Hermann Simon--reformer of psychiatry,social Darwinist,and National Socialist?

Hermann Simon (1867-1947) was shaped in his psychiatric thinking and views of society by the German empire. He showed a strongly conservative attitude and thought in ethnic-nationalistic terms. Beginning in 1905 and drawing on practical experience, he developed the concept of a "more active therapy." Simon perceived patients in a holistic way, regarding them not so much as sick people but as fellow men. He believed in the ability of a healthy personality to practice responsible and "well ordered self determination." Thus he defined the role of the doctor in a new way. Within Germany as well as internationally, active therapy was well-received, especially because of its positive effect on the atmosphere within asylums. In the context of reform of so-called open care during the Weimar epoch, Simon's approach was perceived in a new way because it allowed individual views of each patient, enabling assessment of the ability to work and chances for release. Simon himself set his concept in a "biological" and psychological context, based on his own biologistic and social Darwinistic world view. This view was open for eugenic, racial hygienic concepts, and fundamental criticism of welfare policy. It was only a short step from this conservative tenor, understanding of the state, and biologistic thinking to his open acclaim of Hitler and National Socialist (Nazi) racist policy.     

Are alexithymia, ambivalence over emotional expression, and social insecurity overlapping constructs?

OBJECTIVE: The aim of the present study was to analyze the relationship and differential validity of three constructs related to reduced emotional expression. METHODS: One hundred six patients of a psychosomatic clinic completed questionnaires assessing alexithymia (TAS-20, BVAQ), ambivalence over emotional expression (AEQ-G18), and social insecurity (UQ). RESULTS: A second-order principal component analysis with the scales of all questionnaires yielded three factors and revealed that the scale Competence Ambivalence assessed by the AEQ-G18 loaded on the same factor as the TAS-20 and BVAQ scales measuring Difficulties Describing and Identifying Feelings. A high correlation between the factor Social Insecurity (composed of all UQ scales) and the factor Difficulty Identifying and Describing Feelings (composed of BVAQ, TAS-20, and AEQ-G18 scales) was found. In contrast to this, the factor Emotionalizing and External Thinking showed only low correlations with the remaining factors. CONCLUSION: The results of the present study did not support the view that the alexithymia facets related to difficulties identifying and describing feelings and Competence Ambivalence are distinct constructs, when measured by self-report. This might be explained by methodological problems with the assessment of alexithymia and ambivalence. Furthermore, the results indicate that social insecurity is strongly related with the "difficulty identifying and describing feelings" facets of alexithymia and with effect ambivalence.     

Children’s mental health service use,neighbourhood socioeconomic deprivation,and social capital

Background: There is accumulating evidence that the shared social environment at the neighbourhood level exerts significant effects on health over and above individual level variables. The aim of this study was to assess the interactive influence of neighbourhood measures of socioeconomic deprivation and social capital (i. e. informal social control, social cohesion and trust) on childrens mental health service use, independent of individual level confounders.Methods: Two different data sources were used: 1) individual socioeconomic measures, derived from a case-control study in which case/control status indicated mental health service use or not, and 2) neighbourhood measures of socioeconomic deprivation and social capital. The data were subjected to multilevel logistic regression analysis.Results: Children living in more deprived neighbourhoods run a higher risk of coming into contact with mental health care services. The social capital variables (informal social control and social cohesion and trust) did not exert main effects, but strong trust and social cohesion between citizens in the neighbourhood mitigated the risk-increasing effect of socioeconomic deprivation on childrens mental health service use.Conclusions: The deleterious effects of socioeconomic deprivation on mental health service use in children are sensitive to the context of cohesion and trust in neighbourhoods. Effects of deprivation on childrens mental health cannot be interpreted without taking into account the context of social capital.     

Affiliative and “self-as-doer” identities: Relationships between social identity,social support,and emotional status amongst survivors of acquired brain injury (ABI)

Social support is an important factor in rehabilitation following acquired brain injury (ABI). Research indicates that social identity makes social support possible and that social identity is made possible by social support. In order to further investigate the reciprocity between social identity and social support, the present research applied the concepts of affiliative and “self-as-doer” identities to an analysis of relationships between social identity, social support, and emotional status amongst a cohort of 53 adult survivors of ABI engaged in post-acute community neurorehabilitation. Path analysis was used to test a hypothesised mediated model whereby affiliative identities have a significant indirect relationship with emotional status via social support and self-as-doer identification. Results support the hypothesised model. Evidence supports an “upward spiral” between social identity and social support such that affiliative identity makes social support possible and social support drives self-as-doer identity. Our discussion emphasises the importance of identity characteristics to social support, and to emotional status, for those living with ABI.     

