Northern Virginia Mental Health Institute

The authors reviewed reported cases of antibiotic-induced manic episodes by means of a MEDLINE and PsychLit search for reports of antibiotic-induced mania. Unpublished reports were requested from the World Health Organization (WHO) and the Food and Drug Administration (FDA). Twenty-one reports of antimicrobial-induced mania were found in the literature. There were 6 cases implicating clarithromycin, 13 implicating isoniazid, and 1 case each implicating erythromycin and amoxicillin. The WHO reported 82 cases. Of these, clarithromycin was implicated in 23 (27.6%) cases, ciprofloxacin in 12 (14.4%) cases, and ofloxacin in 10 (12%) cases. Cotrimoxazole, metronidazole, and erythromycin were involved in 15 reported manic episodes. Cases reported by the FDA showed clarithromycin and ciprofloxacin to be the most frequently associated with the development of mania. Statistical analysis of the data would not have demonstrated a significant statistical correlative risk and was therefore not undertaken. Patients have an increased risk of developing mania while being treated with antimicrobials. Although this is not a statistically significant risk, physicians must be aware of the effect and reversibility. Further research clearly is required to determine the incidence of antimicrobial-induced mania, the relative risk factors of developing an antimicrobial-induced manic episode among various demographic populations, and the incidence of patients who continue to have persistent affective disorders once the initial episode, which occurs while the patient is taking antibiotics, subsides. The authors elected to name this syndrome "antibiomania."

Large-scale blackouts typically result from cascading failure in power systems operation. Their mitigation in power system planning calls for the development of methods and algorithms that assess the risk of cascading failure due to relay overtripping, short-circuits induced by overgrown vegetation, voltage sags, line and transformer overloading, transient instabilities, voltage collapse, to cite a few. This paper describes such a method based on composite power system reliability evaluation via sequential Monte Carlo simulation. One of the impediments of the study of these phenomena is the prohibitively large computational burden involved by the simulations. To overcome this difficulty, importance sampling technique utilizing the Weibull distribution is applied to power generator outages. Another method combing importance sampling and antithetic variates together is implemented as well. It is shown that both methods noticeably reduce the number of samples that need to be investigated while maintaining the accuracy at a given level. It is found that the combined method outperforms importance sampling to certain extent. To illustrate the developed techniques, two case studies are conducted and analyzed on the IEEE one-area and three-area reliability test system.

New large-sample data show that non-additive genetic effects, probably epistatic interactions between loci, and sex-limited gene expression are significant features of the genetic architecture of human personality as measured by questionnaire scales of extraversion and neuroticism. Three large data sets--new data on large samples (n = 20,554) of US twins, their spouses, parents, siblings and children, correlations for Australian twins (n = 7,532), and previously published twin data from Finland (n = 14,288)--are subjected to an integrated analysis to test alternative hypotheses about the genetic causes of family resemblance in personality. When allowance is made for differences in reliability of the scales, the combined data are consistent with the same model for variation. There are significant amounts of genetic non-additivity for both dimensions of personality. The evidence favours additive x additive epistatic interactions rather than dominance. In the case of neuroticism, there is especially strong evidence of sex differences in genetic architecture favouring a greater relative contribution of non-additive genetic effects in males. The data confirm previous claims to find no major contribution of the shared environment of twins and siblings to these dimensions of personality. Correlations between spouses are zero, and the correlations for very large samples of siblings and non-identical twins do not differ significantly.

