McLean Hospital Research Articles

Differences in Lymphocyte Electron Transport Gene Expression Levels Between Subjects With Bipolar Disorder and Normal Controls in Response to Glucose Deprivation Stress

Bipolar disorder (BPD) is among the top 10 causes of disability worldwide. Recent findings on the etiology of the disease point to a disturbed mitochondrial energy metabolism in the brain of subjects with BPD. To test whether gene transcripts for proteins of the mitochondrial respiratory chain have altered levels in glucose-deprived lymphocytes from patients with BPD. Microarrays were used to measure gene expression levels in fresh lymphocytes and in lymphocytes cultured for 5 days in regular or low-glucose medium. Subjects with BPD were recruited through the Schizophrenia and Bipolar Disorders Program, McLean Hospital, Belmont, Mass. Controls were recruited through advertising. Patients A total of 21 patients with BPD (inpatients and outpatients) and 21 control subjects. Main Outcome Measure Expression levels for genes of proteins involved in mitochondrial respiration. We found an opposite molecular response of control and BPD lymphocytes to glucose deprivation. Whereas lymphocytes of normal controls responded to glucose deprivation with an up-regulation of nuclear transcripts for proteins of the electron transfer chain, subjects with BPD had a tendency to down-regulate these transcripts. The results suggest that the normal molecular adaptation to energy stress is deficient in lymphocytes from patients with BPD.

Postpsychiatry: Mental Health in a Postmodern World

Back to table of contents Previous article Next article Book ReviewFull AccessPostpsychiatry: Mental Health in a Postmodern WorldScott E. Provost M.M., M.S.W.Scott E. Provost M.M., M.S.W.Search for more papers by this authorPublished Online:1 May 2007https://doi.org/10.1176/ps.2007.58.5.718aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The President's New Freedom Commission on Mental Health called for a consumer-centered mental health system ( 1 ). Unfortunately, many consumers "find it little more than a vehicle for delivering medications, sometimes under the cloud of court orders" ( 2 ). Postpsychiatry represents a framework for mental health through the lens of critical psychiatry and consumer involvement in treatment. The authors are affiliated with the Centre for Citizenship and Community Mental Health, School of Health Studies, University of Bradford in the United Kingdom and specialize in hermeneutics, phenomenology, narrative, and community development. Concepts in this book were previously published in an article on critical psychiatry ( 3 ). The book contains ten chapters organized into three sections. The first section provides context about the mental health profession and how treatment is delivered to consumers. Section 2 reviews the philosophy of science, including the work of postmodern philosophers such as Foucault and Wittgenstein as applied to mental health practice. It also critiques current trends in psychiatry, including the perceived control that pharmaceutical companies exert on academic psychiatry through the marketing of medications for depression and schizophrenia. The final section describes the influence that narrative, recovery, community development, and consumer-centered social policies and programs can have on shaping postpsychiatry. This section contains examples of innovative community development and consumer empowerment programs, including the Soteria project developed to help individuals during acute psychotic episodes without the use of neuroleptic medication. In addition to the three main sections, the book also includes six fictional vignettes from a consumer perspective highlighting illustrative points. Overall, Postpsychiatry is quite relevant to readers of this journal. Themes in this book will resonate with those interested in comparative mental health policy, consumer empowerment, human rights, and action research. The authors also emphasize the importance of including humanities and cultural studies in medical education, which could be offered as a source of dissenting opinion for training in evidence-based psychiatry. To truly appreciate this book, it is helpful if the reader has an understanding of the philosophy of science. A drawback is that the book does not specifically include a concluding summary chapter. Although readers may argue that postpsychiatry is simply antipsychiatry, the authors assert that "postpsychiatry is our attempt to subdue the bright light of medical science: not because we want to get rid of or deny its benefits, but because we believe that the insights of other approaches are equally important and valuable. We hope that our critique of the central assumptions of the psychiatric canon will open a space in which other voices will be heard and taken seriously. We believe that these voices will hold the key to the future." Although the authors do not include any specific policy prescriptions, the postpsychiatry framework may help to engage clinicians, consumers, program managers, and policy makers in a dialogue about directions to take in transforming the mental health system.Mr. Provost is affiliated with the Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, Massachusetts.

