Working Things Out Through SPHE? A Journey from Community to Clinic and Back

Working Things Out is a DVD resource developed by young people who had experienced a mental health difficulty in which they tell their stories of how they successfully got through their own ‘tough times’. Participants in an Irish community-based epidemiological study, who had recovered from a mental health difficulty, joined young people attending a Child and Adolescent Mental Health Service to develop the resource to assist other young people in coping with their own mental health difficulties. While originally developed for use with clinical populations, the resource has been developed to enhance the Mental Health promotion component of the Social, Personal and Health Education (SPHE) Programme, which supports the personal development, health and well-being of Irish young people, and forms part of the school curriculum at both primary and secondary school levels. A preliminary pilot study evaluating its use in enhancing the effectiveness of mental health promotion in the SPHE programme has shown promising results, and the empirical effectiveness of the programme is currently being evaluated in a much larger and randomised controlled trial in some 18 Irish Secondary schools.     

Economic “Activity-Silent” Synaptic Mechanisms of Working Memory

正Working memory(WM)allows humans to hold necessary information in temporary storage and manipulate such information online for higher-order cognitive functions,such as language understanding,decision making,and problem solving.Since its first appearance in the science of psychology in the 1960s,many theories have sought to elucidate the nature of WM.The most accepted model is     

Determinism, “Freedom,” and Psychotherapy†

Objective: Childhood abuse is associated with a wide range of negative outcomes, including increased risk for development of emotion dysregulation and psychopathology, such as posttraumatic stress disorder (PTSD). The goal of the present study was to examine associations between child abuse, PTSD symptoms, and performance on an emotional conflict regulation task that assesses implicit emotion regulation abilities. Method: The sample consisted of 67 (94% African American) females recruited from a public, urban hospital. Childhood abuse was measured using the Childhood Trauma Questionnaire, and PTSD was measured using the modified PTSD Symptom Scale. Task accuracy and implicit emotion regulation were measured through an emotional conflict regulation behavioral task. Results: A multivariate analysis of covariance showed that exposure to moderate to severe childhood abuse was significantly related to worse emotional conflict regulation scores independent of current PTSD symptoms, depressive symptoms, and adult trauma exposure, suggesting a deficit in implicit emotion regulation. We also found an interaction between PTSD symptoms and abuse exposure in predicting accuracy on the behavioral task; high levels of PTSD symptoms were associated with poorer task accuracy among individuals who reported moderate to severe exposure to childhood abuse. However, no relationship between implicit emotion regulation abilities and overall PTSD symptom severity was found. Conclusions: This study provides preliminary evidence of an implicit emotion regulation deficit for individuals exposed to significant childhood abuse and further supports the growing evidence that addressing various aspects of emotion dysregulation, such as awareness of emotions and strategies to manage strong emotions, in the context of treatment would be valuable.     

Leadership,Organizational Climate,and Working Alliance in a Children’s Mental Health Service System

The goal of this study was to examine the relationships of transformational leadership and organizational climate with working alliance, in a children’s mental health service system. Using multilevel structural equation modeling, the effect of leadership on working alliance was mediated by organizational climate. These results suggest that supervisors may be able to impact quality of care through improving workplace climate. Organizational factors should be considered in efforts to improve public sector services. Understanding these issues is important for program leaders, mental health service providers, and consumers because they can affect both the way services are delivered and ultimately, clinical outcomes.     

Cholinergic Behaviors,Emotions, and the “Self”

Macromolecular cholinergic pathways are involved in the regulation of addiction, emotions, and motivations, as described at this ISCM. Indeed, in view of the omnipresence in the brain of cholinergic pathways and of their connections with other transmitters’ sites and pathways, their involvement in all known human and animal behaviors could be expected and numerous current reports describe such cholinergic correlates. This minireview describes the current status and the future of the cholinergic impact on behavior and emotions, and particularly on one important human phenomenon, the “self” or the “I” (it is only speculative to impute the self to animals).     

