Psychologists In Medical Settings Research Articles

Assessing ADHD-related Family Stressors with the Disruptive Behavior Stress Inventory (DBSI): A Replication and Extension

The Disruptive Behavior Stress Inventory (DBSI) was developed to provide information related to the occurrence and severity of stressors that result from having a child with ADHD. Data provided in the initial 2002 study by Johnson and Reader (Journal of Clinical Psychology in Medical Settings, 9, 51-62) provided good preliminary support for the reliability of the DBSI, as well the ability of the scale scores to differentiate primary caregivers of children with and without a history of ADHD. The present study was an attempt to replicate major findings of the 2002 study using an additional larger sample and extend it by conducting item-level analyses to determine the degree to which individual DBSI items differentiate primary caregivers of children with and without a history of ADHD. Results provided additional support for the reliability and validity of the DBSI by replicating major findings from the 2002 study and further suggesting that a large majority of the 40 items individually differentiate between primary caregivers of children with and without a history of ADHD.

Psychologists in Academic Health Centers: Reflections on Traditions and Innovations in Education, Science, and Practice

In 2007, the Association of Psychologists in Academic Health Centers (APAHC), formerly known as Association of Medical School Psychologists (AMSP), held its first national conference since 1997. At the latter conference, the author of this article [Sheridan (1999) Journal of Clinical Psychology in Medical Settings, 6, 211-218] was asked to present some of the issues that would be important to health care psychologists in the next decade. These issues included the role of psychology in academic health centers, interventions psychologists offer, reimbursements for such treatments, education and training models, and research. This article examines those observations, offers new data, and explores the current challenges and opportunities for psychologists in academic health centers. The presentation also addresses aspirations of psychologists as well as resistances within the profession.

Battlefield Acupuncture

Battlefield Acupuncture

Our Case Debut: A Case Presentation from the Association of Psychologists in Academic Health Centers

This ‘‘Case Debut’’ was accidentally left out of the June 2007 issue. We are pleased to lead this new and innovative case presentation series with the work of Drs. Macht, Pasqualini and Taba concerning the use of cognitive behavioral strategies for Parkinson’s disease. For some time, the editors of the Journal of Clinical Psychology in Medical Settings, the official journal of the Association of Psychologists in Academic Health Centers have planned to develop a case presentation series that illustrates the important advances, contributions and clinical thinking which psychologists have brought to their work in medical and health care settings. The feature patterns itself after the case presentations in the New England Journal of Medicine in which cases are discussed by various clinicians with appropriate medical, laboratory, radiographic and pathology data included along with psychological and neuropsychological tests. We believe that the practice of psychology in these health settings has reached a level of sophistication and maturity that a case series of this type is warranted for this specialization. There are many experienced and senior medical/ health psychologists who can contribute substantially to this literature by illustrating their cases and perspectives. These are not traditional case presentations in which a case and a specific intervention are given but instead the clinical process, diagnosis, prognosis and decision-making of several clinicians are shared. Education and discussion are the primary goals for the series rather than ‘‘the correct diagnosis or correct intervention.’’ We hope by developing this series and bringing it to the attention of health and medical psychologists that it will serve to be a teaching tool for students and a platform for discussion and continuing education for experienced and senior psychological clinicians. We are excited and thrilled about this series and present in this issue of JCPMS the initial case presentation. The time has come for medical and health psychologists to share their clinical wisdom, experience and contributions to patient care.

Our Case Debut: A Case Presentation from the Association of Psychologists in Academic Health Centers

