Psychiatry's pursuit of euthymia: another wild goose chase or an opportunity for principle-based facilitation?

The authors are encouraged that the field of psychiatry is moving towards including euthymia and its components (e.g., well-being, flourishing and resilience) as well as dysfunction (i.e., psychopathology and its symptoms) in its assessment and treatment. We are concerned, however, that to guide its pursuit of euthymia, psychiatry appears to be adopting the same 'outside-in' paradigm as positive psychology; that the positive must be 'put into' people via assisting them to adopt new positive beliefs and persistently practice psychotherapeutic techniques. We fear that if psychiatry continues to view the positive through this 'outside-in' lens, its pursuit of euthymia will bear small fruit. In this editorial, we posit that mental health and psychopathology can be viewed from the same basis because both are created in the same way; from the 'inside-out' via people's use of three psycho-spiritual Principles-Universal Mind, Consciousness and Thought. We posit that people can use these Principles in a way that either creates distressing symptoms or releases innate euthymia. We further posit that via awareness and sufficient insight-based understanding of how these Principles manifest within everyone, psychiatry can achieve a deeper understanding of the source of all psychological experience that will facilitate its pursuit of euthymia.

Examining the association between work-family conflict and the work attitudes of job satisfaction and organizational commitment among Chinese correctional staff.

Considerable empirical research has shown that work-family conflict has a negative effect on the job satisfaction and organizational commitment of United States correctional staff. This study is the first to examine the effect of work-family conflict on job satisfaction and organizational commitment for staff at Chinese prisons. Findings from ordinary least squares (OLS) regression analyses indicated that strain-based conflict, behavior-based conflict and family-on-work conflict had negative effects on the job satisfaction of Chinese prison staff. Also, strain-based conflict and behavior-based conflict had negative effects on organizational commitment. Overall, the results support the conclusion that work-family conflict was generally perceived as stressful by Chinese prison staff and negatively impacted their job satisfaction and organizational commitment, as has been found among United States staff.

The Efficacy of Principle-Based Correctional Counseling for Improving the Self-Control and Mental Health of People Incarcerated for Sexual Violence.

This study is the first to test the efficacy of principle-based correctional counseling (PBCC) for improving the self-control and mental health of people incarcerated for sexual violence (SV). A total of 132 males incarcerated for SV were assigned to a treatment group that received cognitive behavior therapy (CBT) supplemented with intensive PBCC and a waitlist control group that received only CBT. Results using paired t-tests and an analysis of covariance (ANCOVA) to control for pretest scores showed that compared with the control group, treatment participants showed a significant increase in affective well-being and a significant decrease in low self-control, depression, anxiety, and anger.

Routine Activities and Criminal Victimization: The Significance of Gendered Spaces.

Gender is arguably the most prominent correlate of criminal victimization. Few studies, however, examine gender-specific dynamics that might help advance criminology's understanding of the persistent gender gap in criminal victimization. We attempt to help fill this research void by examining data from the 2012 National Incident-Based Reporting System (NIBRS) through the lens of routine activity theory to investigate the relationship between "gendered spaces" and criminal victimization. We propose that gendered spaces constructed by people's routine activities may increase their exposure to motivated offenders, which in turn may increase their risk of victimization. Our findings appear to support our proposition and to shed new light on the nature of the victimization gender gap. The results showed that females were significantly more likely than males to be victimized at each of the three "feminine gendered spaces" (i.e., bank, shopping center, and grocery store). However, the relationship between gendered space and criminal victimization varied by crime type. Females were significantly more likely than males to be robbed at each of the three feminine gendered spaces. For sexual assault and aggravated assault, females were significantly more likely than males to be victimized at a "masculine gendered space" (i.e., bar/nightclub). For simple assault, females were significantly less likely than males to be victimized at two of the three feminine gendered spaces (i.e., bank and shopping center). Our findings appear to highlight the importance of gendered spaces in helping explain the gender gap in criminal victimization and suggest that future researchers should investigate how other gendered spaces formed by people's routine activities affect their risk of victimization.