Can’t Get Enough of That Dopamine

Can’t Get Enough of That Dopamine

Mental Illness Publications in Major Pastoral Care Journals from 1950 to 2003

The issue of mental illness has been of considerable interest to both of us over the past several years. The first author has taught a course on the subject for a decade, and his recent publications on the subject include several articles on John Nash (Capps, 2003b, 2004a,b, 2005b), a book on mental illness for pastoral care professionals (2005a), and an article on whether William James was a patient at McLean Hospital (2007). The second author has had experience with the mentally ill through his pastoral work at Trenton Psychiatrist Hospital in Trenton, New Jersey, a mental hospital with a rather checkered history (see Scull, 2005), and in Scotland and has also written an article on John Nash (Carlin, 2006). This shared interest, together with evidence that serious mental illness in America has been steadily increasing (Torrey & Miller, 2001, pp. 295–299), caused us to wonder what sort of attention mental illness has received in our major journals of pastoral care from 1950 to the present. Specifically, has this attention kept pace with the increase in mental illness?

This Changes Everything: The Relational Revolution in Psychology

This Changes Everything: The Relational Revolution in Psychology

The Price of a Gift: An Approach to Receiving Gifts from Patients in Psychiatric Practice

When a patient or patient's family presents a psychiatrist with a gift, the clinician is challenged to maintain appropriate professional boundaries but have the flexibility to respond with warmth and appreciation. The psychiatrist must consider such factors as the intention of the gift, its value to the patient, and the anticipated effect of accepting or refusing it on the patient and the treatment. Psychiatric practitioners are ethically obligated to consider patients' best interests when deciding about how to handle the offer of a gift. Ethical deliberations about such situations occur on a case-by-case basis and require careful analysis of how to promote the patient's best interest while adhering to professional ethics. In this article, members of the McLean Hospital Ethics Committee present a pragmatic model for managing the presentation of a gift from a patient or a patient's family member. The pragmatic model, which focuses on the practical results of accepting or declining the gift, minimizes the risk of exploiting the patient by accepting a gift or hurting the patient by declining it. We present five clinical cases that raise ethical dilemmas concerning patient gift giving in psychiatry and discuss each case from the standpoint of the pragmatic model.

Meeting Report: The First International Collaborative Symposium on Stem Cell Research, Seoul, Korea

DAVID WARBURTON, CHESTER KOH, HYUNG MIN CHUNG, KWANG RYUL CHA, KWANG-SOO KIM Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children’s Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, California, USA; CHA Stem Cell Institute, Pochon CHA University College of Medicine, Seoul, Korea; Molecular Neurobiology Laboratory, McLean Hospital and Harvard Stem Cell Institute, Harvard Medical School, Belmont, Massachusetts, USA

Epigenetic mechanisms expressed in basal ganglia GABAergic neurons differentiate schizophrenia from bipolar disorder

In the cerebral prefrontal cortex (PFC), DNA-methyltransferase 1 (DNMT1), the enzyme that catalyzes the methylation of cytosine at carbon atoms in position 5 in CpG dinucleotides, is expressed selectively in GABAergic neurons and is upregulated in layers I and II of schizophrenia (SZ) and bipolar disorder patients with psychosis (BDP). To replicate these earlier findings and to verify whether overexpression of DNMT1 and the consequent epigenetic decrease of reelin and glutamic acid decarboxylase (GAD) 67 mRNA expression also occur in GABAergic medium spiny neurons of the caudate nucleus (CN) and putamen (PT) of SZ and BDP, we studied the entire McLean 66 Cohort (Harvard Brain Tissue Resource Center, McLean Hospital, Belmont, MA) including SZ and BDP, which were matched with nonpsychiatric subjects. The data demonstrate that in GABAergic medium spiny neurons of CN and PT, unlike in GABAergic neurons of layer I and II PFC, the increased expression of DNMT1 and the decrease of reelin and GAD67 occur in SZ but not in BDP. This suggests that different epigenetic mechanisms must exist in the pathogenesis underlying SZ and BDP and implies that these disorders might involve two separate entities that are characterized by a well-defined neuropathology.

