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The development and preliminary evaluation is described of a rating scale to measure disturbances of maternal behaviour in 26 women who were hospitalised with severe puerperal mental illness. Serial ratings were made about once weekly by nurses and the scores were compared with parallel clinical ratings that were independently made by a psychiatrist. Associations between aspects of psychopathology and disturbances of maternal behaviour are described and the value of serial measures is illustrated by means of 5 case vignettes. In the great majority of cases, improvements of mothers' interactions with their infants closely followed clinical recovery and there did not seem to be any gross residual areas of dysfunction. Multiparae were less affected than primiparae and there seemed to be very few women in whom severe disturbances of maternal behaviour were not obviously secondary to puerperal illness.

Described the development of the Rogers Criminal Responsibility Assessment Scales (RCRAS) as an empirically based testing procedure specifically designed for use in insanity evaluations. A pretest of the RCRAS that employed 10 case vignettes and a preliminary study of 25 patients are reported. Initial results indicated that the RCRAS has satisfactory interrater reliability and successfully discriminated between those patients evaluated as sane and insane. Results of the discriminant analysis, MANOVA, and factor analysis are discussed with reference to the RCRAS' construct validity and the need for further extensive studies.

Despite the obvious fact that loss and bereavement are an integral part of the war experience, surprisingly little has been written about bereavement and grief in combat. This article discusses reasons for the resistance to the concepts of loss and bereavement in military psychiatry, distinctive aspects of combat bereavement, factors that impede appropriate grieving in war, and, with the aid of case vignettes, the varieties of bereavement states seen in combat situations. The authors conclude that the clinical phenomena of grief run like a connecting thread through the various presentations of combat-related psychiatric syndromes, including post-traumatic stress disorders, and that more research in this area is called for.

This article reports on some clinical applications in the 9 to 30 month age range of a new structured paradigm. The Infant Clinical Assessment Procedure (ICAP) is not a test, but an assessment technique. It is particularly aimed at the evaluation and ongoing monitoring of problems in the emotional development of infants. Its eight episodes represent a wide array of effective, social, and cognitive stimuli. The primary focus of these episodes is on the infant, with the exception of the mother-infant task that specifically gauges the mother-infant ralationship. It is suggested through case vignettes that the ICAP may be useful for the documentation of the efficacy of treatment.

The assumed connection between exhibitionist acts and indecent telephone calls is reviewed and questioned. Four case vignettes are provided where indecent telephone calls were made without the expression of other sexually deviant behaviors.

This paper examines the variations in childrens' responses to parent loss. Initially examined is the effect of institutionalization and foster care, and these experiences are contrasted with that of parent loss through death, divorce, and abandoment. Illustrative case vignettes are offered to attempt to highlight useful concepts drawn from ego psychology and self psychology, theories useful in providing clinicians with more precise diagnostic and prognostic acumen, to enrich ongoing treatment interventions with these child populations.

The parent-child activity group combines the concepts of group and family systems theory with therapeutically planned activities as a tool for the assessment and treatment of behaviorally disordered children and their families. This paper describes the development of the group with its flexible and adaptive formats—task performance, family interaction, and parent education/training. An extended case vignette illustrates the effectiveness of the group's design as a unique and replicable treatment modality on an inpatient psychiatric unit.

Practical issues and treatment considerations in brief, problem-focused group therapy with adolescents are discussed, including selectivity factors, group composition, and leadership style. The need for therapists using this approach to engage actively in emotional exchange and self-disclosure is emphasized, and the varieties of interventions encompassed in this approach are illustrated by case vignettes.