This ‘‘Case Debut’’ was accidentally left out of the June 2007 issue. We are pleased to lead this new and innovative case presentation series with the work of Drs. Macht, Pasqualini and Taba concerning the use of cognitive behavioral strategies for Parkinson’s disease. For some time, the editors of the Journal of Clinical Psychology in Medical Settings, the official journal of the Association of Psychologists in Academic Health Centers have planned to develop a case presentation series that illustrates the important advances, contributions and clinical thinking which psychologists have brought to their work in medical and health care settings. The feature patterns itself after the case presentations in the New England Journal of Medicine in which cases are discussed by various clinicians with appropriate medical, laboratory, radiographic and pathology data included along with psychological and neuropsychological tests. We believe that the practice of psychology in these health settings has reached a level of sophistication and maturity that a case series of this type is warranted for this specialization. There are many experienced and senior medical/ health psychologists who can contribute substantially to this literature by illustrating their cases and perspectives. These are not traditional case presentations in which a case and a specific intervention are given but instead the clinical process, diagnosis, prognosis and decision-making of several clinicians are shared. Education and discussion are the primary goals for the series rather than ‘‘the correct diagnosis or correct intervention.’’ We hope by developing this series and bringing it to the attention of health and medical psychologists that it will serve to be a teaching tool for students and a platform for discussion and continuing education for experienced and senior psychological clinicians. We are excited and thrilled about this series and present in this issue of JCPMS the initial case presentation. The time has come for medical and health psychologists to share their clinical wisdom, experience and contributions to patient care.

Objectivation du corps en médecine et incidences subjectives

The medical body and the body as experienced by the subject him–herself cannot be considered the same, and are sometimes even incompatible. The first one is the product of a constant process of objectification in the history of medicine, and is correlated to the extraordinary development of knowledge and techniques in this discipline. The second one, on the contrary, refers to a subjectivation process grounded in the world as experienced by the patient, with a special emphasis on notions such as the body proper and inter-subjectivity. Despite substantial improvements in the prognosis of some serious illnesses, this objectification has important effects on the patient's and on the physician's subjectivity, as well as on their relationship. This mechanization of the human body is strongly linked with the advent of science, as characterized by the philosophy of Descartes and by the first anatomical dissections by Vesale, it established a real epistemological rupture by separating man from his body. This break gave birth to three separate dimensions: the world, others, and oneself. Indeed, before Vesale, man was considered as a part of the world, inseparable from it, and an expression of God's will as any other part of the world. Anatomy thus introduced the human body as a particular study object, independent from its symbolic or material environment. Before, man was also a member of a strong community, defined by its values and by its laws. By contrast the anatomical body was then a desocialized one, without any of the usual signs that could demonstrate its membership of a given community. Finally, man was separated from himself, by the identification of his body to a machine, an object that could be reduced to a simple catalogue of organs. This separation between the anatomical body in medicine and the lived body of the patient leads to profound changes in the physician-patient relationship, detrimental to the subjectivity of both. In order to restore a real inter-subjectivity in this relationship, empathy could then be an important dimension to enhance the communication process in medical settings. Nevertheless, empathy, according to Husserl, is not only a capacity to represent or to infer the other's mental state, but is more profoundly based on the analogy between the bodies. The physician's body is then, in some way, implied in the apprehension of his patient's distress. A core dimension for a clinical psychology in medical settings could then be the fact of giving its proper place to this subjectivity, and more particularly to the subjectivation process within the illness experience proper. In this context, clinical psychology, without ignoring the contributions of medical sciences, is of particular importance in sustaining the subject and his singularity beyond his illness.

