Broader Definition of the Disease Could Help Doctors with Early Diagnosis and Intervention

In April of this year, the National Institutes of Health and the Alzheimer’s Association announced significant changes in the clinical diagnostic criteria for Alzheimer’s disease dementia. These revisions—the first in 27 years—are intended to help diagnose patients in the very early stages of the disease, allowing doctors to prescribe medication when it is most effective; that is, before a patient’s memory becomes compromised.

The new guidelines recognize two early stages of the disease: preclinical Alzheimer's, in which biochemical and physiological changes caused by the disease have begun; and mild cognitive impairment, a stage marked by memory problems severe enough to be noticed and measured, but not severe enough to compromise a person’s independence. The new guidelines also reflect the increased knowledge scientists have about Alzheimer’s, including a better understanding of the biological changes that occur and the development of new tools that allow early diagnosis.

William H. Thies, chief scientific and medical officer of the Alzheimer’s Association, explains, “If we start 10 years earlier and could push off the appearance of dementia by, say, five years … that could cut the number of demented people in the U.S. by half” (Los Angeles Times, April 25, 2011).

For more information about the updated guidelines, as well as a list of journal articles and answers to frequently asked questions for clinicians, visit the National Institute on Aging Web site at http://www.nia.nih.gov/Alzheimers/Resources/diagnosticguidelines.htm.

The recent electronic release of Adam Mansbach’s “Go the F--- to Sleep” has taken the Web by storm. The book, which features as narrator a tired parent attempting to put his child to sleep for the night, combines mock-sweet prose with bursts of exasperation and annoyance. If you’re a parent, and you remember the sleepless nights—and you have a sense of humor—this amalgamation of genuine parental love with the eye-rolling that goes along with nighttime routines will probably strike a chord with you.

The book and its release bring up several interesting issues, including the frustration experienced by all parents of young children. Ranging from mild annoyance to real anger, the feeling can be surprisingly overwhelming. Parenthood is generally advertised as a joyous walk through a meadow, and, for some, discovering that the meadow is filled with divots, bumblebees, and sharp branches is a shock. Though it could be said that the book uses strong language for shock value, for most readers, the use of expletives serves to highlight just how intense the aggravation can be.

The book’s message goes a little deeper, though, as it effectuates a collective sigh of relief in its readers who are parents. Many parents inherently feel guilty about having negative feelings about parenthood. It may be psychologically reassuring for a young parent to know not only that many—okay, most— children have trouble going to sleep at night, but also that he or she is not the only one who finds the bedtime routine—and, for that matter, any routine that requires the parent to coerce the child—a vexing experience.

So, what do you think of the book? Do you think it’s vulgar and/or inappropriate? Do you think it serves a purpose in letting parents know they’re not alone? Are you willing to admit that it could have been written from your very own thoughts? Most important, do you have any tips for those of us who are trying to put little ones to sleep every night?

Jacob Barnett, a 12-year-old boy from Hamilton County, Indiana, has caught the attention of researchers from some of the most prestigious universities in the country with his challenge to Einstein’s theory of relativity. Jacob grasps some of the most complex concepts in mathematics and physics. Instead of junior high school, he attends Indiana University-Purdue University Indianapolis (IUPUI), where there is a movement to get him on board as a paid research assistant. Recently, he created a YouTube video in which he explains his work, using markers on the windows of his home to show the mathematical calculations behind some of his ideas. Not bad for a boy who didn’t speak his first words until after his second birthday and has been diagnosed with Asperger’s disorder, a mild form of autism. But then again: Einstein didn’t speak until age four, and many psychiatrists now believe that he may have had Asperger’s disorder, as well.

Early on, Jacob’s parents were concerned that he might have problems in school. “Oh my gosh, when he was two, my fear was that he would never be in our world at all,” Jacob's mother told The Indianapolis Star last month. “He would not talk to anyone. He would not even look at us.” Instead, his abilities have soared. He taught himself algebra, geometry, and calculus, leaving high school at age eight and enrolling at IUPUI, where he is currently studying and excelling in his advanced physics and mathematics courses.

Although they give him plenty of opportunities to explore his interest in physics, Jacob’s parents also insist that he spend time with friends his own age. He plays video games and basketball with friends; he has a girlfriend and he recently attended his first dance.

In his YouTube video, Jacob explains his expanded hypothesis, based on Einstein’s theory of relativity. Professors at the Institute for Advanced Study in Princeton, New Jersey have followed Jacob’s work with interest. “The theory that he’s working on involves several of the toughest problems in astrophysics and theoretical physics,” Professor Scott Tremaine wrote to Barnett’s family.