Changes in the Quality of Care for Bipolar I Disorder During the 1990s

Changes in the Quality of Care for Bipolar I Disorder During the 1990s

Zinc May Play Major Role In Mechanism of Fear

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessZinc May Play Major Role In Mechanism of FearJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:17 Nov 2006https://doi.org/10.1176/pn.41.22.0025Although fear is known to arise from the amygdala—that almond-shaped labyrinth located in front of the hippocampus—the molecular mechanisms of fear production have remained elusive.Then, a few months ago, Gleb Shumyatsky, Ph.D., an assistant professor of genetics at Rutgers University; Nobel Prize–winning psychiatrist Eric Kandel, M.D., of Columbia University, and colleagues reported that a protein called stathmin, made in the amygdala, appears to be crucial for both the expression of innate fear and the formation of memory for learned fear (Psychiatric News, February 3).Now more insights into the molecular mechanics of fear production appear to have been obtained by Shumyatsky, Kandel, and their group, and the metal zinc seems to be a crucial player. Results were published in the September 27 online early edition of the Proceedings of the National Academy of Sciences.First the scientists found that zinc is plentiful in sections of the rat amygdala as well as in the rat auditory cortex, which sends auditory information to the amygdala during fear learning. Then they discovered that those nerves in the rat amygdala that use the neurotransmitter glutamate release zinc as well as glutamate when communicating with each other, and that release boosts electrical transmission between the nerves.Thus zinc may well contribute to the learning of fear, the researchers concluded. Or as the lead researcher, Vadim Bolshakov, Ph.D., director of the Cellular Neurobiology Laboratory at McLean Hospital, put it in an accompanying press release: “Our results provide the first direct evidence that zinc released during the communication between neurons has an impact on neurotransmission in the amygdala, thus potentially contributing to fear learning.”The findings may also lead to a new classification of anxiety disorders, Shumyatsky told Psychiatric News. “Our new study, along with our earlier work... demonstrates that the neuroanatomic circuits of fear and fear behaviors have their own molecular substrates. This, in turn, suggests that anxiety disorders are not of one common molecular origin, but instead have their specific molecular signatures..., and perhaps in the future will allow for a new type of classification of anxiety states according not only to their behavioral phenotypes, but also with regard to their anatomic and molecular characteristics.”And the results might even lead to new antianxiety drugs, Shumyatsky speculated. “In our study, a gene encoding [the zinc transporter, which is a specific marker for zinc-containing nerves, was] expressed in the cortico-amygdala pathway, but not in the thalamo-amygdala pathway. These two parallel neural pathways are important in relaying fearful stimulus information... to the amygdala. Which of these two pathways is more important, or whether they are equally important, for fear behavior is not clear yet. However, their differences in zinc requirement suggest [that we might be able to design drugs] to target one type of fear processing versus another.”The study was funded by the National Institutes of Health, the Esther A. and Joseph Klingenstein Fund, the National Alliance for Research on Schizophrenia and Depression, the New Jersey Governor's council on Autism, and the Charles and Johanna Busch Memorial Fund.An abstract of “Synaptically Released Zinc Gates Long-Term Potentiation in Fear Conditioning Pathways” is posted at<www.pnas.org/cgi/content/abstract/0607131103v1>.▪ ISSUES NewArchived

Alzheimer’s neuroborreliosis with trans-synaptic spread of infection and neurofibrillary tangles derived from intraneuronal spirochetes

