WKPIC would like to extend a hearty hurrah to this year’s graduates of the WSH/PMHC Leadership Forum. These folks did a lot of reading, studying, and homework-ing! Good job, all. Special nod to those three on the left, who just happen to be our current interns.
Recently, the man charged with murdering Chris Kyle, a U.S. Navy sniper whose autobiography inspired the film American Sniper, was said to have faked schizophrenia. Yet, the defense expert witness testified that the accused had paranoid schizophrenia and exhibited signs that could not be faked (Herskovitz, 2015).
So the question arises, how does one distinguish feigned psychosis from the authentic experience of psychotic disturbance?
First, it is important to understand that malingering is an intentional and voluntary deception for secondary gain by fabricating or grossly exaggerating psychiatric symptoms (American Psychiatric Association [APA], 2013). Also, becoming familiar with the diagnostic criteria for Schizophrenia Spectrum and Other Psychotic Disorders is needed to recognize thought-disorder-based psychosis. Additionally, understanding the cluster of symptoms and how they contribute to psychosocial impairment is necessary when assessing psychosis (Richter, 2014).
Malingered psychosis is skewed to the presentation of positive rather than negative symptoms of schizophrenia (Resnick & Knoll, 2008). Specifically, those who malinger are found to show higher proclivity of bogus symptoms, suicidal ideation, visual hallucination, and memory problems (Cornell & Hawk, 1989, as cited in Richter, 2014). A sudden onset of positive symptoms, with no history of negative or chronic symptoms may indicate possible malingering (Richter, 2014).
With schizophrenia, the experiences of tactile and olfactory hallucinations are rare, tend to be intermittent and correlate with existing delusions (Richter, 2014). Possible malingering is suspected when hallucinations are “continuous or not associated with delusions” (Richter, 2014, p. 216). Also, no indications of developed coping strategies for hallucinations are common with malingered psychosis (Richter, 2014). Individuals who malinger report visual hallucinations more often (Richter, 2014). Of note, genuine visual hallucinations tend to be in color, are of normal sized people, may appear suddenly, and do not change if eyes are open or closed (Caldwell, 2009; Resnick, 1997; as cited in Richter, 2014). Auditory hallucinations are most common in schizophrenia, and usually are clear, with both familiar and unfamiliar voices of male and female type (Richter, 2014). Malingered command hallucinations are presented as terrifying and overpowering, with the inability to resist compliance (Richter, 2014). They are also characterized as being dramatic, with stilted language, as well as continuous and presented without association to delusional thought (Richter, 2014).
Delusions as presented by the malingering person often have a sudden onset or termination and the individual eagerly discusses the content (Richter, 2014). Malingering is suspected when disclosure of persecutory nature occurs in the absence of paranoid behavior (Richter, 2014) and when bizarre, atypical delusions are presented without disorganized thought (Resnick & Knoll, 2005; as cited in Richter, 2014). In general, the absence of disorganized thinking is often associated with malingering (Richter, 2014).
Furthermore, individuals who malinger initially show treatment compliance, yet become difficult, often accusing the clinician of believing their symptoms are being faked (Resnick & Knoll, 2008). Moreover, highly social behavior is largely inconsistent with the negative symptoms of schizophrenia and would suggest malingering if observed. Overall, the negative symptoms (anhedonia, alogia, avolition) are often not consistent with malingered psychosis, but are replaced by bizarre positive symptoms (Richter, 2014). The above material offers a brief synopsis of characteristics consistent with malingered psychosis, for a more comprehensive review and discussion of assessment strategies please see Richter’s (2014) article listed below.
References:
American Psyciatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Herskovitz, J. (2015, February 20). Accused in U.S. sniper’s murder faked schizophrenia: psychologist. Reuters, retrieved from http://news.yahoo.com/accused-u-snipers-murder-faked-schizophrenia-psychologist-172922927.html
Richter, J. G. (2014). Assessment of malingered psychosis in mental health counseling. Journal of Mental Health Counseling, 36(3), 208-227.
Dannie Harris, M.A., M.A., M.A.Ed., Ed.S.,
WKPIC Practicum Trainee
Introduction
The researchers believe that music therapy can be used to effectively treat schizophrenia, depression, and personality disorders. When utilizing both a psychodynamic and relational approach to treatment, music therapy can be used to create the necessary conditions for psychological change and support. The techniques used are both active and receptive: 1) active techniques include making music and/or musical improvisation, such as musical composition (e.g., song writing) or musical performance; 2) receptive techniques include listening and responding to music.