Abstract This study reports on genetic and environmental influences on the frequency of orgasm in women during sexual intercourse, during other sexual contact with a partner, and during masturbation. Participants were drawn from the Australian Twin Registry, and recruited from a large, partly longitudinal twin-family study. Three thousand and eighty women responded to the anonymous self-report questionnaire, including 667 complete monozygotic (MZ) pairs and 377 complete dizygotic (DZ) same-sex pairs, 366 women from complete DZ opposite-sex pairs, and 626 women whose co-twins did not participate. Significant twin correlations were found for both MZ and DZ twin pairs for all three items of interest. Age effects were statistically significant for some items. Models incorporating additive genetic, shared and nonshared environmental influences provided the best fit for Items 1 and 3, while a model with additive and nonadditive genetic influences along with nonshared envir-onment fitted the data from Item 2. While an independent pathway model fits the data most par-simoniously, a common pathway model incorporating additive genetic (A), shared environment (C), and unique environment (E) effects cannot be ruled out. Overall, genetic influences account for approximately 31% of the variance of frequency of orgasm during sexual intercourse, 37% of the variance of frequency of orgasm during sexual contact other than during intercourse, and 51% of the variance of frequency of orgasm during masturbation. Following Baker (1996), we speculate that this additive genetic variance might arise from frequency-dependent selection for a variety of female sexual strategies.

New large-sample data show that non-additive genetic effects, probably epistatic interactions between loci, and sex-limited gene expression are significant features of the genetic architecture of human personality as measured by questionnaire scales of extraversion and neuroticism. Three large data sets – new data on large samples (n = 20 554) of US twins, their spouses, parents, siblings and children, correlations for Australian twins (n = 7 532), and previously published twin data from Finland (n = 14 288) – are subjected to an integrated analysis to test alternative hypotheses about the genetic causes of family resemblance in personality. When allowance is made for differences in reliability of the scales, the combined data are consistent with the same model for variation. There are significant amounts of genetic non-additivity for both dimensions of personality. The evidence favours additive × additive epistatic interactions rather than dominance. In the case of neuroticism, there is especially strong evidence of sex differences in genetic architecture favouring a greater relative contribution of non-additive genetic effects in males. The data confirm previous claims to find no major contribution of the shared environment of twins and siblings to these dimensions of personality. Correlations between spouses are zero, and the correlations for very large samples of siblings and non-identical twins do not differ significantly.

Abstract Depression scores (DSSI) were available for 1232 MZ and 751 DZ female twin pairs who completed a mailed questionnaire. Pairs were divided into those concordant for being in a marriage-like state, concordant for having no partners, and those discordant. The pattern of twin correlations differed according to marital status. Our results suggest that having a marriage-like relationship acts as a protective factor in reducing the impact of inherited liability to symptoms of depression in the general population.

With recent calls for accountability in school counseling, it is imperative that counselor educators are structuring the professional identity development of counselors-in-training through guided learning experiences with a focus on demonstrated effectiveness. The author presents examples of course objectives and learning experiences from five courses in a counselor education program that specifically address training the effective professional school counselor. Suggested classroom activities, projects, and resources are included. An action research project undertaken by the author demonstrates her accountability through a disciplined process of inquiry to improve counselor education practice for training the effective professional school counselor.

Depression scores (DSSI) were available for 1232 MZ and 751 DZ female twin pairs who completed a mailed questionnaire. Pairs were divided into those concordant for being in a marriage-like state, concordant for having no partners, and those discordant. The pattern of twin correlations differed according to marital status. Our results suggest that having a marriage-like relationship acts as a protective factor in reducing the impact of inherited liability to symptoms of depression in the general population.

The authors investigated changes in treatment team functioning in an adult inpatient psychiatric hospital after the implementation of a mindfulness-based mentoring intervention. Using a multiple baseline across treatment teams design, the authors assessed levels of functioning of three treatment teams using a 50-item rating scale and then introduced mindfulness-based mentoring successively across the treatment teams. Following intervention, four follow-up assessments at 3-month intervals were undertaken to assess the durability of the enhanced treatment team functioning levels in the absence of mentoring. Results showed that with the introduction of mindfulness-based mentoring, treatment team performance was enhanced, patients'attendance at therapeutic groups and individual therapy sessions was maximized, and patient and staff satisfaction with treatment team functioning was substantially increased, with patient satisfaction showing greater gains than staff satisfaction. Mindfulness-based mentoring may be an efficient and effective intervention for enhancing and maintaining the performance of treatment teams in adult psychiatric hospitals.

