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Mental Health Professionals (mental + health_professional)
Selected AbstractsPersonal Recovery and Mental Illness: A Guide for Mental Health ProfessionalsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2010MICHAEL COFFEY phd rmn No abstract is available for this article. [source] Sources of stress experienced by occupational therapists and social workers in mental health settingsOCCUPATIONAL THERAPY INTERNATIONAL, Issue 2 2005Chris Lloyd Senior Lecturer Abstract This study examined the sources of stress experienced by occupational therapists and social workers employed in Australian public mental health services and identified the demographic and work-related factors related to stress using a cross-sectional survey design. Participants provided demographic and work-related information and completed the Mental Health Professionals Stress Scale. The overall response rate to the survey was 76.6%, consisting of 196 occupational therapists and 108 social workers. Results indicated that lack of resources, relationships and conflicts with other professionals, workload, and professional self-doubt were correlated with increased stress. Working in case management was associated with stress caused by client-related difficulties, lack of resources, and professional self-doubt. The results of this study suggest that Australian occupational therapists and social workers experience stress, with social workers reporting slightly more overall stress than occupational therapists. Copyright © 2005 Whurr Publishers Ltd. [source] Which comes first: atypical antipsychotic treatment or cardiometabolic risk?ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2009S. M. Stahl Objective:, To provide an overview for practicing clinicians on the pharmacological basis of cardiometabolic risk induced by antipsychotic drugs in patients with serious mental illness, to propose hypotheses to explain these risks and to give tips for managing cardiometabolic risk during antipsychotic treatment. Method:, A MEDLINE search using terms for atypical antipsychotics (including individual drug names), metabolic, cardiovascular, weight gain and insulin resistance, cross-referenced with schizophrenia was performed on articles published between 1990 and May 2008. Results:, Strong evidence exists for significant cardiometabolic risk differences among several antipsychotic agents. Histamine H1 and serotonin 5HT2C antagonism are associated with risk of weight gain, but receptor targets for dyslipidemia and insulin resistance have not yet been identified. Convincing data indicate that hypertriglyceridemia and insulin resistance may occur in the absence of weight gain with certain antipsychotics. Conclusion:, Although lifestyle and genetics may contribute independent risks of cardiometabolic dysfunction in schizophrenia and other serious mental illness, antipsychotic treatment also represents an important contributor to risk of cardiometabolic dysfunction, particularly for certain drugs and for vulnerable patients. Mental health professionals must learn to recognize the clinical signposts indicating antipsychotic-related cardiometabolic problems to forestall progression to type II diabetes, cardiovascular events and premature death. [source] Relational aggression: Understanding, identifying, and responding in schoolsPSYCHOLOGY IN THE SCHOOLS, Issue 3 2006Ellie L. Young Relational aggression, harm through injury or manipulation of a relationship, has become fashionable, particularly in the popular press. Mental health professionals in schools can better serve students when they understand what is known about relational aggression, how it influences social behavior, and how it is related to children's well-being. This article discusses the definition, identification, and consequences of relational aggression. Available intervention programs are introduced, and future directions for research, assessment, and intervention are addressed. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 297,312, 2006. [source] Positive Connections: a programme for children who have a parent with a mental illnessCHILD & FAMILY SOCIAL WORK, Issue 2 2003Nancy A. Orel ABSTRACT Mental health professionals working with parents who suffer from a mental illness often overlook the children within the family. Children whose parents are mentally ill face numerous obstacles to their own emotional development and these children are at higher risk for developing mental illnesses than other children. These risks can be decreased if protective or positive interventions are available for the children. This article will describe the development and implementation of Positive Connections, an effective intervention programme specifically designed for children whose parents have been diagnosed with a mental disorder. The effectiveness of this programme has been evaluated using both qualitative and quantitative research strategies, and the results are presented. [source] Computer Use and Attitudes Towards Computerised Therapy Amongst Young People and Parents Attending Child and Adolescent Mental Health ServicesCHILD AND ADOLESCENT MENTAL HEALTH, Issue 2 2010Paul Stallard Background:, There has been little research examining attitudes towards computerised therapy in young people. Method:, A self-report survey of 37 young people and 31 parents using Child and Adolescent Mental Health Services (CAMHS). Results:, Young people reported high levels of computer usage and online help-seeking behaviour. Young people were cautious about computerised therapy whereas parents were more positive, identifying more benefits than concerns. Conclusions:, Mental health professionals need to be aware of young people's online help-seeking behaviour in order to correct inaccuracies and maximise uptake of computerised therapy. [source] Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders,DEPRESSION AND ANXIETY, Issue 10 2010Zofia A. Wilamowska M.A. Abstract Anxiety and mood disorders are common, chronic, costly, and characterized by high comorbidity. The development of cognitive behavioral approaches to treating anxiety and mood disorders has left us with highly efficacious treatments that are increasingly widely accepted. The proliferation of treatment manuals targeting single disorders, sometimes with trivial differences among them, leaves the mental health professional with no clear way to choose one manual over another and little chance of ever becoming familiar with most of them, let alone trained to competence in their delivery. Deepening understanding of the nature of emotional disorders reveals that commonalities in etiology and latent structures among these disorders supersedes differences. Based on empirical evidence from the domains of learning, emotional development and regulation, and cognitive science, we have distilled a set of psychological procedures that comprise a unified intervention for emotional disorders. The Unified Protocol (UP) is a transdiagnostic, emotion-focused cognitive behavioral treatment, which emphasizes the adaptive, functional nature of emotions, and seeks to identify and correct maladaptive attempts to regulate emotional experiences, thereby facilitating appropriate processing and extinction of excessive emotional responding to both internal (somatic) and external cues. The treatment components of the UP are briefly outlined. Theory and rationale supporting this new approach are described along with some preliminary evidence supporting its efficacy. Implications for the treatment of emotional disorders using the UP are discussed. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source] Health service utilization for eating disorders: Findings from a community-based study,INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 5 2007Jonathan M. Mond PhD Abstract Background: Prior use of health services was examined in a community sample of women with bulimic-type eating disorders. Method: Participants (n = 159) completed a structured interview for the assessment of eating disorder psychopathology as well as questions concerning treatment-seeking and type of treatment received. Results: Whereas a minority (40.3%) of participants had received treatment for an eating problem, most had received treatment for a general mental health problem (74.2%) and/or weight loss (72.8%), and all had used one or more self-help treatments. Where treatment was received for an eating or general mental health problem, this was from a primary care practitioner in the vast majority of cases. Only half of those participants who reported marked impairment associated with an eating problem had ever received treatment for such a problem and less than one in five had received such treatment from a mental health professional. Conclusion: Women with bulimic-type eating disorders rarely receive treatment for an eating problem, but frequently receive treatment for a general mental health problem and/or for weight loss. The findings underscore the importance of programs designed to improve the detection and management of eating disorders in primary care. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [source] Recognizing and engaging depressed Chinese Americans in treatment in a primary care settingINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2006Albert Yeung Abstract Objectives To examine the effectiveness of depression screening and the Engagement Interview Protocol (EIP) in identifying and engaging in treatment depressed Chinese Americans in a primary care setting. Methods Chinese American patients who attended a primary care clinic between 15 September, 2004 and 14 September, 2005 were screened for depression using the Chinese Bilingual version of the Patient Health Questionnaire (CB-PHQ-9). Patients who screened positive (CB-PHQ-9,,,15) were evaluated using the EIP to establish psychiatric diagnosis and to engage patients in treatment. Results Three thousand eight hundred and twelve patients completed the CB-PHQ-9, of which 113 (3.2%) screened positive for MDD. Among those screening positive, six (5.3%) had been receiving psychiatric treatment for depression, 57 (50%) declined to receive a psychiatric interview or were unable to be contacted, and 50 (44%) agreed to be interviewed with the EIP. Out of the 50 patients interviewed, 44 (88%) had their MDD diagnosis confirmed; among them, 41 (93%) agreed to receive treatment for depression and three (7%) declined intervention. Conclusions Under-recognition and under-treatment of depressed Chinese Americans in primary care settings continue to be prevalent. Recognition of depression can be enhanced by using the brief CB-PHQ-9 to screen for depression. Half of the Chinese Americans who screened positive for MDD declined evaluation by a mental health professional. Most of the depressed Chinese Americans who were evaluated agreed to receive treatment. Enhanced cultural sensitivity with the use of the EIP in psychiatric assessment may have contributed to the success in engaging depressed Chinese Americans in treatment. Copyright © 2006 John Wiley & Sons, Ltd. [source] Personal characteristics and depression-related attitudes of older adults and participation in stages of implementation of a multi-site effectiveness trial (PRISM-E)INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2005Marsha N. Wittink Abstract Background No study has assessed attitudes about depression and its treatment and participation at each step of recruitment and implementation of an effectiveness trial. Our purpose was to determine the association between personal characteristics and attitudes of older adults about depression with participation at each step of the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) treatment effectiveness trial. Methods Information on personal characteristics and attitudes regarding depression and its treatment were obtained from all potential participants in PRISM-E. Results Persons who reported better social support were more likely to complete a baseline interview, but were less likely to meet with the mental health professional carrying out the intervention. Attitudes about taking medicines were significantly associated with uptake of the intervention, but not with earlier phases of recruitment. Persons were much more likely to have a visit with the mental health professional for treatment of depression if they were willing to take medicine for depression but did not endorse waiting for the depression to get better [odds ratio (OR),=,3.16, 95% confidence interval (CI),=,1.48,6.75], working it out on one's own (OR,=,5.18, 95% CI,=,1.69,15.85), or talking to a minister, priest, or rabbi (OR,=,2.01, 95% CI,=,1.02,3.96). Conclusion Social support and other personal characteristics may be the most appropriate for tailoring recruitment strategies, but later steps in the recruitment and implementation may require more attention to specific attitudes towards antidepressant medications. Copyright © 2005 John Wiley & Sons, Ltd. [source] Seeking help from a mental health professional: The influence of one's social networkJOURNAL OF CLINICAL PSYCHOLOGY, Issue 3 2007David L. Vogel The decision to seek psychological help may be hindered or facilitated by many factors. Two potential factors that might facilitate help seeking are having a relationship with someone (a) who recommends seeking help or (b) who themselves have sought help. In two studies (N = 780, N = 746), we explored the relationship between these factors and intentions to seek mental health services. In Study 1, being prompted to seek help and knowing someone who had sought help were both related to positive expectations about mental health services. In Study 2, being prompted to seek help and knowing someone who had sought help were related to more positive attitudes toward help seeking. Also, knowing someone who had sought help was related to the intention to seek help. Of those who sought psychological help, approximately 75% had someone recommend that they seek help and about 94% knew someone who had sought help. © 2007 Wiley Periodicals, Inc. J Clin Psychol 63: 233,245, 2007. [source] Substance Abuse Treatment and Hospitalization among a Cohort of HIV-Infected Individuals with Alcohol ProblemsALCOHOLISM, Issue 3 2005Anita Palepu Background: We examined the association of substance abuse treatment services on hospitalization among participants in the HIV-Alcohol Longitudinal Cohort (HIV-ALC) study of HIV-infected individuals with a history of alcohol problems. Methods: A standardized questionnaire that inquired about demographics, substance use, use of substance abuse treatment services, and hospitalization was administered to 349 HIV-ALC participants. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility, 12 visits to a substance abuse counselor or mental health professional, or participation in any methadone maintenance program. Results: Almost one third of this cohort were hospitalized in the past 6 months. Substance abuse treatment was not significantly associated with hospitalization adjusted odds ratio (AOR) 1.0; 95% confidence interval (CI) 0.7,1.5), whereas homelessness (AOR 2.3; 95% CI 1.5,3.6), injection drug use (AOR 1.7; 95% CI 1.0,2.7), severity of alcohol dependence (AOR 1.02; 95% CI 1.00,1.05), CD4 cell count (AOR 0.999; 95% CI 0.998,1.00), and HIV RNA (AOR 1.1; 95% CI 1.0,1.2) were independently associated with increased odds of hospitalization over time. Conclusions: Engagement in substance abuse treatment was not associated with a decrease in hospital use by HIV-infected individuals with a history of alcohol problems. The period of substance abuse treatment may present an opportunity to address health care utilization patterns of HIV-infected individuals. [source] The impact of children's emotional and behavioural difficulties on their lives and their use of mental health servicesPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2009Gloria A. Simpson Summary This paper examines the relationship between the impact of children's emotional and behavioural difficulties and the use of mental health services, using 3 years of nationally representative data from the National Health Interview Survey. Data for the years 2001, 2003 and 2004 were combined (n = 29 265) to identify a sample of 1423 children aged 4,17 years with emotional/behavioural difficulties. Multivariable logistic regression analysis was used. About 5% of U.S. children had emotional or behavioural difficulties. Children whose difficulty was a burden on their family were almost twice as likely to have contact with a mental health professional. Younger children (aged 4,7 years), Hispanic children and non-Hispanic black children with emotional or behavioural difficulties were less likely to use mental health services. These findings indicate that children's emotional and behavioural difficulties influence their lives and those of their families, leading parents to seek help. Racial disparities in mental health service use exist when controlling for the severity and the burden of these difficulties. [source] The validity of the family relationships index as a screening tool for psychological risk in families of cancer patientsPSYCHO-ONCOLOGY, Issue 7 2005Ben Edwards The Family Relationships Inventory (FRI) has been proposed as a measure of psychological risk however its validity has only been tested in one cross-sectional study against another measure of family functioning where patients had less than six months to live. The current study presented longitudinal data on the validity of the FRI in identifying family dysfunction, and clinical levels of depression and anxiety in 48 families where the patient had been recently diagnosed. Over the three phases, the FRI identified all families at risk of family dysfunction, 88% or more families with one or more members with clinical depression and 78% or more with a member with clinical levels of anxiety. The FRI was also far more sensitive in identifying families with a member with clinical levels of depression and anxiety than the General Functioning (FAD-GF) scale of the Family Assessment Device. Although other measures of screening adequacy (such as specificity), suggested that the FRI identified too many false positives, the higher sensitivity of the FRI makes it preferable to the FAD-GF as a screening measure for families at risk of a poor psychological outcome in the oncology setting. However, because of the FRI's poor specificity, further follow-up of those families that are identified as being at some risk of a poor psychological outcome should be undertaken before referral to a mental health professional is warranted. Copyright © 2004 John Wiley & Sons, Ltd. [source] Obstetrician-gynecologists' screening patterns for anxiety during pregnancy,DEPRESSION AND ANXIETY, Issue 2 2008Victoria H. Coleman M.A. Abstract As obstetrician-gynecologists (ob-gyns) take on a greater role in women's healthcare, it is important that they are aware of the high prevalence of anxiety disorders in their patient population. Anxiety disorders present during pregnancy can have detrimental effects on both mother and child. In this study, we queried 1,193 ob-gyns on their screening rates, practice patterns, training, and knowledge as they relate to anxiety disorders during pregnancy. We achieved a 44% response rate (n=397) after three mailings. Physicians reported a moderate interest in screening for and diagnosing anxiety, but less interest in treatment. Only 20% of respondents (n=79) screen for anxiety during pregnancy, and they typically refer anxiety-disordered patients to mental health professionals. Ob-gyns with comprehensive or adequate training were significantly more likely to screen than those who stated that their training was inadequate. Having a friend who has been diagnosed with an anxiety disorder also significantly increased both the likelihood that these physicians would screen and the reported level of interest in screening of anxiety disorders during pregnancy. At present, the majority of ob-gyns feel that their training in this area was barely adequate to inadequate. Specifically, generalized anxiety disorder may be the least understood. Increased training in this area would allow ob-gyns to overcome what they list as the primary barrier to anxiety screening during pregnancy,that is, inadequate training about anxiety disorders. Depression and Anxiety 0:1,10, 2007. Published © 2007 Wiley-Liss, Inc. [source] Structured assessment of current mental state in clinical practice: an international study of the reliability and validity of the Current Psychiatric State interview, CPS-50ACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2005I. R. H. Falloon Objective:, To develop a reliable standardized assessment of psychiatric symptoms for use in clinical practice. Method:, A 50-item interview, the Current Psychiatric State 50 (CPS-50), was