Brain injury in a forensic psychiatry population.

OBJECTIVES: The prevalence and profile of adults with a history of traumatic brain injury (TBI) has not been studied in large North American forensic mental health populations. This study investigated how adults with a documented history of TBI differed with the non-TBI forensic population with respect to demographics, psychiatric diagnoses and history of offences. METHOD: A retrospective chart review of all consecutive admissions to a forensic psychiatry programme in Toronto, Canada was conducted. Information on history of TBI, psychiatric diagnoses, living environments and types of criminal offences were obtained from medical records. RESULTS: History of TBI was ascertained in 23% of 394 eligible patient records. Compared to those without a documented history of TBI, persons with this history were less likely to be diagnosed with schizophrenia but more likely to have alcohol/substance abuse disorder. There were also differences observed with respect to offence profiles. CONCLUSIONS: This study provides evidence to support routine screening for a history of TBI in forensic psychiatry.

Normative clinical relationships between orientation and memory: age as an important moderator variable.

The present study examined the relationship between memory and orientation to time, place, and personal and general information, as moderated by age, education, and simple attentional ability. A heterogeneous sample of 312 clinical referrals was divided into four groups, according to delayed memory functioning. Patients with globally good, globally poor, poor visual, and poor auditory memory were at differential risk of being disoriented, with the globally poor memory patients having the greatest risk. Overall, poorly oriented patients were older and less educated, with worse recall of digits backward. Discriminant Function Analysis selected visual and auditory memory and age as predictors of orientation. Normative tables stratified by age and memory performance are presented.

Pharmacological modulation of cortisol secretion and dexamethasone suppression in Alzheimer's disease.

We have investigated the dexamethasone suppression of cortisol release in a group of 28 patients with senile dementia of the Alzheimer type (SDAT) after stimulation by physostigmine and clonidine, as compared with basal conditions. All patients but one had previously been evaluated with a depression symptom checklist and had submitted to a standard Dexamethasone Suppression Test (DST). SDAT patients showed normal baseline cortisol values measured at 4:00 PM. DST was reproducible, but nonsuppression did not appear to be a feature of the disease, nor of the dementia syndrome, although a majority of the most demented patients were found to be nonsuppressors. Physostigmine stimulated cortisol secretion in 20 of 24 cases, irrespective of the severity of dementia. Clonidine induced a secretion in 12 of 15 cases, but this was less than that observed after cholinergic stimulation. Physostigmine made cortisol release significantly less sensitive to the suppressive effect of dexamethasone than clonidine in SDAT. This double response should be tested as a possible predictor of a cholinergic therapeutic effect.

Sex role psychodynamics in psychotherapy supervision.

Supervision of the female psychotherapy neophyte is discussed in relation to sex role-exacerbated ambivalence toward the transition from classroom passive-dependency to self-reliance as a professional clinician. Supervisors are alerted to hostile-dependent strategies, such as seductive flattery, that serve immediate ego-protective needs but ultimately block the attainment of fuller professional functioning.

Sex bias in psychotherapy: a failure to confirm.

The authors examined the questions of sex-related countertransference and bias in psychotherapy by asking 65 male and 57 female experienced group therapists for clinical reactions to case materials of a bogus outpatient who was designated either male or female. They found that varying the patient's gender produced only small differences in the therapists' responses, and conclude that sex-related countertransference problems may not be as prevalent as had been previously thought.

Are men therapists soft on empathy? Two studies in feminine understanding.

A serendipitous finding and a replication among successive populations of clinical-counseling practicum students suggest that the typical female therapist communicates more empathically than her male colleague. In the first study, reactions of 8 women trainees were evaluated as more empathic than those of 10 men counterparts. Despite control for sex-typed handwriting cues in the second study, 8 male novitiates' responses were assessed as less empathic than those of 8 females. The results are consistent with the notion of differential sex-role prescriptions for interpersonal sensitivity.

The effectiveness of group psychotherapy with children.

Review of empirical outcome research on children's activity, behavior modification, play, and verbal therapy groups reveals unconvincing evidence of their effectiveness. An approximately equivalent number of studies yielded generally positive, mixed, and null results. Little evidence of deterioration was found. On a comparative basis, the results tend to favor behavioral as opposed to other approaches. This article includes recommendations for improving the quality of the data base and increasing its potential for influencing practice.

Sex-role related countertransference in psychotherapy.

Data from one psychological and one psychiatric agency were collected to determine if psychotherapists' treatment decisions about opposite-sex persons might be influenced by sex-role prescriptions for dealing with sexual impulses. Accordingly, male therapists were hypothesized to prolong and female therapists to avoid treatment situations likely to arouse their sexual curiosities. The results at both facilities provide some support for these notions and, if generalizable, establish sex-role primed countertransference as a factor in patient selection and termination.

Sex-related effects on clinicians' attributions of parental responsibility for child psychopathology.

An attempt was made to reproduce and extend previously reported data suggesting the operation of sex-related bias in clinicians' attributions of parental involvement in children's psychopathologies. More and less sex-role traditional male and female family-oriented practitioners were shown contrived profiles in which a boy or girl was described as masculine or feminine role-deficient, and apportioned maternal versus paternal blame, treatment focus, adjunctive therapy need, and likelihood of sabotage. As in the previous study, mothers were implicated slightly more than fathers and also were viewed as requiring relatively greater therapeutic attention by female than by male clinicians. However, several earlier findings were not replicated. Overall, the results offer only marginal support for the notion of sex-related practitioner bias.