Jacob’s professors at IUPUI agree. “We have told him that after this semester . . . enough of the bookwork. You are here to do some science,” physics professor John Ross told The Indianapolis Star. “If we can get all of those creative juices in a certain direction, we might be able to see some really amazing stuff down the road.”

As those who work in the field of mental health know only too well, mental illness carries a stigma that adds a significant burden to the challenges already facing many clients. Unlike other medical conditions such as cancer or heart disease, mental illness is often seen as a personal weakness or a character flaw. The detrimental effects of this stigma are well understood. In his 1999 Mental Health Report, former Surgeon General David Satcher asserted that “Stigma assumes many forms, both subtle and overt. It appears as prejudice and discrimination, fear, distrust, and stereotyping. It prompts many people to avoid working, socializing, and living with people who have a mental disorder. Stigma impedes people from seeking help for fear the confidentiality of their diagnosis or treatment will be breached.”

What perpetuates the stigma? Unfortunately, it’s not just outdated social attitudes. In fact, negative images and distortions about mental illness abound in current popular media. The National Alliance on Mental Illness (NAMI), an advocacy group for people affected by mental illness, publishes a regular column on their website called “StigmaBusters”, which asks members to send in alerts about stereotypes they find in the media. Examples include a November 2010 episode of the popular musical comedy “Glee”, which mocked and trivialized bipolar disorder in a scene where a “crazed” Mary Todd Lincoln is shown shouting at a teapot. A recent issue of Vs., a high-end fashion magazine, features actress Eva Mendes as a patient in a psychiatric institution, writhing on a bed to keep from being restrained. A new television commercial for Burger King shows “The King” on a rampage, chased and then taken away by men in white coats. Some of the most egregious examples have appeared around Halloween. This past fall, “The Pennhurst Asylum,” a Halloween “insane asylum” attraction, opened on the grounds of the former Pennhurst State School and Hospital outside Philadelphia, sparking a controversy that included protests from former residents of the facility (http://www.nami.org/).

If negative images in the media are helping to form the popular perception of mental illness, what are some ways to help clients cope with their effects and counter the stereotypes that the images perpetuate? Advocacy organizations like NAMI offer support to individuals with mental illness and their families, and participating in groups like “StigmaBusters” is one way that people can become advocates, doing their part to fight inaccurate and hurtful representations of mental illness. The Mayo Clinic website (http://www.mayoclinic.com/health/mental-health) is another excellent resource that describes steps to cope with stigma, including advice on how to seek support and educate others about mental illness.

And it’s not all bad news in the media. The Voice Awards, sponsored by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), recognize writers and producers of television and film who have given voice to people with mental health problems by incorporating dignified, respectful, and accurate portrayals of people with mental illness into their scripts, programs, and productions. In 2010, a Voice Award for best documentary went to actor Joe Pantoliano for his film No Kidding, Me Too!, which explores the journey of several individuals with mental illness and includes a candid account of his personal struggle with depression. Although best known for his roles in The Matrix, Memento, and the televisions series “The Sopranos,” Pantoliano is an activist, working to raise social awareness and understanding of mental health through a non-profit organization that he created to encourage members of the entertainment industry to help educate the public about mental illness. “We know this is a tough fight,” says Pantoliano. “We know years of ingrained socialization causes people to recoil or isolate anyone with the scarlet letter of mental illness…. However, we also know that by releasing the talents of those with mental illness—by giving them the opportunity to use their outstanding artistic and intellectual skills—we will vastly improve the world. And this is a cause worth supporting” (http://nkm2.org/about-us/).

In your practice, is stigma affecting your clients? How do you help clients to cope with stigma, and what resources have you found to be most useful? We want to hear from you, so post your comments and let’s start the conversation!

PAR author David J. Schretlen, PhD, will be giving a workshop at the annual conference of the American Academy of Clinical Neuropsychology (AACN) in Washington, D.C., on June 9, 2011.  Dr Schretlen’s workshop, entitled “Threats to the Validity of Inference in Neuropsychology and Novel Methods of Practice to Help Overcome Them,” will encourage participants to consider fundamental questions about inference in clinical psychology:

• How do we decide when a neuropsychological examination is abnormal?
• What constitutes “impaired” test performance?
• When does a set of abnormal test scores represent a clinically meaningful pattern?