Music therapy is the most common treatment modality for schizophrenia and personality disorders in Denmark. Music therapy has been demonstrated to improve global assessment of functioning, depression, anxiety, and symptoms of psychosis. Improvements can be seen within 12 sessions; however, large effect sizes can be seen after 16-51 sessions. In this study, the researchers investigated treatment adherence for music therapy for both treatment groups (schizophrenia and personality disorders). They were examining two components: 1) general treatment adherence between the two groups; and, 2) factors that could predict treatment adherence. Treatment adherence was defined as staying in treatment during the length of time that was agreed upon. Rates of dropout / discontinuation was used to assess lack of treatment adherence.
Materials and Methods
The researcher examined medical records of 27 patients that began music therapy treatment in 2005-2006 across three psychiatric centers in Denmark in this one year follow up study. The following data was collected: demographic variables, psychiatric variables, and therapeutic variables (e.g., prior therapeutic experiences, concurrent therapeutic experiences, etc.). Of the 27 participants, 10 were diagnosed with Schizophrenia and 17 with a Personality Disorder. Of the 27 participants, 12 were male and 15 were female. Participant ages ranged from 19-59; the mean age was 30. Of the 27 participants, 22 were receiving medication at onset of the study; by the conclusion of the study, 24 were receiving medication. 20 of the participants received group music therapy sessions, while 7 received individual sessions. The majority (24/27) of the participants received music therapy in an outpatient setting.
Results
Of the 27 total participants, only three dropped out. Participants in the Schizophrenia category had a 90 % adherence rate; those in the Personality Disorder category had an 87 % adherence rate. The average number of sessions was 18. The researchers were unable to determine any identifying predictors for adherence (e.g., diagnosis, sex, age, etc.).
Discussion
This study was a naturalistic follow up study examining the adherence rates for music treatment of participants diagnosed with Schizophrenia and participants diagnosed with a Personality Disorder. The findings yielded from this research suggest that patients with Schizophrenia and Personality Disorders can adhere to music therapy treatment. This finding is a contrast from previous research, which indicated that similar patient populations had a low treatment adherence rate when in a music therapy group. The researchers cite the development of a therapeutic alliance between client and clinician as a process that is integral to a successful treatment outcome. Based on the results from the present study, it can be inferred that it is possible to build a strong therapeutic alliance despite severity of illness (as the participants in the current study had severe psychotic and non-psychotic issues).
A limitation of the current study is the low sample size (N = 27). Due to a dropout rate of only three, it is difficult to draw inferences based on demographic, diagnostic, or therapeutic variables. Further, the researchers did not provide data regarding demographic data for those that dropped out, data regarding comorbidity amongst the participants, or data regarding what type of personality disorder a participant had been diagnosed with. Regardless, the present study demonstrates that patients with a primary diagnosis of either Schizophrenia or a Personality Disorder can adhere to music therapy, and it should be viewed as a viable treatment modality for these populations. This can lead the way for further research studies in which a larger number of patients with Schizophrenia and/or Personality Disorders can be assessed.
Hannibal, N., Pedersen, I., Hestb, T., Rensen, T., and Rgensen, P. (2012). Schizophrenia and personality disorder patients’ adherence to music therapy. Nord J Psychiatry, 66, p. 376-379.
Faisal Roberts, MA
WKPIC Doctoral Intern
Panic attacks are often described as a sudden fear of dying, going crazy, with an on slot of somatic experiences (e.g., palpitations, sweating, shaking, chest pains, dizziness, paresthesias, etc.). Panic attacks in isolation have a high prevalence in society and result in significant impairment (Kessler et al., 2006). Though not considered a mental disorder, according to the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), panic attacks can occur with any anxiety disorder or other mental disorder (American Psychiatric Association, 2013). However, as noted by psychologist Ricks Warren of the University of Michigan there are several myths associated with the experience of panic attacks (Holmes, 2015).
Warren indicates many believe that panic attacks are merely an overreaction to stress. The experience of a panic attack far surpasses being too worried or high strung, instead in the course of a panic attack, one’s fight or flight response is triggered. Individuals feel they are in danger and must avoid the trigger. Others believe that individuals can pass out from a panic attack. Actually, as Warren notes, during a panic attack an individual’s blood pressure actually increases, which is counter to the experience of fainting, where there is a dip in blood pressure. Yet, other physical symptoms are experienced and often individuals feel they may be experiencing a heart attack. Some believe panic attacks are the same as anxiety. In fact they are distinct, while anxiety is considered an overarching term concerning worry, panic attacks are considered episodes. Consequently, one can develop worry about having a panic attack, which alludes to the development of panic disorder.
