Token economies in institutional settings. Historical, political, deprivation, ethical, and generalization issues.

The use of the token economy in institutional settings is examined in light of historical, political, deprivation, ethical, and generalization issues. The major points may be summarized as follows. a) The token economy may be viewed as a palliative measure to prevent the incredibly regressive effects of institutionalization. b) To achieve control in token programs in many "total institutions," an artificial state of deprivation must be achieved. c) Generalization of behaviors into the natural environment following the patient's stay in a token economy program should not be taken for granted. d) What the patient learns in a token economic system may not be what the token economy's program director probably intends.     

The adult psychiatrist in the medical environment

To function effectively in the medical environment a psychiatrist must be comfortable with the skills and values of medicine. He or she must nurture his or her original knowledge in this area with an ongoing learning program. Certain problems are uniquely encountered in this environment. The psychiatrist must understand that various psychiatric disorders may be masked by or may mask somatic complaints. He or she must expect to deal with threatened and threatening patients. Most important, the psychiatrist must understand that to be effective he or she must make a commitment to involvement.     

Structuring the Black Family for Survival and Growth

The options presented in this article provide an additional frame of reference for understanding some of the relationships between the parts, the whole, and the environment in which they exist, on the assumption that a "holistic" view may give a more accurate picture of the problem, as well as suggest some possible solutions. The black family, as the primary unit of socialization for the black community, must maximize the survival and facilitate the growth of its members. From a social systems persepctive, the relationship of the black family's internal structure to the external environment provides important insights. Internal boundaries must be firm but permeable to maximize both survival (firm boundaries) and growth (permeable boundaries). Assaults from the external environment must be managed to provide psychic relief for family members. What becomes clear, in structuring the black family to cope with boundary intrusions, is the way in which family members can organize, prepare, and preserve the integrity of the family system without losing sight of the task.     

Commentary on education and training for mental health administration

The diversity of administrative positions indicates that future training programs may need to be tailored to the specifics of the job and to the special environment in which the administrator must function. This article explores the issues of training administrators, i.e., who should lead, preparation for the different roles administrators must assume, and anticipation of physical and mental stress. Suggestions, are offered for the reduction of administrative stress.     

Protein aggregation,misfolding and consequential human neurodegenerative diseases

Proteins are major components of the biological functions in a cell. Biology demands that a protein must fold into its stable three-dimensional structure to become functional. In an unfavorable cellular environment, protein may get misfolded resulting in its aggregation. These conformational disorders are directly related to the tissue damage resulting in cellular dysfunction giving rise to different diseases. This way, several neurodegenerative diseases such as Alzheimer, Parkinson Huntington diseases and amyotrophic lateral sclerosis are caused. Misfolding of the protein is prevented by innate molecular chaperones of different classes. It is envisaged that work on this line is likely to translate the knowledge into the development of possible strategies for early diagnosis and efficient management of such related human diseases. The present review deals with the human neurodegenerative diseases caused due to the protein misfolding highlighting pathomechanisms and therapeutic intervention.     

Psychoanalysis, creativity, and hope: forward edge strivings in the life and work of choreographer Paul Taylor

Psychoanalysis and creativity are not interchangeable enterprises; however, both creativity and psychoanalysis promise the hope of transformation. But hope may be fragile. Healthy aspects of self may hide and diminish hope to protect it against invasion from toxic pathological patterns. Hope may be rekindled by an empathically responsive environment and the reengagement of healthy forward edge strivings. Psychoanalysis illustrates creativity as a conduit for hope. Modern dance choreographer Paul Taylor's 1988 autobiography, Private Domain, describes Taylor's hope and strivings through creative engagement. Unfortunately, when Taylor's body inevitably falters after years of performing, he is unprepared psychologically to cope successfully. Taylor's sense of self begins to fragment and his forward edge strivings to decay. Eventually, Taylor collapses on stage from drug addiction and illness; his performing career crashes to an end. Taylor must search for his forward edge strivings with hope. Psychoanalysis illuminates Taylor's journey to find hope, motivation, meaningful intention, and transformation through creativity and dance-making.     