Relational aggression and victimization in gay male relationships: the role of internalized homophobia.

This article presents two studies that are the first to examine relational aggression and relational victimization in gay male peer relationships. A qualitative pilot study provides a strong rationale for a subsequent empirical investigation of 100 young adult, self-identified gay males. Results of both studies demonstrate that relational aggression and relational victimization are common experiences in gay male relationships. They also reveal forms of relational aggression and victimization that appear to be unique to gay males (e.g., outing). Results of the empirical study found significant relations between engaging in relational aggression against gay males and experiencing relational victimization and between experiencing relational victimization and internalized homophobia. However, there was no significant correlation between internalized homophobia and engaging in relational aggression. A multiple regression analysis found that experiencing relational victimization was correlated more strongly with the combination of engaging in relational aggression and internalized homophobia together than with relational aggression alone. Results are discussed within the framework of Allport's "traits due to victimization" theory and Meyer's theory of "minority stress." Implications for the prevention of relational aggression/victimization in gay male relationships are offered.

Teaching Health versus Treating Illness: The Efficacy of Three Principles Correctional Counseling with People in an English Prison.

Three principles correctional counseling (3PCC) posits that people in prison have inner mental health they have obscured to varying degrees with their own thinking. 3PCC further posits that people in prison can rekindle and sustain this inner health via understanding how three psychospiritual principles-Universal Mind, consciousness, and thought-coalesce to form people's psychological experience. We review the three principles and explain how exposure to these principles can lead to improved mental health and improved behavior. Then, we describe 3PCC and distinguish it from prevailing correctional counseling methods. Finally, we present a preliminary study that examines the efficacy of 3PCC for improving the mental health and behavior of people in an English prison. Our findings show that participants exposed to 3PCC showed a significant improvement in mental well-being and purpose in life, significant reductions in anxiety and anger, and improved behavior in the prison community.

Intercostal Nerve Blockade with Exparel® Results in Lower Opioid Usage during the First 24 Hours after Video-Assisted Thorascopic Surgery.

Liposomal bupivacaine (LipoB) provides prolonged local anesthetic effects and has seen usage in several fields of surgery. We review our experience using LipoB intraoperatively for intercostal nerve blocks after video-assisted throacoscopic surgery (VATS). A retrospective, single-center review was conducted for patients undergoing VATS from August 2012 to December 2014. Patients those who received LipoB as an intercostal nerve block were compared with patients who received blocks with standard bupivacaine. Opiate amounts used within the first six hours and then subsequent 18, 48, and 72 hours were converted into morphine equivalents for comparison. Forty-seven patients met inclusion criteria: 21 receiving LipoB intercostal nerve block and 26 controls. Groups were similar for age, diabetes, hypertension, chronic kidney disease, body mass index and American Society of Anesthesiologists scores. The LipoB group had a larger portion of males (P < 0.02). Postoperatively, morphine equivalent usage was significantly less in the LipoB group compared with the standard bupivacaine within the first six hours after surgery (15.62 vs 52.41, P = 0.001) and in the subsequent 18 hours (28.98 vs 65.17, P = 0.01). After the first 24 hours there was not a significant difference in opiate usage between the two groups. There was no difference in length of stay between the two groups. In our study group of VATS patients, an intercostal nerve block with LipoB significantly reduced the usage of postoperative opioids in the first 24 hours only when compared with standard bupivacaine.

Anterior Leaflet Augmentation With CorMatrix Porcine Extracellular Matrix in Twenty-Five Patients: Unexpected Patch Failures and Histologic Analysis.

