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Dissociative identity disorder [DID] is a chronic complex psychiatric condition related to cumulative psychological traumatization in childhood. It is characterized by a marked disturbance of identity due to the presence of distinct personality states and repetitive dissociative amnesias which interfere with the continuity of the affected persons autobiography. These personality states [alter personalities] recurrently take control of or influence the individual undermining one’s sense of self and agency. Although working with alter personalities is the hallmark of psychotherapy in DID, a detailed and specific clinical and theoretical psychopathology of alter personalities do not exist yet. Hence, the present paper addresses the formation and functions of alter personalitiesin DID. The hypotheses, proposals, andassumptions developed in this paper have been derived from experiences inintensive treatment of a very large number of patients with DID over more than two decades. The authors propose that the reconciliation between diverse perspectives about one’s internal world and external reality carried by various personalities is necessary for successful treatment of DID. The hallmark of dealing with alter and host personalities constitutes of the elimination of misperceptions of themabout each other personality state and even about themselves.This requires an analysis of the missions and functions of alter personalities which are usually different thanthe perceived conceptualizations.This recognition usually increases the therapeutic alliance and even consent between the therapist, and alter and host personalities and decreases the duration of treatment. The present paper is a preliminary one on this subject and may serve as a basis both for further theoretical elaborations as well as for development of hypotheses in empirical research devoted to understanding operations of human mind when exposed to stress in particular as well as the mechanisms of effective therapeutic interventions in those conditions.

The presentation of any psychiatric patient to a general hospital Emergency Department is at best a potential for disruption of the routine and requiring special care, special attention and precautions and definitely needing special logistics. The Emergency physician intervention is an emergency measure: IE life or limb saving intervention, so medical stabilization is a major goal. When it comes to well and seemingly healthy presentation with psychiatric symptoms or behavioral disturbances, the referral is made directly to the psychiatrist with little history of the current presentation and usually it is filed to consultation as “Abnormal Behavior”. We looked into this group to see what is hidden behind the blanket that label. Our results were congruent with many other published papers as to the frequency of non-psychiatric cases referred to psychiatry. A practical recommendation was derived from the experience in this paper we are discussing the results and the recommendations.

Experiencing traumatic events may often lead individuals to post-traumatic stress disorder (PTSD). Traditional psychotherapies (e.g., CBT) and their variations have proven efficacious in their ability to target PTSD symptoms. Moreover, recent research integrating mindfulness within psychotherapeutic interventions has shown promising results. This paper briefly highlights the importance and use of mindfulness-based interventions in treating PTSD and trauma-related symptoms.

Infants and children with problems of self-regulation are commonly seen in clinical practice. These are children with persistent problems in self-calming, mood regulation, feeding, sleep, and sensory hypersensitivities. The different types of regulatory disorders have been proposed to include children with hypersensitivities: fearful/cautious or negative and defiant type; under-reactive; and motorically disorganized. Preliminary studies conducted on infants and young children with moderate regulatory disorders suggest that most of these children have hypersensitivities and motor disorganization. They are also at risk for emotional and developmental disabilities as they develop over time. To date few studies have validated the different types of regulatory disorders and their impact on mental health and overall development. This paper reviews problems of self-regulation, the different types of regulatory disorders, and presents a detailed case of a child with the hypersensitive type of regulatory disorder spanning the course of infancy through early adulthood. The case description helps to provide validation of the proposed classification of the hypersensitive type of regulatory disorder, and also presents longitudinal data to support the evolution of symptoms in a child with moderate regulatory disorder from infancy to adulthood.

This paper seeks to highlight phenomena related to resistance in the psychotherapy of dissociative disorders and other trauma- and stress-related psychiatric disorders. The authors consider a particular psychological construct to be at the origin of resistance: the trauma-self. The resistances of the trauma-self consist of three main groups: Depressive manifestations, traumatic obsessions, and loss of psychosocial mutuality. Detemporalization, treating oneself as an object, suicidality, obsessions of abnormality, rupturing the mutuality of the patient-therapist relationship, and dissociative somatic crises are clues of these resistances. Succesful treatment is expected to minimize the resistances of the trauma-self. This is expected to be achieved through the careful contextualization of the trauma-self while conducting psychotherapy. Approaching the patient’s experiences from multiple angles not only from the angle of the therapist but also from the patient’s distinct perspectives are crucial in working through the resistances of the trauma-self.