used to assess 237 patients with a range of psychiatric diagnoses. Ratings were made by interviewers after a 2-day training. Comparisons of inter-rater reliability on each item and on eight clinical subscales were made across four international centres and between psychiatrists and non-psychiatrists. A principal components analysis was used to validate these clinical scales. Results:, Acceptable inter-rater reliability (intra-class coefficient > 0.80) was found for 46 of the 50 items, and for all eight subscales. There was no difference between centres or between psychiatrists and non-psychiatrists. The principal components analysis factors were similar to the clinical scales. Conclusion:, The CPS-50 is a reliable standardized assessment of current mental status that can be used in clinical practice by all mental health professionals after brief training. [source] Pathological gambling: an increasing public health problemACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2001Article first published online: 7 JUL 200 Gambling has always existed, but only recently has it taken on the endlessly variable and accessible forms we know today. Gambling takes place when something valuable , usually money , is staked on the outcome of an event that is entirely unpredictable. It was only two decades ago that pathological gambling was formally recognized as a mental disorder, when it was included in the DSM-III in 1980. For most people, gambling is a relaxing activity with no negative consequences. For others, however, gambling becomes excessive. Pathological gambling is a disorder that manifests itself through the irrepressible urge to wager money. This disorder ultimately dominates the gambler's life, and has a multitude of negative consequences for both the gambler and the people they interact with, i.e. friends, family members, employers. In many ways, gambling might seem a harmless activity. In fact, it is not the act of gambling itself that is harmful, but the vicious cycle that can begin when a gambler wagers money they cannot afford to lose, and then continues to gamble in order to recuperate their losses. The gambler's ,tragic flaw' of logic lies in their failure to understand that gambling is governed solely by random, chance events. Gamblers fail to recognize this and continue to gamble, attempting to control outcomes by concocting strategies to ,beat the game'. Most, if not all, gamblers try in some way to predict the outcome of a game when they are gambling. A detailed analysis of gamblers' selfverbalizations reveals that most of them behave as though the outcome of the game relied on their personal ,skills'. From the gambler's perspective, skill can influence chance , but in reality, the random nature of chance events is the only determinant of the outcome of the game. The gambler, however, either ignores or simply denies this fundamental rule (1). Experts agree that the social costs of pathological gambling are enormous. Changes in gaming legislation have led to a substantial expansion of gambling opportunities in most industrialized countries around the world, mainly in Europe, America and Australia. Figures for the United States' leisure economy in 1996 show gross gambling revenues of $47.6 billion, which was greater than the combined revenue of $40.8 billion from film box offices, recorded music, cruise ships, spectator sports and live entertainment (2). Several factors appear to be motivating this growth: the desire of governments to identify new sources of revenue without invoking new or higher taxes; tourism entrepreneurs developing new destinations for entertainment and leisure; and the rise of new technologies and forms of gambling (3). As a consequence, prevalence studies have shown increased gambling rates among adults. It is currently estimated that 1,2% of the adult population gambles excessively (4, 5). Given that the prevalence of gambling is related to the accessibility of gambling activities, and that new forms of gambling are constantly being legalized throughout most western countries, this figure is expected to rise. Consequently, physicians and mental health professionals will need to know more about the diagnosis and treatment of pathological gamblers. This disorder may be under-diagnosed because, clinically, pathological gamblers usually seek help for the problems associated with gambling such as depression, anxiety or substance abuse, rather than for the excessive gambling itself. This issue of Acta Psychiatrica Scandinavica includes the first national survey of problem gambling completed in Sweden, conducted by Volberg et al. (6). This paper is based on a large sample (N=9917) with an impressively high response rate (89%). Two instruments were used to assess gambling activities: the South Oaks Gambling Screen-Revised (SOGS-R) and an instrument derived from the DSM-IV criteria for pathological gambling. Current (1 year) and lifetime prevalence rates were collected. Results show that 0.6% of the respondents were classified as probable pathological gamblers, and 1.4% as problem gamblers. These data reveal that the prevalence of pathological gamblers in Sweden is significantly less than what has been observed in many western countries. The authors have pooled the rates of problem (1.4%) and probable pathological gamblers (0.6%), to provide a total of 2.0% for the current prevalence. This 2% should be interpreted with caution, however, as we do not have information on the long-term evolution of these subgroups of gamblers; for example, we do not know how many of each subgroup will become pathological gamblers, and how many will decrease their gambling or stop gambling altogether. Until this information is known, it would be preferable to keep in mind that only 0.6% of the Swedish population has been identified as pathological gamblers. In addition, recent studies show that the SOGS-R may be producing inflated estimates of pathological gambling (7). Thus, future research in this area might benefit from the use of an instrument based on DSM criteria for pathological gambling, rather than the SOGS-R only. Finally, the authors suggest in their discussion that the lower rate of pathological gamblers obtained in Sweden compared to many other jurisdictions may be explained by the greater availability of games based on chance rather than games based on skill or a mix of skill and luck. Before accepting this interpretation, researchers will need to demonstrate that the outcomes of all games are determined by other factor than chance and randomness. Many studies have shown that the notion of randomness is the only determinant of gambling (1). Inferring that skill is an important issue in gambling may be misleading. While these are important issues to consider, the Volberg et al. survey nevertheless provides crucial information about gambling in a Scandinavian country. Gambling will be an important issue over the next few years in Sweden, and the publication of the Volberg et al. study is a landmark for the Swedish community (scientists, industry, policy makers, etc.). This paper should stimulate interesting discussions and inspire new, much-needed scientific investigations of pathological gambling. Acta Psychiatrica Scandinavica Guido Bondolfi and Robert Ladouceur Invited Guest Editors References 1.,LadouceurR & WalkerM. The cognitive approach to understanding and treating pathological gambling. In: BellackAS, HersenM, eds. Comprehensive clinical psychology. New York: Pergamon, 1998:588 , 601. 