BACKGROUND: This study reported on the treatment of Carpentier type IIIa and type IIIb mitral regurgitation (MR) with a large patch anterior mitral valve leaflet augmentation technique using CorMatrix (CorMatrix Cardiovascular Inc, Alpharetta, GA) extracellular matrix (ECM). METHODS: A single-site chart review was conducted on patients who underwent anterior leaflet augmentation performed with the Da Vinci surgical robot (Intuitive Surgical, Sunnyvale, CA) or through a median sternotomy. Only patients who had anterior leaflet augmentation with porcine intestine ECM or autologous pericardium were included. Follow-up echocardiography was performed on all patients. Histologic specimens were available on ECM patches from a subset of patients who required reoperation. RESULTS: Between August 2011 and April 2014, 44 patients (mean age, 62.6 ± 12.2 years) underwent anterior leaflet augmentation with either porcine intestinal ECM or autologous pericardium at the Temple University Hospital in Philadelphia. Two (4%) late deaths occurred, one in each group. One patient who underwent ECM augmentation died of non-cardiac-related causes 7 months after discharge as a result of complications of chronic renal failure. The second late death occurred 5 months after discharge because of complications of a stroke in a patient in the pericardial augmentation group. Eight (32%) of the patients with ECM had recurrence of severe MR on echocardiography at an average time of 201 ± 98 days. Seven (28%) patients required reoperation because of failure of the ECM patch including perforation (4%), excessive patch dilation (20%), and suture line dehiscence (4%). In contrast, none of the patients with pericardial augmentation developed severe MR or required operation. Statistical analysis of the patients with ECM augmentation demonstrated no correlation of the following: age; sex; comorbid conditions such as diabetes, chronic obstructive pulmonary disease, and hypertension; left ventricular ejection fraction; surgical approach; annuloplasty size; or type of MR with patch failure. A lower body mass index was the only factor associated with recurrent severe regurgitation on univariate analysis (p = 0.039). Histologic study of the four available explants demonstrated intense inflammation without evidence of host integration. The remaining 15 (60%) patients had normal mitral leaflet structure and function on follow-up echocardiograms out to 12 months. CONCLUSIONS: For type III MR, a large anterior leaflet patch technique with porcine ECM was associated with a 32% recurrence rate of severe MR related directly to patch failure. Further research and development should be performed on the use of ECM materials with a goal to decrease the failure rate experienced in this study.

Ascending Aortic Endoballoon Occlusion Feasible Despite Moderately Enlarged Aorta to Facilitate Robotic Mitral Valve Surgery.

OBJECTIVE: Aortic occlusion with an endoballoon is a well-established technique to facilitate robotic and minimally invasive mitral valve surgery. Use of the endoballoon has several relative contraindications including ascending aortic dilatation greater than 38 mm in size. We sought to review our experience using the endoballoon in cases of totally endoscopic mitral valve surgery with aortic diameters greater than 38 mm. METHODS: A retrospective review of our single-site database was conducted to identify patients undergoing totally endoscopic mitral valve surgery by a single surgeon using an endoballoon and who had ascending aortic dilation. We defined aortic dilation as greater than 38 mm. Computed tomography was done preoperatively on all patients to evaluate the aortic anatomy as well as iliofemoral access vessels. Femoral artery cannulation was done in a standardized fashion to advance and position the endoballoon, to occlude the ascending aorta, and to deliver cardioplegia. RESULTS: From October 2011 through June 2015, 196 patients underwent totally endoscopic mitral valve surgery using an endoballoon at our institution. Twenty-two patients (11.2%) had ascending aortic diameters greater than 38 mm (range, 38.1-46.6 mm; mean, 40.5 ± 2.5 mm). In these cases, there were no instances of aortic dissection or other injury due to balloon rupture, balloon migration, device movement leading to loss of occlusion, or inability to complete planned surgery due to occlusion failure. CONCLUSIONS: Our experience suggests that it is possible to successfully use endoaortic balloon occlusion in patients with ascending aortic dilation with proper preoperative imaging and planning.

Quantitative analysis of cerebral cortical atrophy and correlation with clinical severity in unilateral Sturge-Weber syndrome.

