The field of clinical decision making is polarized by two predominate views. One holds that treatment recommendations should conform with guidelines; the other emphasizes clinical expertise in reaching case-specific judgments. Previous work developed a test for a proposed alternative, that clinical judgment should systematically incorporate both general knowledge and patient-specific information. The test was derived from image theory’s two phase-account of decision making and its “simple counting rule”, which describes how possible courses of action are pre-screened for compatibility with standards and values. The current paper applies this rule to clinical forecasting, where practitioners indicate how likely a specific patient will respond favorably to a recommended treatment. Psychiatric trainees evaluated eight case vignettes that exhibited from 0 to 3 incompatible attributes. They made two forecasts, one based on a guideline recommendation, the other based on their own alternative. Both forecasts were predicted by equally- and unequally-weighted counting rules. Unequal weighting provided a better fit and exhibited a clearer rejection threshold, or point at which forecasts are not diminished by additional incompatibilities. The hypothesis that missing information is treated as an incompatibility was not confirmed. There was evidence that the rejection threshold was influenced by clinician preference. Results suggests that guidelines may have a de-biasing influence on clinical judgment. Subject to limitations pertaining to the subject sample and population, clinical paradigm, guideline, and study procedure, the data support the use of a compatibility test to describe how clinicians make patient-specific forecasts.

Objective: In cognitive behavioural therapy (CBT), case formulation (CF) is an integral process in ensuring clinicians’ work is grounded in evidence-based practice (EBP). The objective of this study was to evaluate psychologists’ perceptions and self-reported applications of CBT-CF, and whether these differed according to clinician experience, training, and professional accreditation. Method: A scale was developed to assess CF beliefs and applications by clinicians who had been practising CBT for a minimum of 6 months. The development of scale items was based on two CBT-CF conceptual models. Seventy-nine psychologists registered in Australia took part in this online survey. Results: Psychologists’ beliefs pertaining to CBT CF supported a three-factor model. On average, psychologists perceived all activities related to CF at least moderately important, and were implemented at least some of the time. However, activities related to use of external evidence were rated as less important, and less frequently implemented. Clinical psychologists endorsed theory and EBP in structuring CF as more important, which also translated into self-reported practice of CF CBT implementation relative to generalist psychologists. Conclusions: The findings indicate some gaps in the knowledge and application of CF CBT in clinical practice and has implications in strengthening clinician training in CF CBT.

Background: In response to the global challenges of population aging in Portugal, it is crucial to improve research, education and clinical training in old age in order to meet the growing demands placed on psychogeriatric care services.

Methods: An overview is provided on the status of old age psychology and psychiatry as part of the multidisciplinary care delivery system for the elderly in Portugal. Available educational offerings and clinical training in geriatric mental health at both undergraduate and postgraduate level are described, as well as primary research associations and initiatives within Portugal.

Results: Important issues raised include the need for more educational and clinical training programs for specialists, a broader commitment to aging research and the need to increase interest in working with older adults among students across disciplines. The recent movement towards multidisciplinary work conducted by researchers, psychiatrists, psychologist and other health professionals in Portugal points to the urgent need for specialist education for all health professionals working in geriatrics. This educational initiative must focus not only on the transmission of knowledge on aging-related topics, but also on the training of specific skills and competencies. Improving geriatric mental health service delivery and connecting research with clinical practice constitute other significant steps forward.

Conclusions: An effective intervention in psychogeriatrics should involve a strategy with the participation of a multidimensional network that includes the commitment of researchers, educators, clinicians, health policy-makers and older adults. Several recommendations to improve late life mental health care are presented.

The last 40 years has seen a virtual revolution in both medical research and medical practice. Child psychiatry has been part of that revolution. The situation in the 1950s is briefly noted and seven examples are used to illustrate how causal research in the past has led to changes in clinical practice. The areas used as examples comprise: autism, hyperactivity/attention deficit syndromes, conduct disorders, depressive conditions, genetic research, organic brain dysfunction, and psychosocial risk processes. Prospects for the future with respect to the impact of research on clinical practice are discussed in relation to molecular genetics, environmental risks, cognitive and affective processing of experiences, links across the lifespan, and functional brain imaging. Attention is drawn to implications for training as well as for practice.