Dilemma 8: A Session with the Spouse

Dr. Faye Miller receives a referral for a 35-year-old female, Betty Drapier, who is both feeling depressed and experiencing marital problems.  During the first few sessions, Mrs. Drapier indicates that her husband, Don, is depressed and in treatment.  Part of her struggle is that she sees her husband as more depressed now than when he started treatment.  By Mrs. Drapier’s report, he appears more stressed because of his job and drinking alcohol more frequently.  She reports that his treating psychologist, Dr. Cooper, is working with her husband and has allegedly advised him to discontinue his medication in favor of an herbal remedy (St. John’s Wort).  Dr. Miller suggests that she meet with both Mr. and Mrs. Drapier to evaluate the marital situation.

At that time, Dr. Miller not only wanted to evaluate the marriage, but to evaluate how impaired the husband was, and Mrs. Drapier’s ability to assess her husband and the marriage accurately.

During the next session, Mr. and Mrs. Drapier arrive separately, but on time.  Mr. Drapier acknowledges many cognitive, behavioral, and physical symptoms of serious depression.  Mr. Drapier smelled as if he had been drinking.  Mr. Drapier also admits that his alcohol use has increased.  He also divulged that his risk-taking behavior has increased as well, such as speeding. During the session, Mr. Drapier verbalized suicidal ideation in a flip manner (“Sometimes I think it would be better if I just killed myself”).  The marital situation appears deteriorated and Mr. Drapier appears significantly depressed. 

As the session winds down, Mr. Drapier spontaneously asks for a second opinion about his treatment with Dr. Cooper.  He indicated that Dr. Cooper recommended that he discontinue a psychotropic medication in favor of an herbal remedy.  Mr. Drapier mentions that Dr. Cooper sells St. John’s Wort to him directly.

After reiterating the purpose of the session (which was to assess the marital situation and not to assess his current treatment), Dr. Miller states that she feels uncomfortable with the request, although she is concerned about the psychologist’s reported behavior. She is also concerned about Mr. Drapier’s level of depression, alcohol use, and suicidal statement.

Abruptly, Mr. Drapier looks at his watch and leaves the office explaining that he is late for a business meeting.

What are Dr. Miller's potential ethical issues in this situation?

What are some actions that you, as the treating psychologist, may have done differently?

If you were Dr. Miller, what are your emotional reactions to this situation?

What obligations does the psychologist have to Mr. Drapier, Mrs. Drapier, Dr. Cooper, and the public?

Woman’s psychiatrist implanted horrific false memories

By Nightdesk, Herald-Tribune
Health and Fitness

The memories that came flooding back were so horrific that Lisa Nasseff says she tried to kill herself: She had been raped several times, had multiple personalities and took part in satanic rituals involving unthinkable acts. She says she only got better when she realized they weren’t real.

Nasseff, 31, is suing a suburban St. Louis treatment center where she spent 15 months being treated for anorexia, claiming one of its psychologists implanted the false memories during hypnosis sessions in order to keep her there long-term and run up a bill that eventually reached $650,000. The claims seem unbelievable, but her lawyer, Kenneth Vuylsteke, says other patients have come forward to say they, too, were brainwashed and are considering suing.

“This is an incredible nightmare,” Vuylsteke said.

Castlewood Treatment Center’s director, Nancy Albus, and the psychologist, Mark Schwartz, deny the allegations. Albus pledged to vigorously fight the lawsuit, which was filed Nov. 21 in St. Louis County and seeks the repayment of medical expenses and punitive damages. As in repressed memory cases, which typically involve allegations of abuse that occurred during childhood, the outcome will likely hinge on the testimony of experts with starkly different views on how memory works.

Nasseff, who lives in St. Paul, Minn., stayed at Castlewood from July 2007 through March 2008 and returned for seven months in 2009. She was struggling with anorexia and as a resident of Minnesota, which requires insurers to cover long-term eating disorders, she could afford to stay at the center, which sits on a high bluff in the suburb of Ballwin overlooking a park and meandering river. Most states, including Missouri, don’t require such coverage.

The entire story is here.

Moral Psychology and Information Ethics

Moral Psychology and IE

Posted with permission from C.R. Crowell.

Practice Guidelines Regarding Psychologists' Involvement in Pharmacological Issues

A psychologist can download this document for future reference.

There is a link to this document under "Relevant Links".

APA Pharmacological

'Sexting' Not Very Widespread Among Kids, Teens

By Todd Neale
Senior Staff Writer
MedPage Today
Reviewed by Robert Jasmer, MD

Sexting does not appear to be a common behavior in children and teens, and usually does not result in legal trouble when only minors are involved, two studies showed.

In a survey of adolescents ages 10 to 17, less than 10% reported appearing in or creating nude or sexually suggestive images or receiving such images in the preceding year, according to Kimberly Mitchell, PhD, of the University of New Hampshire's Crimes Against Children Research Center in Durham, and colleagues.
Only 2.5% had appeared in or created (as opposed to having received) these images, a percentage that dropped to 1.3% when a strict definition of sexually explicit -- something that could be classified as child pornography -- was used, the researchers reported in the January issue of Pediatrics.