Family social support,community “social capital” and adolescents’ mental health and educational outcomes: a longitudinal study in England

Purpose  

To examine the associations between family social support, community “social capital” and mental health and educational outcomes.     

APOE ϵ4 allele carriers: Biological,psychological, and social variables associated with cognitive impairment

Objective: The apolipoprotein (APOE) ε4 allele genotype is a risk factor for dementia, but not all people with the APOE ε4 allele develop cognitive impairment (CI). Among participants with the APOE ε4 allele (N = 664), we identified biological, psychological, and social variables that discriminate between participants who develop CI from those who do not. We then determined if these variables predicted CI in noncarriers (N = 1421). In the sample as a whole we then determined if each of these identified variables moderate the relationship between the APOE ε4 allele and CI.

Methods: We used data from a biracial community-dwelling sample of older adults. Data were collected at four time points over a 10-year period. Cognitive functioning was assessed at each wave, using the Short Portable Mental Status Questionnaire (SPMSQ). APOE genotyping was performed at Wave 3.

Results: Among APOE ε4 allele carriers, but not noncarriers, variables associated with CI included white race, female gender, low BMI, number of negative life events, and health problems (high blood pressure, heart disease, and stroke). In analyses testing for moderate effects and including the entire sample, significant interactions with APOE ε4 allele and predictor variables revealed that white race, low BMI, stroke, heart disease, and negative life events had a greater effect on CI among those with the APOE ε4 allele compared to those without the allele. Conclusion: There are biological, psychological, and social variables associated with increased risk for CI among individuals with the APOE ε4 allele.     

The social interview schedule (SIS) — content,structure and reliability

Summary The English original form of a standardized social interview was presented by Clare and Cairns (1978). The German version is described with regard to concept, structure, and methodology. The interview is designed to assess social maladjustment by measuring three conceptual categories (Objective Material Conditions, Social Management, and Satisfaction) in eight role areas. The instrument is especially suited for outcome assessment in various clinical and non-clinical populations and takes an average of about 30–45 min to complete. The 39 items are rated on 4-point scales either by the interviewer with the help of an extensive rating manual, or by the subject himself (all Satisfaction items). The results of a reliability study are presented using both the test-retest and the interrater method. In general, the results show that the instrument is satisfactorily reliable, but some possible weaknesses are discussed. Finally, the structure of the instrument is examined by an analysis of interrelationships between the items in a normal population sample. The results are discussed with regard to questions of score construction.     

Unemployment, social isolation, achievement–expectation mismatch and psychosis: findings from the ÆSOP Study

INTRODUCTION: In this study, we aimed to establish: (1) whether social isolation modifies the effect of unemployment on first episode psychosis and duration of untreated psychosis (DUP); and (2) whether the gap between high employment expectations and perceived poor employment achievement is associated with first-episode psychosis; and (3) whether the relationship of this achievement-expectation gap and first-episode psychosis is strongest in the African-Caribbean population. METHOD: All patients with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in south-east London and Nottingham over a 2-year period were included in the study. A random sample of healthy participants living within the same catchment areas was also recruited. Data were collected on socio-demographic and clinical characteristics, DUP, social contacts, and perceived levels of employment achievement and expectation. Analysis was conducted on data of 546 participants (224 cases, 322 controls) from the AESOP study. RESULTS: The relationship between unemployment and risk of non-affective psychosis was moderated by social contacts (unemployed/low social contacts, OR 7.52, 95% CI 2.97-19.08; unemployed/medium social contacts, OR 3.27, 95% CI 1.66-6.47; unemployed/high social contacts, OR 1.36, 95% CI 0.47-3.93). Unemployed patients experienced a longer DUP when having reported lower levels of social contacts. Participants whose employment achievement was lower than their expectations were more likely to be cases than those in whom achievement matched or exceeded expectations (adjusted OR 1.84, 95% CI 1.13-3.02). This applied equally to both African-Caribbean and White British participants (the Mantel-Haenszel test for homogeneity of odds ratios, chi (2 )= 0.96, P = 0.33). CONCLUSIONS: This study suggests that unemployment, social isolation, employment achievement and expectations are important environmental factors associated with risk of psychosis. More attention needs to be focused on interactions between environmental factors as well as subjective experience of those factors in future research on the aetiology of psychosis.     

Associations of familial risk factors with social fears and social phobia: evidence for the continuum hypothesis in social anxiety disorder?