2.,ChristiansenEM. Gambling and the American economy. In: FreyJH, ed. Gambling: socioeconomic impacts and public policy. Thousand Oaks, CA: Sage, 1998:556:36 , 52. 3.,KornDA & ShafferHJ. Gambling and the health of the public: adopting a public health perspective. J Gambling Stud2000;15:289 , 365. 4.,VolbergRA. Problem gambling in the United States. J Gambling Stud1996;12:111 , 128. 5.,BondolfiG, OsiekC, FerreroF. Prevalence estimates of pathological gambling in Switzerland. Acta Psychiatr Scand2000;101:473 , 475. 6.,VolbergRA, AbbottMW, RönnbergS, MunckIM. Prev-alence and risks of pathological gambling in Sweden. Acta Psychiatr Scand2001;104:250 , 256. 7.,LadouceurR, BouchardC, RhéaumeNet al. Is the SOGS an accurate measure of pathological gambling among children, adolescents and adults?J Gambling Stud2000;16:1 , 24. [source] Couples with Schizophrenia "Becoming like Others" in South Korea: Marriage as Part of a Recovery ProcessFAMILY PROCESS, Issue 3 2009MYUNG-YEE YU PH.D. Very little is known about the married life of couples with schizophrenia. In this paper, authors report perceptions and experiences of 5 married couples with schizophrenia on their strategies in forming and maintaining healthy marriage. Our data reveal that participants had realistic expectations of marriage, and recognized benefits as well as obstacles in their marriages with respect to their recovery. This paper examines the importance of extended family members, mental health professionals, and the larger society's attitudes toward marriage as a factor in the recovery process for persons with schizophrenia. The authors identify implications for mental health professionals regarding the respect of client dignity and the applicability of a strengths perspective when working with couples with schizophrenia. The authors argue that mental health professionals' decisions regarding the balance between respecting a client's self-determination and protecting a client from risks associated with cohabitation and marriage should no longer be a dilemma for those working with people with mental illness. RESUMEN Se sabe muy poco de la vida matrimonial de las parejas que padecen esquizofrenia. En este trabajo, los autores informan sobre las percepciones y las experiencias de 5 parejas casadas que padecen esquizofrenia y sus estrategias para constituir y mantener un matrimonio sano. Nuestros datos revelan que los participantes tuvieron expectativas realistas en relación con el matrimonio, y reconocieron los beneficios y los obstáculos de sus matrimonios con respecto a su recuperación. Este artículo analiza la importancia de los familiares, de las actitudes de los profesionales de la salud mental y de la sociedad en general hacia el matrimonio como factor en el proceso de recuperación para las personas con esquizofrenia. Los autores identifican las implicancias para los profesionales de la salud mental con respecto a la dignidad del paciente y la aplicabilidad de una perspectiva de énfasis en las virtudes cuando se trabaja con parejas que padecen esquizofrenia. Los autores sostienen que las decisiones de los profesionales de la salud mental con respecto al equilibrio entre respetar la autodeterminación de un paciente y proteger a un paciente de los riesgos asociados con la convivencia y el matrimonio ya no debería ser un dilema para aquellos que trabajan con personas que tienen enfermedades mentales. Palabras clave: preservación del matrimonio, esquizofrenia, coreano, recuperación, dignidad del paciente, perspectiva de énfasis en las virtudes [source] Vulvar Pain: A Phenomenological Study of Couples in Search of Effective Diagnosis and TreatmentFAMILY PROCESS, Issue 2 2008JENNIFER J. CONNOR PH.D. Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of, the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships. RESUMEN Dolor vulvar: estudio fenomenológico de parejas que buscan un diagnóstico y tratamiento efectivos El síndrome de vestibulitis vulvar (svv), un trastono de dolor vulvar, continúa dejando perplejos a los profesionales de la salud física y mental debido a su etiología desconocida y a la inexistencia de un tratamiento efectivo. Este estudio utilizó metodología fenomenológica experimental para explorar las experiencias de parejas en que a la mujer se le ha diagnosticado el svv. Se llevaron a cabo dieciséis entrevistas (en profundidad y semiestructuradas) con 13 parejas heterosexuales y 3 mujeres, de las que se obtuvieron cuatro conclusiones esenciales: (1) En busca de , la investigación médica requería una búsqueda más exhaustiva de médicos eruditos y respetuosos que aportasen un tratamiento. (2) El proceso de desarrollar una comprensión personal del trastorno condujo a varias parejas a plantearse su papel en la causa y la prolongación del svv. (3) Desarrollar estrategias para afrontar un coito doloroso condujo a tres estrategias: prescindir del sexo, optar por alternativas al sexo vaginal y modificar o soportar el coito doloroso. (4) Se experimentaron sensaciones de aislamiento, pues el proceso de adaptación a este síndrome de dolor crónico resultó, a menudo, un proceso solitario. Entre los consejos clínicos se incluyen tratar a la pareja, y no sólo a la mujer con svv; animar a las parejas a ampliar las definiciones de la importancia y preferencia por el coito vaginal, así como sugerir actividades sexuales con menor riesgo de causar dolor vulvar; desarrollar un significado común como pareja; y ayudar a las parejas a encontrar médicos y recursos. Palabras clave: síndrome de vestibulitis vulvar; dolor vulvar; terapia de pareja. [source] Professional and service-user perceptions of self-help in primary care mental health servicesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2009Rebekah Pratt MSocSci PGDip Comm Psych Abstract Self-help is becoming an increasingly accessible option for addressing mental health problems. Despite this, self-help is subject to a variety of interpretations, little is known about how professionals and service-users conceptualise self-help, or how service-users engage in self-help activities. This study aimed to explore the views of self-help by service-users and health professionals in one area of Scotland, including the perceptions of what constitutes self-help and how it might be used to address mental health problems in primary care. The research involved semistructured interviews with 31 primary care mental health professionals, and in-depth interviews