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.

Within the psychodrama setting, the patient takes on the role of the protagonist and actively delves into their emotional conflict. This therapeutic approach was created by Jakob Moreno and involves the dramatisation of emotional struggles in a group setting. The group leader of therapist, known as the director, plays an active role in guiding the process.

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.

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.

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.

Cognitive behavioural therapy aims to address specific disorders by challenging negative thought patterns through conscious cognitive processes. Behavioural experiments are conducted with therapist guidance to gather evidence for and against interpretations of experiences. Analytic psychotherapy involves the therapist interpreting the client’s experiences based on joint experiences. Cognitive analytic therapy involves exploring past relationships and identifying repetitive behavioural patterns. Interpersonal theory focuses on problem areas in the client’s life, such as grief of role disputes. Motivational interviewing helps clients identify motivation for change and move through the stages of change.

Agreeableness pertains to an individual’s prioritization of social harmony, often demonstrated through traits such as generosity, consideration, trust, and helpfulness. Conscientiousness refers to an individual’s level of self-discipline. Extraversion pertains to an individual’s engagement with the external world. Neuroticism describes an individual’s emotional stability, rather than the Freudian concept of neuroticism. Openness to experience pertains to an individual’s inclination towards intellectual curiosity.

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.

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.

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.

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.

High degree of adoption of new culture and high degree of retention of culture of origin result in integration, while low degree of adoption of new culture and high degree of retention of culture of origin lead to separation. On the other hand, high degree of adoption of new culture and low degree of retention of culture of origin result in assimilation, while low degree of adoption of new culture and low degree of retention of culture of origin lead to marginalization.

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.

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.

Schwartz et al. identified five types of errors in drug adherence. These include errors of omission, errors of purpose, errors of dosage, errors of timing and sequence, and taking additional medication not prescribed by the doctor. An example of errors of purpose is when a patient takes medication for the wrong reason. Other types of errors include not taking the medication, taking the wrong dosage, and taking medications at the wrong time and sequence.

This individual is currently in the preparation phase of quitting smoking. According to Prochaska et al.’s stages of change model, this means they are currently smoking but have a strong intention to quit within the next 30 days and have been seriously considering quitting for the past six months. The stages of change are a spiral, meaning individuals may move back and forth between stages and even experience relapses. The other stages include precontemplation (not considering quitting within the next six months), contemplation (seriously considering quitting within the next six months but not within the next 30 days), action (currently not smoking and quit within the last six months), and maintenance (currently not smoking and quit more than six months ago).

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.

The idea of filial imprinting was initially observed in domestic chickens by Douglas Spalding in the 1800s, and later discussed by Heinroth before being made well-known by Lorenz. Additionally, Immelmann discussed sexual imprinting, while Westermarck introduced the concept of reverse sexual imprinting, which suggests that individuals who spend their early years in close proximity are less likely to be sexually attracted to each other later in life.

Patients who are not informed about the potential side effects of a medication may initially agree to treatment, but are less likely to follow through if they experience adverse effects. To improve adherence, healthcare providers can implement various strategies. These include educating patients about the treatment, discussing the benefits and drawbacks of different options, and promoting insight into the importance of prophylactic treatment. Encouraging patients to be open about any side effects they experience, even if they are embarrassing, can also help. Regular reviews of the medication plan, including discussions about side effects and the possibility of stopping medication if necessary, can further improve adherence. Simplifying the medication regimen and choosing medications with tolerable side effect profiles can also be helpful. Communication between the patient and their GP should be clear and in writing. Finally, the use of depot antipsychotics may be considered as an option.

Principles of Therapeutic Communities

Therapeutic communities are based on four main principles that guide their operations. The first principle is communalism, which emphasizes that staff and service users should not be separated by uniforms of behaviours. This means that everyone in the community is treated equally and with respect. The second principle is democratisation, which involves shared decision-making and unit management. This means that everyone in the community has a say in how things are run and decisions are made collectively. The third principle is permissiveness, which involves accepting and tolerating occasional unpredictable behaviour. This means that members of the community are encouraged to be themselves and express their emotions freely. The fourth principle is reality confrontation, which involves group members challenging self-deception among others. This means that members of the community are encouraged to be honest with themselves and others.

Group cohesion is another important aspect of therapeutic communities. It refers to the sense of belonging and acceptance that members of the community feel. This sense of belonging is fostered by the shared goal that the community is working towards. Members of the community understand that they are all in this together and that they need to support each other to achieve their goals. The sense of belonging and acceptance that comes with group cohesion is essential for the success of therapeutic communities.

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 reverse-learning theory, which explains how the brain eliminates unnecessary information, was introduced by Crick and Mitchison. Foulkes believed that dreams reflect a person’s current preoccupations, while Freud viewed them as a means of expressing repressed thoughts and desires, famously calling them the royal road to the unconscious. Hobson and McCarley proposed the activation-synthesis theory. Jung was known for his work on dreams and symbolism, and his autobiography was titled Memories, Dreams, Reflections.

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 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.

The recommended treatment for emotionally unstable personality disorder (borderline type) does not involve a single psychological therapy of drug treatment as a first line of defense. However, for women who prioritize reducing self-harm, DBT is recommended. Drug treatments may be considered for comorbid conditions. According to NICE guidelines on Borderline personality disorder (BPD) (CG78), a comprehensive dialectical behaviour therapy programme should be considered for women with borderline personality disorder who prioritize reducing recurrent self-harm. Brief psychological interventions of less than 3 months’ duration should not be used specifically for borderline personality disorder of for the individual symptoms of the disorder. Drug treatment should not be used specifically for borderline personality disorder of for the individual symptoms of behavior associated with the disorder, such as repeated self-harm, marked emotional instability, risk-taking behavior, and transient psychotic symptoms. If sedatives are used for crisis intervention in a patient with EUPD, they should be prescribed for a maximum period of one week.

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.

The Millon Clinical Multiaxial Inventory-III (MCMI-III) is a self-report questionnaire that can be utilized to evaluate personality disorders. It is designed to provide information on a patient’s personality traits, clinical syndromes, and overall psychological functioning.

The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a computer-based cognitive assessment system that measures various cognitive functions such as attention, memory, and executive function. It is commonly used in research and clinical settings to assess cognitive impairment in patients with neurological disorders.

The Hayling-Brixton tests are neuropsychological tests that evaluate executive function, specifically response inhibition and initiation. These tests are often used to assess patients with brain injuries of neurological disorders.

The Luria-Nebraska Battery is a comprehensive neuropsychological battery that assesses various functions such as motor skills, memory, rhythm, reading, and writing. It is commonly used to evaluate patients with brain injuries of neurological disorders.

The Stanford-Binet test is an intelligence test that measures cognitive abilities such as verbal and nonverbal reasoning, spatial perception, and quantitative reasoning. It is commonly used in educational and clinical settings to assess intellectual functioning.

For further reading on these assessments, additional information can be found through Pearson, the publisher of the MCMI-III.

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.

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.

Expressed emotion (EE) in schizophrenia was first introduced by Brown et al., which refers to the emotions exhibited by family members towards their loved one with the illness. The James-Lange theory is one of two fundamental theories of emotions, alongside the Cannon-Bard theory. Fromm-Reichmann coined the term ‘schizophrenogenic mother.’ Harris proposed a model of emotional development consisting of five stages. Plutchik identified eight primary emotions.