Early detection of psychosis: finding those at clinical high risk

AIM

In early detection work, recruiting individuals who meet the prodromal criteria is difficult. The aim of this paper was to describe the development of a research clinic for individuals who appear to be at risk of developing a psychosis and the process for educating the community and obtaining referrals.

METHODS

The outcome of all referrals to the clinic over a 4-year period was examined.

RESULTS

Following an ongoing education campaign that was over inclusive in order to aid recruitment, approximately 27% of all referrals met the criteria for being at clinical high risk of psychosis.

CONCLUSIONS

We are seeing only a small proportion of those in the community who eventually go on to develop a psychotic illness. This raises two important issues, namely how to remedy the situation, and second, the impact of this on current research in terms of sampling bias and generalizability of research findings.

Usage and longitudinal effectiveness of a Web-based self-help cognitive behavioral therapy program for panic disorder

BACKGROUND

Anxiety disorders are common problems that result in enormous suffering and economic costs. The efficacy of Web-based self-help approaches for anxiety disorders has been demonstrated in a number of controlled trials. However, there is little data regarding the patterns of use and effectiveness of freely available Web-based interventions outside the context of controlled trials.

OBJECTIVE

To examine the use and longitudinal effectiveness of a freely available, 12-session, Web-based, cognitive behavioral therapy (CBT) program for panic disorder and agoraphobia.

METHODS

Cumulative anonymous data were analyzed from 99695 users of the Panic Center. Usage statistics for the website were examined and a longitudinal survey of self-reported symptoms for people who registered for the CBT program was conducted. The primary outcome measures were self-reported panic-attack frequency and severity at the beginning of each session (sessions 2-12).

RESULTS

Between September 1, 2002 and February 1, 2004, there were 484695 visits and 1148097 page views from 99695 users to the Panic Center. In that same time period, 1161 users registered for the CBT program. There was an extremely high attrition rate with only 12 (1.03%) out of 1161 of registered users completing the 12-week program. However, even for those who remained in the program less than 12 weeks we found statistically significant reductions (P<.002) in self-reported panic attack frequency and severity, comparing 2 weeks of data against data after 3, 6, or 8 weeks. For example, the 152 users completing only 3 sessions of the program reduced their average number of attacks per day from 1.03 (week 2) to 0.63 (week 3) (P<.001).

CONCLUSIONS

Freely available Web-based self-help will likely be associated with high attrition. However, for the highly self-selected group who stayed in the program, significant improvements were observed.

Effects of past abuse experiences on children's eyewitness memory

Relations between child maltreatment and children's eyewitness memory were examined. A matched sample of abused and nonabused 3- to 10-year-old children (n = 70) participated in a play session with an unfamiliar adult and were interviewed about the interaction 2 weeks later. Consistent with results from previous research, older compared to younger children's reports were more complete and accurate. Abused and nonabused children performed similarly with several exceptions: Nonabused children were more accurate in answering specific questions, made fewer errors in identifying the unfamiliar adult in a photo identification task, and (at least for younger boys) freely recalled more information. Most effects remained when group differences in IQ and behavioral symptomology were statistically controlled. Importantly, abused and nonabused children did not differ in their accuracy or suggestibility in response to questions that were relevant to abusive actions. Among abused children, however, those who suffered more severe sexual abuse made more omission errors to specific abuse-relevant questions. Contributions to psychological theory and legal implications for understanding children's eyewitness memory and testimony are discussed.

Re-examining the efficacy of child sexual abuse prevention strategies: victims' and offenders' attitudes

Current sexual abuse prevention programs have been forced to rely on anecdotal clinical information to guide curriculum development. Recent evidence that suggests that sexual abuse offenders can reliably offer information regarding their modus operandi implies that sexual abuse offenders can be important sources of information about the victimization process. However, only one study to date has examined offenders' attitudes about sexual abuse prevention topics, and methodological problems limit the applicability of that study. The current study asked 16 intrafamilial victims, 16 intrafamilial perpetrators, and 15 extrafamilial perpetrators of child sexual abuse to rate the efficacy of various prevention strategies on a Likert-type scale. Results indicated that there were no differences between the three groups and that both victims and offenders appeared to have difficulty discriminating the value of 12 prevention topics, perhaps because the items were too global or because they engendered socially desirable responses. Open-ended questions that asked offenders to identify factors that would dissuade them from pursuing the abuse of particular victims indicated that different prevention skills or strategies may be effective at different stages of the victim-offender "relationship." Overall, the findings suggest that when questioning offenders or victims about the victimization process, investigators need to utilize specific (rather than global) questions and need to separately analyze each stage in the victim-offender relationship. These methodological improvements may offer greater potential for enhancing our knowledge of how to reduce child sexual abuse.

Testifying in criminal court: emotional effects on child sexual assault victims

Child victims must cope not only with the emotional consequences of criminal acts but also with the potentially traumatizing effects of legal involvement. Dramatic increases in the reporting of child sexual abuse are bringing greater numbers of children into contact with the criminal justice system, raising fears that child victims of sex crimes will be further harmed by the courts. In the present study, the effects of criminal court testimony on child sexual assault victims were examined in a sample of 218 children. From this sample, the behavioral disturbance of a group of "testifiers" was compared to that of a matched control group of "nontestifiers" at three points following testimony: 3 months, 7 months, and after prosecution ended. At 7 months, testifiers evinced greater behavioral disturbance than nontestifiers, especially if the testifiers took the stand multiple times, were deprived of maternal support, and lacked corroboration of their claims. Once prosecution ended, adverse effects of testifying diminished. In courthouse interviews before and after testifying, the main fear expressed by children concerned having to face the defendant. Children who appeared more frightened of the defendant while testifying were less able to answer the prosecutors' questions; and later, after the cases were closed, they were more likely to say that testifying had affected them adversely. The two most pervasive predictors of children's experiences in the courtroom, however, were age and severity of abuse. Despite relevant laws, few innovative techniques were used to help the children testify. The results are discussed in relation to children's ability to cope with stressful situations, the interaction of the legal system with the child/family system, and debates about the need to protect child victims who testify in criminal court.

The Effect of Preceptorship Upon Diploma Program Nursing Students' Transition to the Professional Nursing Role

This quasi-experimental study determined the effect of a 17-week pregraduate preceptorship program upon diploma nursing students' (N = 22) performance of the professional nursing role. Nine students participated in the preceptorship program; 13 received the standard pregraduate clinical experience. Nursing performance was measured using Schwirian's Six Dimension Scale of Nursing Performance prior to, during, and upon completion of the pregraduate clinical experience. Based on the faculty adviser's appraisals, the preceptorship program was associated with significantly greater improvements in nursing performance within the teaching/collaboration and planning/evaluation dimensions.