Use of CBT to Treat Depression Among Patients on Hemodialysis

Use of CBT to Treat Depression Among Patients on Hemodialysis

Use of CBT to Treat Depression Among Patients on Hemodialysis

Use of CBT to Treat Depression Among Patients on Hemodialysis

Comorbid Psychiatric Disorders in Adults with ADHD

Adults with ADHD have been found in prior studies to have a greater risk for various psychiatric disorders. Chief among these are oppositional defiant disorder (ODD) and conduct disorder (CD). Approximately 24–35% of clinic–referred adults diagnosed with ADHD have ODD and 17–25% have CD, either currently or over the course of their earlier development (Barkley, Murphy, & Kwasnik, 1996; Biederman, et al., 1993; Murphy & Barkley, 1996; Murphy, Barkley, & Bush, 2002; Spencer, 2004). These figures for clinic–referred adults are below those reported in studies of ADHD children, particularly studies of hyperactive children followed to adulthood, where levels of ODD and CD may be double or triple these rates reported for adults diagnosed with ADHD (see Barkley, 2006, for a review; Barkley, Fischer, Edelbrock, & Smallish, 1990; Fischer, Barkley, Smallish, & Fletcher, 2002; Weiss & Hechtman, 1993). Among parents of children having ADHD who also meet criteria for ADHD, disruptive behavior disorders are also significantly more common (McGough et al., 2005; Minde, et al., 2003). For instance, one study found that 53% have had ODD and 33% have had CD sometime in their lives (Biederman et al., 1993), figures closer to those seen in follow–up studies of hyperactive or ADHD children. Antisocial Personality Disorder is often an associated adult outcome in a large minority of those children or adolescents who have both ADHD and CD; thus it is not surprising to find that 7–44% of clinic–referred adults diagnosed with ADHD also qualify for a diagnosis of this personality disorder (Biederman et al., 1993; Shekim, Asarnow, Hess, Zaucha, & Wheeler, 1990; Torgersen, Gjervab, & Rasmussen, 2006). Even among those who do not qualify for this diagnosis, many receive higher than normal ratings on those personality traits associated with this personality disorder (Tzelepis, Schubiner, & Warbase, 1995). Substance dependence and abuse are known to occur to a more frequent degree among hyperactive or ADHD children who develop CD by adolescence or Antisocial Personality Disorder by adulthood (Barkley, 2006; Tercyak, Peshkin, Walker, & Stein, 2002). Arecent study of a large general population sample likewise found an association between ADHD and antisocial disorder (Kessler, et al., 2006). Adults clinically diagnosed with ADHD seem to be no exception to this rule linking ADHD, antisocial activities, and drug use disorders. Studies have found lifetime rates of alcohol dependence or abuse disorders ranging between 21% and 53% of adults diagnosed with ADHD, whereas 8–32% may manifest some other form of substance dependence or abuse disorder (Barkley,

Passing the Torch: The Future of Psychology in Academic Health Centers

From 1993–2006 the Journal of Clinical Psychology in Medical Settings (JCPMS) was under the helm of its founding editor, Ron Rozensky, Ph.D., and his editorial board. In 2007 a new editorial board will guide JCPMS. This manuscript outlines the anticipated driving forces for the future of JCPMS and highlights the challenges and opportunities the journal faces.

Clinical Psychology in Medical Settings: Celebrating our Past, Enjoying the Present, Building our Future

This article reviews the history of the Journal of Clinical Psychology in Medical Settings. The many special issues of the Journal over the first thirteen years of publication are discussed, highlighting such topics as psychology and primary care, psychology's role in medical settings internationally, diversity issues in medical settings, the impact of relationships on health care, psychology and transplantation, combined psychotherapy and pharmacotherapy, public health and psychology, and a series of issues focused upon research, practice, salaries, politics and policies surrounding psychology in medical settings. The 481 published manuscripts are discussed as a reflection of psychology's role in the study and treatment of the most prevalent diseases leading to death and those illnesses most likely to restrict activity and limit quality of life. Several areas of focus for the future of the Journal, and for the field of psychology in medical settings, are presented. The Editor then takes the opportunity to thank those who contributed to the Journal since its inception, including associate editors, advisory board, editorial board members, reviewers, contributors and published authors, readers, publishing editors, and colleagues Tovian and Sweet, co-founders of the Journal. The article concludes with the encouragement that “the future of clinical psychology in medical settings appears bright.”

The Journal of Clinical Psychology in Medical Settings and the Association of Psychologists in Academic Health Centers

The Journal of Clinical Psychology in Medical Settings and the Association of Psychologists in Academic Health Centers

