Numerous Clinical Examples Research Articles

31.3 Providing Psychiatric Care for Children With Genetic Disorders of Neurodevelopment: A New Era in Child and Adolescent Psychiatry

It has long been established that some genes impact the development and function of multiple organ systems simultaneously (referred to as “pleiotropy”). Consequently, genetic testing for any indication may have implications with respect to a child’s future developmental trajectory. There are numerous clinical examples whereby genetic investigations motivated by a congenital cardiac malformation, by hypotonia, or by cleft lip/palate subsequently identify genetic variants associated with substantially increased rates of ASD, intellectual disability, or adult-onset psychotic disorders.

Transparent decision support for mechanical ventilation using visualization of clinical preferences

BackgroundSystems aiding in selecting the correct settings for mechanical ventilation should visualize patient information at an appropriate level of complexity, so as to reduce information overload and to make reasoning behind advice transparent. Metaphor graphics have been applied to this effect, but these have largely been used to display diagnostic and physiologic information, rather than the clinical decision at hand. This paper describes how the conflicting goals of mechanical ventilation can be visualized and applied in making decisions. Data from previous studies are analyzed to assess whether visual patterns exist which may be of use to the clinical decision maker.Materials and methodsThe structure and screen visualizations of a commercial clinical decision support system (CDSS) are described, including the visualization of the conflicting goals of mechanical ventilation represented as a hexagon. Retrospective analysis is performed on 95 patients from 2 previous clinical studies applying the CDSS, to identify repeated patterns of hexagon symbols.ResultsVisual patterns were identified describing optimal ventilation, over and under ventilation and pressure support, and over oxygenation, with these patterns identified for both control and support modes of mechanical ventilation. Numerous clinical examples are presented for these patterns illustrating their potential interpretation at the bedside.ConclusionsVisual patterns can be identified which describe the trade-offs required in mechanical ventilation. These may have potential to reduce information overload and help in simple and rapid identification of sub-optimal settings.

Penetrating Ocular Trauma in a Goldfish Model after Chloramphenicol or Traditional Medicine Angong Niuhuang Pill Treatment: An Analysis of Retinal Responses after 7 Days

Purpose: While there were numerous clinical examples of ocular damage, the histopathology of retinal responses was poorly characterized, and animal model research was limited. The consequences of retinal lesions with traditional medicine treatment were mostly unknown. In this work, goldfish was employed as a model for penetrating injury of the eyes to study the ocular trauma with antibiotic and traditional medicine treatments. Materials and Methods: The penetration of the eyes was performed at 2mm above the midline of the limbus in the superior quadrant with an 18-gauge sterile needle, all the way to the retina but avoiding the lens while the animals were anaesthetized in water containing 100 mg/L ethyl 3-aminobenzoate methanesulfonate (MS-222). The animals were divided into three groups and received treatments of saline, chloramphenicol, and Angong Niuhuang pill (Angong) eyedrops twice a day respectively. Angong after seven days, the animals were sacrificed. Immunohistochemical evaluation of proliferative cell nuclear antigen (PCNA), brain-derived neurotrophic factor (BDNF), catalase, and cleaved caspase-3, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) for apoptotic cells were performed on the fish’s superior quadrants of the retinae. The whole experiment was repeated two times. Result: It was evident that both the retinae treated with chloramphenicol and Angong had fewer apoptotic cells and more proliferative cells, particularly in the cases of the Angong treatment. BDNF was in the inner nuclear layer and ganglion cell layer of all groups. In the chloramphenicol and Angong groups, some cells in the outer nuclear layer displayed BDNF. Catalase reactions confirmed equivalent findings that the treated retinae with chloramphenicol or Angong treatment had less catalase. Conclusion: Angong Niuhuang pill is a traditional medicine composite formula with antibiotic and neuroprotective effects on the brain and the eyes, and this work also pointed out its possible pharmaceutical potential.

Reverberation Clutter Suppression Using 2-D Spatial Coherence Analysis.

