tical perspective. For instance, there are only three passing references to kuru in a book of 650 pages. This edition reflects the renewed interest in the immunological theories of multiple sclerosis. More than half the text is devoted to Professor Lumsden's analysis of the pathoIogy and, in particular, the chemical pathology of the immune response. There is a great deal of original work devoted to the chemistry and behaviour of the immunoglobulins. Much of this appears in specialist journals and one must be grateful for the critical summary provided here. Professor Lumsden unequivocally sees the key to the problem of multiple sclerosis in the study of its immunochemistry, relegating infection by a virus or a slow virus to a quite subsidiary role. The clinical studies drawing on wide practical experience help to get one's prejudices about the illness onto a more reasoned footing. The section on treatment is still sadly limited. Dr. McAlpine found little to add to the regime which he described in 1955. McAlpine, Lumsden, and Acheson's reappraisal is an essential reference for the practising neurologist and the new edition makes important modification of and changes in emphasis from the edition of 1965.

https://jnnp.bmj.com/content/jnnp/36/5/894.3.full.pdf

The assessment of aphasia and related disorders

Depression and anxiety are the most common psychiatric conditions in late life. Despite their prevalence, we know relatively little about their unique manifestation in older adults. And, Although the most common intervention for late-life depression and anxiety continues to be medication, research on psychosocial interventions for late-life depression and anxiety has burgeoned in the past several years. Unfortunately, this growing body of intervention research has yet to be widely translated into improved systems of care for late-life depression. This article is one step toward synthesizing the knowledge in this growing area of research. The review of literature presents the conclusions of several meta-analyses that have reviewed psychosocial interventions for late-life depression and anxiety. In addition, intervention studies concerning the effectiveness of cognitive behavioral therapy, interpersonal therapy, reminiscence therapy, and alternative therapies with depressed and/or anxious older adults are reviewed. A brief description of various approaches to psychosocial intervention with anxious and/or depressed older adults is also presented.

Depression and anxiety.

Grief counseling and grief therapy: A handbook for the mental health practitioner

Summary
Thriving is defined as the psychological state in which individuals experience both a sense of vitality and learning. We developed and validated a measure of the construct of thriving at work. Additionally, we theoretically refined the construct by linking it to key outcomes, such as job performance, and by examining its contextual embeddedness. In Study 1, we conducted second-order confirmatory factor analyses in two samples, demonstrating initial support for the two-dimensional structure of thriving. We provided evidence for the convergent and discriminant validity of thriving in relation to theoretically related constructs, such as positive and negative affects, learning and performance goal orientations, proactive personality, and core self-evaluations. In Study 2, across two different samples, we further assessed construct validity by establishing a relationship between thriving and career development initiative, burnout, health, and individual job performance, explaining significant variance beyond traditional attitudinal predictors, such as job satisfaction and organizational commitment. Finally, in Study 3, we focused on understanding the contextual embeddedness of thriving. We found differences in reports of thriving across two points in time, when substantial changes are occurring in peoples' work lives and across contexts (i.e., work and non-work). Implications for theory and practice, as well as directions for future research, are discussed. Copyright © 2011 John Wiley & Sons, Ltd.

/pdf/thriving-at-work-toward-its-measurement-construct-validation-1g77cunacr.pdf

Thriving at work: Toward its measurement, construct validation, and theoretical refinement

Since the early 1970s, Sroufe, Egeland, Carlson, Collins and others have been following a large cohort of children from the sixth month of the mother’s pregnancy through to the present. Eighty-five percent of the 212 at 24 months are still in the study close to three decades later. Early losses occurred before the decision was made to change the initial shorter study (started by Egeland, a psychologist, and Deinard, a pediatrician) to a longitudinal study. The authors noted that the losses were in the most high stress and unstable of the families.

The families were chosen intentionally to include caregivers who may present parenting difficulties by selecting first born children to mothers who qualified for public assistance for prenatal care and delivery. Poverty was the marker that would ensure this. They were careful to note that these mothers had a wide variety of backgrounds and degrees of support available, thus also ensuring a wide range of outcomes 28 years later (the age now under study).

The authors started with an excellent overview of the challenges faced, the key claims and guide to the book, conceptual and theoretical supports, organizing perspective and assessments. Understanding the frequency, breadth and depth of the assessments with over 10,000 resultant variables is crucial to giving credence to the resulting conclusions. The strength of this work comes not just from the lessons learned about development, change and continuity but from the impressive evidence that places the lessons on a firm foundation and the even more fascinating predictability about development that emerged from the data.

Throughout the book, it is easily possible to pull out sentences that may have made intuitive clinical sense but are now backed up with statistics (kept to an appropriate minimum since background papers are well-referenced). For instance: by heightening and chronically emitting signals of need toward an only intermittently responsive caregiver, a resistant attachment organization is established which is correlated with anxiety disorders at age 17½. By minimizing signals of need that may further alienate rejecting caregivers, an avoidant attachment organization is established which shows a connection to externalizing behavioural disorders through early childhood and adolescence. Anxious attachment in general, with no distinction between avoidance and resistance, was associated with depression. There are remarkable parallels between how mothers responded to tasks with their children at 24 months and the same children more than 20 years later, responding to their own 24-month-old children.

Other conclusions have implications for prevention and intervention. In breaking the cycle of abuse, three relationship factors were most helpful for the mothers: (1) receiving emotional support from an alternative non-abusive adult, therapy experience of at least six months, supportive and satisfying relationship with a mate; (2) ability to predict high school dropping out with 77% accuracy using only quality of care measures up to age 42 months; (3) boundary violators during middle childhood were less competent in dealing with mixed gender relationships during adolescence and were more likely to have mothers who were abused.

