity of the measure. The 0-10 NRS was sensitive enough to detect changes in the perceived effort following fatigue and significantly increased at the level of voluntary contraction used in its assessment (p < 0.001). These findings suggest the 0-10 NRS is a valid and reliable scale for rating perception of effort in healthy individuals. Future research should seek to establish the validity of the 0-10 NRS in clinical settings.     

How do experts in psychiatric genetics view the clinical utility of polygenic risk scores for schizophrenia?

Polygenic risk scores (PRS) are promising for identifying common variant-related inheritance for psychiatric conditions but their integration into clinical practice depends on their clinical utility and psychiatrists' understanding of PRS. Our online survey explored these issues with 276 professionals working in psychiatric genetics (RR: 19%). Overall, participants demonstrated knowledge of how to interpret PRS results. Their performance on knowledge-based questions was positively correlated with participants' self-reported familiarity with PRS (r = 0.21, p = 0.0006) although differences were not statistically significant (Wald Chi-square = 3.29, df = 1, p = 0.07). However, only 48.9% of all participants answered all knowledge questions correctly. Many participants (56.5%), especially researchers (42%), indicated having at least occasional conversations about the role of genetics in psychiatric conditions with patients and/or family members. Most participants (62.7%) indicated that PRS are not yet sufficiently robust for assessment of susceptibility to schizophrenia; most significant obstacles were low predictive power and lack of population diversity in available PRS (selected, respectively, by 53.6% and 29.3% of participants). Nevertheless, 89.8% of participants were optimistic about the use of PRS in the next 10 years, suggesting a belief that current shortcomings could be addressed. Our findings inform about the perceptions of psychiatric professionals regarding PRS and the application of PRS in psychiatry.     

Clinicians' implicit and explicit attitudes about the legitimacy of functional neurological disorders correlate with referral decisions

Objectives

Uncertainty regarding the legitimacy of functional neurological disorder (FND) remains among some health care professionals. Despite treatment guidelines and consensus recommendations, variability in clinical practice referral decisions persists. Evidence from other conditions suggests such clinical decision making is impacted by practitioners' implicit and explicit attitudes. We aimed to identify whether health care professionals hold implicit and/or explicit attitudes about the legitimacy of FND and whether these attitudes are associated with referral decision making.

Design/Methods

We included 66 health care professionals who work with people with neurological conditions: n = 37 medical doctors, mainly neurologists (n = 18) and psychiatrists (n = 10), and n = 29 doctoral level practitioner psychologists. Participants completed an Implicit Association Test (IAT), Implicit Relational Assessment Procedure (IRAP), a referral decision-making vignette task and self-report measures of explicit attitudes on FND-legitimacy, therapeutic optimism and clinician confidence. Multiple Sclerosis (MS) was used as a comparator condition.

Results

Participants self-reported strong explicit FND-legitimate and MS-legitimate attitudes but demonstrated an implicit FND-illegitimate/MS-legitimate bias. Deeper examination provided by the IRAP data indicated pro-FND-legitimate attitudes, but no bias for or against FND-illegitimate—contrasting the pro-MS-legitimate, anti-MS-illegitimate attitudes for the comparator condition. Attitudes about FND-illegitimacy were negatively associated with likelihood of referral to physical interventions such as physiotherapy. Medical doctors had lower treatment optimism and stronger explicit attitudes that FND is illegitimate than psychologists.

Conclusions

At an implicit level, clinicians are uncertain about the illegitimacy of FND, and such attitudes are associated with lower likelihood of referral to physiotherapy in particular. Improved education on FND among health care professionals is indicated.