Repressed memories. When are they real? How are they false?

The precise mechanisms by which such false memories are constructed awaits further research. Much is left to learn about the degree of confidence and the characteristics of false memories created in these ways. We have more to learn about the types of individuals who are particularly susceptible to these forms of suggestion, and conversely, who is resistant. As we are learning more, it is probably important to heed the cautionary tale in the data already obtained; mental health professionals, interviewers, and others need to know how much they can potentially influence participants in research, clinical, and forensic contexts and take care to avoid that influence when it might be harmful. Periodic re-reading of Shakespeare's A Midsummer Night's Dream, with a small substitution (change "poet" to "therapist" or to "biased interviewer"), might help keep these important ideas in mind, reminding us how hard it can sometimes be to distinguish a bush from an imagined bear: The poet's eye, in fine fanciful rolling, Doth glance from heaven to earth, from earth to heaven; And as imagination bodies forth The forms of things unknown, the poet's pen Turns them to shapes and gives to airy nothing A local habitation and a name. Such tricks hath strong imagination, that if it would but apprehend some joy, it comprehends some bringer of that joy; Or in the night, imagining some fear, How easy is a bush supposed a bear!     

Who are patients on conventional antipsychotics?

The advent of atypical antipsychotics presented psychiatrists with an effective way of treating psychosis without the many side effects associated with conventional agents. Given the superiority of atypical antipsychotics, we examined demographic information and treatment histories of patients currently treated with conventional antipsychotics, especially in regard to treatment with atypical agents. Medication histories and demographic information for 276 patients admitted to an urban hospital were obtained by patient/family interviews and review of medical records. Chi-square and logistic regression tests were used to analyze data for possible predictive factors of which patients within the sample were still receiving conventional antipsychotics for treatment. Seventy-eight (28%) patients were currently being treated with conventional antipsychotics. More than half of them had never received a trial of an atypical agent. African-Americans, who are more likely to suffer adverse effects from conventional antipsychotics, and substance abusers were overrepresented in this group. It is unclear to what extent ethnic or cultural bias played a role in determining medication choice. Because conventional antipsychotics are associated with more side effects and greater medication nonadherence, these patients should be evaluated for appropriateness of a trial with an atypical agent even if they are currently stable with a conventional antipsychotic.     

Pathological gambling: addiction or compulsion?

There is considerable debate about the appropriate conceptualization of pathological gambling and its place in psychiatric nosology. The authors examined the existing research on different areas of pathological gambling to find evidence for a particular model of this disorder. There are 2 dominant models of pathological gambling: as a nonpharmacologic addiction and as an obsessive-compulsive spectrum disorder. The data available from different areas seem to converge in suggesting that pathological gambling has characteristics that are similar to those of substance abuse, and less close to those of obsessive-compulsive disorder, although those conceptualizations are not mutually exclusive. An alternative model of pathological gambling is that it constitutes a heterogeneous disorder with some subtypes resembling obsessive-compulsive disorder, and other subtypes being closer to substance abuse disorders. Improved understanding of the conceptualization of this disorder may help improve the quality of the treatments available.     

Positively Biased Self-Perceptions: Who Has Them and What are Their Effects?

This study examined demographic and social competency characteristics of children who hold overly-positive self-perceptions of their social acceptance (positive bias). The effects of holding positive bias on aggressive and depressive symptoms were examined in a sample that excluded children on the extreme negative end of the bias continuum. Measures of peer-rated and self-perceived acceptance were obtained for 366 children in the 3rd through 5th grades. Peer-rated aggressive behavior and self-reported depressive symptoms were also collected. Results demonstrated sex, ethnicity, and social preference were uniquely associated with positive bias. Positive bias was related to aggression beyond the effects of social preference. Positive bias was not related to depressive symptoms. This study clarified who is likely to hold positive bias and replicated findings that suggest positive bias is a risk factor for aggressive outcomes. The idea that positive bias is neither a risk nor protective factor for depressive symptoms is discussed.     

Crime-related amnesia: real or feigned?

In the context of criminal forensic evaluations, experts are often confronted with the problem of offenders' claims of crime-related amnesia. Because of the far-reaching legal consequences of the expert opinion, the nature of the suspected memory disorder has to be investigated with special care and due consideration of differential diagnoses. While the diagnosis of organic amnesia is comparatively easy to make, the same is not true for dissociative amnesia. Despite existing theoretical explanations such as stress, peritraumatic dissociation or repression, to date there is no sound, scientifically based and empirically supported explanation for the occurrence of genuine, non-organic crime-related amnesia. In the criminal context of claimed amnesia, secondary gain is usually obvious; thus, possible malingering of memory loss has to be carefully investigated by the forensic expert. To test this hypothesis, the expert has to resort to methods based on a high methodological level. The diagnosis of dissociative amnesia cannot be made by mere exclusion of evidence for organic amnesia; instead, malingering has to be ruled out on an explicit basis.