We examined parental psychopathology and family environment in subthreshold and DSM-IV threshold conditions of social anxiety disorder (SAD) in a representative cohort sample of 1,395 adolescents. Offspring and parental psychopathology was assessed using the DIA-X/M-CIDI; recalled parental rearing and family functioning via questionnaire. Diagnostic interviews in parents were supplemented by family history reports from offspring. The cumulative lifetime incidence was 23.07% for symptomatic SAD, and 18.38 and 7.41% for subthreshold and threshold SAD, respectively. The specific parent-to-offspring association for SAD occurred for threshold SAD only. For subthreshold and threshold SAD similar associations were found with other parental anxiety disorders, depression and substance use disorders. Parental rearing behaviour, but not family functioning, was associated with offspring threshold SAD, and although less strong and less consistent, also with subthreshold SAD. Results suggest a continued graded relationship between familial risk factors and offspring SAD. Parental psychopathology and negative parental styles may be used defining high-risk groups to assign individuals with already subthreshold conditions of SAD to early intervention programs.     

Which future for social psychiatry?

Social psychiatry started over a century ago under the auspices of mental and racial hygiene, but after World War II it embraced concepts of community-based care and de-institutionalization. The major psychiatric reforms in the second half of the last century were mainly based on such concepts, including the reforms of Swiss and especially Zurich psychiatry. The present needs for psychiatric care, and the specific political and economic conditions for a continuation along this line are explored and found to be favourable. Also, the profile of future psychiatrists, as formulated by professional associations and expert groups, corresponds to concepts of social psychiatry. The World Health Organization stimulates service improvements in the same direction. The consequences concern the education and training, and the professional role of future psychiatrists. Finally, the future of social psychiatry will be shaped by public expectations and acceptance of community-based services.     

Mental state attribution, neurocognitive functioning, and psychopathology: what predicts poor social competence in schizophrenia best?

BACKGROUND: Research into mental state attribution has repeatedly shown that patients with schizophrenia are impaired in their capacity to reflect upon their own and others' beliefs, knowledge and intentions, with important confounds being executive functioning, intelligence, duration of illness, and medication. Furthermore, the extent to which impaired mental state attribution, neurocognition and psychopathology explain abnormal social behavior in schizophrenic patients has been a matter of debate. We sought to determine whether mental state attribution in schizophrenia predicts poor social competence better than "non-social" cognitive factors or psychopathology. METHODS: Intelligence, executive functioning, mental state attribution, psychopathology and social behavior were assessed in 38 patients diagnosed with schizophrenia according to DSM-IV criteria and compared with 29 healthy controls paralleled for age and sex. All patients received antipsychotic treatment, and all participants had no history of substance abuse or traumatic brain injury. RESULTS: In the entire schizophrenia group impaired mental state attribution alone accounted for about 50% of the variance of deviant social behavior, whereas the PANSS positive score and the duration of illness contributed an additional small amount of variance. This effect was even more pronounced in a subgroup of patients with at least normal intelligence, where neither the PANSS score nor the chronicity of the disorder remained significant predictors of poor social competence. Medication was not associated with any one of the neurocognitive measures including mental state attribution, psychopathology or social behavior. CONCLUSIONS: Impaired capacity to appreciate one's own and others' mental states is the single-best predictor of poor social competence in schizophrenia, and should perhaps be included in future definitions of the "core" symptomatology of schizophrenic disorders.     

Danger of social breakdown: compulsory admission, but not treatment? A case study

Compulsory treatment is permitted (article 38 paragraph 5 Bopz (the Act on Special Admissions to Psychiatric Hospitals in the Netherlands)) if this is necessary for preventing danger to the patient or other persons and if this danger arises from impairment of the patient's mental functioning. Two patients are described in which compulsory drug treatment was considered on the grounds that the patients were in danger of social breakdown if they remained without hope or perspectives in a psychiatric hospital. The court ruled that that danger was insufficient to justify compulsory drug treatment. The authors are of the opinion that a stay in hospital with no hope or perspectives constitutes social breakdown and that the compulsory drug treatment should be applied.     

Depressive comorbidity of panic, social phobic, and obsessive-compulsive disorders re-examined: is there a bipolar II connection?

