________________________________________________________________ VOLUME 2, ISSUE 5 THE INTERPSYCH NEWSLETTER JUNE, 1995 ________________________________________________________________ SECTION C: INTERPSYCH UPDATE (2/2) =============================================================== 4. RECENT IP MEMBER PUBLICATIONS =============================================================== -------------------------------------------------- | As a way of recognizing their volunteer efforts | | for InterPsych as well as their academic status, | | this section is to inform InterPsych members of | | some of the recently published writing by IP | | forum leaders, members of the board of directors | | and strategic planning group, and other IP staff.| | | | Matt Merkley (email@example.com) is the editor | | of the section. | | | | The citations are based on a search of new | | additions to the databases at the National | | Library of Medicine in Washington D.C. | -------------------------------------------------- a. Klein DF; Wender PH ------------------- Understanding depression [letter] Am J Psychiatry 1995 Apr;152(4):652 Unique Identifier: SDILINE 95208943 LETTER (Publ. Type) b. Stinson CH; Milbrath C; Horowitz MJ ----------------------------------- Dysfluency and topic orientation in bereaved individuals: bridging individual and group studies. Langley Porter Institute, University of California, San Francisco 94143. J Consult Clin Psychol 1995 Feb;63(1):37-45 Unique Identifier: SDILINE 95204679 JOURNAL ARTICLE (Publ. Type) c. Corballis MC ------------ Can commissurotomized subjects compare digits between the visual fields? Department of Psychology, University of Auckland, New Zealand. Neuropsychologia 1994 Dec;32(12):1475-86 Unique Identifier: SDILINE 95191787 JOURNAL ARTICLE (Publ. Type) d. Klein DF -------- Cognitive therapy [letter] Br J Psychiatry 1994 Dec;165(6):838 Unique Identifier: SDILINE 95187591 LETTER (Publ. Type) e. Mannuzza S; Schneier FR; Chapman TF; Liebowitz MR; Klein DF; and others -------------------------------------------------------- Generalized social phobia. Reliability and validity. Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY. Arch Gen Psychiatry 1995 Mar;52(3):230-7 Unique Identifier: SDILINE 95177721 JOURNAL ARTICLE (Publ. Type) f. Galatzer-Levy RM ---------------- Children, bad happenings, and meanings [editorial] J Am Psychoanal Assoc 1994;42(4):997-1000 Unique Identifier: SDILINE 95173308 EDITORIAL (Publ. Type) =============================================================== 5. THE BEST OF INTERPSYCH =============================================================== ----------------------------------------------------- | This section contains some of the eloquent, timely, | | or particularly informative messages from recent | | discussions on InterPsych's forums. These selections| | were either chosen by the editor of this section or | | sent to the IPN mailbox. Our hope is that these | | messages will offer a snapshot of the enthusiasm | | and activity of InterPsych's many members. | | | | Reproduced postings are subject to possible | | distortion by complicated mail headers or other | | technical hardships. While effort has been made | | to keep messages in their original form, they | | have been reformatted to comply with the IPN's | | line length. Neither InterPsych nor the InterPsych | | Newsletter staff can be held liable regarding the | | selection, use, content, and redistribution of this | | section. Sole responsibility rests with Matthew | | Merkley (firstname.lastname@example.org), the editor of this | | section. | | | | If you have seen a posting that falls into this | | category and deserves another look by the larger | | InterPsych community, please forward it to the IPN | | mailbox at (email@example.com). Include | | either a "Best of IP" subject heading or put a note | | to this effect in the body of the message. | ----------------------------------------------------- =============================================================== a. Source-Date: Mon, 1 May 1995 22:41:55 -0400 From: DonaldK737@aol.com Subject: Re: Trend Toward Significance =============================================================== Saklad@uthscsa.edu says: Anyone want to explain why most authors & editors of journals consider p(0.05 to be significant, yet many papers never even report the power? Many studies have very low power (0.5), yet are still considered to have conclusions that we should base our clinical decisions on. Why not equalize both types of errors? On p(.000001 not being definitive proof of a fact: I agree that it is not definitive proof, however, it certainly tells you which side to bet on :-) Steve -------------------------------------------------------- in the trade off between seeing something significant where there is nothing vs. seeing nothing significant where there is something (or as a cynical statistician friend puts it-the difference between love and apathy) most feel that sins of comission are of more concern than sins of omission. i think it depends on whether you are working in the context of discovery to be followed by replication where i would accept more type1 error and less type 2 or working in the context of verification where the opposite holds. don klein =============================================================== b. Source-Date: Tue, 2 May 1995 23:55:35 +0000 From: firstname.lastname@example.org Subject: Feedback and thanks re: Consult =============================================================== I posted last Thursday about my concerns re: 60 year old woman with anxious and depressive symptoms, on multiple meds for rheumatoid arthritis. Within 12 hours I had several helpful notes; within two days I had received the most comprehensive consultative assistance I could have hoped for. The woman is currently psych hospitalized for stabilization. She is under the care of a different psychiatrist; currently on increased Effexor dosage. Thanks to Rae Montor for the various comments, the coaching, and the phrase "concatenation of nostrums". To Jeffrey Kramer, your comments were very helpful in crystallizing some of the dynamics of the case for me. Very valuable stuff. To Paul King, I was intrigued by your questionging of my client's use of humor. She DOES, in my mind, have an engaging and dry humor. I seem to notice it more than she herself does. I'd be interested in hearing more of where your thoughts lead in this area. Thanks to Jim Scheel for the SAD and anniversary reaction questions. I'd like to hear more about your ideas on the connection between panic attacks and repressed rage. Thanks also to Rami Kaminski for your e-mailed suggestion. To Kaan Ozbayrak, your comments on the relationship between myself and the attending psychiatrist were accurate. I've shared several cases with him over the years and like him personally; he agreed to the switch in psychiatrists upon the patient's hospitalization. I think it's hard for MD's in these managed-care cases to be as enthused about a case, since they are authorized such short and infrequent times for medication evaluations, and non-MD therapists such as myself engage in the lion's share of time with the patient. I learned a great deal from the posts by Bill Bennett, Mike Johnson, George Nasra and other MD's who shared your knowledge so skillfully and graciously with me. Don Gallup, Marc Bostick and others were also very responsive. Sorry if I've missed others. I only had one reply that didn't open any space for dialogue, in a private post from an MD who seemed miffed about my presentation for some reason. I'll certainly keep anyone posted who'd like further follow-up. I owe you all a buncha favors. email@example.com is Bill Herring, LCSW 8097 Roswell Road, Suite A-102 Atlanta, Georgia USA 30350 Telephone: (404) 396-1933 =============================================================== c. Source-Date: Wed, 3 May 1995 13:39:10 -0400 From: firstname.lastname@example.org Subject: Re: how memories are implanted =============================================================== Denis Franklin noted: There were family legends I heard told as a child, to which I had put such vivid images while listening that I later believed I had been present at the events themselves... This reminds me of yet another kind of "memory" -- which I note here mostly to amuse: I used to write children's books, and try them out before sending them to publishers on my then-young children (those people who have long since turned into adults); I am not an artist, and therefore all narratives were verbal only, usually read aloud. One of my daughters, when she turned 13 or so, asked me for a copy of one of the books (one which had never been sold), because she wanted to look at the illustrations again. I told her there weren't any. She argued heatedly with me about this, because she could clearly remember every line of them: detailed ink drawings in a 19th-century-engraving style. I wish: the book might have been bought if they had existed. (She eventually accepted my version of reality -- but not without being *very* angry about it! And, unfortunately, although she could see these illustrations in memory, she could not reproduce them [although we both knew they had come from her imagination...].) This aside, I do wish to applaud Dr. Franklin's view of metaphorical reality, since it gives as much *emotional* weight to the events being remembered as does most courtroom evidence. And although I do see the point to many legal actions in this arena, I am not entirely sure that those are entirely therapeutic activities. After all, what if the perpetrators of horrible acts are, at the time the memories are actually recovered, dead? Surely, this does not mean that the