The culture of empowerment in a therapeutic community involves democratisation, which is demonstrated through voting, decision-making, and achieving seniority. This is essential in developing an individual’s sense of agency and ability to carry out meaningful actions. Rapoport’s four principles, which define the work of a therapeutic community, include permissiveness, democracy, reality confrontation, and communalism. These principles are updated by Haigh, with containment corresponding to permissiveness, communication to communalism, involvement to reality confrontation, and agency to democracy. Overall, the therapeutic community aims to provide support, establish rules and boundaries, confront reality, and foster a sense of shared responsibility among its members.

Engrossment refers to the emotional connection that a father develops with his child. This term was coined by Greenberg and Morris in their 1974 study, which explored the impact of newborns on fathers. In contrast, Bowlby used the term ‘attachment’ to describe the bond that develops between a child and their mother. Bonding, on the other hand, refers to the process by which a mother develops a strong emotional connection with her child. Imprinting is a phenomenon observed in some animal species, where newborns acquire certain behavioral characteristics from their parents shortly after birth. Finally, sociability is a crucial aspect of attachment, as it involves the pursuit of social contact and connection with others.

The concept of recovery in mental disorder goes beyond symptom resolution and focuses on developing a rewarding and meaningful life while accepting the impact of mental distress on the self. Clinical remission, on the other hand, refers to the cessation of symptoms and is often measured through clinical outcome scales. Chronic psychosis is the ongoing experience of psychotic symptoms. Recovery in mental disorder is a rephrasing of the conventional medical definition of remission and recognizes the need for a holistic approach to treatment while still involving clinicians and allied professionals. For further reading, Anthony’s Recovery From Mental Illness and Davidson and Roe’s Recovery from versus recovery in serious mental illness offer valuable insights.

The serum lithium level is not in the therapeutic range, which is an example of an error of omission. It is likely that the patient has not been taking their medication, as the dose was increased during the last medical review. Errors in drug adherence can be classified into four categories: errors of omission (not taking medication), errors of purpose (taking medication for the wrong reason), errors of dosage (taking the wrong dosage of medication), and errors of timing and sequence (taking medication at the wrong time and sequence). Schwartz et al. added a fifth category, which involves taking additional medication not prescribed by a doctor.

Mentalisation therapy is a psychotherapy approach that is particularly helpful for individuals with borderline personality disorder. It is psychodynamically-oriented and focuses on helping individuals develop the ability to mentalise, of understand their own and others’ thoughts, feelings, and intentions. This therapy approach aims to improve interpersonal relationships and reduce impulsive and self-destructive behaviors.

Strategic systemic therapy incorporates reframing and the domino effect. Haley’s approach assumes that symptoms are perpetuated by attempts to suppress them, and reframing involves giving negative emotions of behaviors a positive connotation. The domino effect refers to the improvement of additional problems after resolving an initial issue. Bowen’s family systems approach emphasizes the patient’s ability to maintain their individuality amidst familial tension. The Milan systemic approach uses circular questioning among family members, while Bateson’s paradoxical therapy involves intentionally engaging in undesirable behaviors. Minuchin’s structural model prioritizes the family hierarchy, rules, and boundaries.

Chomsky is known for his nativist theory and introduction of the language acquisition device (LAD) in the 1960s. Empiricism theory is often attributed to Locke, while parsing was described by Saffran. Skinner is associated with behaviourism, and Werker studied how infants distinguish between phonemes.

The psychosocial theory of development, as described by Erikson, involves eight stages that continue into adulthood and require the resolution of a crisis at each stage. Bowlby is known for attachment theory and maternal deprivation, while Freud focused on psychosexual development. Kohlberg studied moral development, and Piaget developed the cognitive model of development.

Erikson’s psychosocial theory of development includes eight stages of crises, while Freud’s psychosexual theory of development consists of five stages. However, there is some overlap between the two theories. For example, Freud’s phallic stage, which focuses on the development of sexual identity, broadly coincides with Erikson’s ‘initiative versus guilt’ stage, which focuses on the development of a sense of purpose and direction.

Erikson’s stages are as follows: trust vs. mistrust (0-18 months), autonomy vs. doubt (18-36 months), initiative vs. guilt (3-6 years), competence vs. inferiority (6-12 years), identity vs. confusion (12 years to adulthood), intimacy vs. isolation (adulthood), generativity vs. stagnation (middle-age), and integrity vs. despair (maturity).

Freud’s stages are: oral (0-18 months), anal (18-36 months), phallic (3-6 years), latency (6-12 years), and genital (12 years to adulthood).

While there are similarities between the two theories, it is important to note that they approach development from different perspectives and emphasize different aspects of human growth and development.