In the realm of dementia, it is astonishing to note that neurofibrillary tangles (NFT) are microscopically identical in a childhood illness (SSPE) and in a dementia of late adult life (Alzheimer's disease). The words "Alzheimer-type" NFT in peer reviewed scientific articles written by acknowledged experts underscore the striking similarities in "tangles" in two different diseases. Subacute Sclerosing Panencephalitis (SSPE) is caused by infection with atypical measles virus. Alzheimer's disease has no known cause. There is little controversy in suggesting that all of the Tangles in SSPE infected neurons are produced by slow viral type variant of Measles infection. But the mere suggestion that infection might be a cause of Alzheimer's disease confounds the establishment. If a good case is to be made for infection in Alzheimer's disease, an excellent nerve cell infection model is needed. Monkeys have provided a very reasonable model. Recently, a primate neuroborreliosis brain infection model demonstrated that Borrelia injected into the skin of monkeys resulted in the appearance of Borrelia transcriptomes in brain neurons. If Borrelia can travel from skin to brain in the monkey, then why not look at human Alzheimer's tissues to see if the DNA of Borrelia is present in the human brain? The molecular detection tools perfected in animal neuroborreliosis studies have been applied to human Alzheimer's disease brain tissues. Seven of ten cases of Alzheimer's disease from McLean Hospital Brain Bank of Harvard University yielded positive signals for infectious DNA in a small pilot study. Alzheimer's diseased neurons analyzed with DNA probes, produced little "dots" of positive staining. Granulovacuolar bodies in Alzheimer's diseased neurons (little dots in a bubble), are one of the expected microscopic profiles of Alzheimer's disease. "Little dots" inside nerve cells are also signatures of viral infectious agents inside of nerve cells. So with the assistance of the microscope and the tools of molecular biology, a new model of infection emerges as a cause of "Alzheimer's-type" neurofibrillary tangles. Here I hypothesize that it is chronic infection of human neurons in Alzheimer's disease that produces neurofibrillary tangles by a pathway similar to the chronic SSPE infection tangle pathway. In addition, transmission of infection from nerve to nerve is proposed to explain the evolution of Alzheimer's disease. Herein is offered a new view for the origins and for the progression of diseased nerves with tangle formations in Alzheimer's disease based on infection.