Diffuse reverberation clutter often significantly degrades the visibility of abdominal structures. Reverberation clutter acts as a temporally stationary haze that originates from the multiple scattering within the subcutaneous layers and has a narrow spatial correlation length. We recently presented an adaptive beamforming technique, Lag-one Spatial Coherence Adaptive Normalization (LoSCAN), which can recover the contrast suppressed by incoherent noise. LoSCAN successfully suppressed reverberation clutter in numerous clinical examples. However, reverberation clutter is a 3-D phenomenon and can often exhibit a finite partial correlation between receive channels. Due to a strict noise-incoherence assumption, LoSCAN does not eliminate correlated reverberation clutter. This work presents a 2-D matrix array-based LoSCAN method and evaluates matrix-LoSCAN-based strategies to suppress partially correlated reverberation clutter. We validated the proposed matrix LoSCAN method using Field II simulations of a 64×64 symmetric 2-D array. We show that a subaperture beamforming (SAB) method tuned to the direction of noise correlation is an effective method to enhance LoSCAN's performance. We evaluated the efficacy of the proposed methods using fundamental and harmonic channel data acquired from the liver of two healthy volunteers using a 64×16 custom 2-D array. Compared to azimuthal LoSCAN, the proposed approach increased the contrast by up to 5.5 dB and the generalized contrast-to-noise ratio (gCNR) by up to 0.07. We also present analytic models to understand the impact of partially correlated reverberation clutter on LoSCAN images and explain the proposed methods' mechanism of image quality improvement.

Empathy: An Integral Model in Clinical Social Work.

Empathy has held a vital and enduring standing in the theory and practice of clinical social work. Defining and conceptualizing empathy is a continuing challenge in social work and across the human services. A multitude of definitions of empathy exist in the therapeutic literature, creating confusion relating to research findings and treatment processes. Recent trends emphasize an overarching and expansive way of conceiving empathic understanding in the therapeutic relationship and informing treatment practice. Multiple perspectives of empathy facilitate a broad and wide-ranging engagement of the practitioner and the client in the therapeutic process. With significant implications for clinical social workers, an integral model capitalizes on the engagement of empathy from multiple ways of knowing: subjective, objective, and interpersonal. Numerous clinical examples illustrate applications of the tripartite model in social work practice. The integral empathy model is amenable to research and training across therapeutic contexts in social work and related fields.

The “Activist Client”: Social Responsibility, the Political Self, and Clinical Practice in Psychotherapy and Psychoanalysis

The idea of the “activist client” is intended to be taken both literally and metaphorically—applying to some extent to a wider range of clients than actual activists. The paper develops a set of ideas about a “political turn” in psychotherapy and psychoanalysis, using the tag “the inner politician.” There is a focus on working directly with political material in the session, and the pros and cos of this practice are reviewed. Wider issues such as social responsibility and social spirituality are discussed, as well as an exploration of the limits of individual responsibility. Some specific topics covered in the paper include the political roots of depression, difficulties with the concept of the therapeutic alliance from the point of view of democratic perspectives on clinical work, and a challenge to the unquestioned valuing of empathy (based on a reading of therapy though a Brechtian lens). There are numerous clinical examples.

The Leader’s Illumination of Group Phenomena Hidden in Plain Sight: Why Is No One Talking About the Elephant in the Room?

ABSTRACTThis article discusses an important leadership function: calling attention to phenomena in group therapy that are NOT observed or observed but not commented on by group members. The article includes group scenarios that often generate member omission, ways to mitigate shame that can result from uncovering members’ blind spots, and misuses of this leadership function. Numerous clinical examples are provided. Concepts borrowed from attachment theory and interpersonal neurobiology help explain how the group’s internalization of this leader function may help the group become a more potent therapeutic environment. The limited contribution of neurological findings to clinical decision-making is discussed.

"Our Time is Up": A Relational Perspective on the Ending of a Single Psychotherapy Session.