 

Dr. Schretlen will describe three basic approaches to clinical inference (pathological signs, deficit measurement, and pattern analysis) and examine the underlying logical assumptions, implementation, strengths, and threats to the validity of each inferential method.  Participants will examine the conceptualization and assessment of pathognomonic signs and cognitive deficits and will discuss the risky practice of sysgiving additional tests to clarify ambiguous findings.  Dr. Schretlen will describe what it means to “calibrate” test performance for demographic characteristics and estimated premorbid ability, and how this fundamentally alters the meaning of high and low test scores.  Participants will learn about the circumstances under which raw scores can be more informative than demographically calibrated scores.  Finally, Dr. Schretlen will argue that symptom validity testing differs from effort testing, and he will present findings from an experiment designed to assess cognitive effort among adults with no incentive to feign impairment and no evidence of symptom exaggeration.

Dr. Schretlen is Associate Professor of Medical Psychology in the Departments of Psychiatry and Radiology at Johns Hopkins University School of Medicine.  He is the author of the Calibrated Neuropsychological Normative System™ (CNNS™) and the companion Software Portfolio (CNNS™-SP), which are designed to assist clinicians and researchers in their interpretation of the tests that make up the normative system.  To learn more about how to improve the precision of neuropsychological test interpretation with the CNNS and to see a list of tests calibrated by the CNNS, visit www.parinc.com.   

In January of this year, the once-taboo subject of teen suicide was brought front-and-center with students at Oak Lawn Community High School in Chicago. According to a recent Chicago Tribune article entitled “Teen suicide: More schools bring issue out of shadows” (February 21, 2011), each Oak Lawn freshman received a short questionnaire about depressive symptoms and suicidal thoughts. Uncomfortable questions were asked: Had they lost interest in everything? Did they feel they weren’t as smart or good-looking as most other people? Were they thinking about killing themselves? For three years, Oak Lawn has been screening freshmen for signs of depression or suicidal thinking. This year, 270 students filled out the questionnaire in their health classes, and a fifth of them were referred to counselors for follow-up interviews. About half of those teens were offered free in-school therapy or referrals to outside counselors.

Until recently, the topic of teen suicide was avoided by many schools. “There were some people who felt that if you talk about it, you might motivate students or put the thought in students’ minds,” said John Knewitz, the school district’s assistant superintendent for student services, speaking with Tribune reporter John Keilman. “The more we studied it, we came to the realization that that was not the case. It was something that needed to be talked about openly” (http://articles.chicagotribune.com).

Last year, Illinois passed a law encouraging teachers and school staff to update their training on suicide prevention. Erika’s Lighthouse, a mental health advocacy group formed in memory of a girl who took her life at 14, offers programs to Chicago area middle schools that help students and their families recognize the signs of depression; the group also offers instruction to school officials. In response to recent suicides, other schools have updated their health curriculum to include depression and suicide, started Facebook pages for mental health awareness, and provided mental health hotline numbers on the back of student IDs.

Screening for childhood and adolescent depression and suicidal ideation may become more common in the coming years as schools try to find ways to address these and other mental health crises in their student population. How are schools in your area responding to this issue? Is the topic of teen suicide avoided, or are there programs in place that address it directly with students?

Let’s start the conversation—PAR wants to hear from you!

Last week, 22-year-old James Durbin wowed the audience—as well as viewers all across the country—as his amazing voice and incredible performing style helped catapult him to the next round on the popular television program “American Idol.” Now among only seven finalists in the competition, Durbin seems unstoppable. Yet success has not come easily to this young Californian, who copes with the twin diagnoses of Asperger’s and Tourette’s disorders. Since his appearance on “American Idol,” Durbin has been very open about the effect of these two conditions on his life and his musical career.

Although awareness of Asperger’s disorder (a high-functioning form of autism) has grown in recent years, Tourette’s is less well known. According to the National Institutes of Health, Tourette’s is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The early symptoms are almost always noticed first in childhood, with the average onset between the ages of 7 and 10 years. Tourette’s occurs in people from all ethnic groups; males are affected about three to four times more often than females. It is estimated that 200,000 Americans have the most severe form, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics or transient tics of childhood. Although Tourette’s can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.

Durbin’s positive attitude and his success as a performer have made him a hero for many children with Tourette’s disorder. Durbin says that he loves hearing that people are inspired by his history of overcoming adversity. “It fuels me to do better and to push myself even further,” he told USA Today in a March 8 interview.