Parents' Verbal Abuse Leaves Long-Term Legacy

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessParents' Verbal Abuse Leaves Long-Term LegacyJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:7 Jul 2006https://doi.org/10.1176/pn.41.13.0028With an M.B.A. degree under her belt, 24-year-old “Jaime” (not her real name) should have glowing job prospects in Chicago. But she harbors memories that erode her self-confidence and make her bristle with anger—memories of her father shouting at her, during drunken rages, that she was ugly and of little value.Indeed, verbal abuse during childhood can scar people deeply, a new study suggests. It was headed by Martin Teicher, M.D., Ph.D., director of the Developmental Biopsychiatry Research Program at McLean Hospital, which is affiliated with Harvard Medical School. Results were published in the June American Journal of Psychiatry.Although the injurious effects of child physical and sexual abuse have been the subject of considerable inquiry, not much attention has been paid to the possibly noxious effects of verbal abuse on children.More than 500 young adults were recruited via advertisements to participate in the study. Each subject was evaluated for childhood exposure to verbal abuse, physical abuse, sexual abuse, and domestic violence. Each subject was also assessed for current anxiety, depression, anger-hostility, and symptoms of dissociation.The researchers then looked to see if there were any associations between verbal abuse during childhood and current anxiety, depression, anger-hostility, and symptoms of dissociation; between other types of abuse during childhood and these current psychological problems; and how any associations for verbal abuse might compare with associations for other types of childhood abuse.The strength of the association between maltreatment history and current psychological difficulties was determined by calculating the effect sizes and 95-percent confidence intervals for the differences between subjects who had no exposure to maltreatment and subjects exposed to the maltreatment categories. “Effect size is a more valuable measure for assessing the impact of an experience than the p value, which is strongly affected by group size,” Teicher and his coworkers explained in their report.Childhood verbal abuse had a relatively weak association with current anxiety, the investigators found, but it had moderate to strong links with current depression, anger-hostility, and dissociative symptoms.Moreover, these links were stronger than those for being a victim of physical abuse during childhood. They were comparable to those for witnessing domestic violence during childhood and for being sexually abused by a nonfamily member during childhood.The only form of child abuse that had a stronger link with current depression and dissociative symptoms than childhood verbal abuse was being sexually abused by a family member. And even it had a weaker connection with current anger-hostility than did childhood verbal abuse.These results, of course, do not prove that childhood verbal assaults can cause psychological consequences in early adulthood since the investigation was of a retrospective rather than a prospective nature. Nonetheless, Teicher and his coworkers believe that it may well be the case. As they concluded in their report, childhood verbal abuse is “a potent form of maltreatment.”But perhaps the most interesting findings to emerge from their study came when they examined the links between more than one type of child abuse and current psychological difficulties.They found, for example, an extraordinarily powerful link between the combination of verbal abuse and witnessing domestic violence and current dissociative symptoms. “This finding is consonant with studies that suggest that emotional abuse may be a more important precursor of dissociation than is sexual abuse,” Teicher and his team said.Indeed, the connections that Teicher and his group found between various combinations of child abuse and current psychological difficulties were so potent that they often equaled or exceeded the link between familial sexual abuse during childhood and current mental health. “This is of great importance,” the researchers noted, “as it suggests that combined exposure to less blatant forms of abuse may be just as deleterious as the most egregious acts we confront.”The study was funded by the National Institute of Mental Health and the National Institute on Drug Abuse.“Sticks, Stones, and Hurtful Words: Relative Effects of Various Forms of Childhood Maltreatment” is posted at<http://ajp.psychiatryonline.org/cgi/content/full/163/6/993?>.▪ ISSUES NewArchived

Letters

Back to table of contents Previous article Next article LettersFull AccessLettersJennifer M. Park M.D.Ravi Hariprasad M.D.Lawrence T. Park M.D.Jennifer M. Park M.D.Search for more papers by this authorRavi Hariprasad M.D.Search for more papers by this authorLawrence T. Park M.D.Search for more papers by this authorPublished Online:1 May 2006https://doi.org/10.1176/ps.2006.57.5.722aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Medicare Part D and DecompensationTo the Editor: We recently evaluated a woman in the emergency department who was disabled by recurrent major depression. One month before her visit, she became extremely distressed and hopeless when she received a brochure outlining the Medicare Part D program and became overwhelmed by the complexity of the possible prescription benefit plans. This hopelessness led her to abruptly discontinue her ten medications for depression and cardiac disease, and she attempted suicide by overdose one week later. Caring for this patient prompted us to compare the Medicare Part D prescription plans ourselves. A Medicare Web site ( 1 ) listed the 18 companies that offer a total of 44 different plans in Massachusetts—a daunting list. We called the customer service number for each company to request a Web site that would provide a drug formulary. Two offices left us on hold indefinitely, two were not open, two provided us with incorrect Web site information, and two did not have formularies accessible online at that time. Of the ten companies' formularies that were online, only one explained the cost of prescription drugs for Medicaid recipients. We searched the formularies for the ten medications used by the patient, using generic and brand names as written in her medication list. Of the various plans, one offered all ten of her medications on its formulary; most offered from four to nine of them. In many cases, it was impossible to know the monthly cost of this list of drugs because of varying premiums, deductibles, copayments, and limits. Among patients with mental illness, anticipation of changes in treatment providers or treatment plans can have a destabilizing effect. This case demonstrates the potential for psychiatrically and medically compromised patients to decompensate as they are faced with a complicated array of coverage options. Given 44 possible plans, each with relative advantages and disadvantages, covered and noncovered medications, and varying copayment options, it is understandable that individuals will experience stress over making such a decision. This stress is likely to be compounded when such a decision is made in the context of life-threatening illness, financial hardship, financial penalties for not choosing a plan in a timely fashion, and the possibility that a single plan will vary its formulary over time ( 2 ). In addition, considering the difficulty we faced as we researched the formularies over several hours, we wonder how physicians will obtain these lists when necessary. Educating ourselves and our patients and maintaining their optimal treatment as they enroll in the Medicare Part D program will be an important and extremely challenging task.Dr. Jennifer Park is director of the acute psychiatry service and Dr. Lawrence Park is director of psychiatric inpatient services at Massachusetts General Hospital (MGH) in Boston. Dr. Hariprasad is a resident in the MGH and McLean Hospital residency program.