Sturge-Weber syndrome is a neurocutaneous disorder with vascular malformations of the skin, brain, and eye. The objective of this study was to determine whether cortical atrophy in patients with Sturge-Weber syndrome correlates with clinical severity. Eighteen subjects (age 4 months-35 years) with unilateral Sturge-Weber syndrome received a neurologic examination and submitted previous magnetic resonance imaging (MRI) films. A blinded investigator assigned clinical severity scores based on seizures, hemiparesis, visual field cut, and cognitive impairments. Computer-aided analysis of MRIs produced laterality scores for cortical volume asymmetry. A significant relationship existed between clinical severity and laterality scores (Spearman's rho = -0.804; P < .001). Laterality scores also correlated well with hemiparesis subscores and weakly with cognitive impairment subscores (Kendall's tau b; P < .05). Using this simple, computer-aided analysis, cortical volume asymmetry correlated with clinical status. This method offers the advantages of relative simplicity, objectivity, and wide applicability to films from outside institutions, as would be encountered in clinical practice.

Positive psychology and adolescent mental health: false promise or true breakthrough?

The emerging field of positive psychology has pledged to improve the mental health of American adolescents. Yet, without a principle-based conceptual foundation to guide its study of optimal youth functioning, positive psychology will ultimately fail to keep its promise. This paper suggests that the principles of Mind, Thought and Consciousness can provide positive psychology with a clearer understanding of optimal psychological functioning, serve as a unifying conceptual framework to guide its proposed mission, and lead to a true breakthrough in adolescent mental health. It first describes how the logic of these principles accounts for all subjective human experience. It then demonstrates how optimal mental health is generated, and how it can be maintained irrespective of present or past circumstances. Finally, it discusses how several contemporary models of positive psychology (i.e., Csikszentmihalyi's flow. Seligman's learned optimism, Goleman's emotional intelligence, and Buss's evolutionary perspective) can be simplified and clarified using the logic of the above three principles.

Evaluation of an individualized treatment program for adolescent shoplifters.

This paper evaluates an individualized treatment program for adolescent shoplifters. Two hundred eighty-six juveniles charged with shoplifting were randomly assigned to treatment and control groups. Treatment contracts included combinations of fines, community service, monetary restitution, written essays, anti-shoplifting videos, apology letters, and individual and/or family counseling. Results revealed that 88% of the treatment group fully completed their treatment contracts. Furthermore, following intervention, the treatment group was rated significantly higher than the control group on personal responsibility and significantly lower on the likelihood of recidivism. Finally, compared to the control group, the treatment group displayed significantly less recidivism over a two-year follow-up period. Regression analyses revealed that several at-risk background variables were significantly associated with less successful treatment outcomes.

Quantitative EEG asymmetry correlates with clinical severity in unilateral Sturge-Weber syndrome.

PURPOSE: Sturge-Weber syndrome (SWS) is a neurocutaneous disorder with vascular malformations of the skin, brain, and eye. SWS results in ischemic brain injury, seizures, and neurologic deficits. We hypothesized that a decrease in quantitative EEG (qEEG) power, on the affected side, correlates with clinical severity in subjects with SWS. METHODS: Fourteen subjects had 16-channel scalp EEG recordings. Data were analyzed using fast Fourier transform and calculation of power asymmetry. Blinded investigators assigned scores for clinical neurological status and qualitative assessment of MRI and EEG asymmetry. RESULTS: The majority of subjects demonstrated lower total power on the affected side, usually involving all four frequency bands (delta, theta, alpha, and beta). qEEG asymmetry correlated strongly with neurologic clinical severity scores and MRI asymmetry scores. qEEG data generally agreed with the MRI evidence of regional brain involvement. In MRI-qEEG comparisons that did not agree, decreased power on qEEG in a brain region not affected on MRI was more likely to occur in subjects with more severe neurologic deficits. CONCLUSIONS: qEEG provides an objective measure of EEG asymmetry that correlates with clinical status and brain asymmetry seen on MRI. These findings support the conclusion that qEEG reflects the degree and extent of brain involvement and dysfunction in SWS. qEEG may potentially be a useful tool for early diagnosis and monitoring of disease progression in SWS. qEEG may prove useful, in severely affected individuals with SWS, for determining regions of brain dysfunction.