This paper, written from a relational perspective, examines the final minutes of an individual psychotherapy session, and is organized around the topics of boundary negotiation, unwitting self-disclosures, visual challenges, and countertransference. Attending to session-ending material is important because the separation involved lends heightened emotional intensity to the oftensignificant material that appears in the final minutes. This material often serves as a bridge to the psychotherapeutic work to be taken up in subsequent sessions. Session-ending dynamics call upon the therapist to prioritize empathy, validation, and support for the patient suffering from early deprivation; identify and heal narcissistic injury in the patient wishing to be special; judiciously alter the frame when doing so will benefit the patient and not constitute a boundary violation; avoid re-traumatization; admit mistakes; confront blatant denial; advance agency; address uncomfortable topics; set appropriate limits; and deal authentically with uncomfortable countertransference. Numerous clinical examples serve to illustrate these clinical phenomena.

Treatment of Depression: Men and Women Are Different?

Treatment of Depression: Men and Women Are Different?

Brief inpatient psychotherapeutic technique.

Trainees rotate onto the medical psychiatric inpatient unit at Massachusetts General Hospital every 6 weeks to learn how to conduct brief inpatient psychotherapy from two staff psychologists and one staff psychiatrist. This article focuses on four key therapeutic principles/techniques used when teaching these trainees about brief inpatient psychotherapy. These include support, affective experience and expression, chain analysis, and identification of relational styles/maladaptive relational patterns. We also briefly discuss our approach to training. Theoretical rationale, numerous clinical examples, and empirical support (of inpatient psychotherapy) are provided.

Schneck, D.J. & Berger, D.S. (2006). The Music Effect. Philadelphia: Jessica Kingsley Publishers. 272 pages. ISBN 1-84310-771-6. $29.95

Schneck, D.J. & Berger, O.S. (2006). The Music Effect. Philadelphia: Jessica Kingsley Publishers. 272 pages. ISBN 184310-771-6. $29.95. Daniel Schneck and Dorita Berger combined their considerable talents to write The Music Effect. The book discusses the reciprocal relationship between physiology and music and provides an excellent resource for clinical practitioners, students, and educators. The authors have extensive experience in their respective fields. Both are internationally known and both are accomplished musicians. A Fellow of the American Institute for Medical and Biological Engineering, Schneck provides information regarding physiology; board-certified music therapist Dorita Berger provides a clinician's insight. Together, they develop the noteworthy paradigm that music can alter behavior in a positive direction through physiological entrainment. The authors offer a new perspective on the subject, which is applicable to various music therapy models. I found the book well organized. Divided into 12 chapters, information is presented in a logical, sequential manner with smooth transitions between chapters. The authors' writing styles differ but do not detract from the work as a whole. In fact, I enjoyed the contrast. Both authors seem to be consummate teachers who are able to translate complex concepts into language that is easy to understand. Chapter 1 lays the foundation for the book. The authors discuss the importance of the survival instinct, input signals for fear, and the manner in which information is processed. They present their paradigm for behavior change in six clear points: (1) the human body acts on information received through the senses; (2) information is evaluated emotionally against a survival backdrop; (3) the need for homeostasis establishes physiological (4) persistent changes known as continuous disturbances result in functional adaptations through entrainment; (5) applying, repeating, and reinforcing sensory stimuli can change set-points; (6) elements embedded in music can be used as the stimuli for change (pp. 19-20). Chapter 2 draws parallels between the basic elements of music and physiology, from the smallest unit to the largest. The effect of sonic energy on the body is explained in the following excerpt: traveling sound energy can disturb the air, and anything else it encounters ... the body's atoms, molecules, cells, organs, tissues, and operational systems will indeed be affected by sonic vibrational energies (p. 36). Thus, the concept of altering human behavior through music is established. Chapters 3 and 4 delve into the physiology and processing of music. Chapter 3 is devoted to the physics of energy as it applies to music; chapter 4 is devoted to sensory processing and the conservation of energy in response to stress. Case studies are introduced in chapter 5. The five examples are included because the clients initially presented with the same predominant emotion of fear while having diverse diagnoses. The authors explain the physiology of fear in detail, the clients' manifestations of the emotion, and the role of music therapy in effecting positive change. The authors contend that entrainment to music can interrupt the fear cycle. Chapter 6 offers an explanation of the complex ways in which the body entrains to stimuli through its nervous system, genes, and enzymes. Acknowledging the contribution of Asian philosophy, the authors postulate that perhaps energy centers within the body can be manipulated through entrainment and thus restore internal balance (p. 135). A discussion of musical stimuli follows. Chapters 7 through 10 are devoted to the primary elements of music that influence behavior: rhythm, melody, timbre, harmony, dynamics, and form. The authors use numerous clinical examples to support the concepts presented. Chapter 7 explores the close relationship between biological rhythms and rhythm in music. …