Commentary: Benchmarks for Work Performance of Pediatric Psychologists

In “Benchmarks for Work Performance of Pediatric Psychologists by Opipari-Arrigan, Stark, and Drotar (2005)” from a previous issue of the Journal of Pediatric Psychology (doi:10.1093/jpepsy/jsj068), the authors provide a timely update on the field and a challenge for the future. This is the first such benchmarking effort since the survey by Drotar and colleagues 11 years ago (Drotar, Sturn, Eckerle, & White, 1993). Clearly, the information provided suggests the need for benchmarking at more frequent intervals, possibly every 5 years. Although the response rate from full division members (45% returned and only 34% usable) was disappointing, the results, recommendations, and accompanying commentaries, challenge all of us to determine future goals/directions, identify needed resources, and guide strategic planning as a professional organization. Over the past 11 years, the health care environment has changed dramatically. Concurrently, the Society of Pediatric Psychology, Division 54 of the American Psychological Association (APA), representing pediatric psychologists, has solidified its relationship with the American Academy of Pediatrics (AAP) working together as a team to set policy and advise members on key intervention and assessment guidelines (i.e., ADHD, violence/injury prevention, care for the dying child, website at www.aap.org/). There is a clear belief in the value of pediatric psychologists’ involvement in the entire range of care from primary care to care of chronically ill children. Despite national discussions regarding health care reform, many of the nation’s poor and disadvantaged are without health care benefits. During this same timeframe, the presence of psychologists in medical schools and academic health centers increased, and their influence broadened. Results from a national survey of psychologists in medical settings coordinated by APA in collaboration with the Association of Medical School Psychologists suggested that there are more than 3900 psychologists working in these settings since 1997 (Pate & Kohout, 2005). At the same time, managed care has altered billing procedures and payment for services rendered by psychologists, whereas resources for research funding have decreased significantly. Numerous articles (i.e., Rae, 2004) have addressed these issues elsewhere and for this reason will not be repeated here. Despite the “erosion of the financial infrastructure that once supported hospital-based pediatric psychologists” described by Opipari-Arrigan and colleagues, most of the respondents to the current survey (63%) continue to work in a hospital setting. This speaks to the solid base of support for the contributions of pediatric psychologists by medical colleagues and administrators. Two-thirds of this hospital-based group report being on an academic track, with one-third actually holding tenure track appointments. Given then that over one-third of the respondents are in nonacademic medical settings, the relative value of the academic track versus nonacademic appointments for pediatric psychologists for income, job flexibility, mobility, and quality of life is unclear. Although this was beyond the scope of the current survey, future benchmarking efforts should explore this issue, especially given the numbers of pediatric psychologists in nonacademic positions. Interestingly, the current survey documents a change in salary for those in research versus clinical positions once they achieve associate professor status. Initially, those with clinical appointments make slightly higher salaries than those in research positions, but the shift begins at the associate professor level, with an even more dramatic difference at full professor. However, the respondents in these categories were small in number, thereby limiting specific conclusions that might be made. Length of time in position may also explain this salary difference and should be included in subsequent surveys. Further differentiating tenure line faculty from

History of the Association of Medical School Psychologists (AMSP), 1982–2005

This paper presents a brief history of the Association of Medical School Psychologists (AMSP) from the Association’s beginning in 1982 to the present day. Prior to 1982, there had been several unsuccessful efforts to form an association that would represent psychologists in academic medical centers. Attempts by psychiatry to limit the growing number and influence of psychologists in medical schools created a sense of threat among psychologists that catalyzed the formation of the Association. Membership was initially restricted to one senior psychologist from each medical school, a restriction that limited AMSP’s development, but AMSP later opened its doors to all academic medical center psychologists. The Association was rebuffed in initial efforts to join the Association of American Medical Colleges, and at a later date, to become a Division of the American Psychological Association (APA). In time, however, AMSP did establish formal ties to both of those organizations, and it has collaborated with APA in important surveys of academic medical center psychologists. Following a period in the late 1990’s when AMSP seemed likely to lose its way, the Association rebounded. AMSP now has an Administrative Director, a stable home base, and revised bylaws that assure greater stability and continuity of leadership. These developments, in conjunction with a strong working relationship with the Journal of Clinical Psychology in Medical Settings, have positioned AMSP to grow and more effectively serve the community of psychologists who work in academic medical centers.

Pathways to Medical Utilization

The role of psychologists in medical settings is evolving to include the development, delivery, and evaluation of psychosocial treatments for individuals who use disproportionate amounts of medical services. The primary purpose of this article is to present a model of psychological factors that drive health care utilization. A stepped care model of treatment delivery is also discussed along with a brief literature review depicting the impact of treatment approaches on high utilizing populations. This article concludes with recommendations for psychologists interested in providing treatment to medical utilizers.