An overview of schizophrenia is presented. The epidemiology and clinical features of this common but serious psychiatric disorder are outlined. Four case vignettes illustrate different presentations and, to some extent, the varying course of the disorder. Diagnostic issues are discussed and the heterogeneity of the disorder highlighted. The major aetiological hypotheses are outlined, including evidence for genetic and biochemical In Volvement, the role of family, social and personality factors, psychological mechanisms and life events. A diathesis-stress view is presented, in which biological vulnerability and psychological and environmental factors are necessary for the development of the clinical disorder. Somatic and psychosocial treatments are briefly discussed as are the course, possible outcomes and factors affecting prognosis. Finally some future research directions in both the biological and psychosocial areas are considered. © 1985, The Author(s). All rights reserved.

This article discusses the issue of interminability from two perspectives: theoretical and affective. Theoretically, it is viewed as unusually long treatment due to numerous factors such as early trauma, significant ego defects, and rigid defensive structures with excessive use of denial and splitting to protect those structures. Affectively, it is seen as the therapist's feelings of endlessness, going nowhere, watertreading, and stuckness. Three case vignettes are offered as examples of these points.

Family caregiving to the elderly has become a source of major concern only in the last decade. Due to the abundance of cross-sectional research, caregiving has been portrayed as a static process. This study was a longitudinal investigation of mental health problems among elderly spouse caregivers. The results revealed an important relationship between mental health problems and the changing caregiving situation. The greatest prevalence of mental health problems was among the group of individuals who had only recently placed their spouse in a nursing home. The second greatest number of problems were found in those caregiving in their home. Four case vignettes served to illustrate common changes in caregiver's mental health.

As more patients with AIDS and AIDS-related syndromes are admitted to psychiatric units, staffs must meet new diagnostic and therapeutic challenges while adapting to the unique stresses of treating these patients. The authors discuss several case vignettes to illustrate how the staff of a voluntary acute-stay psychiatric unit progressed over a two-year period from having difficulty treating AIDS patients within the usual therapeutic milieu to directly confronting the issues raised by the disease both among themselves and in the patient community. The authors believe that the staff's ability to cope with AIDS patients may have strongly influenced the patient community's ability to cope, and that clinical experience and educational programs were major contributors to the staff's adaptation. They conclude with several recommendations for psychiatric staffs beginning to treat AIDS patients.

Studies of clinical judgment are frequently based on analogue research, which uses experimenter-controlled stimuli to elicit judgments. The stimuli may be live models, audio- or video-taped models, or written case vignettes describing a clinical encounter. A major challenge of analogue research is to construct stimuli that maintain a balance between experimental rigor and clinical reality. An ideal set of case vignettes, for example, will contain summaries that resemble actual case histories and that are varied only on the specific clinical factors being studied. The model presented here demonstrates the empirical development of written case analogues in which several variables are studied simultaneously. The model can be adapted to any setting in which professionals are required to make judgments or decisions about individuals. The vignettes described here have been used in a variety of clinical settings to assess the reliability of clinicians'judgments and to aid in evaluation and program planning.

A therapist's pregnancy is a unique event which holds profound implications for both patient and therapist in any therapeutic relationship, and it inevitably affects the course of the patient's treatment. A number of theoretical and clinical articles have been written over the past 15 years on the topic of the pregnant therapist, but very few have concentrated specifically on the child patient. This article explores the therapist's pregnancy and treatment implications in clinical work with children and offers an in-depth case vignette to illustrate how a child may effectively utilize the experience to work through previously unresolved feelings and conflicts. The therapist's pregnancy can, therefore, provide the child with an opportunity for conflict resolution and growth, if the process is handled in a therapeutically sound and sensitive way.

The authors present the results of a preliminary study measuring dysphoria in house officers toward patients with anorexia nervosa, diabetes, and obesity. Case vignettes are presented to demonstrate how negative affects in clinicians can interfere with the delivery of goal clinical care. Patients with anorexia nervosa tended to generate more anger, stress, and helplessness in house officers than other groups of patients did. Hypotheses are presented to explain those findings and questions are posed to stimulate future research.

