Robin Harvey

Social reasoning: a source of influence on aggression.

Aggressive children show deficits and biases in their social information processing. Cognitions based on early experience and social schemas are also related to development and maintenance of aggressive behavior. Social reasoning can be linked to these aspects of social cognition, impacting on the situational cues individuals encode, their interpretations of events, and influencing response decisions. Past experience also influences development of social reasoning and social schema. Despite this, current discussion of the links between cognition and aggression rarely involves consideration of the influence of social reasoning. In this review, domain theory (E. Turiel, 1978, 1983) underpins an examination of links between social reasoning and aggression using empirical evidence drawn from research on the social reasoning of normal and aggressive children. Children as young as 3 appear to use consistent patterns of social reasoning when making judgments about transgressions and other social events, and these patterns are linked to social reasoning domains. We propose that aggressive children access information from the underlying social reasoning domains differently than their prosocial peers. This in turn affects their decision making and subsequent behavior in social situations. Our review explores developmental and clinical implications of the proposal and provides directions for future research.

A methodology for preparing ideal treatment outlines in psychiatry: the Quality Assurance Project

The methodology of preparing treatment process criteria for agoraphobia and the depressive disorders is described. To avoid bias three sources of information were used: the results of a meta-analysis of the treatment outcome literature, the views of a sample of practising psychiatrists, and the views of a small representative expert committee. When criteria for schizophrenia and the neuroses have been completed the quality assurance project should serve two main purposes: first as an aid to continuing and postgraduate education and second as a basis for clinical review criteria required by peer review and other quality assurance activities.

Evaluation of an Online Relapse Prevention Program for Bipolar Disorder An Overview of the Aims and Methodology of a Randomized Controlled Trial

Bipolar disorder is a chronic relapsing remitting illness affecting 1–2% of the general adult population. Awareness of the limitations of pharmacological treatment for this disorder has encouraged the development of psychological treatments and a large body of evidence now exists demonstrating the effectiveness of several types of psychosocial interventions in the treatment and prevention of relapse for bipolar disorder. Unfortunately, it is difficult for many individuals with bipolar disorder to access such programs due to financial constraints and restricted roll-out. One solution to this difficulty is to use Internet-based delivery of targeted psychoeducation, cognitive behavior management and online medication monitoring to improve relapse prevention for those with bipolar disorder.The focus of this article is to discuss the aims and methodology of this unique, collaborative randomized control trial that evaluates the effectiveness of an Internet-based disease management program (termed Recovery Road [RR]). The RR program incorporates both symptom monitoring with feedback, and targeted psychosocial treatment for adults with bipolar disorder delivered over a 12-month period. The overall aim was to determine whether this web-based adjunctive relapse prevention program can improve mental health outcomes. Upon successful enrolment, participants were automatically randomized into either the intervention (RR) or control group. The control group received some relevant information but did not include program components considered to be active parts of the experimental intervention.This article also describes a recruitment, enrolment and randomization process that maximizes the potential of the Internet for research and data collection purposes. At the time of writing full results were not yet available and, thus, were not reported in this article. Interim outcomes indicate that the online enrolment has been successful and participants are making full use of all online features of the active program included by the support facility. The difficulties with maintaining individuals on the control program are described and samples of typical anecdotal comments provided by participants to the research group via the support facility are presented.

Review of the quality of information on bipolar disorder on the Internet

Objectives: The aim of the present study was to assess the quality of commonly found websites on bipolar disorder. A specifically designed quality tool, the Bipolar Website Quality Checklist (BWQC), was developed for this purpose. Methods: The BWQC was developed from quality criteria identified by a literature review of Medline (1966 +), Medline in-process and non-indexed citations, PsychINFO, CINAHL, EMBASE, Pub Med, Science citation index, and Psych Articles, using keywords: ‘quality, reliability, accuracy, readability, evaluation, assessment, information, internet, web, www’. To identify relevant websites, seven common search engines were accessed and searched using a string of key words: ‘bipolar disorder + mania+ manic depression+ hypomania’. The top active 15 sites identified were rated by three independent raters, using the BWQC and DISCERN instruments. Results: There was a wide variability in the quality of the websites reviewed. The Black Dog Institute website was ranked first by the BWQC and DISCERN instruments. The National Institute of Mental Health website was ranked second by DISCERN and seventh by BWQC. The BWQC demonstrated high interrater reliability (r = 0.89) and correlated strongly (r = 0.78, p = 0.001) with the more generic DISCERN instrument. Websites with an editorial board or affiliation to a professional organization or which contained information on a variety of mental health issues had higher quality information on bipolar disorder and its treatment than websites that did not share these characteristics. Conclusions: High-quality information on bipolar disorder does exist on the Internet. It is important that clinicians are familiar with such websites so that they can recommend the most appropriate site that meets the specific need of the individual. Use of such websites can assist clinicians in adhering to clinical practice guidelines by providing material to augment psychoeducational interventions.

The Hurricane Choir: Remote Mental Health Monitoring of Participants in a Community-based Intervention in the post-Katrina Period

N disasters such as the hurricanes that struck the coast of southern Louisiana, Mississippi, and Texas in 2005 are synonymous with the destruction of the physical environment and the depletion of material assets of individuals and whole communities. They are unique in that the widespread destruction they cause often results in collective trauma in which whole communities find themselves engulfed in severe shock.1 In the case of the 2005 hurricane season, the rapid succession of a number of large and destructive hurricanes is likely to have intensified the psychological impact of the disasters, as infrastructure that survived previous storms was destroyed, rebuilding efforts were restricted, and stressors on survivors were exacerbated and drawn out over a long period. Typically, post-disaster stress symptoms include (among others) recurrent nightmares, intrusive memories, hypervigilant arousal, impaired concentration, depression, emotional detachment from others, and disengagement from parts of life that were previously rewarding.1,2 With exposure to such severe psychological distress, post-traumatic stress disorder (PTSD) can develop, having a severe impact on healthy functioning and making emergence from the effects of a disaster much more difficult.3 For example, David and colleagues4 demonstrated that 51% of survivors who were exposed to Hurricane Andrew developed a new-onset psychiatric disorder. Of these, PTSD was the

A Survey of Practising Psychiatrists' Views on the Treatment of Agoraphobia*

The views of practising psychiatrists on the treatment of agoraphobia were investigated as part of a Quality Assurance Project. A one in six random sample of psychiatrists was mailed a questionnaire. This asked for treatment recommendations for each of three case descriptions of patients with agoraphobia and respondents were asked to choose three treatments from a predetermined list of treatments. Eighty-six percent of the sample responded. Behavioural psychotherapy was recommended most often, usually in conjunction with psychodynamic psychotherapy. Recommendations varied across the three cases and were also marginally affected by the format of the question used to elicit them.