Reflections on introspection.

Reviews theoretical positions on introspection and its methods and the validity of the observations gained. Whether introspection is a method at all, whether one can be trained to perform introspection, and what the results of the process are, are discussed. Introspection as data and introspection as a method are distinguished; "data" refers to the statements or reports of introspection which can be used and measured as can any behavior. Introspection as method, however, involves "data" accessible only by observation. Several classifications of introspective methods are proposed (self-observation, self-reports, and thinking aloud) and related to historical definitions of psychology (e.g., W. Wundt, E. B. Titchener, and J. B. Watson). It is concluded that arguments about introspection and its methods are merely a question of what one is interested in; introspection is a technique which yields information that cannot be obtained in another way and arguments over its validity or definition are theoretically unhelpful. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical implications of "subthreshold" depressive symptoms.

There is active debate regarding whether diagnosable depression exists on a continuum with subthreshold depressive symptoms or represents a categorically distinct phenomenon. To address this question, multiple indexes of dysfunction (psychosocial difficulties, mental health treatment history, and future incidence of major depression and substance abuse/dependence) were examined as a function of the extent of depressive symptoms in 3 large community samples (adolescent, adult, and older adult; N?=?3,003). Increasing levels of depressive symptoms were associated with increasing levels of psychosocial dysfunction and incidence of major depression and substance use disorders. These findings suggest that (a) the clinical significance of depressive symptoms does not depend on crossing the major depressive diagnostic threshold and (b) depression may best be conceptualized as a continuum. Limitations of the present study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical and research implications of revising psychological tests.

This article integrates those of other contributors to this special section, Methods and Implications of Revising Assessment Instruments, to underscore important conceptual factors to consider when undertaking test revisions. These considerations include determination of when test measures have become sufficiently understood to be incorporated in a test revision, cohort effects, revision of administration formats and test instructions, and comparisons of performance levels across test versions. The discussion of these factors also takes into consideration clinical practice and educational implications of making a transition to revised test versions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spouses of workaholics: Clinical implications for psychotherapy.

This article examines the impact of work addiction on the family system, particularly spouses of workaholics—an area that has been neglected by social scientists and mental health clinicians. An argument is made for researchers and psychotherapists to pay more attention to this essential area of mental health. Recommendations for how to address this issue in clinical settings are presented along with research considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lesbian families: Clinical issues and theoretical implications.

Examines the influence of lesbian family structure on parenting within the context of both psychodynamic and family systems theories by providing a review of the literature, as well as information based on the author's clinical work with lesbians and their families. The uniqueness of the lesbian family is considered, and the varieties of lesbian family structure are outlined (e.g., blended, single parent, couples having children together, donors, and noncustodial fathers). The impact of parenting is discussed in terms of common issues in lesbian distance and boundary regulation, power/equality, shared parenting, relationships with extended families, lesbian friendship networks, and issues unique to lesbian "divorce." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical implications of clubfoot histopathology

PURPOSE: Multiple primary cancers are a feature of hereditary nonpolyposis colorectal cancer in which defects in DNA repair mechanisms result in accumulation of replication errors within tumor DNA. We assessed replication error incidence in multiple primary cancer patients who may have similar genetic defects. METHODS: DNA was obtained from 69 patients from the Yorkshire region who had developed colorectal cancer and one other primary tumor from the hereditary nonpolyposis colorectal cancer tumor spectrum (28 colorectal, 12 stomach, 15 ovary, and 14 uterus). DNA was also obtained from 86 sporadic, single primary cancer patients attending a colorectal cancer clinic. Replication error status was assessed at five microsatellite loci using fluorescent polymerase chain reaction and computer-assisted analysis. RESULTS: The replication error phenotype was observed in 7 of 86 (8 percent) of the sporadic single primary patients. This compared with 23 of 69 (33 percent) of the multiple primary group (P < 0.001). Replication error was also observed more frequently in each subgroup. Even excluding patients from families meeting the Amsterdam criteria (likely to be hereditary nonpolyposis colorectal cancer and have the replication error phenotype), this increased frequency remained in both the multiple primary group (P < 0.005) and multiple colorectal and colorectal/uterine subgroups (P < 0.001). CONCLUSIONS: Results suggest that genetic instability plays an important role in development of multiple primary cancers, particularly from certain cancer subsets. Testing for replication errors may be an appropriate way of identifying individuals at risk of multiple primary cancers.     

Clinical implications of endothelial dysfunction

Endothelial dysfunction is increasingly recognized as an early event in the pathogenesis of cardiovascular disease. This observation is consistent with the growing appreciation of the role of endothelium in maintaining cardiovascular health. Endothelial dysfunction and coronary artery disease are both linked to hypertension, hypercholesterolemia, diabetes mellitus, and cigarette smoking. Modification of these conditions improves both endothelial function and coronary artery disease outcomes. Dietary and lifestyle modifications and antioxidant vitamin supplementation have a beneficial effect on endothelial function, as do angiotensin-converting enzyme inhibitors and lipid-lowering agents. Future studies will determine whether interventions that specifically target endothelial dysfunction can reduce rates of clinical disease.     