Treating Suicidal Behavior

Treating Suicidal Behavior: An Effective, Time-Limited Approach is a well-written, thorough, and comprehensive review of an important topic. While providing more information than many primary care providers may be willing to review or are able to utilize, the authors appear to make a conscious effort to present the contents of this volume as accessibly as possible by thoughtfully dividing the text into 2 major sections. The first section, “Establishing a Foundation for Treatment,” contains 3 chapters that review the literature related to suicidality, present an overview of cognitive-behavioral theory (CBT), and summarize the treatment process. These 3 chapters provide a useful orientation to providers wishing to increase their comfort level when dealing with suicidal patients prior to referral for more intensive psychiatric treatment. An understanding of the complexity of primary care is acknowledged by the authors' recognition and consideration of issues related to medical as well as psychiatric comorbidity. The second section, which includes the remaining 7 chapters, provides extensive detail, suggestions, and treatment advice for practitioners interested in learning more about the actual mechanics of the therapeutic process. The standard treatment framework presented is based on a series of 20 sessions that would typically take place over a 6-month time period. Guidelines are provided for topics and tasks to be addressed at each session, which are illustrated with a longitudinal case example. Individual chapters expand on topics introduced earlier such as initial evaluation, risk assessment, crisis intervention, behavioral management, and cognitive restructuring. The authors' obvious interest in providing clinically relevant information is seen throughout the text. Research reviews are chosen on the basis of their clinical orientation and are followed by summary statements discussing implications for clinical practice. CBT and its application to suicide prevention are presented in a clear yet concise manner, with a thoughtful recognition of the tension between theory and practice. Numerous clinical examples, tables, acronyms, and case studies are used to enhance retention and illustrate working concepts. In summary, this is a thoughtfully organized and well-developed text that is structured in such a way as to allow professionals with various levels of interest to improve their understanding of suicidal behavior and treatment. Information is clearly presented and organized in a manner that facilitates quick reference. Treating Suicidal Behavior is a useful guide for clinicians at any level of practice and an excellent tool for those interested in improving their psychotherapeutic skills in this area.

Resorbable Polymer Fixation for Craniomaxillofacial Surgery

Advances in medical technology continue to present clinicians with new treatment options for their patients. Frequently, however, a "settling-in" period occurs after initial introduction, during which continued use and experience present new considerations. Absorbable internal fixation has been available in the orthopedic arena for more than a decade, but has been widely available in the craniomaxillofacial arena for only the past few years. Although the major considerations governing its use were obvious initially, since then a set of essential paradigms has presented itself. The authors summarize these principles, providing numerous clinical examples, with the goal of illustrating the current potential of this technology as well as establishing a baseline from which future developments can issue.

COHORT STUDIES AND RANDOMIZED CONTROLLED STUDIES IN ENDOCRINOLOGY

This article describes the basic skills for the design, implementation, and interpretation of randomized controlled studies. Strengths and limitations of each study design are discussed. Epidemiologic issues in the analysis and interpretation of studies, such as loss to follow-up and biases, are included. Numerous clinical examples are provided to better illustrate the epidemiologic methodology.