with 34 service-users. We found that professionals and service-users describe self-help in different ways, which has great implications for referral to and implementation of self-help in primary care settings. It also emerged that self-help was not necessarily perceived to be able to address the causes of mental distress, which could leave some professionals defaulting to offering no interventions despite the fairly positive attitude service-users show to self-help strategies. Finally, professionals need to be convinced that interventions are useful, effective and accessible as there are significant barriers in professionals using self-help; if they are not convinced, such approaches will support their therapeutic approach. The research supports the need to develop methods of delivery that offer self-help as part of a broad package of care that also considers social causes of distress. [source] Guided self-help supported by paraprofessional mental health workers: an uncontrolled before,after cohort studyHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2009Paul Farrand Senior Lecturer in Health Psychology Abstract There has been considerable development of guided self-help clinics within primary care. This uncontrolled before,after cohort study examines efficiency and effectiveness of these clinics when supported by paraprofessional mental health workers having little mental health training and experience. Data were collected by seven Graduate Mental Health Workers (GMHW) located in South-west England. Alongside an analysis of clinic attendance and dropout, efficiency was measured with respect to the number and length of sessions to support patients with the effectiveness of the interventions examined with respect to problem severity. Over a 15-month period, 1162 patients were referred to the GMHW clinics with 658 adopting guided self-help. Patients using guided self-help received an average input per patient, excluding assessment, of four sessions of 40 minutes. Dropout rate was comparable to other primary-care-based mental health clinics supported by experienced mental health professionals with 458 patients completing all support sessions. However, only 233 patients went on to attend the 3 months of follow-up session. Effectiveness of guided self-help clinics supported by paraprofessional mental health workers was comparable to that supported by an experienced mental health nurse. Improvements in problem severity were statistically significant, with 55% and 58% (final support session) and 63% and 62% (3 months of follow-up) of patients experiencing clinically significant and reliable change for anxiety and depression, respectively. However, concerns exist over the efficiency of the GMHW clinic especially with respect to the use of longer support sessions and high dropout rate at the 3 months of follow-up session. The paper concludes by highlighting the effectiveness of guided self-help when supported by paraprofessional mental health workers, but questions the utility of the two-plus-one model of service delivery proposing a collaborative care approach as an alternative. [source] Being a parent of an adult son or daughter with severe mental illness receiving professional care: parents' narrativesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2001Anita Pejlert RNT PhD Abstract The aim of this study was to illuminate the meaning of parental care-giving with reference to having an adult son or daughter with severe mental illness living in a care setting. The parents were asked to narrate their relationship to offspring in the past, in the present, and their thoughts and feelings concerning the future. The study was guided by a phenomenological hermeneutic perspective. The meaning of parental care was illuminated in the themes ,living with sorrow, anguish and constant worry', ,living with guilt and shame', ,relating with carer/care; comfort and hardships',coming to terms with difficulties' and ,hoping for a better life for the adult child'. Parental care-giving emerged as a life-long effort. The narratives revealed ongoing grief, sorrow and losses interpreted as chronic sorrow. The narratives disclosed a cultural conflict between the family system and the care system, which was interpreted as a threat to the parental role, but also experiences of receiving comfort and having confidence in the care given. Experiences of stigma were interpreted from the way of labelling illness, narrated experiences of shame and relations with the public and mental health professionals. Parents' persisting in the care-giving role, striving to look after themselves and expressing hopes for the future were interpreted as a process of coming to terms with difficulties. Results suggest that mental health professionals need to be aware of their own attitudes and treatment of families, improve their cooperation with, and support to families, and provide opportunities for family members to meet one another. [source] Caught in the Act?HEALTH SERVICES RESEARCH, Issue 6 2006Consequences of Physician Detection of Unannounced Standardized Patients, Predictors, Prevalence Objective. To examine the prevalence, predictors, and consequences of physician detection of unannounced standardized patients (SPs) in a study of the impact of direct-to-consumer advertising on treatment for depression. Data Sources. Eighteen trained SPs were randomly assigned to conduct 298 unannounced audio-recorded visits with 152 primary care physicians in three U.S. cities between May 2003 and May 2004. Study Design. Randomized controlled trial using SPs. SPs portrayed six roles, created by crossing two clinical conditions (major depression or adjustment disorder) with three medication request scripts (brand-specific request, general request for an antidepressant, or no request). Data Collection. Within 2 weeks following the visit, physicians completed a form asking whether they "suspected" conducting an office visit with an SP during the past 2 weeks; 296 (99 percent) detection forms were returned. Physicians provided contextual data, a Clinician Background Questionnaire. SPs filled in a Standardized Patient Reporting Form for each visit and returned all written prescriptions and medication samples to the laboratory. Principal Findings. Depending on the definition, detection rates ranged from 5 percent (unambiguous detection) to 23.6 percent (any degree of suspicion) of SP visits. In 12.8 percent of encounters, physicians accurately detected the SP before or during the visit but they only rarely believed their suspicions affected their clinical behavior. In random effects logistic regression analyses controlling for role, actor, physician, and practice factors, suspected visits occurred less frequently in HMO settings than in solo practice settings (p<.05). Physicians more frequently referred SPs to mental health professionals when visits aroused high suspicion (p<.05). Conclusions. Trained actors portrayed patient roles conveying