A Jungian-oriented reflection is presented on the theoretical description of and possible clinical response to male midlife transitions within pastoral psychotherapy. After a brief introduction, a focused case vignette is offered, followed by a detailed theoretical discussion and outline of significant psycho-spiritual frames in the treatment of such clients and this crucial initiatory threshold in the male's life experience.

This article describes the development of a long-term inpatient treatment program in a general hospital setting for severely disturbed patients with personality disorder. A treatment model is outlined, with case vignettes included, that illustrates pertinent clinical issues. Also, the issue of regression in therapy, the role of consultation in a teaching unit, and research perspectives are discussed.

A review of literature on eating disorders in terms of the components of the model of human occupation suggests that eating disordered individuals are dysfunctional not only in their attitudes and habits related to eating and weight control, but also in their pursuit of and engagement in meaningful occupation. This article begins with a discussion of components of the model of human occupation and relevant research on eating disorders, using case vignettes to illustrate occupational dysfunction. The article concludes with the delineation of an occupational therapy approach to assessment and treatment of occupational dysfunction in eating disordered clients.

The main focus of investigations, treatment programs, and strategies for managing the problems of cancer patients and their families has been on how individual health care staff members treat individual patients and families. This article discusses the issues involved in organizing a psychosocial team, the team's functions and responsibilities, its strengths and weaknesses, and how team members work together to treat difficult patients. Models of team approaches in three settings-a radiotherapy center, an oncology unit, and the oncologist's office-are provided, and case vignettes are used to illustrate problems presented by difficult patients as well as those related to unresolved issues such as team leadership.

Consumers' acceptability of withdrawal designs was investigated. Subjects in the present study, middle and high school teachers, were presented case vignettes describing an apparently effective program used to treat a behavior problem student. Subjects in (one of six) withdrawal conditions rated the acceptability of temporarily withdrawing this program, while those in the control condition rated vignettes describing its continuation. Withdrawal conditions varied with respect to the rationale used to justify treatment withdrawal. Results would suggest teachers viewed withdrawal designs as generally acceptable. Practical implications of these findings, as well as future research needs, are discussed.

Attitudes toward problem drinkers were investigated in an experiment utilizing a 2 X 2 X 2 X 2 multivariate analysis of variance design. Subjects read one of eight case vignettes about hypothetical stimulus persons and then completed verbal report inventories to assess attitudes. All vignettes were identical except for references to the stimulus person's drinking behavior (problem or nonproblem drinking), sex, and socioeconomic status (upper-middle or low). Sex of the rater was the other independent variable in the four-way design. Problem drinking elicited a powerful halo effect such that attitudes toward persons exhibiting such behavior were found to be negative relative to normal drinkers in all attitudinal domains and across almost all variables measured. Drinking behavior may have exerted such a strong effect that the potential influence of the other variables was overpowered.

The attitudes of junior psychiatrists to deliberate self-poisoning were assessed on the basis of their answers to a series of questions concerning four case vignettes. They spontaneously indicated goals for the behaviour in only a minority of cases. Emphasis should be placed on identifying instrumental aspects of overdoses during training in the assessment of self-poisoning patients. The psychiatrists attributed similar reasons for the cases as did physicians and nurses who were previously investigated using the same method. However, compared with the physicians, the psychiatrists showed more sympathetic attitude to the patients and their behaviour, and a greater willingness to help them. The psychiatrists and nurses were similar in this respect. The findings are discussed in the light of recent innovations in the management of self-poisoning patients in general hospitals. Language: en

Shooting incidents are a rare phenomenon in low violence police work. However, when an incident occurs, the psychological impact for the officers involved may take the form of severe PTSD symptomatology. Of 37 police officers who had been involved in serious shooting incidents between 1977 and 1984 we found that 17 (46%) fulfilled DSM-III criteria for PTSD, either at the time of the interview (n=7, 19%) or prior to it (n=10, 27%). Of the PTSD-negative group 17 still showed an impressive pattern of PTSD symptoms. Only three showed no symptoms of PTSD at all. Lauferet al. (1985) presented a two-dimensional model which seems to fit the PTSD-pattern in police officers reacting to trauma. From clinical experience, it is apparent that most police officers involved in these incidents seek refuge in denial (Lazarus, 1984). Focused psychotherapy in combination with working through of the incidents and sometimes psychopharmacological intervention appear to be of value in alleviating PTSD in police officers. Preliminary experience in psychotherapy with these police officers is presented in two case vignettes.

