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Trauma and Natural Disasters
Trauma and Ritual
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To Be added to Home Page
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Sleep Disorders DSM-IV-R
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Circadian Rhythm |
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Psychological
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Trauma
Research
Seize Your Journeys
_______________________
Traumatic stress is found in many competent, healthy, strong, good people.
No one can completely protect themselves from traumatic experiences.
Many people have long-lasting problems following exposure to trauma.
Up to 8% of persons will have PTSD at some time in their lives. People who
react to traumas are not going crazy. What is happening to them is
part of a set of common symptoms and problems that are connected with being
in a traumatic situation, and thus, is a normal reaction to abnormal events
and experiences. Having symptoms after a traumatic event is
NOT a sign of personal weakness. Given exposure to a trauma that is
bad enough, probably all people would develop PTSD.
By understanding trauma
symptoms better, a person can become less fearful of them and better able to
manage them. By recognizing the effects of trauma and knowing more about
symptoms, a person will be better able to decide about getting treatment.
_______________________
Secure Attachments as a
Defense Against Trauma
“All
people mature and thrive in a social context that has profound
effects on how they cope with life’s stresses. Particularly early
in life, the social context plays a critical role in fuffering an
individual against stressful situations, and in building the
psychological and biological capacities to deal with further
stresses. The primary function of parents can be thought of as
helping children modulate their arousal by attuned and well-timed
provision of playing, feeding, comforting, touching, looking,
cleaning, and resting—in short, by teaching them skills that will
gradually help them modulate their own arousal. Secure attachment
bonds serve as primary defenses against trauma-induced
psychopathology in both children and adults (Finkelhor & Browne,
1984). In children who have been exposed to severe stressors, the
quality of the parental bond is probably the single most important
determinant of long-term damage (McFarlane, 1988).” van der
Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996.
Traumatic stress: The effects of
overwhelming experience on mind, body, and society. New
York and London: Guilford Press. .p. 185
_______________________
Secure Attachments as a Defense Against Trauma
“All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses. Particularly early in life, the social context plays a critical role in buffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses. The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984). In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).”
van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 185
Affect Dysregulation in Traumatized Individuals
“As children mature, they gradually become less vulnerable to over-stimulation and learn to tolerate higher levels of excitement. Over time, their need for physical proximity to their primary caregivers to maintain comfort decreases, and children start spending more time playing with their peers and with their fathers (Field, 1985). Secure children learn how to take care of themselves effectively as long as the environment is more or less predictable; simultaneously, they learn how to get help when they are distressed. In contrast, avoidant children learn how to organize their behavior effectively under ordinary conditions, but they remain unable to communicate or interpret emotional signals. In other words, they know how to handle cognition, but not affect (Crittenden, 1994
Cole and Putnam (1992) have proposed that people’s core concepts of themselves are defined to a substantial degree by their capacity to regulate their internal states and by their behavioral responses to external stress. The lack of development, or loss, of self-regulatory processes in abused children leads to problems with self-definition: (1) disturbances of the sense of self, such as a sense of separateness, loss of autobiographical memories, and disturbances of body image; (2) poorly modulated affect and impulse control, including aggression against self and others; and (3) insecurity in relationships, such as trouble functioning in social settings; they tend either to draw attention to themselves or to withdraw from social interactions. Thus, they tend to display either angry, threatening, fearless, acting-out behavior or meek, submissive, fearful, incompetent behavior. Problems in articulating cause and effect make it hard for them to appreciate their own contributions to their problems and set the stage for paranoid attributions.”
van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects o overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 187
Manifestations of the Absence of Self-Regulation
“The lack or loss of self-regulation is possibly the most far-reaching effect of psychological trauma in both children and adults. The DSM-IV field trials for PTSD clearly demonstrated that the younger the age at which the trauma occurred, and the longer its duration, the more likely people were to have long-term problems with the regulation of anger, anxiety, and sexual impulses (van der Kolk, Roth, Pelcovitz, & Mandel, 1993). Pitman, Orr, and Shalev (1993) have pointed out that in PTSD, hyperarousal goes well beyond simple conditioning. The fact that the stimuli that precipitate emergency responses are not conditioned enough and that many triggers not directly related to the traumatic experience may precipitate extreme reactions is merely the beginning of the problem. Loss/lack of self-regulation may be expressed in many different ways: as a loss of ability to focus on appropriate stimuli; as attentional problems; as an inability to inhibit action when aroused (loss of impulse control); or as uncontrollable feelings of rage, anger, or sadness. The results of a study by McFarlane, Weber, and Clark (1993) of event-related potentials in people with PTSD illustrate these various effects.”