In a separate study, led by Janis Wolak, JD, also at the New Hampshire center, the researchers found that most cases of youth sexting that came to the attention of law enforcement did not result in arrests, except for incidents involving adults.

Although the results are somewhat reassuring, Mitchell and colleagues wrote, "receiving and thus possession of potentially illegal images among young people is widespread enough that education about this and its consequences is strongly warranted."

This story is here.

Abstract: Prevalence and Characteristics of Youth Sexting: A National Study

Abstract: How Often are Teens Arrested for Sexting? Data From a National Sample of Police Cases

Many Suicidal Teens Make First Try Before High School

By Molly McElroy

News and Information

University of Washington

Thoughts about killing oneself and engaging in suicidal behavior may begin much younger than previously thought. While about one of nine youths attempt suicide by the time they graduate from high school, new findings reveal that a significant proportion make their first suicide attempt in elementary or middle school.

In a study published in the November issue of the Journal of Adolescent Health, nearly 40 percent of young adults who said they had tried suicide said that they made their first attempt before entering high school.

The researchers also found that suicide attempts during childhood and adolescence were linked to higher scores of depression at the time of the attempts, validating for the first time that young adults can reliably recall when they first attempted suicide.

“Young adults who end up having chronic mental health problems show their struggles early,” said James Mazza, lead author and professor of educational psychology at the University of Washington. “This study suggests that implementation of mental health programs may need to start in elementary and middle schools, and that youth in these grades are fairly good reporters of their own mental health.”

Adolescence can often be a struggle for some youth with ongoing pressures of drugs, alcohol, sexual relationships and sexual orientation. At the same time, they’re becoming more autonomous.

The entire press release is here.

UCLA breach: Do Not Take Data Home

By PAMELA LEWIS DOLAN

amednews.com

Even if practices think they have a strong data security plan in place, too often a new breach occurs that reminds them there are always additional steps that can be taken, or that certain vulnerabilities were overlooked.

The most recent reminder came through the UCLA Medical Center, which issued a public notice on Nov. 4 saying that a former employee's computer external hard drive that contained information about 16,288 patients was stolen during a house burglary. Although the data were encrypted, a piece of paper containing the password needed to unencrypt the data also came up missing after the burglary.

UCLA said in the notice that the records did not contain Social Security numbers or financial information. But they did include first and last names and possibly birth dates, addresses and medical record numbers and information. The data ranged from July 2007 to July 2011. The theft occurred in September, and UCLA said it took until November to determine who was affected and obtain valid addresses for notification. The employee whose home was burglarized ended his employment with UCLA in July.

The entire story is here.

Texas Physician Pleads Guilty in Whistle-Blowing Nurses Case

By Robert Lowes
Medscape News Today

Rolando Arafiles Jr, MD, today pled guilty to criminal charges in a state court in Winkler County, Texas, for retaliating against 2 nurses who had anonymously reported him in 2009 to the Texas Medical Board (TMB) over the quality of his patient care.



Anne Mitchell, RN and Vickilyn Galle RN



The case set off a national conversation on the protection afforded healthcare whistle-blowers.

The 2 nurses, Anne Mitchell, RN, and Vickilyn Galle, RN, had worked with Dr. Arafiles at Winkler County Memorial Hospital in Kermit, Texas. Once they were identified as the whistle-blowers by a county investigation that Dr. Arafiles instigated, the nurses were charged with misuse of official information, which is a third-degree felony, and fired. The charge against Galle was dropped, and a jury last year quickly found Mitchell not guilty.

Today, the 59-year-old Dr. Arafiles pled guilty to 1 count each of misuse of official information and retaliation, which is also a third-degree felony. He was sentenced to 60 days in jail and fined $5000. A press release issued by the office of Texas Attorney General Greg Abbott stated that with today's plea, Dr. Arafiles admits to urging former Winkler County Sheriff Robert Roberts Jr and former Winkler County Attorney Scott Tidwell to strike back against the nurses.

On November 4, he signed an order with the TMB to voluntarily surrender his state medical license effective November 11. He faced the possibility of the board revoking his license on account of a felony conviction.

The entire story is here.

Pfizer Settlement on Foreign Bribery Charges

By Christopher Matthews
The Wall Street Journal Blogs

So that’s how it got started.

The government’s sprawling foreign bribery sweep into the pharmaceutical industry was built, in a large part, on information Pfizer Inc. and Johnson & Johnson provided about their competitors, according to a story in the Wall Street Journal Monday.

Not surprisingly, ratting on your competitors has its rewards.

Pfizer will pay more than $60 million to settle alleged violations of the U.S. Foreign Corrupt Practices Act, according to people familiar with the matter. The sum could have been higher had Pfizer not cooperated with the Department of Justice and the Securities and Exchange Commission. Johnson & Johnson agreed to pay $70 million in April to settle its FCPA probe, and likewise benefited from dropping a dime on its competitors.

The two companies’ cooperation contributed to a government investigation that has affected several major drug companies, also including Merck & Co., AstraZeneca PLC, Bristol-Myers Squibb Co. and GlaxoSmithKline PLC, according to the people familiar with the investigations. The four companies last year said in regulatory filings that they received letters of inquiry from the Justice Department and the SEC. The companies have said they are cooperating with investigators.

The entire story is here.