Warren also highlights misconceptions that some believe panic is a lifelong problem and that it is difficult to relate to someone with panic attacks. Actually, pharmacological and therapeutic interventions have shown to be effective, and through empathy and compassion one can offer support to those who suffer from panic attacks. Finally, it is common to hear people advise taking deep breaths to calm panic or even to avoid what causes the panic attacks. First, deep breaths often incite a hyperventilation state, which exacerbates symptoms of dizziness and numbness; instead, taking shallow breaths has shown to be effective. Furthermore, the act of avoidance leads to living a restrictive life. Instead, it is important to understand that engaging in such safety behaviors reinforces fear; yet, working through these fears alongside a professional can demonstrate how one can overcome them as well as subsequent panic attacks.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Holmes, L. (2015). 9 panic attack myths we need to stop believing. Retrieved from
http://www.huffingtonpost.com/2015/01/29/panic-attack-myths_n_6509750.html
Kessler, R. C., Chiu, W. T., Jin, R., Ruscio, A. M., Shear, K., & Walters, E. E. (2006).
The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Archives of General Psychiatry, 63(4), 415–424. doi:10.1001/archpsyc.63.4.415
Dannie Harris, M.A., M.A., M.A.Ed., Ed.S.,
WKPIC Practicum Trainee
The practice of self-affirmation or statements that reflect on one’s core values and beliefs has recently shown to impact how our brain accepts medical advice that is difficult to hear (Simple interventions, 2015).
Researchers at the University of Pennsylvania’s Annenberg School for Communication, alongside researchers at the University of Michigan and the University of California Los Angeles, have examined activity in the ventromedial prefrontal cortex (VMPFC) on a sample of 67 sedentary adults as they were given typical medical advice. The experimental design consisted of participants wearing devices on their wrists to measure activity levels for one week before and one month after receiving feedback of brain activity in the VMPFC. During the monitoring period, all participants were sent text messages related to health risks and activity levels (e.g., “According to the American Heart Associations, people at your level of physical inactivity are at much higher risk for developing heart disease”). The experimental group, in addition to receiving the overall health message, was also sent self-affirmation messages. Results indicate that when self-affirmations were paired with health messages there was an increase in activity in the VMPFC and participants were more likely to follow the advice given.
In theory, the use of self-affirmation helps one reflect on core values, and when people are affirmed, their brains process information differently (Simple interventions, 2015). Thus, self-affirmation allows one to receive threatening messages as more valuable and personally relevant. Furthermore, the VMPFC is an area of the brain that increases activity when individuals think about themselves and when values are ascribed to ideas (Simple interventions, 2015). It is noted that activity in the VMPFC during the reception of a health message can predict behavior change better than one’s own intentions of changing (Simple interventions, 2015). These findings suggest that self-affirmations facilitate change by altering how our brain responds to messages that are counter to our current behaviors.
As a result, it is fitting to quote the character Stuart Smalley from Saturday Night Live, “I’m good enough, I’m smart enough, and dog-gone-it, people like me.”
References
Simple interventions can make your brain more receptive to health advice. Retrieved from (2015, February 2).
To review original article:
Falk, E. B., O’donnell, M. B., Cascio, C. N., Tinney, F., Kang, Y,…Strecher, V. J. (2015). Self-affirmation alters the brain’s response to health messages and subsequent behavior change. Proceedings of the National Academy of Sciences, in press. Epub ahead of print retrieved from http://www.pnas.org/content/early/2015/01/29/1500247112.short?rss=1
Dannie Harris, M.A., M.A., M.A.Ed., Ed.S.,
WKPIC Practicum Trainee
There is no way–NO WAY–that a computer can be a more accurate, better judge of an individual’s personality than other people, right? RIGHT??
Well, results yielded from a new research study conducted by Cambridge University is implicating just that. But whoa, how can this be? I mean computers are great with statistics and numbers, you know, hard data. But how can a computer effectively assess something as utterly intangible and ludicrously abstract as personality? Impossible, yeah?
Well, according to this research, it is quite possible. In this specific case, computers used one specific metric to assess an individual’s personality: Facebook Likes. Results from this study demonstrated that by assessing a person’s Facebook Likes, a computer model was able to predict an individual’s personality more accurately than most of that person’s own family and friends. If the computer was given a sufficient amount of Likes to analyze, only an individual’s spouse could parallel the computer’s accuracy of personality (as measured by broad psychological traits).