Pharmacokinetics of quinine, chloroquine and amodiaquine. Clinical implications

Malaria is associated with a reduction in the systemic clearance and apparent volume of distribution of the cinchona alkaloids; this reduction is proportional to the disease severity. There is increased plasma protein binding, predominantly to alpha 1-acid glycoprotein, and elimination half-lives (in healthy adults quinine t1/2z = 11 hours, quinidine t1/2z = 8 hours) are prolonged by 50%. Systemic clearance is predominantly by hepatic biotransformation to more polar metabolites (quinine 80%, quinidine 65%) and the remaining drug is eliminated unchanged by the kidney. Quinine is well absorbed by mouth or following intramuscular injection even in severe cases of malaria (estimated bioavailability more than 85%). Quinine and chloroquine may cause potentially lethal hypotension if given by intravenous injection. Chloroquine is extensively distributed with an enormous total apparent volume of distribution (Vd) more than 100 L/kg, and a terminal elimination half-life of 1 to 2 months. As a consequence, distribution rather than elimination processes determine the blood concentration profile of chloroquine in patients with acute malaria. Parenteral chloroquine should be given either by continuous intravenous infusion, or by frequent intramuscular or subcutaneous injections of relatively small doses. Oral bioavailability exceeds 75%. Amodiaquine is a pro-drug for the active antimalarial metabolite desethylamodiaquine. Its pharmacokinetic properties are similar to these of chloroquine although the Vd is smaller (17 to 34 L/kg) and the terminal elimination half-life is 1 to 3 weeks.     

Contemporary fathers reconstructing masculinity: Clinical implications of gender role strain.

How can research data about gender role strain improve clinical work with men? The authors present qualitative data from 3 groups of fathers in the Yeshiva University Fatherhood Project: Haitian American, Promise Keeper, and gay fathers. The data illustrate the specific types of gender role strain associated with contemporary fathering and show how men are spontaneously reconstructing fathering and masculinity in general. The authors use clinical examples to show how psychologists can make use of this research knowledge in the diagnosis and treatment of men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical relevance and implications of antenatal hydronephrosis

Detailed antenatal sonography was performed on 18766 pregnant women between 1990 and 1994. Antenatal hydronephrosis, defined as an antero-posterior diameter of the renal pelvis (APPD) greater than 5 mm, was detected in 100 cases (0.59%). Sixty four infants had postnatal hydronephrosis at one and/or six weeks after delivery; 21 of these had urological anomalies. Twelve infants had vesico-ureteric reflux. In all refluxing units the APPD of the renal pelvis was less than 10 mm. Three patients had obstruction at the pelviureteric junction (PUJ); all required surgery. Vesico-ureteric reflux is emerging as the most common urological finding in infants with antenatal hydronephrosis and is likely to be missed if kidneys with APPD of less than 10 mm are not further investigated. In contrast, pelvi-ureteric junction obstruction may be overdiagnosed, based only on drainage patterns of dynamic renogram studies.     

Clinical implications of IgA rheumatoid factor subclasses

OBJECTIVES: To evaluate the diagnostic and pathogenetic significance of IgA rheumatoid factor (RF) subclasses in rheumatoid arthritis (RA). METHODS: Rheumatoid factors of the IgA class and IgA1 and IgA2 subclasses were measured by enzyme linked immunosorbent assay in 58 patients with RA, 31 patients with other rheumatic diseases, 30 non-rheumatic individuals with increased concentrations of IgA RF, and in 100 randomly selected healthy controls. RESULTS: Using a 95% cut off for the controls, 55% of the RA patients had increased total IgA RF, 64% IgA1 RF, and 60% IgA2 RF. RA patients with extraarticular manifestations more often had increased concentrations of IgA RF and both subclasses than patients without such manifestations (p < or = 0.01). Nearly all (31/32) RA patients with increased IgA RF had increases in both IgA RF subclasses, compared with 67% (20/30 of nonrheumatic symptom free individuals with increased IgA RF (p = 0.002). CONCLUSION: Increased concentrations of the IgA2 RF subclass appears to be more specific for RA than increased IgA1 RF. Measurement of IgA RF subclasses may be clinically useful.     

Chronotropic incompetence--Part II: Clinical implications

Multiple myeloma is a rare malignancy in cats. While hypercalcemia is reported frequently in association with myeloma in humans and dogs, it has not been reported in cats. Two cats with hypercalcemia and multiple myeloma were treated with alkylating agents and corticosteroids. One cat was a long-term (16 months) survivor.     

Clinical utility of the MMPI research scales in the assessment of adolescent acting out behaviors.

The substantial number of MMPI research scales developed during the last 50 yrs provides a unique opportunity to compare the practical value of a large number of related scales and the methodologies used to develop them. To this end, the concurrent validity of 93 MMPI scales as measures of acting out (aggressiveness, chemical dependency, delinquency, family conflict, and school behavior problems) was evaluated in a sample of 327 adolescent inpatients. Results generally support the construct validity of the Psychopathic Deviate scale but also reveal several research scales that function well as broad measures of acting out. There were, however, relatively few scales that were narrowly related to specific behavioral tendencies. Scales consisting exclusively of face-valid items generally performed better in this regard than did scales including "subtle" items, and they appear to have greater clinical utility with this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical implications of the co-occurrence of substance use and other psychiatric disorders.

The co-occurrence of substance use and psychiatric disorders is the rule rather than the exception in mental health and substance use treatment settings across the United States. Such co-occurrence may call for special assessment and evaluation procedures, modified treatment plans, and specialized follow-up. Treatment of co-occurrence of substance abuse and psychiatric disorders requires more cross-disciplinary collaboration; greater integration of substance use, mental health, and social services treatment approaches; and modifications in the training of care providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)