Utilizing the DSM-III-R schema, we have investigated lifetime comorbidity between panic disorder with or without agoraphobia (PD), social phobia (SP) and obsessive-compulsive disorder (OCD) on the one hand, and mood disorder on the other. Compared with PD, the results for SP and OCD showed significantly higher numbers of comorbid anxiety and mood disorders. In addition, SP and OCD were significantly more likely to cooccur with each other than with PD. The complexity of these comorbid patterns is underscored by the finding of significantly higher numbers of anxiety disorders in those with lifetime comorbidity with bipolar (especially bipolar II) disorder. We conclude that the comorbidity between anxiety and mood disorders - conventionally conceived as the relationship between anxiety and unipolar depressive states -- might very well extend into the domain of bipolar spectrum disorders in a subset of these disorders. Among the latter, the spontaneous or antidepressant-induced switches into brief disinhibited (hypomanic) behavior can be conceptualized to lie on a dimensional continuum with the temperamental inhibition (or constraint) underlying the anxiety disorders under discussion. These findings and theoretical considerations have important therapeutic implications.     

Do trauma type,stressful life events,and social support explain women veterans’ high prevalence of PTSD?

Objectives

To examine factors that account for women veterans’ higher prevalence of past-year DSM-5 posttraumatic stress disorder (PTSD) compared to women civilians and men veterans.

Methods

Cross-sectional analyses of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Face-to-face interviews with 379 women veterans, 20,007 women civilians, and 2740 men veterans were conducted. Trauma type (child abuse, interpersonal violence, combat or war zone, and other), number of trauma types, past-year stressful life events, current social support, and DSM-5 PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Generalized linear models were used that accounted for the complex survey design.

Results

Women veterans had a higher unadjusted prevalence of past-year PTSD (11.40%) compared to their civilian (5.96%) and male (5.19%) counterparts. Individual predictor models indicated that the difference between women veterans’ and civilians’ prevalence of PTSD was attenuated when adjusting for number of trauma types, whereas the difference between men and women veterans was attenuated when adjusting for child abuse, interpersonal violence, and stressful life events. Nonetheless, while full adjustment in a multiple predictor model accounted for the difference in PTSD between women veterans and civilians, gender differences between men and women veterans remained.

Conclusions

Number of trauma types, type of trauma, and social factors may together help explain women veterans’ higher PTSD prevalence compared to women civilians, but do not fully account for differences between men and women veterans. Results highlight a need to explore additional explanatory factors and evaluate associations with longitudinal data.

     

Could schizophrenic subjects improve their social cognition abilities only with observation and imitation of social situations?

Schizophrenics display impairments in domains of social cognition such as theory of mind and emotion recognition. Recent studies, showing that the relationship of social cognition abilities with functional outcome is more significant than other neuro-cognitive functions, have considered these abilities as a target for intervention research. This article describes preliminary data from a new group-based study focused on Emotion and ToM Imitation Training (ETIT), an imitation treatment aimed at improving social cognition and social functioning in schizophrenia.

In the present study, 16 outpatients with schizophrenia completed ETIT assessment and were compared with 17 outpatients who participated to a Problem Solving Training group. Participants were assessed at pre- and post-test on measures of emotion recognition, theory of mind, cognition, flexibility and social functioning. We compared the rehabilitation training effects on neuro-physiological activation through the event-related potentials (ERPs) method, which was recorded pre- and post-rehabilitation training. The results showed that when compared to the control group, ETIT participants improved on every social cognitive measure and showed better social functioning at post-test. Improvement in social cognition, in particular in emotion recognition, is also supported by ERP responses: we recorded an increase in electroactivity of medio-frontal areas only after ETIT treatment. Action observation and imitation could be regarded as a new frontier in rehabilitation.     

Is there a complex relation between social anxiety disorder,childhood traumatic experiences and dissociation?

Background: A possible relationship has been suggested between social anxiety and dissociation. Traumatic experiences, especially childhood abuse, play an important role in the aetiology of dissociation.

Aim: This study assesses childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with social anxiety disorder (SAD).

Method: The 94 psychotropic drug-naive patients participating in the study had to meet DSM-IV criteria for SAD. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the Dissociation Questionnaire (DIS-Q), the Liebowitz Social Anxiety Scale (LSAS), and the Childhood Trauma Questionnaire (CTQ). Patients were divided into two groups using the DIS-Q, and the two groups were compared.

Results: The evaluation found evidence of at least one dissociative disorder in 31.91% of participating patients. The most prevalent disorders were dissociative disorder not otherwise specified (DDNOS), dissociative amnesia, and depersonalization disorders. Average scores on LSAS and fear and avoidance sub-scale averages were significantly higher among the high DIS-Q group (p?p?Conclusions: It is concluded that, on detecting SAD symptoms during hospitalization, the clinician should not neglect underlying dissociative processes and traumatic experiences among these patients.