Arthur C. Houts

Regions of the mind : brain research and the quest for scientific certainty

Acknowledgments Preface 1. Studying scientific work 2. The institutional contexts of localization research 3. Uncertainty clinical and basic research 4. Triangulating clinical and basic research 5. The debate about cerebral localization 6. The mind/brain problem: parallelism and localization 7. The legacy of localizationism Appendices Notes Indexes.

Models of Scientific Progress and the Role of Theory in Taxonomy Development: A Case Study of the DSM

The proliferation of categories in recent editions of the Diagnostic and Statistical Manual of Mental Disorders (e.g., 4th ed.; DSM; American Psychiatric Association, 1994) is discussed as an indication that the underlying classification scheme is inadequate and unlikely to produce the scientific progress originally envisioned. In any nosological system, it eventually becomes necessary to reduce the number of categories by an organizing theory that describes the fundamental principles underlying the taxonomy. The DSM has put itself in an awkward position by claiming to be atheoretical. Although taking such a tack had historical advantages to promote the acceptability of the 3rd edition of the DSM, it now limits the progression of science. It is argued that the DSM should not be used as the basis for guiding scientific research programs because it emphasizes primarily behavioral topography rather than providing an explicit theory that would allow for an evaluation of scientific progress. Theoretically driven taxonomies should be allowed to compete on the basis of how successful they are at achieving their specified goals that might include illuminating etiology, course, and response to treatment. Such systems are not likely to attend primarily to behavioral topography alone and would probably organize behavior differently than the current categorical syndromes seen in the 4th edition of the DSM.

Effectiveness of Psychological and Pharmacological Treatments for Nocturnal Enuresis.

This review provides a quantitative integration of research on the effectiveness of psychological and pharmacological treatments for nocturnal enuresis. With the use of experiments that compared treatments with either no treatment or another form of treatment, this article assesses (a) the overall effectiveness of psychological and pharmacological treatments, (b) the relative effectiveness of specific types of treatments, and (c) moderators of treatment effectiveness including investigator allegiance. Findings from the review confirm that enuretic children benefit substantially from treatment. However, more children improve from psychological than from pharmacological interventions. Moreover, psychological treatments involving a urine alarm are most likely to yield benefits that are maintained once treatment has ended.

Nocturnal enuresis as a biobehavioral problem

A biobehavioral conceptualization of childhood nocturnal enuresis is presented. Recent research on the etiology and pathophysiology of enuresis suggests two important physiological parameters are involved: (1) deficient circadian release of antidiuretic hormone, and (2) deficient spontaneous inhibitory muscular responses. A brief review of medical and behavioral treatments also suggests that these two physiological processes are involved in successful treatments. Suggestions for future collaborative investigations between medical and behavioral researchers are offered. Advances in basic research on the pathophysiology of enuresis present the opportunity for behavioral and medical researchers to identify the mechanisms of action of proven treatments such as the urine alarm.

Children as independent variables: Some clinical implications of child-effects

The influence that childrens behavior has on changing the behavior, cognitions, or affect of adults is an important but often overlooked factor in clinical interventions with children. Childrens behavior often plays a prominent role in maintaining patterns of adult-child interactions that are detrimental to the childs healthy psychological adjustment. Recognition of such child-effects holds important implications for improving assessment and follow-through in adult-mediated behavior change programs. This recognition also suggests that children can act as the primary change agent in certain interventions, a strategy that may serve to empower children while enhancing their perceptions of control. In general, the concept of reciprocal influence in adult-child interactions underscores the importance of the emerging concept of behavioral family therapy.

Prevention of relapse in full-spectrum home training for primary enuresis: A components analysis

Forty-five primary enuretic children were randomly assigned to three treatment groups comprised of sequentially, combined components of Full Spectrum Home Training: bell-and-pad treatment, retention control training, and overlearning. Eleven children served as wait-list controls and showed no spontaneous remission. The group that received all three components reached success criterion (14 consecutive dry nights) faster than the group that received the first component alone. In addition, relapse at 3-month follow-up was significantly less for the group that received all three components compared to groups that received either the first or the first two in combination. Retreatment of relapsers was successful in 22% of re-treated cases. It is suggested that overlearning be routinely incorporated into bell-and-pad treatments to prevent relapse.

Fifty years of psychiatric nomenclature: Reflections on the 1943 War Department Technical Bulletin, Medical 203

War Department Technical Bulletin, Medical 203 is presented in historical context as the first psychodynamic nomenclature. The history of Medical 203 is presented to show how Medical 203 was adapted to become DSM-I. Medical 203 then is compared and contrasted to DSM-IV to illustrate how changes in the modern DSMs have led to an 800% increase in the number of psychiatric diagnoses over the last half century. The role of critical history is emphasized in evaluating those changes and in speculating about the next 50 years of psychiatric nomenclature.

A delivery system for the treatment of primary enuresis

To illustrate how to deliver underutilized psychological treatments, a comprehensive, low-cost treatment for primary enuresis was developed consisting of bell-and-pad training, cleanliness training, retention control, and overlearning. Sixty primary enuretic children and their parents attended 1-hour group training sessions and implemented treatment in the home. Each case required 15 minutes of professional time, and net cost to each family was

The Zero Acceptance of Pain (ZAP) Quality Improvement Project: evaluation of pain severity, pain interference, global quality of life, and pain-related costs.

50. Forty-eight (81%) achieved initial arrest of bedwetting and only 11 (24%) relapsed at 1-year follow-up. Significant association between relapse and prior treatment failure with imipramine was noted. The outcome was found to compare favorably with previous treatments that required more professional time.

Implications of IV monoclonal antibody infusion reaction for the patient, caregiver, and practice: results of a multicenter study

The Zero Acceptance of Pain (ZAP) Quality Improvement Project was a multi-site effort to improve the lives of outpatients with cancer pain by enhancing the clinical practice of pain assessment and management. Independent samples of patients completed self-report measures of severity of pain, pain interference, global quality of life, pain treatment satisfaction, general medical treatment satisfaction, pain attitudes, and pain-related medical costs before and after the implementation of ZAP. Results suggested that ZAP decreased the severity of recent pain, decreased interference of pain on daily functioning, and improved satisfaction with pain treatment and attitudes about addiction to opioid medication. Direct medical costs consisting of pain-related hospitalizations, emergency department visits, and physician office visits were greatly reduced. In summary, the findings of this study support the idea that clinic-based efforts to improve the practice of pain management are effective in improving the lives of cancer patients who are experiencing pain.