Known and unexpected constraints evoke different kinematic,muscle, and motor cortical neuron responses during locomotion

During navigation through complex natural environments, people and animals must adapt their movements when the environment changes. The neural mechanisms of such adaptations are poorly understood, especially with respect to constraints that are unexpected and must be adapted to quickly. In this study, we recorded forelimb‐related kinematics, muscle activity, and the activity of motor cortical neurons in cats walking along a raised horizontal ladder, a complex locomotion task requiring accurate limb placement. One of the crosspieces was motorized, and displaced before the cat stepped on the ladder or at different points along the cat's progression over the ladder, either towards or away from the cat. We found that, when the crosspiece was displaced before the cat stepped onto the ladder, the kinematic modifications were complex and involved all forelimb joints. When the crosspiece displaced unexpectedly while the cat was on the ladder, the kinematic modifications were minimalistic and primarily involved distal joints. The activity of M. triceps and M. extensor digitorum communis differed based on the direction of displacement. Out of 151 neurons tested, 69% responded to at least one condition; however, neurons were significantly more likely to respond when crosspiece displacement was unexpected. Most often they responded during the swing phase. These results suggest that different neural mechanisms and motor control strategies are used to overcome constraints for locomotor movements depending on whether they are known or emerge unexpectedly.     

Chronic medical complications of drug abuse

The wide array of chronic medical and dental complications of drug abuse make a thorough working knowledge mandatory for the physician treating patients with addictive illness. The patients must be examined with these disorders in mind and when any drug related illness is found, it must be treated immediately. Detection and treatment of the chronic medical disorders of drug abuse is one critical part of the complex procedures necessary for the comprehensive evaluation of the chronically drug-abusing patient. The other procedures must include: control of the patient's environment; detection and treatment of acute medical complaints; laboratory testing; stabilization of medications; detoxification; and complete psychiatric evaluation before final treatment decisions are made and the patient is triaged to the most appropriate treatment unit.     

ASSESSMENT OF CHILDREN FOR PSYCHO DYNAMICALLY ORIENTED PSYCHOTHERAPY

ABSTRACT

The ideas presented for consideration are based broadly on Object Relation Theory. According to this theory, development and disturbance are essentially the outcome of the inherited potential helped or hindered by the facilitating environment. Therefore any assessment must comprehensively explore both the child's external as well as internal environment. This combined information helps to give an estimate of the strengths and vulnerabilities in both the child and his/her environment. It is on the balance of these factors that psychotherapy may or may not be recommended.     

Sensory transmission in the gastrointestinal tract

Abstract  The gastrointestinal (GI) tract must balance ostensibly opposite functions. On the one hand, it must undertake the process of digestion and absorption of nutrients. At the same time, the GI tract must protect itself from potential harmful antigenic and pathogenic material. Central to these processes is the ability to 'sense' the mechanical and chemical environment in the gut wall and lumen in order to orchestrate the appropriate response that facilitates nutrient assimilation or the rapid expulsion through diarrhoea and/or vomiting. In this respect, the GI tract is richly endowed with sensory elements that monitor the gut environment. Enteric neurones provide one source of such sensory innervation and are responsible for the ability of the decentralized gut to perform complex reflex functions. Extrinsic afferents not only contribute to this reflex control, but also contribute to homeostatic mechanisms and can give rise to sensations, under certain circumstances. The enteric and extrinsic sensory mechanisms share a number of common features but also some remarkably different properties. The purpose of this review is to summarize current views on sensory processing within both the enteric and extrinsic innervation and to specifically address the pharmacology of nociceptive extrinsic sensory pathways.     

The architectural design of a psychotherapeutic milieu.

The physical environment of a treatment program affects patient outcome, but how and to what degree is not known. However, decisions about the design of the environment must be made, and they must be made in the face of cost and building-code constraints and widely varying patient characteristics and treatment models. The authors describe the design principles and philosophies they followed in the remodeling of an in-patient treatment and research service in a university psychiatric hospital and indicate where cost and code constraints resulted in a less than ideal solution. They point out that many apparent amenities, such as a ward kitchen, are significant milieu therapy resources, and they advocate the involvement of all levels of staff in the planning process.     

A three-dimensional treatment programme for chronic pain

ABSTRACT – The treatment of chronic pain contains several problems such as ineffectiveness, side effects and drug dependence. The concepts of respondent and operant pain are introduced, together with a general operant learning model for analysis and treatment of psychological problems. To make a psychological analysis of pain, evidence for learned pain behaviour must be assessed, reinforcers for treatment revealed, goal behaviours set up, and support in the environment secured. In the further analysis, account must be taken to a) time pattern of pain, b) pain behaviour, c) reactions from the environment, d) pain activators, e) pain reducers, f) the effect of tension versus relaxation on pain, and g) changes in the family structure necessary because of the pain problem. A three-dimensional operant treatment programme for chronic pain is presented. It consists of 1) reduction of medication, 2) increase of activity, and 3) reduction of pain behaviour. Results, supporting the efficacy of the model, are presented.     