Truths, errors, and lies around “reflex sympathetic dystrophy” and “complex regional pain syndrome”

The shifting paradigm of reflex sympathetic dystrophy–sympathetically maintained pains–complex regional pain syndrome is characterized by vestigial truths and understandable errors, but also unjustifiable lies. It is true that patients with organically based neuropathic pain harbor unquestionable and physiologically demonstrable evidence of nerve fiber dysfunction leading to a predictable clinical profile with stereotyped temporal evolution. In turn, patients with psychogenic pseudoneuropathy, sustained by conversion-somatization-malingering, not only lack physiological evidence of structural nerve fiber disease but display a characteristically atypical, half-subjective, psychophysical sensory-motor profile. The objective vasomotor signs may have any variety of neurogenic, vasogenic, and psychogenic origins. Neurological differential diagnosis of “neuropathic pain” versus pseudoneuropathy is straight forward provided that stringent requirements of neurological semeiology are not bypassed. Embarrassing conceptual errors explain the assumption that there exists a clinically relevant “sympathetically maintained pain” status. Errors include historical misinterpretation of vasomotor signs in symptomatic body parts, and misconstruing symptomatic relief after “diagnostic” sympathetic blocks, due to lack of consideration of the placebo effect which explains the outcome. It is a lie that sympatholysis may specifically cure patients with unqualified “reflex sympathetic dystrophy.” This was already stated by the father of sympathectomy, René Leriche, more than half a century ago. As extrapolated from observations in animals with gross experimental nerve injury, adducing hypothetical, untestable, secondary central neuron sensitization to explain psychophysical sensory-motor complaints displayed by patients with blatantly absent nerve fiber injury, is not an error, but a lie. While conceptual errors are not only forgivable, but natural to inexact medical science, lies particularly when entrepreneurially inspired are condemnable and call for peer intervention. Received: 4 May 1999 Accepted: 18 July 1999     

Working with mental health problems: clients’ experiences of IPS, vocational rehabilitation and employment

Background

Although the effectiveness of individual placement and support (IPS) has been well established, little is known about clients’ perceptions of the model compared to usual vocational rehabilitation, nor about their experiences of searching for and returning to work with this kind of support. This qualitative study aimed to explore clients’ views of the difficulties of obtaining and maintaining employment, their experiences of the support received from their IPS or Vocational Service workers and the perceived impact of work on clients’ lives.

Method

Semi-structured interviews were conducted with 48 people with psychotic disorders participating in a six-centre international randomised controlled trial of IPS compared to usual vocational rehabilitation. To assess their experiences of the services and the perceived effects of working, two IPS and two Vocational Service clients at each centre who had found work during the study period were interviewed, along with two IPS and two Vocational Service clients at each centre who had not.

Results

IPS clients reported having received more help seeking and maintaining employment, whereas Vocational Service clients reported having received more help in finding sheltered employment or placements. Clients who had worked associated this with financial stability, improved social lives, increased self-esteem, integration into society and amelioration of their symptoms, as well as reduced feelings of boredom and isolation, but also reported increased levels of stress. IPS clients as well as Vocational Service ones reported not receiving enough follow-up support, despite this being proposed as a key feature of the model.

Conclusion

Findings from the in-depth interviews reflect differences in service models that have also been tested quantitatively but further work in disaggregating the IPS model and assessing the impact of each component would be valuable.     

How service users and carers understand,perceive, rephrase,and communicate about “depressive episode” and “schizophrenia” diagnoses: an international participatory research

Background

For ICD-11, the WHO emphasized the clinical utility of communication and the need to involve service users and carers in the revision process.

Aims

The objective was to assess whether medical vocabulary was accessible, which kinds of feelings it activated, whether and how users and carers would like to rephrase terms, and whether they used diagnosis to talk about mental health experiences.

Method

An innovative protocol focused on two diagnoses (depressive episode and schizophrenia) was implemented in 15 different countries. The same issues were discussed with users and carers: understanding, feelings, rephrasing, and communication.

Results

Most participants reported understanding the diagnoses, but associated them with negative feelings. While the negativity of “depressive episode” mostly came from the concept itself, that of “schizophrenia” was largely based on its social impact and stigmatization associated with “mental illness”.

When rephrasing “depressive episode”, a majority kept the root “depress*”, and suppressed the temporal dimension or renamed it. Almost no one suggested a reformulation based on “schizophrenia”. Finally, when communicating, no one used the phrase “depressive episode”. Some participants used words based on “depress”, but no one mentioned “episode”. Very few used “schizophrenia”.

Conclusion

Data revealed a gap between concepts and emotional and cognitive experiences. Both professional and experiential language and knowledge have to be considered as complementary. Consequently, the ICD should be co-constructed by professionals, service users, and carers. It should take the emotional component of language, and the diversity of linguistic and cultural contexts, into account.

     

On the Neuropathology of Schizophrenia and its Dementia: Neurodevelopmental,Neurodegenerative, or Both?