mood disorders at low levels of detection. There was some evidence for differential treatment of detected standardized patients by physicians with regard to referrals but not antidepressant prescribing or follow-up recommendations. Systematic assessment of detection is recommended when SPs are used in studies of clinical process and quality of care. [source] A meta-analysis of home visiting programs: Moderators of improvements in maternal behavior,INFANT MENTAL HEALTH JOURNAL, Issue 5 2010M. Angela Nievar A meta-analysis of home visiting programs for at-risk families (K = 35, N = 6,453) examined differences in the effects of programs on maternal behavior. On average, programs with more frequent visitation had higher success rates. The frequency of home visits explained significant variance of effect sizes among studies in the United States, with two visits per month predicting a small, substantive effect. Intensive programs or programs with at least three visits per month were more than twice as effective as were less intensive programs. Home visiting programs using nurses or mental health professionals as providers were not significantly more effective than were programs using paraprofessionals. In general, programs showed a positive effect on maternal behavior, but programs with frequent home visits were more successful. Un meta-análisis de programas de visita a casa para familias bajo riesgo (K = 35, N = 6,453) examinó las diferencias en cuanto a los efectos de programas sobre la conducta maternal. En promedio, los programas con visitas más frecuentes tuvieron puntajes más altos en cuanto al éxito del programa. La frecuencia de las visitas a casa explicó la significativa variación del alcance de los efectos tal como se presenta en los estudios en los Estados Unidos, con el resultado de que dos visitas por mes predijeron un efecto pequeño y substancial. Los programas intensivos, o programas con tres visitas por mes por lo menos fueron más del doble efectivos que los programas menos intensivos. Los programas de visitas a casa en los que participan enfermeras o profesionales de la salud mental como proveedores del servicio no fueron significativamente más efectivos que los programas en los que participan ayudantes de profesionales. En general, los programas mostraron un efecto positivo en la conducta maternal, pero los programas con frecuentes visitas a casa fueron más exitosos. Une méta-analyse de programmes de visite à domicile pour des familles à risques (K = 35, N = 6,453) a examiné les différences dans les effets des programmes sur le comportement maternel. En moyenne, les programmes avec des visites plus fréquentes ont reçu de meilleurs taux de succès. La fréquence des visites à domicile a expliqué une variance importante de tailles d'effet au sein des études aux Etats-Unis, avec deux visites par mois prédisant un petit effet d'importance. Les programmes intensifs ou les programmes avec au moins trois visites par mois se sont avérés être deux fois plus efficaces que les programmes moins intensifs. Les programmes de visite à domicile utilisant des infirmières ou des professionnels de la santé mentale comme visiteurs ne se sont pas avérés être plus efficaces que les programmes utilisant des paraprofessionnels. En général, les programmes ont fait état d'un effet positif sur le comportement maternel, mais les programmes avec des visites à domicile fréquentes se sont avérés plus couronnés de succès. Eine Meta-Analyse von Unterstützungsprogrammen für gefährdete Familien (K = 35, N = 6453) die im häuslichen Umfeld stattfinden, untersuchte Unterschiede der Wirkung auf das Verhalten der Mütter. Im Durchschnitt zeigten Programme mit häufigeren Besuchen höhere Erfolgsraten. Die Häufigkeit der Hausbesuche zeigte einen signifikanten Effekt innerhalb der nordamerikanischen Studien. Zwei monatliche Besuche zeigten bereits einen kleinen aber stichhaltigen Effekt. Intensive Programme und solche mit mindestens drei monatlichen Besuchen waren bereits mehr als doppelt so wirksam wie die weniger intensive Programme. Die Programme mit Hausbesuchen, in denen Krankenschwestern oder Experten der seelischen Gesundheit eingesetzt wurden, waren nicht signifikant wirksamer als Programme, in denen ungeschulte Mitarbeiter einsetzt wurden. Generell zeigten die Programme eine positive Wirkung auf das mütterliche Verhalten, wobei die Programme mit häufigeren Hausbesuchen erfolgreicher waren. [source] Infant mental health, child maltreatment, and the law: A jurisprudent therapy analysis,INFANT MENTAL HEALTH JOURNAL, Issue 1 2008James J. Clark Scholarly and clinical discussions of the legal issues facing infant mental health professionals typically focus on the seemingly intractable differences in philosophies, goals, and approaches inherent in the law and the mental health professions. We argue that forensically informed approaches to practice with very young children can potentially enhance many mental health and child welfare outcomes. This article describes the relatively new conceptual frameworks known as "therapeutic jurisprudence" and "jurisprudent therapy." Using these conceptual frameworks, we analyze representative problems that are typical in infant mental health practice with maltreated children through case examples drawn from their evaluations of children and families in the child protection and legal systems. Demonstrations of how such dilemmas can be approached with enhanced analytic decision-making and practice approaches are presented. We argue that applying such jurisprudent therapy approaches opens up fresh perspectives for evidence-based practices that facilitate creative, rigorous, and intellectually stimulating clinical work. [source] When infants grow up in multiperson relationship systemsINFANT MENTAL HEALTH JOURNAL, Issue 4 2007James P. Mchale Despite prompts from the field of family therapy since its inception, contemporary infant mental health theory and practice remain firmly rooted in and guided by dyadic-based models. Over the past 10 years, a groundswell of new empirical studies of triadic and family group dynamics during infancy have substantiated that which family theory has contended for decades: looking beyond mother-infant or father-infant dyads reveals a myriad of critically important socialization influences and dynamics that are missed altogether when relying on informant reports or dyad-based interactions. Such family-level dynamics emerge within months after infants are born, show coherence through time, and influence the social and emotional adjustment of children as early as the toddler and preschool years. This report summarizes key findings from the past decade of empirical family studies, highlights several areas in need of further conceptual development and empirical study by those who work with infants and their families, and outlines important implications of this body of work for all practicing infant mental health professionals. [source] Improving communication