The relationship between the use of benzodiazepines and shoplifting behaviour is reviewed. Three case vignettes are presented in which shoplifting is temporally associated with benzodiazepine treatment. The mechanisms for this association are explored and the potentialfor reduction/releasefrom criminal responsibility is noted.

Every clinician has treated the adolescent who precipitously decides to terminate therapy before satisfactory resolution or diminution of the presenting symptoms. Most clinicians feel awkward, if not therapeutically impotent, when faced with an adolescent who is proclaiming a desire to stop treatment prematurely. A conceptual framework is presented in which the therapist takes an inclusive view of the adolescent and his/her world and tries to understand the meaning of premature termination at several levels: (1) the intrapsychic economy, (2) the dyadic relationship with the therapist, (3) the treatment approach, (4) the family system, and (5)’ other practical influences. Once the meaning is elucidated in a particular case, the therapist can then take steps to intervene at the most appropriate level in an empathic yet direct manner. Descriptions of these five levels along with illustrative case vignettes are provided.

DSM-III and DSM-III-R aid diagnostic clarity but do not help clinicians plan for common therapies available. A psychodynamic formulation has been described for adults to complement diagnosis and guide management. Child and adolescent psychiatrists would benefit if such a scheme were available for their use. Psychodynamic formulations based on current models are offered and their elements are described. Case vignettes and therapeutic plans are presented to show the practical value of a formal psychodynamic formulation, regardless of the treatment employed.

The authors describe a method for training group leaders in ethical decision making using ASGW's ethical guidelines, case vignettes, and Carkhuffs three goals of helping.

Not every divorcing client comes equipped with a family system that is willing to participate in divorce therapy. This paper emphasizes that a divorce therapist can still use a systemic approach with an individual who seeks help even without the luxury of the family's presence in-session. Case vignettes serve to illustrate how a clinician can create new and more productive realities for the newly divorced client during early therapy, mid-therapy, and late therapy. The structural-strategic orientation suggested culminates in a single case study which links theory and technique with actual practice.

The family therapy field has produced a number of expressive modalities for use in training and therapy. The family floor plan, as a tool for training, teaches systems concepts while involving trainees in an examination of their family-of-origin. In family therapy, the floor plan can be used to assess family interaction patterns and to intervene. The floor plan tool and its applications are described, including short case vignettes.

Countertransference interference is a problem often addressed in psychotherapy supervision. After a brief review of concepts, a case vignette is presented to illustrate the development of a transfe...

This paper examines adolescents who are mourning the traumatic death of peers. A psychodynamic model is employed in offering crisis intervention to individuals and groups of grieving adolescents within a school setting. Case vignettes highlight the psychological impact of the death of a peer on an adolescent's functioning and ego development.

This article describes how the authors use reparenting in a hospital setting to treat schizophrenic adolescents and young adults. Case vignettes and a research study are presented. Randomly selecte...

The authors describe patient progress rounds, a weekly meeting of representatives of all disciplines associated with a university hospital cardiology service. The objective is coordination of treatment for all patients in the interest of providing comprehensive care. Each patient's clinical status is reviewed, but primary attention is given to psychosocial aspects. These rounds provide a medium for identifying and dealing with patients' needs, a cooperative teaching and learning venture for staff, a multidisciplinary team approach that increases quality of care, and an opportunity for doctors to confront the reality of their patients as psychosocial beings. Case vignettes illustrate the use and effectiveness of patient progress rounds.

The authors examined the ability of psychotherapists to diagnose premenstrual syndrome (PMS). They developed two case vignettes that were identical except that symptoms were described as cyclical in one and noncyclical in the other. Participants were asked to provide selected demographic information and requested to make a diagnosis, to indicate the clinical feature in which they made the diagnosis, and to select a treatment they would recommend for treating the case. The results indicated that most therapists can distinguish a PMS case from a non-PMS case based on the cyclical versus noncyclical feature. The number of psychotherapists who misdiagnosed the case, however, is seen as cause for concern.

The major aspects and implications of separation and loss in foster children are reviewed. Case vignettes are presented to illustrate the difficulties these children have in establishing relationships with houseparents and the psychotherapist. The concepts of attachment theory are utilized as a framework for understanding the behavior of foster children and for the selection of patients for psychotherapy. We suggest the use of a specific type of nondirective short-term psychotherapy designed to facilitate the working through of feelings surrounding separation and loss. The importance of the child psychiatrist's role as consultant to the houseparents is emphasized.

This paper, using case vignette and discussion, will elaborate on two specific functions of the clinical social worker practicing in a medical setting. The first, helping patient, family and staff to acknowledge the psychological impact of physical illness; the second is helping a family to accept that there may be no organic etiology for a symptom, and that the sympton may be psychogenic in origin. Barriers for performing these functions are discussed as well as reasons why the social worker is in an ideal position to integrate medical and psychological information into a coherent and practical treatment plan.

The authors describe a 2 1/2-day training program designed to teach mental health professionals how to use a new DSM-III classification scheme. The 251 participants had previous clinical training but no prior exposure to DSM-III. They were asked to diagnose three cases from a series of five videotapes case vignettes; the authors then compared the participants' diagnoses with the expert opinion of clinical faculty. The degree of agreement among the participants with the expert opinion varied across the five cases, but the overall level of agreement was high (74.2%). These results indicate that with adequate training the new DSM-III classification scheme can be accurately applied to diagnostic situations.

Regarding the determination of resuscitation status (RS) and the writing of do-not-resuscitate orders, we compared the recent Presidential Guidelines with the attitudes and perceptions of 143 medical professionals in a major medical center. Seventy-four percent of respondents believed that RS was primarily determined by the physician. Only 1% believed the patient decides and a minority (40%) believed the patient should decide; 61% would want to decide for themselves if they were ill. Most respondents agreed that neither patients nor staff were well-informed about the individual patient's RS. When presented case vignettes requiring a decision about RS, the respondents frequently chose a RS contrary to the wishes of a competent patient. The findings of this survey point to the significant differences between the Presidential Commission's guidelines and the actual attitudes and perceived practices of clinicians.

The civil commitment statutes of Oregon were changed in 1973 and 1975 to include nonphysician court examiners and public prosecutors in the commitment hearing. To evaluate the effect of these changes the authors compared the commitment decisions actually made by panels composed of two physicians with those made by panels with one physician and one nonphysician mental health professional. They also compared the commitment decisions made by six groups of medical and nonmedical people involved with the commitment process regarding five case vignettes. They found that decisions made by the nonmedical mental health professionals were not significantly different from those made by the psychiatric examiners.

This article discusses three major topics: First, the family processes one typically finds in families with a substance abusing adolescent are described. These processes include pseudo-separation and defensive delineation. A case vignette is used to illustrate these processes. Second, an overview of the importance of family therapy in treating substance abusing adolescents is provided. Third, specific principals and techniques for involving families in family therapy are described. This area includes a discussion of such topics as using the initial telephone contact to join with and involve the family, and suggestions for handling some typical problems which the therapist may encounter in the initial interview. These problems or resistances must be handled sensitively if the family is to remain in treatment. This is an important area since involving the families of substance abusing adolescents in treatment can be quite difficult and there is little practical literature available.

