Recovery-based practice: do we know what we mean or mean what we know?

The concept of recovery is now widely promoted as the guiding principle for the provision of mental health services in Australia and overseas. While there is increasing pressure on service providers to ensure that services are recovery oriented, the way in which recovery-based practice is operationalized at the coalface presents a number of challenges. These are discussed in the context of five key questions that address (i) the appropriateness of recovery as a focus for service delivery, (ii) the distinction between recovery as a process and an outcome, (iii) the assessment of recovery initiatives, (iv) the alignment of recovery with current service delivery models, and (v) the risks associated with recovery-based practice. It is argued that these questions provide a framework for a debate that must extend beyond patients and providers of mental health services to the broader public, whose attitudes will ultimately determine the possibilities and limits of recovery-oriented practice.     

Measuring anxiety: are we getting what we need?

This article discusses several studies describing either the reevaluation and validation of existing scales for measuring anxiety (i.e., the Spielberger Trait Anxiety Inventory, the Liebowitz Social Anxiety Scale for adults and for children and adolescents, the Clinical Global Impression Scale, the Self-Rating Inventory for Posttraumatic Stress Disorder, and the Yale-Brown Obsessive Compulsive Scale Symptom Checklist), or the development and validation of new scales (i.e., the Social Thoughts and Beliefs Scale, the Social Phobia Diagnostic Questionnaire, the Aberdeen Trauma Screening Index and the Health Anxiety Inventory). As an increasing number of rating scales have been developed over the past several years, a critical review of their usefulness and psychometric properties seems pertinent and prudent.     

Have we met?

Over 160 adults attending day workshops for people with mental handicap were interviewed regarding the persons they had talked to in the community and who was usually with them on these occasions. The number of community contacts was heartening, with most occurring around the neighbourhood, fewer in the city, and least of all at home. However, there were only three groups of people with whom the majority of respondents had recent contact – local shopkeepers, bus conductors, and chemists. In general, community contacts were rarely in the company of friends – cinema-going was the only exception. Usually they were with their family, or alone. Results from surveys of this type can help to establish the effectiveness of our social education programmes, can challenge parental assumptions about their son or daughter's abilities, and can identify groups within the community who would best benefit from guidance on how to interact with a person who is mentally handicapped.     

Schizophrenia today: what do we know-and how sure are we?

The growth of our understanding of the biology and treatment of schizophrenia is still very much a work in progress. In this article, which introduces a series of papers presented at a conference entitled "Schizophrenia: Doing the Right Thing Well," held at Northcoast Behavioral Healthcare System (Cleveland, May 2000), the authors provide a short overview of what is known about schizophrenia today. He briefly reviews findings concerning epidemiology, phenomenology and course, neurobiology, and treatment, and highlights some of the most significant findings to date as well as areas needing further research. Early evaluation and treatment, in advance of the florid presentation of the illness, offer much hope, but only if our knowledge of the diagnostic specificity of prodromal and neurodevelopmental precursors can be enhanced. Significant advances in medication treatment have been made, and the newer antipsychotic medications overall have a more benign adverse-effect profile than the older agents, although the specter of endocrine/metabolic complications looms as a significant long-term concern. The authors conclude that, although many advances in our understanding of the etiology and treatment of schizophrenia have been made, much remains to be learned.     

Gephyrin: where do we stand, where do we go?

Gephyrin is a multifunctional protein responsible for molybdenum cofactor synthesis and the clustering of glycine and GABA(A) receptors at inhibitory synapses. Based on the structure of its two conserved domains, G and E, gephyrin is thought to form a hexagonal lattice serving as a scaffold for accessory proteins at postsynaptic sites. However, important aspects of gephyrin gene expression, protein structure and regulation, as well as the role of gephyrin in synapse formation and plasticity, remain poorly understood. Here we review the current state of knowledge about gephyrin, highlighting new research avenues based on a different structural model and a revised nomenclature for gephyrin splice variants. Unraveling the biology of gephyrin will further our understanding of glycinergic and GABAergic synapses in health and disease.     

Why do we sleep?

Slow-wave sleep consists in slowly recurring waves that are associated with a large-scale spatio-temporal synchrony across neocortex. These slow-wave complexes alternate with brief episodes of fast oscillations, similar to the sustained fast oscillations that occur during the wake state. We propose that alternating fast and slow waves consolidate information acquired previously during wakefulness. Slow-wave sleep would thus begin with spindle oscillations that open molecular gates to plasticity, then proceed by iteratively 'recalling' and 'storing' information primed in neural assemblies. This scenario provides a biophysical mechanism consistent with the growing evidence that sleep serves to consolidate memories.     

The working alliance: Where are we and where should we go?

This article describes important findings that have emerged from decades of research on the working alliance, as well as some of the clinical implications of these findings. In addition, future directions of research on this construct are suggested. Our hope is that this article will provide useful heuristics for better understanding the alliance, the therapeutic relationship more broadly, and the process of therapeutic change in general. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Genetic screening for susceptibility to depression: can we and should we?

OBJECTIVE: To summarize current knowledge about genetic susceptibility to mood disorders and examine ethical and policy issues that will need to be addressed if robustly replicated susceptibility alleles lead to proposals to screen and intervene with persons at increased genetic risk of developing mood disorders. METHOD: Empirical studies and reviews of the genetics of unipolar and bipolar depression were collected via MEDLINE and psycINFO database searches. RESULTS: A number of candidate genes for depression have been identified, each of which increases the risk of mood disorders two- or threefold. None of the associations between these alleles and mood disorders have been consistently reported to date. CONCLUSIONS: Screening the population for genetic susceptibility to mood disorders is unlikely to be a practically useful policy (given plausible assumptions). Until there are effective treatments for persons at increased risk, screening is arguably unethical. Screening within affected families to advise on risks of developing depression would entail screening children and adolescents, raising potentially serious ethical issues of consent and stigmatization. Genetic research on depression should continue under appropriate ethical guidelines that protect the interests of research participants.     

Do we need theory?

In response to the question raised by Lindon in his paper, "Does Technique Require Theory?" the author replies in the affirmative, arguing that theory is inherently involved in the application of psychoanalytic treatment. In contrast to Lindon's view that theory must be downplayed in treatment, the author contends that this perspective is itself part of a theory--the intersubjective theory of self psychology. The author concludes that theory provides numerous benefits to therapists; indeed, Lindon's own account suggests the value of the sensitive use of theory.