Abstract The rework cycle is at the heart of modeling projects, one of the major research and application areas in system dynamics. The current formulations for the rework cycle assume each task is either defective or not. Yet in many projects multiple defects can occur in one task. In this study we introduce a new rework cycle formulation that accounts for multiple defects per task and flexibly captures the testing process. We compare this formulation with two established formulations from the literature. Analysis shows some differences in simulated projects' finish time and delivered quality across different models and we discuss how these differences depend on project characteristics and task structure. The new formulation could be especially useful when data on tasks, defects, and testing have different measures, and when each new defect in a task significantly increases the chances of the task being rejected. Copyright © 2010 John Wiley & Sons, Ltd.

Access to health care continues to be one of the major challenges to individuals, communities, and policy makers. In rural areas, the challenges are especially acute. This article examines the use of digital technology to provide health care services to underserved communities. An experimental telepsychiatry program is used to illustrate the promise and the obstacles to using technology to link communities to advanced health care services.

Sixty-nine MSW practitioners were queried about termination reactions in their most recently terminated individual case. Clients'strongest reactions were positive affect (that is, a sense of pride, accomplishment, and indepen-dence), evaluation of success, evaluation of the therapeutic experience, and positive flight (constructive outside-treatment activities). Least strong client reactions were nihilistic flight, regression, denial, recapitulation, and expression of a need for further treatment. Practitioners' strongest reactions to termination were pride in the client's success and pride in their own skill; their least strong reactions were relief, doubt about their own effectiveness, doubt about their client's progress, and reexperiencing of previous losses. Overall, positive evaluative responses far outweighed the negative for both clients and practitioners. Study participants' reactions varied depending on who made the termination decision, on the treatment outcome, and on the difficulty of terminating.

Abstract In a concurrent development process different releases of a software product overlap. Organizations involved in concurrent software development not only experience the dynamics common to single projects, but also face interactions between different releases of their product: they share resources among different stages of different projects, including customer support, they have a common code base and architecture that carries problems across releases, they use the same capabilities, and their market success in early releases impacts their resources in later ones. Drawing on two case studies we discuss some of the feedback processes central to concurrent software development and build a simple simulation model to analyze the resulting dynamics. This model sheds light on tipping dynamics, the nature of inter‐project feedback loops, and alternative resource allocation policies relevant to management of concurrent software development. Copyright © 2009 John Wiley & Sons, Ltd.

In 1990, Blum and colleagues first reported an association between DRD2 and alcoholism. While there have been subsequent replications of this genetic association, there have also been numerous studies that failed to detect an association between DRD2 and alcohol dependence. We propose that one aspect contributing to this inconsistency is the variation in alcohol phenotype used across studies. Within the population-based Finnish twin sample, FinnTwin16, we previously performed multivariate twin analyses to extract latent genetic factors, which account for the variation across seven measures of alcohol consumption (frequency of drinking, frequency × quantity, frequency of heavy drinking, frequency of intoxication and maximum drinks in a 24-hour period) and problems (the Rutgers Alcohol Problem Index-RAPI and the Mälmö-modified Michigan Alcohol Screen Test-MmMAST) in 3065 twins. In the present study, we examined the association between 31 DRD2/ANKK1 single-nucleotide polymorphisms (SNPs) and the genetic factor scores generated by twin analyses in a subset of FinnTwin16 (n = 602). We focus on two of the genetic factors: a general alcohol consumption and problems factor score, which represents shared genetic variance across alcohol measures, and a alcohol problems genetic factor score, which loads onto the two indices of problematic drinking (MAST and RAPI). After correction for multiple testing across SNPs and phenotypes, of the 31 SNPs genotyped across DRD2/ANKK1, one SNP (rs10891549) showed significant association with the general alcohol consumption and problems factor score (P = 0.004), and four SNPs (rs10891549, rs1554929, rs6275, rs6279), representing two independent signals after accounting for linkage disequilibrium, showed significant association with the alcohol problems genetic factor score (P = 0.005, P = 0.005, P = 0.003, P = 0.003). In this study, we provide additional positive evidence for the association between DRD2/ANKK1 and alcohol outcomes, including frequency of drinking and drinking problems. Additionally, post hoc analyses indicate stronger association signals using genetic factor scores than individual measures, which suggest that accounting for the genetic architecture of the alcohol measures reduces genetic heterogeneity in alcohol dependence outcomes in this sample and enhances the ability to detect association.