Let’s examine some of the results, shall we? Given a mere 10 likes, computers could assess an individual’s personality better than a colleague. Given 70 likes, the computer was more accurate than a friend or roommate. Given 150 Likes to analyze, the computer was more accurate than a parent or sibling. And given 300 Likes, a computer could more accurately predict an individual’s personality than a spouse. Since the average Facebook user has approximately 227 Likes, the computers have no shortage of data to analyze.
In this study, researchers used a sample of 86,220 individuals on Facebook that completed a 100 item personality questionnaire (from a myPersonality app) and provided access to their Facebook Likes. From the self-reported personality test, scores were generated based on the “Big Five” personality traits (also called the OCEAN model): openness, conscientiousness, extraversion, agreeableness, and neuroticism. The researchers were able to establish which Likes equated with higher levels of specific traits; for example, a Like of “meditation” showed a higher degree of openness. The aforementioned myPersonality app then gave users the option of inviting others (such as friends and family) to assess the psychological traits of the user via a shorter version of the personality test. The results from people the individual knew and the computer were assessed.
Shockingly, the computer came closer to the results from an individual’s self-reported personality than close friends and family members. It seems that the artificial intelligence depicted in the science fiction genre isn’t as far off in the future as we may have believed…
Nauert, R. (2015). Computers Better Than Humans for Assessment of Personality?. Psych Central. Retrieved on January 19, 2015.
Faisal Roberts, MA
WKPIC Doctoral Intern
How much do you know about Post-Traumatic Stress Disorder? By now, it would appear that the general population has heard of this disorder and are aware of what it is at least on a fairly rudimentary level.
PTSD currently affects approximately 7 % of the population of the United States and has become a pressing health issue for veterans of war. Have you ever wondered about such variables as the threshold for what will cause PTSD? For instance, two people could experience the same motor vehicle collision, yet only one of them may develop PTSD symptoms. Why is that? Researchers from the University of California, Los Angeles (UCLA) have recently linked two gene variants to PTSD. This suggests that hereditary factors can influence an individual’s risk of developing PTSD. These new findings could provide a biologically based approach for diagnosing and treating PTSD more effectively.
Dr. Armen Goenjian and his team discovered two genes, COMT and TPH-2, which are linked to PTSD. These two genes play important roles in brain function. COMT is an enzyme that degrades dopamine, a neurotransmitter that assists in regulating thinking, mood, attention, and behavior, as well as controlling the brain’s pleasure and reward centers. TPH-2 controls the production of serotonin, a brain hormone that regulates mood, alertness, and sleep–all areas that are disrupted by PTSD. Dr. Goenjian and his team found significant associations between variants of COMT and TPH-2 with symptoms of PTSD. This may be indicative that these genes contribute to both the onset and the persistence of PTSD.
The results yielded from the study suggest that individuals that carry the genetic variants of COMT and TPH-2 may be at a higher risk of developing PTSD after a traumatic event. Now that scientists have begun to develop new ways of assessing risk factors for PTSD, what benefits do you believe can come from it? Would examination of these two genes play a role in recruitment criteria for the armed forces? Let me know what you think.
References
Goenijian, A., Noble, E., Stenberg, A., Walling, D., Stepanyan, S., Dandekar, S., and Bailey, J. (2015). Association of COMT and TPH-2 genes with DSM-5 based PTSD symptoms. Journal of Affective Disorders, 172.
University of California, Los Angeles (UCLA), Health Sciences. (2015, January 9). Study identifies two genes that boost risk for post-traumatic stress disorder. ScienceDaily. Retrieved January 12, 2015 from www.sciencedaily.com/releases/2015/01/150109123321.htm
Faisal Roberts, MA
WKPIC Doctoral Intern
By now most people are aware, at least to some degree, of things that are good for your heart. Exercise? Check. Oatmeal? Done. Salmon? Affirmative. Managing Stress effectively? Why of course! Now let’s throw in a healthy dose of optimism for good measure! Results yielded from a new study conducted by the University of Illinois are suggestive that optimism can lead to improved heart health.
Led by Dr. Rosalba Hernandez, a professor of social work, the study examined more than 5,100 adults between the ages of 45 and 84. The construct of cardiovascular health was calculated by assessing seven dimensions: blood pressure, body mass index, fasting plasma glucose and serum cholesterol levels, dietary intake, physical activity, and tobacco use. These are the current metrics used by to American Heart Association to assess heath health. Each of these seven dimensions were rated either zero, one, or two (denoting poor, intermediate, and ideal scores, respectively) with higher scores corresponding with healthier heart states. To evaluate level of optimism, the participants completed surveys measuring mental health, levels of optimism, and physical health. In their results, a correlation was found between the participants’ total health score and their levels of optimism.