In the past, television and movies have often highlighted Coprolalia, a form of Tourette’s disorder in which patients curse or spit out racial epithets uncontrollably. In reality, only about ten percent of patients have this severe form of Tourette’s. With the media attention generated by performers like Durbin, some common misconceptions can be dispelled, and the public can see a person with Tourette’s who is talented, successful, and popular. Durbin summed it up on a recent episode of “American Idol” when he said, “I have Tourette’s and Asperger’s, but Tourette’s and Asperger’s don’t have me.”

PAR is the first in the test publishing industry to bring your favorite products to you in digital versions! Now there is no need to carry hard copies of professional manuals with you; bring convenience and flexibility to your practice with digital versions of 11 of our most popular manuals. Simply download select manuals to your computer or laptop, where you will be able to access information with the click of your mouse! The following products are now available in digital editions:

Behavior Rating Inventory of Executive Function® (BRIEF®)

Behavior Rating Inventory of Executive Function®–Preschool Version (BRIEF®-P)

Behavior Rating Inventory of Executive Function®–Adult Version (BRIEF®-A)

Behavior Rating Inventory of Executive Function®–Self-Report Version (BRIEF®-SR)

The NEO™ Inventories: NEO Personality Inventory-3™ (NEO-PI-3™)

Personality Assessment Inventory™ (PAI®)

Personality Assessment Inventory™–Adolescent (PAI®-A)

Reynolds Intellectual Assessment Scales™ (RIAS™)

Trauma Symptom Inventory™-2 (TSI™-2)

Wide Range Assessment of Memory and Learning, Second Edition (WRAML™2)

Wide Range Achievement Test 4 (WRAT4)

With spring training now underway, people’s thoughts tend to move toward thoughts of America’s favorite pastime – baseball. You may not be aware, however, that major league baseball (MLB) is, perhaps, the most progressive of all professional sports when it comes to issues involving mental health. In fact, on April 1, 2009, the MLB put in place a disabled list (DL) for players suffering from emotional disorders. Teams were then allowed to place players on the DL if they were evaluated and diagnosed as suffering from a psychological problem that prevents them from playing, the same way they handle physical injuries.

During the 2009 season, five players were put on the disabled list with diagnoses ranging from clinical depression to anxiety attacks to social anxiety disorder.

While the MLB may be bringing more awareness to mental health issues, no other professional sports league has followed this path. While we know there are many professional athletes who live with mental health diagnoses (remember Ron Artest thanking his psychiatrist after winning the NBA championship?), why do you think they have not created similar programs? Do you believe that mental health still has a stigma in professional sports?

While the forefathers of psychology established many theories that became building blocks of what we study today, sometimes some of our highest-regarded researchers came up with some ideas that don’t necessarily fit with today’s view of the world of psychology. The following are some bits of “wisdom” from some familiar names.

“I wish that one would be persuaded that psychological experiments, especially those on the complex functions, are not improved [by large studies]; the statistical method gives only mediocre results; some recent examples demonstrate that. The American authors, who love to do things big, often publish experiments that have been conducted on hundreds and thousands of people; they instinctively obey the prejudice that the persuasiveness of a work is proportional to the number of observations. This is only an illusion.”
— Alfred Binet (1903). L' Études expérimentale de l'intelligence (p. 299). Paris, France: Schleicher.

“Being in love with the one parent and hating the other are among the essential constituents of the stock of psychical impulses which is formed at that time and which is of such importance in determining the symptoms of the later neurosis... This discovery is confirmed by a legend that has come down to us from classical antiquity: a legend whose profound and universal power to move can only be understood if the hypothesis I have put forward in regard to the psychology of children has an equally universal validity. What I have in mind is the legend of King Oedipus and Sophocles' drama which bears his name.”
— Sigmund Freud (1953). The Interpretation of Dreams. In J. Strachey (Ed.), The Standard Edition of the Complete Psychological Works of Sigmund Freud (Vol. 4, pp. 260-261). Retrieved from http://books.google.com/books (Original work published 1900)

“Since my mother is the type that's called schizophrenogenic in the literature—she's the one who makes crazy people, crazy children—I was awfully curious to find out why I didn't go insane.”
— Abraham Harold Maslow (2001). In Colin Wilson, New Pathways in Psychology: Maslow and the Post-Freudian Revolution (pp. 155-156). Retrieved from http://books.google.com/books (Original work published in 1972)

What do you think is psychology’s funniest or most interesting misstep?