H. Jonathan Polan

Attachment and psychopathology in a community sample

Abstract The Structured Clinical Interview for DSM-III-R (SCID-I) and the Adult Attachment Interview (AAI) were administered to 60 women participating in a study (n = 226) of mother – child interaction. These women were not referred to the study for psychiatric care. The 60 women interviewed with the AAI were selected from the first 190 women who completed the SCID-I, so that 30 received a diagnosis and 30 did not. Analyses indicated that psychopathology diagnoses were associated significantly with mental representations of attachment classified in the AAI. The non-autonomous groups had increased likelihood of SCID diagnosis, compared to the autonomous group. While 32% of women with autonomous AAI transcripts received SCID diagnoses, 63% of women with Dismissing, 100% of woman with Preoccupied, and 65% of women with Unresolved transcripts received diagnoses. Secondary analyses indicated that Dismissing classifications were associated with Axis I diagnoses and Preoccupied classifications with affective disorders. Of note was that among women with Unresolved classifications, underlying secure attachment was associated with low risk of psychopathology, while underlying anxious attachment was associated with elevated risk of diagnosis. These findings support the premise from attachment theory that early relationships affect patterns of interpersonal expectations and behavior and affect regulation.

Olfactory preference for mother over home nest shavings by newborn rats

The developmental course and behavioral processes by which infant rats come to prefer one of two prominent natural odors within their rearing environment, those of their mother and home nest shavings, was studied. Pups as young as 4-5 days and as old as 9-10 days prefer their mothers odor that of their home nest shavings in a two-choice test chamber; pups deprived overnight prior to testing express that preference more strongly than nondeprived littermates when the mother is awake, but not when anesthetized. Encountering maternal and shavings odors in a two-choice paradigm engages a behavioral sequence that progresses from arousal and active sampling of both odors during the establishment of preference to increased mouthing after the choice has been made. A .5 degrees C thermal gradient augments the maternal preference response from 4-5 days of age on, and is necessary to it in 2-day-olds. One-day-old pups do not express a preference for their mothers in our test apparatus on the basis of odor even with the addition of a .5 degrees C thermal gradient, suggesting that preference for the odor of mother over home shavings may be acquired between 1 and 2 days of age.

Role of the mother's touch in failure to thrive: a preliminary investigation.

OBJECTIVE This study investigated the hypothesis that specific types of maternal touch that might promote infant growth are reduced in cases of failure to thrive (FTT) and tested reports that maternal physical interaction and physical affection are diminished in FTT. METHODS Frequencies of operationally defined maternal touch categories were scored by blinded raters from videotaped mother-child feeding and play interactions of 21 children, aged 9 to 19 months, with FTT and 18 normally growing comparison children. After scoring and statistical analyses were completed, investigators unblinded to group status and clinical data reviewed the videotapes of the dyads with the lowest touch scores. RESULTS Mothers of children with FTT provided less matter-of-fact touch in feeding (p = .017) and unintentional touch in play (p = .048) than the comparison group, and there was a trend (p = .082) for them to provide less proprioceptive stimulation in play. Unblinded case reviews indicate that, among children with FTT, extremely infrequent touch signals a marked touch aversion by either the mother or child. CONCLUSIONS Types of maternal touch that may promote growth or facilitate feeding are reduced in FTT, due, in extreme cases, to maternal or child touch aversion. Clinicians evaluating FTT should be alert to very infrequent touch in the mother-child interaction and consider whether it may represent a maternal intolerance of physical contact with her infant or a problem with the infants feeding competence.

Disturbances of Affect Expression in Failure-to-Thrive

Positive and negative affects were assessed in 28 6- to 36-month-old children with failure-to-thrive and 14 normally growing children in feeding and nonfeeding situations. The roles of malnutrition and severity of organic effects also were examined. Failure-to-thrive children expressed less positive affect in the feeding and nonfeeding situations and more negative affect in feeding than normally growing children. Among failure-to-thrive children, the presence of both acute and chronic malnutrition was associated with heightened negative affect during feeding, whereas the degree of organic contribution had no effect. These results, if replicated, may have implications for clinical assessment and are discussed in terms of current theories of failure-to-thrive.

Genetic Variation in COMT Activity Impacts Learning and Dopamine Release Capacity in the Striatum.

A common genetic polymorphism that results in increased activity of the dopamine regulating enzyme COMT (the COMT Val(158) allele) has been found to associate with poorer cognitive performance and increased susceptibility to develop psychiatric disorders. It is generally assumed that this increase in COMT activity influences cognitive function and psychiatric disease risk by increasing dopamine turnover in cortical synapses, though this cannot be directly measured in humans. Here we explore a novel transgenic mouse model of increased COMT activity, equivalent to the relative increase in activity observed with the human COMT Val(158) allele. By performing an extensive battery of behavioral tests, we found that COMT overexpressing mice (COMT-OE mice) exhibit cognitive deficits selectively in the domains that are affected by the COMT Val(158) allele, stimulus-response learning and working memory, functionally validating our model of increased COMT activity. Although we detected no changes in the level of markers for dopamine synthesis and dopamine transport, we found that COMT-OE mice display an increase in dopamine release capacity in the striatum. This result suggests that increased COMT activity may not only affect dopamine signaling by enhancing synaptic clearance in the cortex, but may also cause changes in presynaptic dopamine function in the striatum. These changes may underlie the behavioral deficits observed in the mice and might also play a role in the cognitive deficits and increased psychiatric disease risk associated with genetic variation in COMT activity in humans.