Elsewhere the authors have called attention to fundamental problems with the Comprehensive System for the Rorschach (CS). G. Meyer (1997) attempts to refute the authors' criticisms of CS interrater reliability, but misrepresents what they actually stated, and several of his arguments are based on psychometric errors and misunderstandings. The meta-analysis in Meyer's article is flawed and fails to demonstrate CS interrater reliability. Instead of defending the CS with unsound arguments and shaky numbers, Rorschach proponents need to accept valid criticisms and undertake high-quality, replicated studies of reliability and validity.

The current study replicated and expanded previous investigations that focused on the incremental contribution of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) content scales. The MMPI-2 and the Symptom Checklist-90-Revised (SCL-90-R) were administered to 597 adult psychiatric patients (289 females, 308 males) receiving inpatient treatment. In addition, clinical psychologists provided ratings on each of these patients with the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment Scale (GAS). A series of hierarchical stepwise multiple regression analyses were conducted with MMPI-2 basic and content scales as the independent variables and SCL-90-R, BPRS, and GAS variables as the dependent criteria. Similar to Findings by Ben-Porath, McCully, and Almagor, MMPI-2 content scales were shown to add incrementally to the prediction of variance on self-report measures; the current study also revealed significant relationships to clinician-rater criteria. Implications of the present findings for test interpretation procedures and future research are presented and discussed.

This article describes two studies that evaluated training intended to improve the family friendliness of five components of the admissions treatment team process (Introduction, Meeting Management, Case Presentation and Discussion, Service Plans, and Tact and Technicalities) at an inpatient child and adolescent psychiatric hospital. In Study 1, we observed 18 case presentations and found that the ratings on family friendliness were low on Service Plans and Tact and Technicalities. Following three role-play training sessions, we found no statistically significant improvement. In Study 2, we used a multiple-baseline design across treatment team process components and enhanced the family friendliness of each component through mindfulness training. Follow-up observations at monthly intervals for 6 months showed continued high rates of family friendly services. Our study suggests that the mindful delivery of mental health services can produce long-term gains in the family friendliness of admissions treatment teams.

This qualitative study explored the impact of caring for a family member with Alzheimer'S on the caregiver'S occupational performance and the perceived influence of respite on occupational performance. Five caregivers participated in semi-structured interviews including the client-centered Canadian Occupational Performance Measure. The caregivers described (a) the desire for respite that would be mutually beneficial for the caregiver and the care receiver; (b) the importance of engaging in occupations that provided a mental break from caregiving; and (c) prioritization of occupations for which they would use respite. The findings emphasize the need for client-centered interventions to promote caregiver occupational performance.

Children in three school grades (kindergarten, Grades 2 and 4) were given 21 preference tasks (unimanual and bimanual) and 5 skill tasks, with half the children retested after a 2-wk. interval. Age changes in performance on each task, in intercorrelations among tasks, and in the reliability of retest performance point to several ways in which tasks differ from one another and also to the general importance of considering the growth of skill in both hands and the development of divisions of labor between them.

The client's home is emerging as a typical site in which family therapy is delivered, yet training programs tend to train students in an office-based model. This qualitative study examines the process that three student interns went through as they learned to do home-based therapy after having been trained in a clinic setting. All three found that the experience of working in the clients' homes challenged their beliefs about therapy as well as the models of a professional relationship; all reformulated their views on therapy because of this challenge. A model is proposed that describes the students' journey from being a clinic-based to becoming a home-based therapist.