Coalescence of Psychiatry, Neurology, and Neuropsychology: From Theory to Practice

In a climate of renewed interest in the synergy between neurology and psychiatry, practitioners are increasingly recognizing the importance of exchange and collaboration between these two disciplines. However, there are few working models of interdisciplinary teams that freely share expertise in real time, while providing clinical and academic training to future physicians who specialize in the central nervous system. Over the past 11 years, the McLean Hospital Neuropsychiatry and Behavioral Neurology service has provided proof-of-principle for such collaboration, demonstrating that a team comprising psychiatrists, neurologists, and neuropsychologists can function effectively as a unit while maintaining the autonomy of these three disciplines and also synthesizing their combined knowledge. In addition to delivering enhanced patient care and promoting medical research, this clinical service has provided enriched cross-specialty training for fellows, residents, and medical students. The practical functioning of the team is described, and case vignettes are presented to illustrate the team's collaborative synergism in practice.

Functional Magnetic Resonance Imaging in Conscious Animals: A New Tool in Behavioural Neuroscience Research

Functional magnetic resonance imaging (fMRI) is a unique window to the brain, enabling scientists to follow changes in brain activity in response to hormones, ageing, environment, drugs of abuse and other stimuli. There are two features that make fMRI unique when compared with other imaging modalities used in behavioural neuroscience. First, it can be entirely noninvasive: each animal can serve as its own control over the natural course of its life, vital for following neuroadaptation and other developmental processes critical to understanding behaviour. Second, fMRI has the spatial and temporal resolution to observe patterns of neuronal activity across the entire brain in less than a minute. Although fMRI does not have the cellular spatial resolution of immunostaining, nor the millisecond temporal resolution of electrophysiology, synchronised changes in neuronal activity across multiple brain areas seen with functional MRI can be viewed as functional neuroanatomical circuits coordinating the thoughts, memories and emotions for particular behaviours. Thus, fMRI affords a systems approach to the study of the brain, complementing and building from other neurobiological techniques to understand how behaviour is organised across multiple brain regions. In this review, we present a general background to fMRI and the different imaging modalities that can be used in fMRI studies. Included are examples of the application of fMRI in behavioural neuroscience research, along with discussion of the advantages and disadvantages of this technology.

The Cult of Personality: How Personality Tests Are Leading Us to Miseducate Our Children, Mismanage Our Companies, and Misunderstand Ourselves