So it looks like we now have another reason to maintain a healthy, optimistic outlook on life!
Nauert, R. (2015). Optimism is heart healthy. Psych Central. Retrieved on January 12, 2015.
Faisal Roberts, M.A.
WKPIC Doctoral Intern
We are now a little past one week into the new year of 2015. Did you make a New Year’s Resolution? If so, how well have you done with keeping it? I have never personally made one, for reasons that I’m unsure of. I didn’t decide to never make them; I just haven’t for whatever reason. Thinking about all of this made me wonder about the origin of making resolutions. Where did this custom start? When beginning my search, I expected a myriad of contradicting answers with the specific origin being evasive and somewhat ambiguous. However, from the little research that I’ve conducted, the answer appears generally consistent amongst a few different sources.
Before New Year’s was celebrated in January, it was celebrated in what we now know as the month of March by the Babylonians nearly 4,000 years ago. This time period was chosen as the start of the New Year as it was the beginning of spring time when the leaves come back and the crops grow, hence why it was a logical choice for them (Blaire, 2006). The Babylonians made promises to their gods at the beginning of the year, with promises to repay their debts and return borrowed objects. The Romans changed New Year’s to January in 153 B.C. (Blaire, 2006), named after one of their gods, Janus, the two faced god that could look backward at the old year while simultaneously looking forward at the new year (Petro, 2015). As opposed to returning objects and repaying debts, their resolutions generally regarding treating each other better. Today, New Year’s Resolutions can encompass a wide variety of areas, but with personal improvement being the center (Blaire, 2006; Petro, 2015). Common resolutions include those pertaining to fitness, finances, altruism, kindness, charity, volunteer work, career goals, reading habits, learning new skills, giving up vices, etc.
What do you think of New Year’s Resolutions? Is it a great way to kick off the new year with a positive mentality? A pointless endeavor that leads people to feel bad when they invariably fail on their goals? Or somewhere in the middle? Either way, belated happy new years from all of us at WKPIC!
Blaire, Gary, R. (2006). The History of New Year’s Resolutions. As retrieved from: http://ezinearticles.com/?The-History-of-New-Years-Resolutions&id=245213
Petro, Bill. (2015). History of New Year’s Resolutions: Where Did They Begin?
As retrieved from: http://billpetro.com/history-of-new-years-resolutions
Faisal Roberts, MA
WKPIC Doctoral Intern
New research from the John Hopkins Bloomberg School of Public Health reveals informative and quite honestly startling data regarding the correlation between diabetes in midlife and cognitive decline in older age. There is a strong correlation between the declination of cognitive processes such as memory, word recall, and executive functioning and the progression of dementia. Results yielded from the research suggest that diabetes tends to age the mind five years faster than the normative effects of aging. For example a 60-year-old with diabetes experiences a similar amount of cognitive decline as a 65-year-old without diabetes.
This study, led by Dr. Elizabeth Selvin, is thought to be the longest running study of its kind as it followed a cross-section of adults as they aged. For the study, Dr. Selvin used data from the Atherosclerosis Risk in Communities Study (ARIC), which began in 1987 and contains a participant pool of 15, 792 adults from four different states. The participants were evaluated (including a cognitive evaluation) four times, approximately three years apart, beginning in 1987. The participants were then seen a fifth and final time between 2011 and 2013. The researchers found that the participants with poorly controlled diabetes experienced cognitive decline that was 19 % worse than expected for their age group.
This research emphasizes the importance of a healthy lifestyle as it can potentially prevent diabetes and, now evidently, dementia. The cost of dementia nationwide was estimated to be approximately 159 billion dollars in 2010. With the fact that people are living longer than ever before, the cost of dementia is estimated to increase by an additional 80 billion dollars within the next 25 years. Dr. Selvin states that even if we could delay dementia for a few years, it could have a huge impact on the population in terms of both quality of life and healthcare costs. With America experiencing its highest obesity rates for both children and adults, it does not bode well regarding the estimated future prevalence of dementia. However, if this information is proliferated and embraced, it may have the potential to motivate people into adopting a healthier lifestyle to avoid the tragic fate of dementia.
Johns Hopkins Bloomberg School of Public Health. (2014, December 1). Diabetes in midlife linked to significant cognitive decline 20 years later. ScienceDaily. Retrieved January 5, 2015.
Faisal Roberts, MA
WKPIC Doctoral Intern