patient is doomed to some kind of permanent hell. Our purpose seems to be, at least in part, to allow patients to come into themselves as individuals, and help them stop the action-reaction enmeshment cycle: does this not mean that actions that have revenge as their entire motive are non-therapeutic, since they continue that cycle? Further, is a lack of ability to "prove" an abuse a basis for reduced rage (I most sincerely doubt it)? There do seem to be reasons in some cases, well beyond "revenge," for court actions. Protection of others (e.g., grandchildren) is certainly a reasonable motive. And in those instances, I do think that "the good of the child" -- the *present* child, not the remembered one -- must prevail in the decision of whether to initiate legal action. Dr. Franklin said: What is the harm, in the case of a competent adult, in not assuming that the memories are... true, until such time as collateral evidence is unearthed... None, say I. In the case of other children, however, I would have to cast my vote in entirely the other direction: better to protect children from possible abuse, than be overly cautious and abandon them to its certainty. Rae Montor Private Practive Brookline, MA email@example.com =============================================================== d. Date: Sat May 06, 1995 3:25 pm CST From: firstname.lastname@example.org Subject: Croatia - Zagreb =============================================================== Hello everybody, I am a psychologist, a lecturer at the Dept. of Health Psychology, College of Nursing, School of Medicine, University of Zagreb, Croatia. Also, I am a member of Executive Board of NGO "Dobrobit" ("Well Being"). For the past 2-3 months, I've been following with interest the discussions on this mailing list. All of you have probably heard about war events in this area of Europe, started 1991. by the army of ex-Yugoslavia, headed by Serbs, which attacked Slovenia, Croatia and finally Bosnia and Herzegovina. Since then, thousands of persons have been killed, wounded, missing, tortured, raped, displaced, lost their families and homes. People have been traumatized by the most atrocious war events, aimed mainly at civilians. Although in Croatia there is a great number of different experts who have tried to alleviate different consequences of war traumatization, their number is not great enough. Many experts from other countries have helped from the beginning of the war, sharing their experiences and knowledge, educating volunteers and paraprofessionals, especially in the filled of psychosocial help and support to war survivors, the field which is well-known to me. I can say that we have managed to establish a psychosocial network with the aim of helping those most in need. At this very moment, however, we have found ourselves in a qualitatively new situation. That is, up fill now, the events have followed some logic of war, although the Serbs attacking Croatia have always been all international conventions committing numerous war crimes. Now, the so called Serbian paramilitary, have undertaken terrorist action against civilian population in Croatia's capital, Zagreb, launching rockets carrying cassette-bombs aimed at targets in the very center of the city, such as main squares and streets, schools, children's clinic, railway station, theater, during lunch time when a lot of people are on the streets. This is a situation when a town of 1 million inhabitants functions under constant stress and fear for life. Not to mention same 100000 displaced persons from occupied territories of Croatia and refugees from B&H. Who have been taken care of in Zagreb and who have already experienced numerous war-stresses. This situation has motivated me to send my message to all of you participating in this list for help and support to all the innocents victims of this war, and especially to inhabitants of Zagreb who have no way of protecting themselves from atrocious terrorist Serbian attacks. It is particularly frustrating to have comments of politicians from some countries (e.g. Owen), that this situation is the expected result of police and military actions undertaken by Croatia in the occupied territory of West Slavonia, in order to establish highway and railway communications, and after Serbs' shooting at the drivers on the highway. It would be the same if someone tried to justify the terrorist bombing in Oklahoma City by the actions of the Government of the USA. Personally, I am involved in NGO "Dobrobit" ("Well being")offering psychosocial help to war survivors trough counseling center, mobile teams who visit them at their homes, editing books, video-cassettes and TV broadcasts and educating both war survivors and relief-workers. Any advice and help is welcome. Thank you for the attention you have devoted to the war survivors in Croatia. With my sincere regards. Damir Lucanin Department of Health Psychology College of Nursing School of Medicine University of Zagreb Mlinarska cesta 38 41000 Zagreb Croatia Tel: 385 (0)1 278 355 Fax: 385 (0)1 434 181, 385 (0)1 435 750 E-mail: email@example.com =============================================================== e. Source-Date: Sun, 7 May 1995 19:52:56 -0700 From: firstname.lastname@example.org Subject: Re: Lunchmeat and Lists/Advertisers =============================================================== Not to belabor the point, but Denise (Late111@aol.com> suggested: )Another idea would be if ALL of us, when we get an )adverstisement, forward that advertisement back to the )sender. They would then see how annoying it is to get )advertisements.(hopefully if we all do it, they will have a )full mailbox) and was sarcastically critiqued by (ASGDP@VMS.ACAD2.ALASKA.EDU): )As as student studying Psy. and SW, I am profoundly )enlightened by such posts. Here I have been under the )impression that people who are "professonal" would have )mutual and reciprocal respect for each other. With this )assumption, it seems rather logical to assume, that the )solution would be to simply state the purpose of the )discussion group, with compliance by all. Here, I personally )see, an attempt of some to control another to comply with )their wishes. Mmmmm, boy, that sure sounds "professional" to )me (NOT). Regards from a mere student who still has lots to )learn from all professionals. Denise's suggestion has a name in Internet lingo: it is called "mailbombing." An offensive Internet user is punished by being flooded by unwanted return email. Some take this idea to extremes, and send huge, meaningless files (e.g., "core-dumps" - don't ask...) that quickly exceed the user's email storage limits, or could even imperil the functioning of his/her host machine, e.g., at AOL. Mailbombing is not effective with a commercial spammer, who undoubtedly realizes this is a one-shot deal -- a very inexpensive advertisement to thousands of people, but one that cannot be repeated, at least on the same Internet service provider. Some feel mailbombing isn't very effective in general. Students of psychology and social work soon learn that supervisors, teachers, and other professionals are human, too. When anyone perceives an unprovoked attack, one that breaches social contract and civility, there's a tendency to "take off one's gloves" and fight. It's not the most noble thing about human nature, but human nature it is. Please accept our clay feet and our warts, and yours will be accepted, too. Besides, how do you know Denise is a professional, and not your classmate? Steve Reidbord, MD email@example.com (preferred) Dept. of Psychiatry, UC San Francisco firstname.lastname@example.org =============================================================== f. Source-Date: Tue, 9 May 1995 15:43:10 -0500 From: email@example.com Subject: SSRI's, weight gain and unsubscribe =============================================================== I generally unsubscribe before leaving on vacation to avoid mailbox overflow on my return. I was touched by a colleague's expression of regret at my unsubscription. Thanks. I guess we are a sort of cybercommunity after all. As to SSRI's and weight gain, Sam Sussman writes: ) A number of family physicians have noticed considerable ) weight gain with SSRIs .A paradoxical re-action. Please ) comment. ) Thank you SS Bill Boyer replies: For every pharmacological action there is an equal, opposite, (but less common) reaction waiting to be reported. In my opinion, weight gain is one of the most underrated side-effects of this group of drugs. In my experience it is quite common and often severe. As someone noted, it can be a late side-effect, occurring after about three months, often following an initial weight loss. That may account for why it is reported as rare in the drug company literature. In addition, they presumably have little incentive to publicize such a finding if they are not compelled to do so by FDA requirements. Sexual side-effects are also grossly underreported. Package inserts indicate that they occur in only a few percent of users. In my experience, it's at least ten times that common. It makes you wonder how they asked about the side-effects. Thanks all for your continued comments and to you Ivan for keeping your eye on the signal-to-noise ratio. In the words of the Terminator, "I'll be back." Norman Norman E. Rosenthal, M.D. Chief, Section on Environmental Psychiatry CPB/NIMH =============================================================== g. Source-Date: Tue, 9 May 1995 23:43:52 -0400 From: ARTSANALYS@aol.com Subject: Diagnoses and Caffeine =============================================================== Ken Pope sends to psychotherapy-practice@ netcom.com John Leo's essay on diagnoses and personal responsibility ("the twinkie defense," etc.), which certainly contains, I agree, an important message about personal accountability and social values that deserves repeating. But embedded in the story is the matter of caffeine and its impact on behavior. IMHO, from a psychiatric and psychotherapy standpoint, as a hazard caffeine is the *most underrated* commonly used (and ab-used) drug among (possibly a majority of) our patients. Ex.: Ca approx 1980 the NE Journal reported caffeine use among women @ 2 cups of coffee/day = the maximum safe intake (above which the incidence of _bladder cancer_ rises shraply). Among men who pump gas, smoke cigarettes, and drink coffee )) hugely higher rate of same, bladder CA. Based on long experience in a psych evaluation and admissions unit as well as in PRx practice, caffeine plays a role which should *always* be evaluated among any cohort of patients, esp where other drug use is present, mood complaints of any sort, sleep complaints, PTSD Ss or c/o, and certainly when "anxiety" or "panic attacks" are c/o by pts. In a string of cases referred to me for pre-screening for much larger (and much, much more expensive) workups at our local fancy panic attack clinic, _every case_ of r/o 'panic attacks' and 'c/o refractory anxiety attacks' was resolved by removal of caffeine. In one ongoing, frequently puzzling, 12 yrs of care for a man with PDD (pervasive developmental disorder r/o adult autism), in this very cooperative pt all aggressive outbursts, as well as refractory depressive Ss, were eliminated by eliminating caffeine. (Pt otherwise managed on a list of antianx and mood stabilizing preps which have always had mixed or transient success.) In PTSD and AxII anxious folks likewise, eliminating caffeine, in many cases by a carefully supported plan of d/c, has delivered excellent results around mood, sleep, fearfulness, self esteem (?) etc etc. One new patient comes in heavily dependent on marihuana and *Moutain Dew* soda pop (the green stuff) which carries a *whopping load* of caffeine. Pt c/o chronic severe headaches, irritability, sleeplessness or reversal. Pt expr no interest in changing her grass/Dew lifestyle. Yet grass and caffeine both run riot on the cerebrovascular (vasoconstriction/vasodilation) system. Guess what the tx plan will include, on the sooner side of eventually? (NB Few moms are aware of the hazards of Dew, even as they forbid Coke to the kids.) In our office, eval of caffeine has become a routine matter in early eval of nearly all cases now, whether or not other substances, mood or sleep complaints are presented early. Yrs trly Bet MacArthur Cambridge MA firstname.lastname@example.org =============================================================== h. Source-Date: Wed, 10 May 1995 00:09:37 -0400 From: email@example.com Subject: Diagnoses & Personal Responsibility =============================================================== On Tue, 9 May 1995 Ken Pope (firstname.lastname@example.org) said: )I really liked the following brief essay about the validity )of diagnoses, bias in assigning diagnoses, and personal )responsibility. I wish it were read in all clinical )training programs so that the questions it raises could be )widely discussed. I agree wholeheartedly and am glad to start some discussion here. Wouldn't it be wonderful if we all announced that we have no basis for *professional* opinions about how society ought to assess or define personal responsibility? That our thoughts on the topic belong on the Op-Ed page, along with those of the lawyers and the Indian chiefs? That society had better get us out of this part of the judicial process *before* we approach 100% objectivity, validity, and reliability in diagnosis, because once we do, we'll be enthroned as the 21st century version of Dostoevski's Grand Inquisitor? Maybe then the legal profession would reflect on the contempt implicit in the broader tendency to shift responsibility for reaching verdicts from the shoulders of a defendant's peers to "answers from the back of the book" obligingly provided by experts. The relationship between "diminished capacity" and diminished responsibility rests on a society's values and goals. It is, IMO, essentially a political equation, disciplined by explicit principles of due process and the weight of tradition. Experts, and especially social and behavioral science experts seem to me to be pressed into service (or volunteering) as the sort of philosoper-kings whose citizenship carries greater authority than that of the carpenter, secretary, or sales rep sitting on the jury. Perhaps it makes lawyers feel more secure to shape trials as a contest between champions in the art of intimidating plain folks, but the nagging thought persists that it is making the process more chaotic and eroding public trust in the rule of law. Do you agree? Do you think our professions could do anything to turn the tide? Tom -- Thomas V. Maguire, Ph.D.