Arch Gen Psychiat
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There is a great interest in the potential usefulness of biomedical tests in psychiatry, but basic statistical principles required for critical evaluation of their value remain poorly integrated into clinical thinking. We developed a useful scheme for organizing clinical test data so as to permit simple calculations of the sensitivity, specificity, and predictive power of medical tests. Some loss of predictive power is inherent in moving from artificial populations used for test development into more typical clinical settings, where prevalence is usually substantially lower.
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We studied 101 inmates of a county jail for women who were randomly selected from those referred for psychiatric evaluation. Eighty-six percent had a history of psychiatric hospitalization; 94% had prior arrest records, 50% of these for felonies. More than half met the criteria for involuntary hospitalization. ⋯ Far fewer mentally ill women than men were incarcerated in county jail. As in our study of male inmates, there appeared to have been some "criminalization" of the mentally ill. There is a need for more mandatory aftercare and ongoing involuntary treatment for this population.
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Biography Historical Article
Discussion of Alfred Alder's preface to The Diary of Vaslav Nijinsky.
In his preface to The Diary of Vaslav Nijinsky, Alfred Adler (1) found his theory of the dynamics of schizophrenia supported in the Diary, (2) alluded to Nijinsky's prepsychotic personality, and (3) briefly touched on the possibility and conditions of recovery. To add to the understanding of Adler's "Preface," this discussion (1) expands his theory of schizophrenia, (2) gives some concrete data of Nijinsky's prepsychotic personality, (3) describes two episodes of recovery subsequent to the "Preface," and (4) introduces an important aspect of Adler's theory, which he had to omit out of consideration for Nijinsky's wife, Romola-namely, her role in her husband's disorder. With the larger theoretical and historical context established. Adler's "Preface" can be appreciated for its predictive validity.
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Recent articles have suggested that muscle biofeedback and transcendental meditation may be useful in treating chronic anxiety. To assess this, we conducted a controlled study comparing muscle biofeedback, transcendental mediation, and relaxation therapy. The study consisted of a six-week baseline period, six weeks of treatment, a six-week posttreatment observation period, and later follow-up. ⋯ There were no differences between treatments with respect to treatment efficacy, onset of symptom amelioration, or maintenance of therapeutic gains. We found no evidence suggesting that the degree of muscle relaxation induced by any of the treatments is related to the therapeutic outcome. Relaxation therapies as a sole treatment appear to have a limited place in the treatment of chronic anxiety.