Book Review: A Primer for Psychologists in Medical Settings

Book Review: A Primer for Psychologists in Medical Settings

Introduction to the Special Issue: Psychology in Academic Health Centers

Articles in this special issue of the Journal of Clinical Psychology in Medical Settings (JCPMS) are adapted from invited papers and symposia presentations organized by the Association of Medical School Psychologists (AMSP) and presented at the 2003 American Psychological Association Convention in Toronto. The Journal enjoys a longstanding special relationship with AMSP. Members of AMSP receive a subscription to JCPMS as a benefit of AMSP membership, and the Journal has published articles in the past that were based on presentations at AMSP meetings. For example, the JCPMS special issue that was published in June 1999 (Vol. 6, No. 2) contained papers from an AMSP conference and dealt with employment trends and salaries of medical school psychologists, the future of psychology in academic health centers (AHCs), as well as administration and governance in AHCs. The articles in this special issue of JCPMS are an expression of the ongoing collaboration between the Journal and AMSP. The issue contents reflect the mission of AMSP, which is to promote psychology in AHCs and medical school settings, and to foster leadership roles for psychologists in all facets of training, clinical practice, research, and administration in those settings. AMSP strives to articulate the priorities of psychologists in AHCs, facilitate networking, and advocate for psychology and psychologists in AHC and medical school settings. AMSP was first established in 1983. The

A Decade of Clinical Psychology in Medical Settings: The Short Longer View

The progress and accomplishments of psychology in medical settings over the past decade since the publication of the Handbook of Clinical Psychology in Medical Settings (J. J. Sweet, R. H. Rozensky, & S. M. Tovian, 1991) and the subsequent founding of the Journal of Clinical Psychology in Medical Settings (JCPMS) in 1994 are highlighted. Areas of progress and accomplishments reviewed include professional developments with our field, roles and services provided by psychologists, education, training and research issues, and program administration in medical settings. The current status of, and possible changes in, medical settings is identified. Future challenges and opportunities for the profession are discussed.

Psychosocial Issues in the Field of Prosthetics and Orthotics

The involvement of psychologists in medical settings has grown at a tremendous rate in recent years, with an ever-increasing number of medical environments developing and promoting interdisciplinary collaboration, and thus enabling psychologists to extend their practice beyond the traditional mental health model. In the context of prosthetic and orthotic practice, we suggest that the realization of the potential of technological innovations in this field may only fully be achieved by equipping prosthetists and orthotists not only with the technical expertise they require but also by fostering an awareness of the importance of psychosocial issues in amputation and rehabilitation, and an understanding of the psychological complexities pertaining to the therapeutic context. Rehabilitation after amputation is fundamentally dependent on the patient’s psychological adjustment to the injury; hence, practitioners’ sensitivity to psychosocial issues has clear practical implications both for successful prosthetic fitting and rehabilitation, and for continuing development and innovation in the discipline. This article highlights a number of key psychosocial issues of particular relevance to prosthetic and orthotic practice and of special importance to the rehabilitation of the amputee.

Barriers and enhancements to physician-psychologist collaboration.

Have you ever wondered why it is so difficult to establish and maintain good relationships with physicians who could be good referral sources for you? Physicians in 2 multispecialty practices that include psychologists reveal what they want from psychologists and what most concerns them about working with psychologists. Strategies are outlined that psychologists can adopt to promote physician– psychologist collaboration, including seeing physicians as their customers and marketing services with an eye toward customer satisfaction. Psychologists practicing in a medical clinic sometimes wonder why some physician colleagues refer more patients than others. Psychologists in medical settings may feel as if they are marginal people in a dominant medical culture and cannot quite get a handle on what physicians want and need from them. What are the barriers to collaboration, and what are some ingredients for successful teamwork? How can psychologists better serve the needs of physicians in a multispecialty medical group practice? What current beliefs do physicians hold about psychologists and the profession of psychology? This study answers these questions. Although there is some overlap, there are strong cultural differences embedded in the two professions of medicine and psychology. Failure to understand and adjust to cultural differences in approaches to patient care can undermine even the most wellintentioned efforts at collaboration. Hamberger, Ovide, and Weiner (1999) highlighted the following four areas that they believe represent significantly different sets of values or approaches to learning and professional practice between the medical and mental health professions: (a) role of theory in practice, (b) teaching focus and learning orientation, (c) problem-solving styles, and (d) expectations for consultations. Several authors have speculated on possible barriers to collaboration (Bray, 1996; Bray & Rogers, 1995; Mauksch & Leahy, 1993; Wickramasekera, 1989), which include proximity of providers, insurance reimbursement, and patient resistance as hindering factors to referral. Drotar (1993) noted the following: