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December 2018 - Volume 206 - Issue 12

  • John A. Talbott, MD
  • 0022-3018
  • 1539-736X
  • 12 issues / year
  • Psychiatry 89/142; Clinical Neurology 134/197
  • 1.940


Schizophrenia and Criminal Responsibility: A Systematic Review
Georgios Tsimploulis, MD, Gérard Niveau, MD, PhD, Ariel Eytan, MD, PhD, Panteleimon Giannakopoulos, MD, PhD, and Othman Sentissi, MD, PhD

We conduct a systematic literature review to examine the relation between schizophrenia and criminal responsibility. We have found that this clinical entity is often associated with diminished or abolished criminal liability. We discuss these findings, focusing on the specific deficits found in patients with schizophrenia and examining how this problem affects their behavior and accountability.


The "Double Whammy": Women's Experiences of Weight Gain After Diagnosis and Treatment for Schizophrenia Spectrum Disorders
Kirsti Haracz, PhD, MSc, BAppSc OT, Michael Hazelton, PhD, MA, BA, and Carole James, PhD, MHSc, BSc, Dip OT

Our aim in this study was to understand the experiences of women who gained weight after their diagnosis and treatment for schizophrenia spectrum disorders (SSDs). We carried out up to three in-depth qualitative interviews with 11 women over 2 years. The women described a "double whammy" –Dlike experience, whereby weight gain and obesity came with their diagnosis and treatment of an SSD and brought with it additional challenges. The double whammy parallels the co-occurrence of mental illness and substance misuse.

A Pilot Test of Group Based Cognitive Behavioral Therapy to Augment Vocational Services for Persons With Serious Mental Illness: Feasibility and Competitive Work Outcomes
Marina Kukla, PhD, Amy M. Strasburger, MA, Michelle P. Salyers, PhD, Angela L. Rollins, PhD, and Paul H. Lysaker, PhD

Fifty-two adults with serious mental illness (SMI) receiving vocational services participated in a pre-post feasibility trial of the Cognitive Behavior Therapy for Work Success (CBTw) intervention. CBTw is a 12-week manualized intervention that addresses cognitive and behavioral factors that impact work functioning. Competitive work outcomes were assessed in the 12 weeks preceding baseline and after the intervention. The results demonstrate strong session attendance and a low attrition rate. There were also significant improvements in work outcomes. Specifically, among participants unemployed at baseline, 50.0% attained work during follow-up. These findings provide preliminary evidence that CBTw may be a feasible intervention to augment vocational services.

Metabolic Syndrome, Anxiety and Depression in a Sample of Italian Primary Care Patients
Giorgio Mattei, MD, Maria Stella Padula, MD, Giulia Rioli, MD, Lodovico Arginelli, MD, Roberto Bursi, MD, Serena Bursi, MD, Antonio Matteo Epifani, MD, Luca Pingani, PhD, Marco Rigatelli, MD, Francesca Maria Rosato, MD, Andrea Sacchetti, MD, Gian Maria Galeazzi, MD, PhD, and Silvia Ferrari, MD, PhD

This cross-sectional study aimed at measuring the correlation and association of anxiety, depression, and comorbid anxiety-depression symptoms with metabolic syndrome (MetS) in a sample of Italian primary care patients who attended their General Practitioner clinics over a 1-month period in 2013. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depressive symptoms. The sample was made up of 129 patients (57% women; mean age, 61 ± 12 years). The prevalence of MetS varied from 40% to 48%. The prevalence of symptoms of anxiety, depression, and comorbid anxiety and depression was, respectively, 26%, 2%, and 15%. MetS was associated with comorbid anxiety-depressive symptoms, but not with anxiety or depressive symptoms only. Out of the individual components of MetS, enlarged waist circumference was associated with anxiety symptoms.

The Future of Psychotherapy in Turkey: Predictions for the Next 10 Years
Orçun Yorulmaz, PhD, Seda Sapmaz-Yurtsever, MSc, Ceren Gökdağ, MSc, Servet Kaçar-Başaran, MSc, Ezgi Göcek-Yorulmaz, MSc, Melikenaz Yalçın, MSc, Seda Tokgünaydın-Arıtürk, MSc, Zeynep Erdoğan-Yıldırım, MSc, Nesibe Olgun-Kaval, MSc, and Nimet Serap Görgü-Akçay, MSc

This opinion survey aimed to examine clinical psychologists' predictions for the next 10 years regarding the status of psychotherapy in Turkey in two stages, with 107 participants in one and 69 in the other. The results revealed that the techniques predicted to increase the most in the next decade were the use of eclectic therapy, mindfulness therapy, solution-focused therapy, system/family approaches, and cognitive-behavioral therapy. Among the therapeutic interventions expected to increase in popularity were Internet-based programs, smartphone applications, and problem solving. In terms of type of psychotherapists, family counselors with certificate/graduate degrees and Internet-based treatment programs were expected to become more common.

Facial Behavior During an Attachment Interview in Patients With Complicated Grief
Manuela Gander, PhD, Cathrin Schiestl, PhD, Rainer Dahlbender, MD, Joram Ronel, MD, and Anna Buchheim, PhD

The present study investigated differences in various aspects of facial behavior among female patients with complicated grief (CG; n = 18) and healthy controls (n = 18) during the assessment of their attachment representation using the Adult Attachment Projective Picture System. All patients were classified with an unresolved attachment status. On a behavioral level, they demonstrated longer gazing behavior away from the interviewer and the picture stimuli, more speech pauses, less smiling toward the interviewer, and more crying, especially in response to stimuli portraying the theme of loss. Focusing on the in-depth analysis of death-related stimuli using the Facial Action Coding System, patients demonstrated less facial affective behavior, less disgust, and less smiling in response to these stimuli compared with the healthy controls. The impaired capacity of patients with CG and responding in an affective appropriate manner regarding bereavement might be interpreted as a specific emotion dysregulation when their attachment and mourning system is activated.

Self Efficacy in Depression: Bridging the Gap Between Competence and Real World Functioning
Melissa Milanovic, MSc, Emma Ayukawa, BSc, Aleksandra Usyatynsky, BSc, Katherine Holshausen, PhD, and Christopher R. Bowie, PhD, CPsych

Forty-two participants with major depressive disorder (MDD) were recruited from mental health clinics. Competence, self-efficacy, and real-world functioning were evaluated in adaptive and interpersonal domains; depressive symptoms were assessed with the Beck Depression Inventory II. Hierarchical regression analysis identified predictors of functional disability and the discrepancy between competence and real-world functioning. Self-efficacy significantly predicted functioning in the adaptive and interpersonal domains over and above depressive symptoms. Interpersonal self-efficacy accounted for significant variance in the discrepancy between interpersonal competence and functioning beyond symptoms. Using a multilevel, multidimensional approach, we provide the first data regarding relationships among competence, functioning, and self-efficacy in MDD.

Motor Dysfunction as a Risk Factor for Conversion to Psychosis Independent of Medication Use in a Psychosis-Risk Cohort
Michael D. Masucci, MA, Amanda Lister, MA, Cheryl M. Corcoran, MD, Gary Brucato, PhD, and Ragy R. Girgis, MD

The Structured Interview for Psychosis-Risk Syndromes (SIPS) contains criteria for the Attenuated Positive Symptom Syndrome (APSS), a period of subthreshold positive symptoms that predates full-blown psychosis. Motor abnormalities are often associated with these symptoms but have not been adequately studied. We assessed a diverse sample of 192 APSS participants (27.1% female; 47.9% white; mean age = 20.03 years) for motor dysfunction (SIPS G.3. score) at baseline and conversion to psychosis every 3 months for up to 2 years. Fifty-nine (30.7%) participants converted to psychosis. Baseline G.3. score was significantly higher among converters than nonconverters (mean difference = 0.66; t[95.929] = 2.579, p < 0.05). No significant differences in baseline G.3. were found between demographic groups or those with differential medication use. These results point to the use of G.3. as a potential predictor of psychosis among APSS individuals and potentially implicate the shared biological underpinnings of motor dysfunction in the APSS and full-blown psychotic illnesses.

Linking Psychological Strain and Suicide Ideation: A Test of the Mediating Effect of Self-Determination Among Chinese Workers
Jie Zhang, PhD, Yuxin Liu, PhD, Jianwei Zhang, PhD, and Chen Chen, MA

Synthesizing the strain theory of suicide and self-determination theory, this research tested a multiple mediator model linking psychological strain with suicidal ideation via three basic psychological need satisfaction. Data from 750 professional employees in China support for the partially mediated effects of psychological strain via need satisfaction of competence and relatedness. These findings contribute to understanding Chinese employees' suicidal ideation from positive psychology perspective that is distinct from what is known from psychopathology.


Psychiatric Services and "the Homeless": Changing the Paradigm
Ira D. Glick, MD and Mark Olfson, MD

Given the changes in our society and worldwide massive migrations across borders, this article argues that we need to change the paradigm of how we think about "the homeless," that is, to rethink our approach to not only those who cannot afford housing, the "economically homeless," but especially important also the larger group—those with chronic, serious medical-psychiatric-addictive disorders, the "medically/mentally ill homeless." We must place a greater emphasis on providing mental health services along with housing, legal, general medical, employment, and other services.

Treat the Patient, Not the Rule Book…: The Art of Psychopharmacology!
Carl Salzman, MD

Experienced clinicians are aware that the results from clinical drug trials do not always translate to office practice. This essay suggests that clinicians use their own diagnostic and interviewing skills when treating with medications, rather than simply relying on published data or suggested treatment algorithms.


Attitudes Toward Disclosing a Mental Health Problem and Reemployment: A Longitudinal Study
Nicolas Rüsch, MD, Patrick W. Corrigan, PsyD, Tamara Waldmann, MA, Tobias Staiger, PhD, Andreas Bahemann, MD, Nathalie Oexle, PhD, Moritz Wigand, MD, and Thomas Becker, MD

This study examined the role of disclosure attitudes for reemployment over time. Clinical and job search variables as well as attitudes toward disclosing a mental health issue to an employer were assessed among 301 unemployed individuals with mental health problems. Predictors of reemployment at 6-month follow-up were assessed using multiple regression, adjusted for sociodemographic variables, unemployment length, and depressive symptoms. Greater reluctance to disclose mental health problems at baseline predicted reemployment after 6 months. Reemployment was also associated with male sex, better education, lower disability levels, and more job offers at baseline. Therefore, a cautious approach toward disclosing a mental health problem may facilitate short-term reemployment. It is unclear whether this is a successful long-term strategy in employment settings.

A Lonely Search? Risk for Depression When Spirituality Exceeds Religiosity
Jeffrey R. Vittengl, PhD

Spirituality's potential emphasis on internal (e.g., intrapsychic search for meaning) versus religiosity's potential emphasis on external (e.g., engagement in socially-sanctioned belief systems) processes may parallel depression-linked cognitive-behavioral phenomena (e.g., rumination and loneliness) conceptually. This study tested the hypothesis that greater spirituality than religiosity, separate from the overall level of spirituality and religiosity, predicts longitudinal increases in depression. A national sample of midlife adults completed diagnostic interviews and questionnaires of spiritual and religious intensity up to three times over 18 years. In time-lagged multilevel models, overall spirituality plus religiosity did not predict depression. However, in support of the hypothesis, greater spirituality than religiosity significantly predicted subsequent increases in depressive symptoms and risk for major depressive disorder (odds ratio = 1.34).


Commentary on Everly et al. (2016), Anne-Catherine Vanhove, PhD, Bert Avau, PhD, Emmy De Buck, PhD, and Philippe Vandekerckhove, MD, PhD.​


Response to Commentary on Everly et al. (2016), Jeffrey M. Lating, PhD, Martin F. Sherman, PhD, and George S. Everly, Jr., PhD.


The Psychology of Gender and Health: Conceptual and Applied Global Concerns. M.P. Sanchez-Lopez and R.M. Limina-Gras, Eds. (2017) San Diego, CA: Elsevier, Inc.​
Reviewed by Kaitlin Slaven, MD and Maria D. Llorente, MD.​


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