Nurses and Families: A Guide to Family Assessment and Intervention

-- Completely new to this edition and to family practice: how to do 15-minute family interviews in a variety of clinical settings-- The only practical and detailed how-to guide for the nursing of families-- Excellent in-depth clinical guide to nursing assessment and intervention with families, with clinical examples-- Updated and expanded Calgary Family Assessment Model-- Updated and revised Calgary Family Intervention Model-- Emphasizes diversity issues such as ethnicity, race, culture, sexual orientation, gender, and socioeconomic class in numerous clinical examples-- Supplies detailed clinical guidelines of how to prepare, conduct, and document a family interview

Students We Don't Refer:

Students search at college for a sense of personal specialness and for soIutions emotional concerns. Colleges often encourage an expectation of this in their marketing phrases a d in their orientation programs. Students are inevitably disappointed as they learn that tbe college cannot really be their new family and that old soliutions are recalcitrant. Some students weather this disappointment and turn it to their advantage for personal growth. For many relationally fragile students this is not possible without psychotherapeutic help. Old emotional wounds when opened overwhelm them, and for a variety of reasons, we propose that referring these students for private treatment is not appropriate. We discuss some of the issues involved in working with these students. We especially focus on the difficulties in hearing and responding to their anger and fears sf being destructive. Numerous clinical examples are included.

Cognitive Therapy in the Trenches: Clinical Applications of Cognitive Therapy

Cognitive Therapy in the Trenches Clinical Applications of Cognitive Therapy. Arthur Freeman, James Pretzer, Barbara Fleming, and Karen Simon. Plenum Press, 1990. This is one of the most useful books I have read in a long time! Freeman and his colleagues set out to write a book that would help practicing clinicians use the principles and techniques of Cognitive Therapy in their work with clients. In my view they have succeeded admirably. This is not a book to read once, but a reference work to be consulted repeatedly as one encounters unexpected difficulties with clients exhibiting a variety of problems. In addition, it provides a nice background to the basic principles of Cognitive Therapy, although at a level that presupposes some familiarity with the model. But the real strength of the book is its detailed descriptions of Cognitive Therapy techniques and their application to the solution of clinical problems, laced with numerous clinical examples. The book is organized into four sections. The first section consists of one introductory chapter outlining the basics of Cognitive Therapy, including general principles and processes, complexities encountered, and misconceptions of Cognitive Therapy. Although this chapter is written at the introductory level, some familiarity with Cognitive Therapy through previous reading is helpful in putting this material in perspective. Particularly helpful in this chapter is the section on the structure of a typical Cognitive Therapy session. The section on misconceptions is obviously a response to critiques of the model over the years. While some of the misconceptions seem to have arisen because of misunderstandings of the initial writings on Cognitive Therapy, I felt that some of the issues discussed in this section (e.g. "Cognitive Therapy ignores the past") represent an implicit expansion of the original Cognitive Therapy model. The second section consists of five chapters on the clinical practice of Cognitive Therapy. There are chapters on clinical assessment, cognitive and behavioral interventions, and separate chapters on the treatment of depression, suicidal behavior, and anxiety, respectively. All chapters are characterized by detailed descriptions of techniques and numerous clinical examples illustrating the use of these techniques. Most of the assessment techniques are interviewbased, although there is a short section on traditional psychological testing. The authors are kinder to these traditional techniques than I might have thought, although there is a pronounced preference for interview-based methods. The next chapter, on cognitive and behavioral interventions, is one of the most useful in the book. The authors have described in detail many techniques (e.g., Guided Association/Guided Discovery, Externalization of Voices, Replacement Imagery, Behavioral Rehearsal), each description being illustrated with a sample client/therapist dialogue snippet Some of these techniques (e.g., decatastrophizing) are familiar from previous writings on Cognitive Therapy, while others (e.g., refocusing, considering the pros and cons) seem to have been adapted from other therapeutic systems and "cognitivised." Still others (e.g., inducing dissonance) seem to have been derived from experimental psychology. All in all, however, this chapter provides a rich cornucopia of therapeutic interventions and merits repeated reading. The next three chapters on depression, suicidal behavior, and anxiety are similar in style. Each chapter consists of three sections. The first is assessment, which uses the DSM-III-R criteria as an organizing principle. The next section is conceptualization, where such topics as the origin of the disorder and cognitive assumptions/distortions are discussed. I was particularly impressed with the authors' attempts to integrate a cognitive conceptualization of these disorders with conceptualizations drawn from other models. The third section, strategies for intervention, provides detailed descriptions of cognitive and behavioral techniques for treating the disorder, with brief clinical examples provided for most techniques. …