In this series of papers under the umbrella of tardive dyskinesia (TD), five major related issues are discussed pertaining to TD. These are integrated together. In Part A we evaluate how to diagnose, screen for physical signs and scales for tardive dyskinesia, and in Part B, we focus on the management. Tardive dyskinesia (TD) is a relatively new condition associated with abnormal involuntary movements caused by or aggravated by so-called "neuroleptic" drugs. Neuroleptics are used to manage psychotic conditions, as well as nausea and acid reflux, and latterly are prescribed as adjunct medications to depression and anxiety. Tardive dyskinesia (TD) has also become a major problem forensically, because of the challenge of management, the lack of patient's being appropriately warned, and insufficient monitoring of patients at risk. In this Part A series of articles we examine several special important priorities in TD. a. First, what is tardive dyskinesia and how does one make the diagnosis? b. The second issue is the need to regularly evaluate patients on neuroleptics because they are at risk for tardive dyskinesia. Measuring and monitoring for symptoms of tardive dyskinesia allows ensuring early detection. The author's clinical STRAW test has thus far been seldom used, but it may be the best way to monitor TD over time. It appears an improvement over the standard test, the AIMS, as it is broader in ranking (0-10) and is the only scale that measures both frequency and severity, so that monitoring of change is more sensitive. In the series that follows, Part B, we emphasize management and theory, particularly high dose buspirone management, justify the dopamine super sensitivity hypothesis, and re-evaluate the neuroleptics in that context.d

Anorexia nervosa is an eating disorder which affects particularly adolescents The media coverage of feminine thinness is demonstrated as a token of beauty with diet food as means to achieve this However diet foods are not enough to explain the numerous cases This disease is the symptom of a psychological disorder and research for the origin must follow up the psychotherapeutic treatment Multi factorial explanations seem dominate in the various case of this article Family problems and sexual assaults can also explain this transition to anorexia In the first case anorexia nervosa is used as a tool for identification and of personalization in the assumption of autonomy and independence In the second the anorexia becomes a means of defense in response to aggression We give a clinical confirmation of the multivariate origins of anorexia nervosa and of the impact of sexual abuse This paper proposes a new approach of the anorexia nervosa treatment

This paper examines how dysfunctional rearing throughout childhood negatively impacts a child particularly focusing on the strong likelihood of subsequent substance abuse as a way to escape the violence and painful emotions from the adverse experiences from which they have been exposed to at an early age This review also examines the genetic vulnerability and impulsivity of drug seeking behavior and the social epidemiology of substance use Do all children raised in a dysfunctional home end up using drugs to the point of addiction What other factors are related to the epidemiology of substance abuse The following information explains the findings of ten peer reviewed articles in an effort to support the hypothesis and answer the noted questions in the clearest manner as can be determined by the referenced published material

Diabetes mellitus is among the chronic health conditions that patient rsquo s cooperation and satisfaction is an important contributing factor for a good treatment outcome Motivation is an important factor in the management of many medical and psychiatric disorders Any change is like a puzzle made from a number of pieces For a complete picture we need to assume motivation as the basis of any change process Motivational interviewing is a client centered and guiding method for the strengthening and increasing internal motivations of the clients rsquo through identifying and discovering their ambi valences Using motivational interviewing is increasing throughout the world The effectiveness of this method can be seen in addressing chronic health problems which are among the important health issues which are affected negatively by mental and behavioral problems The effectiveness of motivational interview as a method for positively influencing drug treatment nutrition weight control hypertension and dyslipidemia is emphasized In this paper we review published studies on motivational interviewing among diabetic patients

One of the important public health issues worldwide is the rise of higher proportion of older aged with advancement of medicine, prolonged life expectancy and for improved health care facilities. Demographic projections suggest that mental illness along with heart diseases, AIDS and cancer will account for the top four illnesses around the globe very soon. It ranks up at the top along with heart disease, cancer, obesity, AIDS and injuries as leading causes of suffering. Increased longevity of elderly led to higher prevalence of age related neurological disorder like depression, anxiety and so on. In view of this, main objective of the paper is to evaluate the level of depression and anxiety among the rural and urban Indian elderly aged 65 years to 79 years and their possible socio-demographic correlates. Severity in depression and anxiety level is found to be significantly higher among rural males and females in comparison to their urban counterparts. The result of logistic regression analysis indicates that several socio-demographic covariates are the significant predictor of depression and anxiety occurrence. It can be inferred from the present study that rural population is in more vulnerable condition than urban elderly in depression and anxiety prevalence.