Creative solutions to psychiatry's increasing reliance on residents as teachers.

This special issue answers an urgent need in academic psychiatry to find creative new solutions to our field’s increasing reliance on residents as teachers. Two forces are driving this. One is an old problem that is now getting the recognition that it deserves. Medical schools and their affiliated hospitals have long neglected the preparation of residents to teach despite the fact that residents work more directly with medical students in clinical settings than do attendings, making residents the students’ main, real-time, “in the trenches” teachers, their most immediate interpreters of clinical material, and their most direct supervisors. It is undeniable that residents must be better prepared for this teaching role than they have been. The second is a new problem. Increasing pressures on faculty to spend more time in direct clinical care or externally funded research are making protected time for faculty teaching scarcer, which, by default, makes teaching by the residents that much more critical. This second pressure makes it imperative that education program directors and departmental administrators guard against simply inserting residents as inexpensive substitute teachers into curricula that were designed to be taught by faculty. We must be sure that, in fairness to our students, their residents are well prepared to teach, and that, in fulfilling our educational obligations to the residents, learning to teach and teaching itself advance their professional development. This issue therefore collects in one place 12 articles reporting 14 new projects and one review from the United States and Canada that demonstrate the great range and variation of current efforts to raise the quality of teaching by psychiatric residents. The collection sheds much new light on what types of techniques residents can use, what content areas they are good at teaching, and even what teaching interventions residents themselves have developed on the basis of their interests and perceptions of resident and medical student educational needs. The issue contains an excellent review on assessment tools to evaluate such curricula (1). Among the issue’s reports of specific projects is an exciting variability in all aspects of structure and content—from the level of resident involvement in the creation of the project to the teaching methods employed and the topics, methods, and duration of the courses. For example, the durations of the teaching programs described ranged from a 1.5-hour single session (2), to multiyear clinician-educator tracks (3). Another dimension of interest, the degree of resident input into the formation of these new courses, ranged from a program that used the results of a resident survey to guide how much time to devote to teaching to teach in the residency curriculum (4) to several projects that were initiated and/or developed and implemented by the residents themselves (5–7). There are also varied structures, from a half-day teaching workshop (4) to several forms of Education Chief Residents (8–10). Thus, this issue of Academic Psychiatry is sure to give its readers new models to fit their program’s unique needs and to match any level of availability of resident, faculty, and curricular time. The specific teaching techniques or combinations of skills that the resident teachers were taught to use in their teaching is truly dazzling. Some examples include:

Experiential Anamnesis and Group Consensus: An Innovative Method to Teach Residents to Teach

ObjectiveUsing a novel method, residents generated examples and principles of good medical teaching from their experiences of being taught as medical students. This article describes and evaluates this method of teaching preparation, gives the main teaching principles the residents derived, and provides representative examples of their experiences which illustrate each principle.MethodsIn this 2-hour session, postgraduate year two (PGY-2) psychiatric residents shared their most notable experiences of being taught as medical students with their cohort and a faculty facilitator and, from these experiences, articulated principles of medical teaching for their immediate use as psychiatric clerkship teachers. The residents responded to a survey questionnaire to gauge the value of the method.ResultsIn 2009, 11 PGY-2 residents recollected 18 experiences of peak or poor teaching and derived five major principles of teaching from them in an affectively intense and cognitively engaging group exercise. The survey results indicated that the session caused residents to feel better prepared for medical student teaching.ConclusionThis method of peer group processing mobilized residents’ memories of being taught and organized them into practical principles of good teaching.

AIDS as a Paradigm of Human Behavior in Disease

A new required psychiatry course for first-year medical students linked the urgent need for acquired immune deficiency syndrome (AIDS) education with the traditional goal of teaching the biopsychosocial model of illness. The course, “Human Behavior in Disease: AIDS as Paradigm,” used HIV/AIDS to demonstrate principles of all life-threatening diseases. Formal evaluations of the course’s impact indicated that it significantly reduced students’ prejudices and increased positive attitudes regarding AIDS patients. The students’ ratings of the course indicated that the AIDS paradigm was understood and valued. Our experience suggests that preclinical psychiatry courses can play an important role in the medical educational response to AIDS, while, at the same time, achieving their traditional curricular goals.

Influence of Clerkship on Attitudes of Medical Students Toward Psychiatry Across Cultures: United States and Qatar

ObjectiveTo assure adequate treatment for patients with mental illness worldwide, medical schools must impart positive attitudes toward psychiatry. The authors examined the effect of culture on changes in attitudes toward psychiatry among medical students receiving the same psychiatry clerkship curriculum in two different countries.MethodsA group of 74 students from Weill Cornell Medical College-New York and 32 from Weill Cornell Medical College-Qatar completed pre- and post-clerkship questionnaires assessing their attitudes toward psychiatry.ResultsOn the pretest, the Qatar students had less positive attitudes than the New York students, as evidenced by lower group mean total scores. During the clerkship, the attitudes of students at both schools improved, but more markedly in Qatar, narrowing the group differences.ConclusionsA psychiatry clerkship with a U.S.-derived curriculum had a positive effect on medical students ’ attitudes toward psychiatry in Qatar, suggesting the usefulness of applying such curricula across cultures.