Sensory transmission in the gastrointestinal tract

Abstract The gastrointestinal (GI) tract must balance ostensibly opposite functions. On the one hand, it must undertake the process of digestion and absorption of nutrients. At the same time, the GI tract must protect itself from potential harmful antigenic and pathogenic material. Central to these processes is the ability to ‘sense’ the mechanical and chemical environment in the gut wall and lumen in order to orchestrate the appropriate response that facilitates nutrient assimilation or the rapid expulsion through diarrhoea and/or vomiting. In this respect, the GI tract is richly endowed with sensory elements that monitor the gut environment. Enteric neurones provide one source of such sensory innervation and are responsible for the ability of the decentralized gut to perform complex reflex functions. Extrinsic afferents not only contribute to this reflex control, but also contribute to homeostatic mechanisms and can give rise to sensations, under certain circumstances. The enteric and extrinsic sensory mechanisms share a number of common features but also some remarkably different properties. The purpose of this review is to summarize current views on sensory processing within both the enteric and extrinsic innervation and to specifically address the pharmacology of nociceptive extrinsic sensory pathways.     

Child and adolescent psychopharmacology in the new millennium: a workshop for academia, industry, and government

OBJECTIVE: To give academic researchers, government officials, and industry scientists an opportunity to assess the state of pediatric psychopharmacology and identify challenges facing professionals in the field. METHOD: Increased federal spending and the introduction of pediatric exclusivity led to large increases in pediatric psychopharmacology research in the 1990s. Despite the increase in research, concerns exist about methods and incentives for making new medications available for use in pediatric psychiatric disorders. In recognition of these concerns, the Duke Clinical Research Institute held a roundtable in September 2004. Participants from the National Institutes of Health, regulatory agencies, academia, and the pharmaceutical industry spoke about the effects of government regulations such as the U.S. Food and Drug Administration Modernization Act and the Pediatric Research Equity Act on pediatric research from academic, clinical, and industry perspectives, and bioethical considerations of such research. CONCLUSIONS: To ensure development of new drugs for treating psychiatric disorders in children and adolescents, we must address the challenges posed by the regulatory environment governing pediatric psychopharmacology research. Strategies were identified for improving the evidence base for psychopharmacologic interventions in youth before widespread use and for more effectively defining a research agenda for the future.     

Treatment of the Stress Casualty during Operation Iraqi Freedom One

Introduction: Service members with mental health issues during Operation Iraqi Freedom receive evaluation and treatment at different echelons of care. Mental health teams consist of professionals and paraprofessionals assigned to Combat Stress Control units, Division Mental Health Sections, and Combat Support Hospitals. Methods: Army doctrine for mental health care is delineated and examples describing how mental health personnel must be flexible in this challenging environment and are useful mental health tools for commanders in the operational environment are presented. Discussion: Specific treatment issues related to the combat environment during Operation Iraqi Freedom are discussed in relation to each team and in light of doctrine.     

Hypothermie aux antipsychotiques : particularités chez le sujet âgé souffrant de schizophrénie

Hypothermia - an adverse drug reaction of antipsychotic drug use potentially severe - seems less well-known than the hyperthermic effects (for example, malignant neuroleptic syndrome) and thus underdiagnosed. Thermoregulation in elderly can be altered. Additionally, some patients suffering from schizophrenia are not able to control their own environment or physical status. Thus, risk factors for hypothermia must be identified and frequent measurements of body temperature must be performed in order to detect developing hypothermia. A case report of hypothermia in a 69 years old patient suffering from schizophrenia is published with this review.     