The fear of new things, such as unfamiliar people, can be observed in infants as young as 6 months old. Children between the ages of 3-5 years may develop fears of animals, monsters, and the dark. Around 6-11 years old, children may start to fear social embarrassment. Adolescents may begin to experience fear of death.

Harry Harlow conducted controversial experiments with rhesus macaque monkeys and surrogate ‘mothers’ made of inanimate objects, revealing that the infants preferred comfort and warmth over food.
Mary Ainsworth created the Strange Situation classification to categorize infants’ attachment behaviors.
John Bowlby coined the term ‘attachment’ to describe a child’s bond with their mother.
Konrad Lorenz studied imprinting in geese that were hatched in incubators.
Mary Main played a role in the development of the Adult Attachment Interview, which evaluates an individual’s early attachment experiences.

Malan’s research centered on the development of the client’s challenges using two ‘triangles’ – the triangle of person and the triangle of defence.

Bowlby is recognized for his work on attachment theory, while Anna Freud is known for her work on defence mechanisms and object relations.

Sigmund Freud is linked to time-limited psychotherapies, and Ryle created cognitive analytic therapy.

It is estimated that around 10% of individuals diagnosed with borderline personality disorder will ultimately take their own lives. While there may be some variation in the findings of different studies, this figure is widely accepted as the general rate of completed suicide among this population over an extended period of time.

Recent clinical trials have shown that various psychotherapy approaches do not differ significantly in terms of effectiveness. This particular trial aimed to prove that psychodynamic psychotherapy was not inferior to other modalities at 22 weeks and one year follow-up. While non-inferiority was observed at 22 weeks, it could not be conclusively demonstrated at one year, despite no significant difference between interventions. Interestingly, individuals who received CBT appeared to require more additional treatment during the year following therapy, although this trend was not statistically significant.

Assimilation refers to the process in which immigrants adopt the practices and values of their new culture while abandoning their own cultural heritage. Marginalization, on the other hand, occurs when immigrants neither adopt the new culture nor retain their own cultural values, resulting in social exclusion and isolation. These two outcomes are on opposite ends of the spectrum in terms of the degree of adoption and retention of cultural values.

René Spitz’s Study on Anaclitic Depression in Children

René Spitz conducted a study on children who were deprived of their primary caregiver and found that they experienced a type of depression known as anaclitic depression. This type of depression is characterized by a lack of interest in the environment, a decrease in physical activity, and a failure to thrive. Spitz’s study highlights the importance of a primary caregiver in a child’s development and the negative effects of deprivation on their emotional and physical well-being. The study emphasizes the need for children to form secure attachments with their caregivers to promote healthy development.

The Drug Attitude Inventory assesses the subjective effects of antipsychotic drugs in patients with schizophrenia. The ASK-20 Adherence Barrier Survey measures barriers to treatment adherence with 20 clinical items. The Brief Evaluation of Medication Influences and Beliefs (BEMIB) Scale is an eight-item Likert-type scale that evaluates the costs and benefits of medication use based on the health belief model. The Medication Adherence Rating Scale (MARS) is a 10-item self-report scale that combines elements of the Drug Attitude Inventory and Medication Adherence Questionnaire for use in patients with schizophrenia and psychosis. The Rating of Medication Influences (ROMI) Scale is a 20-item interviewer-rated scale that assesses adherence attitudes in psychiatric patients, particularly those with schizophrenia, with good inter-rater reliability.

The ‘strange situation’ has been utilized to depict different attachment styles exhibited by infants, with contributions from Bowlby’s observations of primate and human attachment behavior, Bateman’s work on psychotherapeutic models in personality disorder, Freud’s structural theory of the unconscious, and Jung’s exploration of archetypes and the collective unconscious.

While Mary Rothbart, Rudolf Steiner, and Jerome Kagan are known for their theories on the stability of personality traits in children, they were not involved in the New York Longitudinal Study conducted in the 1970s. However, Solomon Diamond, who focused on personality and temperament and conducted research on various animal studies, is also associated with this field.

Assessment Tools:

Luria’s Test:
Luria’s test is a motor task designed by Alexander Luria, a Russian neuropsychologist. The test was developed based on his observation that individuals with significant frontal lobe damage were unable to modify their responses to a programmed motor task when the order of actions in the task was changed.

Geriatric Depression Scale:
The Geriatric Depression Scale is a screening tool used to identify depression in older adults. It is not designed to assess cognitive impairment.

Mini-Mental State Examination:
The Mini-Mental State Examination is a brief, 30-question screening tool used to assess cognitive impairment. It does not evaluate frontal lobe functions.