Back to table of contents Previous article Next article Book ReviewsFull AccessThe Cult of Personality: How Personality Tests Are Leading Us to Miseducate Our Children, Mismanage Our Companies, and Misunderstand OurselvesScott E. Provost, M.M., M.S.W.Scott E. ProvostSearch for more papers by this author, M.M., M.S.W.Published Online:1 Feb 2006https://doi.org/10.1176/appi.ps.57.2.280AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The use of personality tests is ubiquitous in contemporary society; the personality testing industry is a $400 million industry (1). Personality tests have been used by both large and small institutions, including schools, corporations, and hospitals, to sort, classify, categorize, and assign diagnoses to people. References to personality tests and other forms of institutional control have even made their way into books and movies. An example is how the legendary wizard Harry Potter was placed into the Gryffindor House at the Hogwarts School of Witchcraft and Wizardry by a "sorting hat" that could gauge the temperament of each student (2). Professionals who work in the mental health and addiction fields are likely to be familiar with some of the types of personality tests applied in child custody hearings, forensic and other clinical diagnostic evaluations, and screening assessments in schools.Personality tests are often considered benign. Until now there has been a dearth of work examining the cultural history of personality tests, the development of the tests, and how the tests are administered and regulated. Annie Murphy Paul, the author of The Cult of Personality: How Personality Tests Are Leading Us to Miseducate Our Children, Mismanage Our Companies, and Misunderstand Ourselves, is uniquely equipped to explore such issues on the basis of her experience as a journalist covering mental health and psychology for a variety of mainstream publications. Although the intended audience is a general readership, the book will be useful for a variety of professionals, including managers, psychologists, and other mental health professionals and educators.The book is well written and traces the cultural history behind the development of many of the most widely known personality tests, including the Rorschach inkblot test, the Minnesota Multiphasic Personality Inventory, the Thematic Appreciation Test, and the Myers-Briggs Type Indicator. In addition, it touches on some of the emerging trends in personality testing, such as functional magnetic resonance imaging (fMRI) and computer-enabled personality tests. Throughout the book, the author critically evaluates the uses, misuses, strengths, and weaknesses of each of the tests specifically, as well as with personality tests in general.Some of the author's conclusions are particularly startling, including the fact that the personality testing industry is, for the most part, unregulated and that many personality tests are administered by untrained and unqualified personnel. However, perhaps the most striking conclusion is that personality tests are overly reductionistic and neglect to account for the context, situation, and environment in which an individual lives and works. Herein lies the danger to personality tests: "People are too erratic and complex to be so pigeonholed" (3) by tests that reduce complex personality traits into narrow, one-dimensional labels. Although this conclusion should not surprise most Psychiatric Services readers, considering the pervasiveness of the biopsychosocial approach to the diagnosis and treatment of psychiatric disorders, it should sound an alarm for anyone who administers personality tests, anyone who interprets the results of personality tests in clinical decision making, and, most important, those who are subjected to a personality test. Most, if not all, ordinary individuals who are subjected to personality tests either as a condition of employment or as mandated by court order are powerless to protect themselves from the damage of being condemned to a one-dimensional label. Despite the evidence that many personality tests lack reliability and validity, they are unlikely to disappear from use in corporations, courts, schools, and other institutions in the near future. The take-home point, therefore, is caveat emptor (buyer beware).Mr. Provost is affiliated with the alcohol and drug abuse treatment program at McLean Hospital in Belmont, Massachusetts.by Annie Murphy Paul; New York, Free Press, 2004, 320 pages, $26

Treating Co-occurring Disorders: A Handbook for Mental Health and Substance Abuse Professionals

