Off-Label Promotion, On-Target Sales

Adriane Fugh-Berman and Douglas Melnick describe techniques by which pharmaceutical companies covertly promote off-label drug use even where such promotion is illegal

Contrasting Stigma: Negative Implicit Attitudes and Attributions about Depression Relative to ADHD

Stigma against individuals with psychological disorders poses serious risk to the mental health field. Perceived prejudice is often internalized by diagnosed individuals (self-stigma), which is in turn related to lower rates of treatment seeking. However, research investigating mental illness stigma has rarely included theory from implicit social cogntiion, a field which suggests many prejudiced attiudes exist outside conscious awareness. The current study comapres stigma between ADHD and depression, two of the most prevalent disorders diagnosed among young people because a consistent difference in their stigmatization has yet to be found. Based on evidence suggesting that people can hold both consciously controlled and more automatic attitudes toward a single social group, the current study included an Implicit Association Test (IAT) along with explicit measures, in an attempt to gain a fuller understanding of the stigma differences between ADHD and depression. The present study predicted that depression would be devalued to a greater extent than ADHD on the IAT, compared to explicit measures. This was expected to occur along three stigma-dimensions: attitude, etiology, and personal responsibility. Support was found for this hypothesis on two out of three IAT’s. Participants had stronger negative implicit attitudes about depressed individuals and implicitly blamed depressed individuals to a greater extent, compared to ADHD. These results provide strong evidence that depression is more unconsciously stigmatized compared to ADHD. Finding no evidence for stigma on explicit measures suggests that implicit methods are more sensitive than explicit measures in studying attitudes about mental illness, and perhaps about social groups, in general. Therefore, this study urges future researchers to utilize indirect measures and further investigate the role of implicit cognition in mental illness stigma

Contexts of concealment: Initial validation of three disclosure avoidance process measures

The choice to withhold subjective distress reflects a multifactorial decision highly sensitive to context. Unfortunately, existing measures are built on unidimensional models (i.e., concealment-disclosure as a single, bipolar dimension) and operationalize the construct as a stable trait. In this article, we outline the development and initial validation of a self-report inventory that accounts for problem-context and assesses multiple processes central to both the concealment and disclosure of emotional distress. Exploratory analysis of pilot items in Study 1 (male student sample; N = 373) guided subsequent item development and revisions to our conceptual model. In Study 2 (mixed-gender community sample; N = 297), we refined the item-pool based on additional tests of latent scale structure and associations with concurrent criteria. In a final validation sample (Study 3; international community participants; N = 978), confirmatory factor analyses corroborated our hypothesized three-factor model (Privacy Management, Disclosure Desire, and Social Fear) and supported measurement invariance by sex. The three Contexts of Concealment Scales (CCS) were internally consistent and associated in expected directions with external indices of concurrent concealment, disclosure, depression, anxiety, loneliness, experiential avoidance, and self-stigma

Off-label prescribing in psychiatric practice

Drug treatment is an essential part of much of psychiatric practice, in patients from a wide age range, across many diagnostic groups and in a variety of settings. Despite the availability of many classes of psychotropic drug, significant numbers of patients remain troubled by distressing and disabling symptoms even after a succession of licensed pharmacological treatments. Psychiatrists may then consider the prescription of a psychotropic outside the narrow terms of its licence, as part of an overall management plan. This article reviews the nature and extent of this aspect of prescribing, outlines when it may be appropriate and makes recommendations for a suggested procedure when prescribing medication ‘off-label’

Masculine depression: A person-centric perspective

The construct of masculine depression is believed to be evident when men express their depressive symptomology via externalizing problems (e.g., anger, substance use, and compulsive overworking) rather than or in addition to traditional, internalizing expression of depression (e.g., sadness, hopelessness, and feeling helpless). We examined whether distinct subgroups of men potentially at risk for depression could be identified based on their self-reported levels of internalizing and externalizing depressive symptomology. Latent profile analysis (LPA) using traditional (Patient Health Questionnaire-9 [PHQ-9]) and masculine (Masculine Depression Scale [MDS]) self-report measures of depression in an online sample of 910 male Mechanical Turk (MTurk) workers in the United States revealed support for a four-class solution: Low Internalizing–Low Externalizing (LI–LE; n = 519), High Internalizing–Moderate Externalizing (HI–ME; n = 68), High Internalizing–High Externalizing (HI–HE; n = 120), and Moderate Internalizing–Moderate Externalizing (MI–ME; n = 209). The LPA indicators and responses to auxiliary measures of traditional masculinity ideology, conformity to masculine role norms, and male depression risk suggested the HI–HE class best represented a masculine depression subtype, whereas the HI–ME class best represented a traditional expression of depression. Consistent with expectations, men in the HI–HE class reported the greatest levels of traditional masculinity ideology and higher levels of male depression risk. However, men in this class reported lower conformity to emotional control and self-reliance masculine norms than men in the HI–ME class. These results highlight the importance of a person-centric perspective of masculine depression but raise questions regarding the conceptualization of the construct in relation to traditional masculine role norms

What factors influence ward nurses’ recognition of and response to patient deterioration? An integrative review of the literature

Aim: In this integrative review, we aimed to: first, identify and summarize published studies relating to ward nurses\u27 recognition of and response to patient deterioration; second, to critically evaluate studies that described or appraised the practice of ward nurses in recognizing and responding to patient deterioration; and third, identify gaps in the literature for further research. Design: An integrative review. Methods: The Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ovid Medline, Informit and Google Scholar databases were accessed for the years 1990–2014. Data were extracted and summarized in tables and then appraised using the Mixed Method Appraisal Tool. Data were grouped into two domains; recognizing and responding to deterioration and then thematic analysis was used to identify the emerging themes. Results: Seventeen studies were reviewed and appraised. Recognizing patient deterioration was encapsulated in four themes: (1) assessing the patient; (2) knowing the patient; (3) education and (4) environmental factors. Responding to patient deterioration was encapsulated in three themes; (1) non‐technical skills; (2) access to support and (3) negative emotional responses. Conclusion: Issues involved in timely recognition of and response to clinical deterioration remain complex, yet patient safety relies on nurses’ timely assessments and actions

Traditional Masculinity Ideology and Diagnostic Aversion Predict Symptom Expression in a Community Sample of Distressed Men

Adherence to traditional masculinity ideology (TMI) is associated with a host of negative outcomes, including higher rates of internalizing and externalizing psychopathology. However, relatively less is known about the mechanisms and contexts through which TMI affects the expression of psychological distress. In the current study, men’s aversion to being diagnosed with a mental health disorder was tested as a mediator and moderator to help clarify the relationship between TMI and symptom expression. A community sample of 72 U.S. men experiencing elevated psychological distress completed self-report questionnaires during a single session. Results demonstrated that diagnostic aversion mediated the positive association between TMI and internalizing symptoms. In addition, diagnostic aversion moderated the positive association between TMI and externalizing symptoms, such that this association was stronger among men who demonstrated higher levels of diagnostic aversion. Aversion to mental health diagnosis may be important in understanding how men who adhere to TMI manifest distress across diagnostic categories