The MMPI-2 is the most frequently used psychological test with parents undergoing child custody evaluations (CCE’s). Studies of parents who completed the MMPI-2 in the CCE context have consistently found that, on average, parents portray a very favorable image of themselves as both virtuous and psychologically well-adjusted. Also, on average, Clinical Scale 6 (Paranoia) and its counterpart on the Restructured Clinical Scales, RC6, “Ideas of Persecution”, have been the most frequently elevated of the clinical scales on the MMPI-2 in samples of child custody litigants, albeit, the reported scores on these scales were well within the norm. This paper examines the significance of clinically elevated scores on Scale 6 (and RC6) in parents undergoing CCE’s, with consideration of both contextual and psychometric features. Based on these considerations, this writer suggests that custody evaluators may encounter the paradox that some parents whose clinical profile suggests mistrust and suspiciousness in interpersonal relations may actually trust enough to report their perceptions in a candid and forthcoming manner. Some of these parents may not be mistrustful in general and might not be inclined to model or influence their children toward the development of mistrust. In contrast, other parents may respond to the test in a more defensive and deceptive manner resulting in a “normal” clinical profile, which may be specific to the evaluation context, but may also reflect moral righteousness and a more insidious tactic. The custody evaluator is advised to use caution when interpreting clinically elevated scores on the MMPI-2.

In the search for the causes of developmental stuttering the findings have constantly proved contradictory. Despite the huge body of knowledge about stuttering its cause is still considered to be unknown; the psychological background is recognized as important, but stuttering is currently regarded as a pure neurological problem. It is generally agreed that therapy should be multidimensional but in fact there is a widespread opinion that the dysfunction has genetic roots. This surprising lack of agreement is blocking the advance of research and the development of therapeutic approaches. In addition, there are serious shortcomings in the currently favored methodology of stuttering research: evidence-based medicine and practice have reduced the amount of high-grade evidence research data to such an extent that much useful information has been lost; the relevance of functional magnetic resonance imaging is controversial, and the hope that one day genetic engineering will correct stuttering-related mutations without severe side effects is unrealistic. A change of approach to research and therapy is required. If this cannot be found on the basis of a generally accepted notion of the cause of stuttering, it must emerge from the search for the best existing therapeutic approach. Conclusion: The present paper offers an evaluation of the basic finding of modern outcome research that the factor of a specific therapeutic approach has less impact on outcome than the common factors, especially the clinician-client relationship. In Speech Language Pathology, and notably in stuttering research and clinical practice, it would be wise to implement this understanding in the form of empathy-based therapies. The requirements for developing the skills for this approach are discussed.

Endogenous juvenile-asthenic failure syndrome (EJ-AFS; Glatzel and Huber [2]), three core features of which are cenesthopathy, alienation, and thought disorder, develops at a young age and is considered to be the initial stage or an abortive form of schizophrenia. It is rarely been discussed in the English-language literature, however, a number of cases have been continuously reported in Japan. In this paper, a case study is presented of a patient who showed the psychopathology of EJ-AFS early on and progression to severe personality and social dysfunction 30 years later. From the 21 reported cases in Japan, an overall trend was observed of the symptoms remaining unchanged or improving somewhat, but persisting, in most cases. Only 3 of the cases had been followed for more than 10 years. The present case leads us to reexamining the concept of EJ-AFS and to consideration of long-term course of an attenuate form of schizophrenia.

This short opinion paper discusses cognitive behavioral therapy (CBT) with youth in the era of health care reform. The commentary addresses the ways CBT is consistent with health care reform imperatives. Further, CBT’s focus on accountability, credentialing, early intervention, and interdisciplinary collaboration is emphasized.