Back to table of contents Previous article Next article Book ReviewsFull AccessTreating Co-occurring Disorders: A Handbook for Mental Health and Substance Abuse ProfessionalsJudy Faberman, L.I.C.S.W.Judy FabermanSearch for more papers by this author, L.I.C.S.W.Published Online:1 Feb 2006https://doi.org/10.1176/appi.ps.57.2.279AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Treating patients with co-occurring disorders is incredibly complex and demanding. Daily challenges include decisions about which disorder requires more immediate attention, who is appropriate for programs, how to treat symptoms of co-occurring disorders simultaneously, and how to support clinicians who struggle with their own limitations in training and confidence. To top it all off, most treatment systems and aftercare options are set up to treat one disorder or the other, a reality that leaves a huge proportion of these patients underserved and improperly treated.Treating Co-occurring Disorders: A Handbook for Mental Health and Substance Abuse Professionals, by Edward Hendrickson, Marilyn Schmal, and Sharon Eckleberry, addresses many of these concerns. The book begins by identifying the need to treat co-occurring disorders simultaneously in one setting, pointing out that sequential or parallel treatment options are essentially inadequate. The authors use research and their own clinical experience in treatment, supervision, consultation, and training in presenting their positions. Underlying the entire book is the explicit understanding that differential diagnosis, assessment, and treatment are difficult because of the incredible diversity of the population itself and the continuum of possible symptom configurations.The first chapters outline the prevalence of specific co-occurring disorders, providing symptom descriptions directly from DSM-IV and how they interact with substance use. The authors present treatment implications that are direct and helpful for both new and experienced clinicians alike. They next address the complexities of differentiating substance-induced versus true co-occurring disorders by identifying assessment tools and diagnostic questions for clinicians. They discuss the implications of various combinations of severity and duration of substance abuse and mental illness, as well as their relationship to each other, stressing the importance of understanding why clients use substances.The authors devote a major portion of the book to the specific treatments for dual diagnosis in terms of individual case management as well as group and family treatment, providing useful information about treatment tasks, foci, and common traps. They do this comprehensively and use case examples. One of the most helpful assertions the authors make is that decisions about intake and treatment need to be tailored not only to patients' motivation levels but, just as importantly, to their impairment levels.Because it is clear that an appropriate treatment setting for every possible combination of disorders does not exist, the authors of this text address the need for clinicians to expand their skills and frames of reference in order to be effective. They also provide helpful direction for supervisors who are trying to make that possible. The book stresses the importance of understanding and accepting that matching the treatment setting to the patients' needs will not always be optimal and that clinicians need to adhere to a competency-based focus in which small changes are celebrated. Treating Co-occurring Disorders is an extremely valuable resource for professionals in the field. Practical, specific, and easy to read, it has helped immeasurably in my practice.Ms. Faberman is director of the alcohol and drug abuse partial treatment program at McLean Hospital in Belmont, Massachusetts.by Edward Hendrickson, Marilyn Schmal, and Sharon Eckleberry; New York, Haworth Press, 2004, 263 pages, $29.95 softcover FiguresReferencesCited byDetailsCited byNone Volume 57Issue 2 February 2006Pages 279-279 Metrics History Published online 1 February 2006 Published in print 1 February 2006

Borderline Girlhoods: Mental Illness, Adolescence, and Femininity in Girl, Interrupted

What about me was so deranged that in less than half an hour a doctor would pack me off to the nuthouse? He tricked me though: a couple of weeks. It was closer to two years. I was eighteen. (Kaysen 39) After a twenty-minute interview with a psychiatrist, eighteen-year-old Susanna Kaysen was compelled to sign herself into McLean Hospital, a psychiatric institute, where she would spend nearly two years. Kaysen’s memoir of the experience, Girl, Interrupted (1994) remained on the New York Times paperback bestseller list for at least seven years after its initial publication. According to Publisher’s Weekly, customer demand for Kaysen’s memoir quickly surpassed the original printing of 13,500, which resulted in Girl, Interrupted being “temporarily out of stock” (Maryles 18). As recently as 2000, a reporter for the Boston Globe suggested that Susanna Kaysen’s Girl, Interrupted threatened to replace Sylvia Plath’s The Bell Jar as the “Must-read for young women in high school and college” (Bass 7). Like The Bell Jar (1963), Girl, Interrupted exists as a cross-written text that straddles the arbitrary border between young adult and adult literature. “Many teenagers read the book long before they encounter it in class, just as a previous generation of young women were drawn to The Bell Jar” (Bass 7). The popularity of Girl, Interrupted and the association of the text with U.S. adolescent girls warrants further consideration of the memoir as a text read by young adults and as a representation of adolescent girlhood that offers a complex commentary on feminine coming-of-age. In this essay, I analyze Kaysen’s memoir as a unique narrative mode through which she intervenes in knowledge about feminine adolescence. Specifically, I trace how Kaysen relies on the figure of the wounded girl

Obesity Epidemic Spurs Search For Psychological Links

Obesity Epidemic Spurs Search For Psychological Links

Rational Buildings Designed To `Calm the Disorderly Mind'

Rational Buildings Designed To `Calm the Disorderly Mind'