The neuropathology of schizophrenia has begun to emerge following renewed investigation in the past 20 years. However, there remain inconsistencies in the data and their interpretation. In particular, although the brains of schizophrenics have been reported to show an excess of neurodegenerative changes, especially astrocytic gliosis and Alzheimer's disease, it is unclear whether these features are an intrinsic part of the neuropathology of schizophrenia. Nor is it apparent how they relate to the symptoms of dementia which afflict a proportion of schizophrenics. This review focuses upon these questions. Two main conclusions are drawn. Firstly, the neuropathological features of schizophrenia together support a neurodevelopmental pathogenesis wherein the aforementioned degenerative changes are either epiphenomenal, artefactual, or are limited to a subgroup of cases which are otherwise indistinguishable clinically or pathologically. Secondly, the dementia of schizophrenia is not attributable to Alzheimer's disease nor to any other recognized neuropathological substrate.     

Bioethics, Assisted Suicide, and the “Right to Die”

Physician-assisted suicide is much talked about. But confusion remains as to what precisely it is, and debate continues about its ethical implications. Is physician-assisted suicide distinguishable from refusal of treatment? Is there a “right to die?” Does assisted suicide necessarily have to mean physician-assisted suicide? What is the relationship of physician-assisted suicide to end-of-life care? How should physicians deal with a request for assisted suicide? These issues are explored in this paper, along with a review of the ethical arguments for and against physician-assisted suicide. The paper concludes that society should encourage individuals not to see assisted suicide as their best option. A better policy than widespread legalization of physician-assisted suicide is to provide the necessary social support, health care including mental health care, hospice care, and compassion to those who feel they face an undignified life, or an undignified painful death. This paper is based on a presentation made at the AACP 2000 Annual Meeting, October 14, 2000.     

Exercise,Fitness, and Neurocognitive Function in Older Adults: The “Selective Improvement” and “Cardiovascular Fitness” Hypotheses

Background   Although basic research has uncovered biological mechanisms by which exercise could maintain and enhance adult brain health, experimental human studies with older adults have produced equivocal results. Purpose   This randomized clinical trial aimed to investigate the hypotheses that (a) the effects of exercise training on the performance of neurocognitive tasks in older adults is selective, influencing mainly tasks with a substantial executive control component and (b) performance in neurocognitive tasks is related to cardiorespiratory fitness. Methods   Fifty-seven older adults (65–79 years) participated in aerobic or strength-and-flexibility exercise training for 10 months. Neurocognitive tasks were selected to reflect a range from little (e.g., simple reaction time) to substantial (i.e., Stroop Word–Color conflict) executive control. Results   Performance in tasks requiring little executive control was unaffected by participating in aerobic exercise. Improvements in Stroop Word–Color task performance were found only for the aerobic exercise group. Changes in aerobic fitness were unrelated to changes in neurocognitive function. Conclusions   Aerobic exercise in older adults can have a beneficial effect on the performance of speeded tasks that rely heavily on executive control. Improvements in aerobic fitness do not appear to be a prerequisite for this beneficial effect.

Easier Said Than Done: The Challenge to Teach “Personal Recovery” to Mental Health Professionals Through a Short,Targeted and Structured Training Programme

This study assesses the effectiveness of our short Personal Recovery Training Program (PRTP) for mental health professionals. Fifty-two healthcare professionals from Italian mental health services and forty students in psychiatric rehabilitation completed the Recovery Knowledge Inventory (RKI) pre- and post-training, divided into two groups: the PRTP (N?=?45) and the Family Psychoeducational Training Program (FPTP; N?=?47). Participants’ understanding of personal recovery improved more significantly for those in the PRTP than for those in the FPTP group in two domains, “Roles and responsibilities” and “Non-linearity of the recovery process”; the FPTP group showed a significant improvement in the “Role of self-definition and peers in recovery” domain. Two consumers were involved in the PRTP and represented a resource to help participants understand the personal recovery process. Our findings indicate that a brief PRTP supported by consumers can improve staff and students' recovery orientation. The translation of the training into clinical practice remains unevaluated.

     

“We’re Working in the Dark Here”: Education Needs of Teachers and School Staff Regarding Student Self-Injury

Although teachers and other school staff encounter adolescents who self-injure, the behaviour evokes strong reactions. We (a) validated a measure of attitudes towards self-injury, (b) examined knowledge, confidence, and education needs regarding self-injury, and (c) explored the relationship between attitudes and responses to self-injury among 501 secondary school teachers and other school staff. Three factors reflecting participants’ attitudes were extracted. Experience was related to knowledge and confidence regarding self-injury, but not to attitudes. Thematic analysis of open-ended questions indicated a desire for education and resources. Implications for teacher education and school policies to support teachers in addressing self-injury are discussed.