National Adult Reading Test:
The National Adult Reading Test is used to assess the premorbid level of intelligence in English-speaking patients.

Wechsler Adult Intelligence Scale:
The Wechsler Adult Intelligence Scale is a comprehensive assessment tool used to measure intelligence in adults and older adolescents.

Traps refer to circular patterns of interaction that create ‘vicious circles’. For instance, when we feel uncertain, we may try to please others, but this can result in others taking advantage of us, which reinforces our uncertainty.

Family therapy has been shaped by various influential figures, each with their own unique approach. Salvador Minuchin is known for his structural model, which emphasizes the importance of family hierarchy, rules, and boundaries. Gregory Bateson, on the other hand, is associated with paradoxical therapy. Murray Bowen is linked to the family systems approach, while Jay Haley is known for his strategic systemic therapy. Finally, the Milan systemic approach is associated with Mara Selvini Palazzoli. Each of these figures has contributed to the development of family therapy, and their approaches continue to be used and adapted by therapists today.

The health belief model is a social cognition model that aims to predict and understand health-related behaviors. It consists of four main constructs: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. Perceived severity refers to an individual’s understanding of the seriousness of a disease. Perceived susceptibility, also known as perceived vulnerability, refers to an individual’s perception of their risk of contracting the disease if they continue with their current behavior. Perceived benefits refer to an individual’s perception of the advantages of adopting a different course of action, including the extent to which it reduces the risk of the disease of its severity. Perceived barriers refer to an individual’s perception of the disadvantages of adopting the recommended action, as well as any obstacles that may hinder its successful implementation.

Several scales are available to measure medication adherence attitudes and behaviors in psychiatric patients, particularly those with schizophrenia. The Rating of Medication Influences (ROMI) scale has 20 interviewer-rated items with good inter-rater reliability. The ASK-20 Adherence Barrier Survey measures barriers to adherence with 20 clinical items. The Brief Evaluation of Medication Influences and Beliefs (BEMIB) scale is an eight-item Likert-type scale that measures costs and benefits of medication use based on the health belief model. The Drug Attitude Inventory is a 30-item self-report scale that evaluates subjective effects of antipsychotic drugs among patients with schizophrenia. The Medication Adherence Rating Scale (MARS) is a 10-item self-report scale derived from the Drug Attitude Inventory and Medication Adherence Questionnaire, and is used in patients with schizophrenia and psychosis.

The term ‘schizophrenogenic mother’ was proposed by Fromm-Reichmann, a contemporary of Freud, who believed that defective parenting caused the disorder. However, this concept has since been proven to be unfounded. Lidz later examined the impact of parents’ socialization on a child’s psychological health, further exploring this concept. Bleuler is credited with coining the term ‘schizophrenia’, while Kraepelin had previously described ‘dementia praecox’.

Transitional objects were conceptualized by Winnicott as items that infants between 4-18 months of age select to aid in their separation and individuation process. These objects, such as a soft toy of blanket, serve as a source of comfort and help reduce anxiety. Object relations theory was also supported by Balint and Fairbairn. Meanwhile, Kleinian theory placed significant emphasis on the interpretation of play.

The recommended treatment options for obsessive-compulsive disorder and body dysmorphic disorder, according to NICE guidelines, include the use of selective serotonin reuptake inhibitors (SSRIs) of cognitive behavioural therapy (CBT), of a combination of both. Other therapies such as cognitive analytical therapy, interpersonal therapy, and psychodynamic psychotherapy have not been found to have sufficient evidence to support their use in managing OCD. Additionally, referral to an anxiety management group would not provide targeted treatment for OCD.

The concept of ‘goodness of fit’ was introduced by Thomas and Chess, which refers to the interdependent relationship between a child’s temperament and their environment that impacts their development. The strange situation procedure is linked to Ainsworth, while Bowlby is known for his research on attachment and maternal deprivation. Main is recognized for developing the adult attachment interview. Winnicott coined the term ‘good-enough mother’.

Irvin Yalom identified 11 therapeutic factors that are unique to group therapy, including universality, altruism, instillation of hope, imparting of information, corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, group cohesiveness, existential factors, catharsis, and interpersonal learning. Group therapy has been practiced by various pioneers in the field, such as Bion at the Tavistock Clinic, Foulkes who developed group analysis, Moreno who is associated with psychodrama, and Pratt who was an early advocate of group therapy in the United States.

Fortnightly injections are required for Risperidone depot antipsychotic. Flupenthixol decanoate injections can be given every two to four weeks. Fluphenazine decanoate injections can be given every 14-35 days. Olanzapine embonate and paliperidone injections are given every four weeks.