As interesting as any individual observation or prediction may have been, it is the general observations and conclusions about development that pull the work together and provide a framework that will be useful to clinicians, program planners and researchers for years to come. They include implications for classification systems such as the Diagnostic and Statistical Manual, for treatment of specific disorders and for prevention and early intervention services. Above all, they have demonstrated that development is a lawful, understandable and predictable process when there have been multiple methods of assessment from multiple independent sources.

This is a book that I wish was written and that I had read as a resident. It’s not that there weren’t books about development, but they were based on the wisdom of clinical observation by gifted clinicians after years of work. What this group has contributed is the research basis for development, and in the process have given it a much more interactive and dynamic life than theory and clinicians have been able to do. They shift us from traits to interactions, from today’s preoccupation with genetics to the psychosocial environment, from blaming parents to acceptance of their unique histories and pasts, and, more importantly, from the unpredictable to the predictable.

Some time ago, when giving an invited talk about personality disorder from the perspective of a child and adolescent psychiatrist, I ended with the thought that we may be training our residents from the wrong end of life. They start out in the world of adult psychiatry and work backwards gradually. My thought was that we needed to start with infancy and the attachment process, then work forward into childhood, adolescence and adulthood. This book has shifted my ‘clinical’ thought into a research base. If we understood the results of this book and the developmental process and predictability, we would practice a more researched based therapy with each growing stage of life.

This book represents the summary of a lifetime dedication by many researchers to the mental health and well-being of children and youth and makes this dedication available to all of us who work with and care about children and youth in society. They deserve not only our thanks, but more importantly, our attention.

Now that the work has been done, the book has been written, it is time for you to read it and then recommend it to every psychiatry resident beginning their career.

The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood

The purpose of this feminist interpretive study was to portray the experience of women thriving after childhood maltreatment (CM) through personal narratives. An interdisciplinary team conducted multiple in-depth interviews of 44 women survivors of CM who identified themselves as successful and doing well. The interviews focused on "what worked" and "what did not" with the aim of exploring aftereffects of CM; strengths and strategies; interactions helpful in overcoming abuse; and related sociopolitical contexts. Narrative analyses revealed a distinct, dynamic process of becoming resolute characterized by six dimensions that were not sequential steps but characteristics, actions, and interactions. This study offers a new understanding of the experience of women gaining solid footing in their lives, the peace of knowing the abuse is over, and power to move in an upward trajectory.

Thriving as becoming resolute in narratives of women surviving childhood maltreatment.

Despite the well known mental and physical health benefits of exercise, persons with schizophrenia spectrum disorders remain sedentary. While the exercise barriers (i.e., lack of motivation, poor concentration, sedative effects of medication, poverty, and lack of access to exercise education/programs) of persons with SSDs are numerous, lack of motivation is considered foremost among them. Exercise interventions have been shown to improve exercise behavior, but there is a need for longitudinal documentation of physical activity after interventions conclude. This pilot study describes the physical activity level of 22 persons with SSDs 14 to 34 (mean 22) months after the conclusion of an exercise intervention provided in a randomized controlled trial (RCT). Eighteen months after the RCT, 22 participants wore pedometers daily for one week without altering their activity. Experimental participants walked more steps and covered more distance on average than control participants on six of the seven days. This pilot study is among the first to document the physical activity level of persons with SSDs after exercise intervention. While our findings confirm the low activity level of persons with SSDs reported by others, experimental participants demonstrated higher activity levels than controls on most days. Future studies should increase the sample size and recruit participants from multiple sites to enhance power and generalizability.

A pilot study describing physical activity in persons with schizophrenia spectrum disorders (SSDS) after an exercise program.

The prevalence of clinically significant depressive disorders in persons 65 years of age or older in the United States has been estimated to be approximately 15%, increasing the risk for functional decline, morbidity, and mortality. Utilization of a well-chosen screening instrument has been shown to improve the rates of recognition of depressive disorders in older adults. This paper presents a targeted review of the most commonly accepted tools for case-finding of depressive disorders in older adults. After a review of the benefits and shortcomings of screening tools, the strengths, weaknesses, and utility of selected depression scales in geriatric clinical settings are discussed.

Screening instruments for older adult depressive disorders: updating the evidence-based toolbox.

Recovery has been identified as a focus for mental health care. Recovery requires learning to live again after a life-altering acute event or during a chronic illness, mental or physical. By analyzing within-person change over time, utilizing multiple sources of evidence, two cases illustrated particular dimensions that influenced the recovery process after stroke, within a biopsychosocial framework. Restoration of the self, through co-occurring, dual processes of grief and reconstruction, appeared to be an essential dimension in the recovery process. Suggestions for integrating this concept into current adult clinical practice are congruent with current models of disease management of several chronic conditions.

The process of recovery: a tale of two men

Childhood maltreatment and its consequences are a public health issue. There continues to be a need for improving the lives and life prospects for survivors of child abuse. The important role that positive interactions can play was evident in a large study of women who considered themselves successful despite maltreatment. Interactions of import ranged from brief encounters with strangers to enduring relationships. Two distinct motifs emerged: The "Saw something in me" and "No matter what" relationships. Findings will be discussed within the context of extant theories with possible implications for researchers, practitioners, and careful, caring adults in any setting. Language: en

Marian W. Roman

Papers

Thriving as becoming resolute in narratives of women surviving childhood maltreatment.

A pilot study describing physical activity in persons with schizophrenia spectrum disorders (SSDS) after an exercise program.

Screening instruments for older adult depressive disorders: updating the evidence-based toolbox.

The process of recovery: a tale of two men

Nurturing natural resources: the ecology of interpersonal relationships in women who have thrived despite childhood maltreatment.