The authors in this article describe a 12-week primary care elective for third-year medical students. The administrative and teaching resources of the Boston University School of Medicine, clinical sites at three Boston community health centers, and federal/state and private foundation funding are coordinated to provide a longitudinal, integrated experience in ambulatory pediatrics and medicine. A literature review revealed no prior medical student programs combining psychiatric, pediatric, and internal medicine teaching in a community setting. Case vignettes and questionnaire results indicate that the program has been a success at introducing students to primary care and the biopsychosocial model. The implications of bridging disciplines as well as academic and community health centers and providing funding resources are discussed. The authors recommend this integrative model for enhancing the development of future primary care physicians.

This paper describes the work of support groups developed to assist couples who have delayed parenthood and now struggle with decisions about having children. For some, decisions are complicated by unconscious conflicts that affect self-image, relationships, and convictions about parenthood. Identification of conflict areas appears to reduce anxiety and facilitate decision-making. Issues frequently encountered are illustrated by case vignettes.

Psychiatric consultants are increasingly asked to evaluate the competency of medically ill patients, but the absence of accepted guidelines and gaps in the law can make their task difficult. A model procedure for evaluating competency developed by the authors stresses the importance of conducting a complete clinical evaluation of the patient, prescribes interventions to clarify the role of the consultant for referring physicians, outlines medical and legal principles governing competency, and identifies the requirements of the consultant's note. Consulting psychiatrists cannot declare a patient legally incompetent; they can only give an opinion about the patient's apparent competency. They can withhold their opinion, however, until they have treated a psychiatric condition that may be affecting the patient's competency. Case vignettes illustrate the application of the guidelines.

Radiation therapists are trained to focus on physiological and medical aspects of administering radiation therapy to cancer patients. They often ignore patients′ psychological needs because they are inadequately prepared to understand and intervene in this area of patient care. We sought to remedy this educational gap by using a generic crisis-intervention training program as a method of sensitizing radiation therapists to the emotional and psychological concerns and problems of patients undergoing radiation therapy. After the training, radiation therapists were cognizant of the presence and effects of the special dependency needs of severely ill patients. Training helped them respond more empathically, to establish better rapport with their patients, and to provide more holistic and effective medical management as an integral part of radiation therapy. This included greater ease in knowing how, when, and where to make psychological referrals. A case vignette illustrates the usefulness and application of enhanced psychological awareness and interviewing skills learned by the physicians.

As more individuals whose lives are affected by acquired immune deficiency syndrome (AIDS) begin to need psychiatric hospitalization, psychiatric staffs must be prepared to handle the strong feelings aroused by the disease. The authors present case vignettes of four patients with AIDS-related problems admitted to a voluntary acute-stay ward of a teaching hospital. They then discuss the largely indifferent reaction of the other ward patients to the AIDS-related patients, the tense and fearful reaction of the staff, and the subsequent interruption of the usual functioning of the therapeutic milieu. To develop an optimal management plan, the authors recommend attention to specific principles of patient and milieu assessment.

The sodium amytal interview has been successfully used to diagnose and treat certain adult psychiatric disorders. However, reports of its use in prepubertal children have been limited. This paper describes a safe and effective method of performing a sodium amytal interview in a child. Indications for its use are discussed and five case vignettes are presented. Subjects were psychiatric inpatients aged 9–12 for whom the interview speeded diagnosis and therby improved treatment. These cases illustrate that in certain clinical situations a properly performed sodium amytal interview is a useful tool in the diagnosis and treatment of prepubertal children.

This article describes social work in a nontraditional area. The author uses two case vignettes to present intervention at the micro level and then outlines change strategies in the institutional and cultural context of dental care. The author discusses active case finding, dynamics of the interdisciplinary team, consultation, and implications for policy development.

Many persons coming to you for care will develop emotional distress from time to time, and for this reason, it is important for you to develop skills for evaluating their psychological status. A psychological evaluation of this type can be accomplished by conducting a specially designed interview, the principles of which you can easily learn and use with your patients.