between health and infant mental health professionals utilizing ongoing Collaborative Peer Supervision GroupsINFANT MENTAL HEALTH JOURNAL, Issue 3 2004Michael Thomasgard This article discusses the use of Collaborative Peer Supervision Groups (CPSG) to promote ongoing professional development for those who work with infants, toddlers, and their families. Our model's strength and clinical utility result from its three major components: (a) a relationship-based perspective that acknowledges the important role that feelings and emotions play across the life span, (b) a peer supervision model that helps to ensure that no individual or discipline is "the expert," and (c) a collaborative case-based continuing-education experience. Salient features of forming and maintaining a CPSG group are discussed including access to a Web site containing many key start-up and evaluation materials. Existing barriers to effective communication between disciplines are discussed as are specific methods to structure case data. Additional tools to help anchor a CPSG are considered as are methods of evaluation. Two case presentations are considered to illustrate group process. Lessons learned from such groups are highlighted. Our intent is to provide sufficient background material so that others with a similar interest will be comfortable starting and maintaining a CPSG group on their own. ©2004 Michigan Association for Infant Mental Health. [source] The Revised Kingston Standardized Cognitive AssessmentINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2004Robert W. Hopkins Abstract The original Kingston Standardized Cognitive Assessment (KSCA) was designed to assess cognitive functioning in the elderly with suspected organic brain damage (i.e. dementia). It was specifically designed to be a relatively quickly administered assessment tool available to mental health professionals who were not trained in specialized cognitive assessment techniques. It was introduced over a decade ago to bridge a gap between brief, narrowly focused rating scales, and intensive, expensive, full neuropsychological assessments. Recently, a revision of the KSCA was completed. This revision includes the addition of a word-list memory task with immediate recall, delayed recall and recognition formats, as well as new norms for patients with Alzheimer's disease (AD). The updated norms reflect the abilities of higher-functioning (community-dwelling) patients. In order to facilitate the Revised KSCAs use we have developed a new scoring and analysis form as well as a more comprehensive scoring and administration manual. These changes have resulted in better detection of earlier Alzheimer's disease and use of comparison groups that reflect the changing referral base. The structure of the revised scale and updated normative data are described. An illustrative clinical case example is also provided. Copyright © 2004 John Wiley & Sons, Ltd. [source] Multilevel investigation of variation in HoNOS ratings by mental health professionals: a naturalistic study of consecutive referralsINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2004R. Ecob Episodes of mental healthcare in specialist psychiatric services often begin with the assessment of clinical and psychosocial needs of patients by healthcare professionals. Particularly for patients with complex needs or severe problems, ratings of clinical and social functioning at the start of each episode of care may serve as a baseline against which subsequent measures can be compared. Currently, little is known about service variations in such assessments on referrals from primary care. We set out to quantify variability in initial assessments performed by healthcare professionals in three CMHTs in Bristol (UK) using the Health of the Nation Outcome Scales (HoNOS). We tested the hypothesis that variations in HoNOS total and sub-scale scores are related to referral source (general practices), healthcare assessor (in CMHTs) and the assessor's professional group. Statistical analysis was performed using multilevel variance components models with cross-classified random effects. We found that variation due to assessor substantially exceeded that due to referral source (general practices). Furthermore, patient variance differed by assessor profession for the HoNOS , Impairment scores. Assessor variance differed by assessor profession for the HoNOS , Social scores. As HoNOS total and subscale scores show much larger variation by assessor than by referral source, investigations of HoNOS scores must take assessors into account. Services should implement and evaluate interdisciplinary training to improve consistency in use of rating thresholds; such initiatives could be evaluated using these extensions of multilevel models. Future research should aim to integrate routine diagnostic data with continuous outcomes to address selection effects (of patients to assessors) better. Copyright © 2004 Whurr Publishers Ltd. [source] A theory of meaning of caregiving for parents of mentally ill children in Taiwan, a qualitative studyJOURNAL OF CLINICAL NURSING, Issue 1-2 2010Wen-Jiuan Yen Aims and objectives., The aim of this study is to generate a theory of meaning of care-giving for parents of mentally ill children in Taiwan. Background., Studies indicate that the meaning of care-giving plays an important role in the psychological adjustment of care-givers to care-giving. With a positive meaning of care-giving, care-givers can accept their roles and adapt to them more readily. Design., The research employs the qualitative method of grounded theory, the inquiry is based on symbolic interactionism. Methods., Twenty parental care-givers of children with schizophrenia were recruited at a private hospital in central Taiwan. Semi-structured interviews were conducted. A comparative method was used to analyse the text and field notes. Results., Responsibility (zeren) emerges as the core category or concept. Responsibility expresses broadly the behavioural principles that are culturally prescribed and centred on familial ethics and values. Related concepts and principles that influence caregiver actions and affections include a return of karma, challenges from local gods and fate. By maintaining their culturally prescribed interpretations of care-giving, parents hope to give care indefinitely without complaints. Conclusions., The findings clearly suggest that the meaning of care-giving is determined through a process of internal debate that is shaped by culturally specific concepts. The paper attempts to explain some of these culturally specific determinants and explanations of care-giving behaviour. Relevance to clinical practice., The theory contributes knowledge about the meaning of care-giving for parents of mentally ill children in Taiwan. It should be useful reference for mental health professionals, who provide counselling services to ethnically Taiwanese care-givers. [source] | |||||||||||||||||||||||||||||||||||||