William H. Berman

Assessment of tardive dyskinesia using the abnormal involuntary movement scale

Over a 10-month period, 33 patients with tardive dyskinesia (TD) were evaluated with the Abnormal Involuntary Movement Scale (AIMS) simultaneously and independently by two experienced and two inexperienced raters. The experienced raters generally had higher levels of agreement and their scores were more consistent over time. It is concluded that experience with TD influences AIMS inter-rater reliability and that it is useful to differentiate TD movements into the dimensions of quality, frequency, and amplitude, dimensions not currently used in the AIMS. The usefulness and difficulty of developing more specific guidelines for AIMS ratings are discussed.

Parental attachment and emotional distress in the transition to college

The continued attachment to parents and peers in adults has been examined in two ways: the individual difference approach, examining characteristic attachment styles across relationships, and the general intensity approach, examining the salience of emotional and behavioral reactions to a particular separation. The present study examines the intensity of attachment to parents at the transition to college. This voluntary separation from parents was expected to elicit heightened attachment for college students, especially residential students, which would decrease over time. In addition, it was expected that high levels of parental attachment at the beginning of college would predispose students to later depression. Results indicate that parental attachment decreases during the first semester of college only for residential students. In addition, maternal attachment is significantly higher for females than for males. Finally, high levels of parental attachment in males at the beginning of college were predictive of high levels of depressed mood at the end of the first semester, while no relationship was found for females.

Psychological assessment of psychopathology in opiate addicts.

A sample of 99 opiate addicts seeking treatment were assessed on three well established clinical assessment procedures; the Loevinger Sentence Completion, the Bellak Ego Functions Interview, and the Rorschach. Their scores were compared using normal and clinical reference groups. On all three procedures, opiate addicts had a significantly greater impairment than normals but significantly less thought disorder and impairments in ego functions than hospitalized borderline and psychotic patients. The results indicate that a primary disturbance in opiate addicts appears to be their relative inability to conceptualize people as well differentiated, articulated, and involved in meaningful, purposeful, and constructive activity. In addition, opiate addicts appear to have greater affective lability. These difficulties in interpersonal relations and affect modulation are consistent with disturbances in the neurotic range and suggest that opiate addicts have selected a particularly untoward, self-destructive, isolated mode of adaptation for achieving the satisfactions and pleasures most people seek in intimate personal relationships.

The effect of psychiatric disorders on weight loss in obesity clinic patients.

Research on psychiatric disorders in obesity has indicated that obese people are not psychiatrically different from nonobese people. Few studies, however, have addressed the potential impact of psychopathology on weight control. In the present study, a consecutive sample of 37 patients presenting to a major metropolitan weight control unit were given structured diagnostic interviews (Structured Clinical Interviews for Diagnosis I and II). These patients completed one of two 12-week diet programs involving either behavior modification or liquid protein diets. After 12 weeks of a liquid protein formula diet, patients with no personality disorder lost significantly more weight than personality disordered patients; personality disordered patients on a behavioral diet tended (p < .15) to lose more weight during a 12-week diet than the patients without personality disorders. These data suggest that there are differential responses to liquid protein and behavioral diets, depending on the presence or absence of a personality disorder.

Women referred for on-site domestic violence services in a managed care organization

ABSTRACT Background: Limited data about victims of domestic violence in health care settings hinder development of appropriate services. A comprehensive program was established in a managed care organization to increase identification and referral of domestically abused female patients. Methods: Female victims of domestic abuse were referred to a trained social worker for further assessment. Information about the women was obtained from clinical consultation forms; initial interviews conducted by social workers; a survey administered to a convenience sample of women seen by the program; and medical chart review. Results: Of 265 women who agreed to a domestic violence referral, 177 (67%) were contacted for further evaluation. The study sample was ethnically diverse and included female victims seen for routine care, women who had been assaulted, women who had depression, and women with various somatic symptoms. Responses from 51 of the 177 women showed the most cited reasons for accepting referral were unhappiness with current situation, wanting to leave or change the situation, concern about children who witnessed abuse, and the suggestion by a health care practitioner that the patients symptoms could be related to the abuse. Most reported having symptoms of depression in the previous year. Conclusions: Comprehensive programs in the health care setting can increase identification of victims of domestic abuse. This descriptive report provides a greater understanding of victims of domestic abuse, their presentation in the medical setting, their motivation for accepting referral, and issues which affect their recovery. Links between health care and community resources are necessary for effective intervention.

MEASURING CONTINUED ATTACHMENT TO PARENTS: THE CONTINUED ATTACHMENT SCALE PARENT VERSION

Continued attachment to parents has correlated with measures of adjustment in both school and peer situations at least through the transition to college. The measurement of parental attachment has relied primarily on self-reports of the quality of the parental relationship in terms of support, encouragement, autonomy, and dependency. Bowlbys original theory and research relied more on reactions to separation, which Berman called “attachment distress” in adults. The present study examined the psychometric properties of the Continued Attachment Scale—Parent version which measures cognitive and emotional responses to the perceived separation from parents. Data from 216 college students were collected on the scale as well as several scales selected to evaluate convergent and construct validities. The scale showed good reliability. Scores were highly correlated with attachment scale scores that measure support, encouragement, and closeness. Correlations with measures of emotional state and personality differed for men and women but generally suggested that the scale assesses a distinct domain of experience related to continued closeness to parents and to depression.

Differentiation of personality types among opiate addicts

A wide range of studies indicate that although sociopathic characteristics are predominant in opiate addiction, depressive and psychotic features are also frequently observed. To test the hypothesis that there are really three types of individuals who become addicted to opiates (rather than a single, predominant personality style), fifty-three opiate addicts were given the Loevinger Sentence Completion Test, the Bellak Ego Functions Interview, and the Rorschach. Variables derived from these three procedures were submitted to cluster and discriminant function analyses. Three groups of addicts were identified--those primarily with impaired interpersonal relationships and affective lability (42%), those primarily characterized by thought disorder and impaired ego functioning (30%), and a group with diminished ideational and verbal activity (28%). Comparison of the assessment of these three groups with independently defined normal, neurotic, and schizophrenic samples provided support for three opiate-addicted personality types, each respectively characterized as character disordered, borderline psychotic, and depressed. Although there seems to be a predominance of character-disordered individuals who become addicted to opiates, the data indicate several additional types of opiate addicts with different types of psychopathology who may require different approaches to management and treatment.

Effectiveness of Long-Term, Intensive, Inpatient Treatment for Seriously Disturbed Young Adults: A Reply to Bein

Beins criticisms of Therapeutic Change: An Object Relations Perspective are based on a misreading of the book; on a confusion between two independent types of analysis that were conducted; on a lack of appreciation of the nature of severe psychopathology and of long-term inpatient treatment; and on an attempt to impose a methodology from studies of treatment efficacy onto the investigation of the effectiveness of a comprehensive, multifaceted, intensive, long-term, inpatient treatment program designed to assist severely disturbed, treatment-resistant patients. Thus, we still contend that our findings, across a wide range of independent measures derived from the evaluation clinical case records and several different psychological assessment procedures, indicate that severely disturbed patients made significant therapeutic gain in long-term, intensive, inpatient treatment. Beins Kritik der Arbeit “Therapeutische Veranderung: Eine Objektbezichungsperspektive” grundet aufeinem falschen Verstandnis des Buches...