Information systems in human services: Misconceptions,deceptions, and ethics

The primary purpose of this report is to expand the arena of concern for administrators employing management information systems to meet the current demands for accountability and evaluative research. Three major areas regarding information systems are discussed: accountability, assumed and functional characteristics, and ethical considerations. The following major points for each area are described. Accountability: Specifying accountability has become more difficult, since service organizations have become more complex and, consequently, defining accountability as a synonym for responsibility is no longer adequate. Who is accountable requires a clear specification of any number of service recipients (e.g., funding sources, clients, society). In addition, services must be demonstrated rigorously, cost-beneficial, open to independent review, and publicly reported. Characteristics of Information Systems: Agencies required to furnish documentation of services (accountability) have applied information systems designed for use in profit-oriented enterprises to nonprofit systems. However, the translation is not isomorphic. Little if any evaluation of information systems per se, or their application to nonprofit enterprises, has occurred. The behavior of individuals using MISs is controlled by contingencies that may have relatively good short-term effects, but that may produce more negative long-term consequences. MISs used solely to document process and not outcome may help to shape beneficial evaluation efforts, although the transition from process to outcome evaluation must be considered. An information system is more than an information-processing device. It is one component of a complex environment that comes to control the behavior of individuals operating in a system. It should be analyzed accordingly, in terms of three-term contingency arrangements. Ethical Considerations: Designers and users of information systems should be aware of the following ethical concerns. 1. Responsibility for understanding the objectives of the system, the objectives of the systems purchaser, the validity and reliability of data with respect to objectives, the limitations of the system and the relationship of organizational goals to personal goals. 2. Confidentiality with regard to disclosure requirements, and the use of personal data to document accountability requirements. 3. Client welfare relationships between management, staff, and the systems designer. 4. Information systems are designed to create change. Users must be aware of consequences to those the system will impact, whether the impact is intentional or not.James C. Noah is an Assistant Professor, Department of Psychology, West Virginia University.     

A change of paradigms--an empowerment,a challenge for ambulatory psychiatry

If one changes the paradigm--what should be changed, what has been changed? Even today, the number of beds at the department head's disposal represents power. Is power the purpose of psychiatry? Rather isn't the purpose the adequate treatment of a mentally impaired persons, about adequate support in a natural environment? In our society, and in particular in psychiatry, the striving for power must be questioned. Our memory of the deportation and the disappearance of mentally ill, of the extermination of "unworthy life", of Hartheim, Grafeneck and Brandenburg is still too fresh. It is imperative to convey the idea of a life worth living even then when this seems hopeless to us. Outpatient psychiatric care has bid farewell to outdated conventional structures, which in their time under certain social conditions had proven not to be unreasonable. Outpatient psychiatric care is about the rediscovery of a sense of life that gives reason for hope. Only the joint contemplation of new resources can bring us forward.     

Stress,burnout, and job dissatisfaction in mental health workers

As the industrial world has transformed toward a service economy, a particular interest has developed in mental health problems at the workplace. The risk for burnout is significantly increased in certain occupations, notably for health care workers. Beyond the effects of an extensive workload, many working hours, or long night shifts, the medical field has specific stressors. Physicians work in emotionally demanding environments with patients, families, or other medical staff. They must make quick decisions while faced with a quite frequent information overload. All of these stressors have to be weighed against a rapidly changing organizational context within medicine. Today, economics objectives have priority over medical values in health care. In principal, mental health workers should experience similar work stressors and the same contextual factors as health professionals from other medical disciplines. However, several studies have identified stressors that are unique to the psychiatric profession. These challenges range from the stigma of this profession, to particularly demanding relationships with patients and difficult interactions with other mental health professionals as part of multidisciplinary teams to personal threats from violent patients. Other sources of stress are a lack of positive feedback, low pay, and a poor work environment. Finally, patient suicide is a major stressor, upon which a majority of mental health workers report post-traumatic stress symptoms.

     

Is there structural specificity in the reversible protein aggregates that are stored in secretory granules?

There are several steps that must occur for secretory granules to form: (1) Secretory proteins that make up the dense cores of the granules must be concentrated; (2) membrane proteins necessary for granule function must accumulate in the correct location; and (3) inappropriate membrane proteins and excess membrane must be removed. Reversible aggregation of secretory granule proteins provides a mechanism for concentrating and sorting these proteins. There is specificity in the way secretory granule proteins are treated in cells that make granules. The specificity has been shown in some cases to occur after the aggregation process, so that granules containing different aggregates function differently. An explanation could be that a property of the aggregate, such as a surface motif, might influence the accumulation of membrane proteins necessary for granule function. Such a conclusion implies that the aggregates are not amorphous but have structure. Use of NMR spectroscopy to investigate changes in the environment of amino acid residues in secretory granule proteins as they form oligomers by using 15N relaxation times might provide a means to determine which residues are specifically involved in aggregation.