Van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 187
Self-Mutilation
Eating Disorders
Substance Abuse
Dissociation
Sleep Disorders
“The sleep disorders are organized into four major sections according to presumed etiology. Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible. Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors. Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions).
Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation.
Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system.
Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications).
That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance.
Five distinct sleep stages can be measured by polysomnography: rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4). Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults. Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep. Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time. REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep.
These sleep stages have a characteristic temporal organization across the night. NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation. REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes. REM sleep periods increase in duration toward the morning. Human sleep also varies characteristically across the life span. After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range. This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep. Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual.
Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity. Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea. Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep. Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night. However, daytime polysomnographic studies also are used to quantify daytime sleepiness. The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day. Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness. The converse of the MSLT is also used: In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day. Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness.
Standard terminology for polysomnographic measures is used throughout the test in this section. Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep. “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness. Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity). Sleep architecture refers to the amount and distribution of specific sleep stages. Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency).
The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders: (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association.
_________________
Substance Dependence
“Features
The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine. The symptoms of Dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for Hallucinogenic Dependence). Although not specifically listed as a criterion item, “craving” (a strong subjective drive to use the substance) is likely to be experienced by most (if not all) individuals with Substance Dependence. Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time in the same 12-month-period.
Tolerance (Criterion 1) is the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance. The degree to which tolerance develops varies greatly across substances. Furthermore, for a specific drug, varied degrees of tolerance may develop for its different central nervous system effects. For example, for opioids, tolerance to respiratory depression and tolerance to analgesia develop at different rates. Individuals with heavy use of opioids and stimulants can develop substantial (e.g., 10-f0ld) levels of tolerance, often to a dosage that would be lethal to a nonuser. Alcohol tolerance can also be pronounced, but is usually less extreme than for amphetamine. Many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking. Individuals with heavy use of cannabis or phencyclidine (PCP) are generally not aware of having developed tolerance (although it has been demonstrated in animal studies and in some individuals). Tolerance may be difficult to determine by history alone when the substance used is illegal and perhaps mixed with various diluents or with other substances. In such situations, laboratory tests may be helpful (e.g., high blood levels of the substance coupled with little evidence of intoxication suggest that tolerance is likely). Tolerance must also be distinguished from individual variability in the initial sensitivity to the effects of particular substances. For example, some first-time drinkers show very little evidence of intoxication with three or four drink, whereas others of similar weight and drinking histories had slurred speech and incoordination.
Withdrawal (Criterion 2a) is a maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing unpleasant withdrawal symptoms, the persons is likely to take the substance to relieve or to avoid those symptoms (Criterion 2b), typically using the substance throughout the day beginning soon after awakening. Withdrawal symptoms, which are generally the opposite of the acute effects of the substance, vary greatly across the calluses of substances, and separate criteria sets for Withdrawal are provided for most of the classes. Marked and generally easily measured physiological signs of withdrawal are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics. Withdrawal signs and symptoms are often present, but may be less apparent, with stimulants such as amphetamines and cocaine, as well as with nicotine and cannabis. No significant withdrawal is seen even after repeated use of hallucinogens. Withdrawal from phencyclidine and related substances has not yet been described in humans (although it has been demonstrated in animals). Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence. However, for most classes of substances, a past history of tolerance or withdrawals is associated with a more severe clinical course (i.e., an earlier onset of Dependence, higher levels of substance intake, and a greater number of substance-related problems). Some individuals (e.g., those with Cannabis Dependence) show a pattern of compulsive use without obvious signs of tolerance or withdrawal. Conversely, some general medical and postsurgical patients without Opioid Dependence may develop a tolerance to prescribed opioids and experience withdrawal symptoms without showing any signs of compulsive use. The specifiers With Physiological Dependence and Without Physiological Dependence are provided to indicate the presence or absence of tolerance or withdrawal.
The following items describe the pattern of compulsive substance use that is characteristic of Dependence. The individual may take the substance in larger amounts or over a longer period than was originally intended (e.g., continuing to drink until severely intoxicated despite having set a limit of only one drink) (Criterion 3). The individual may express a persistent desire to cut down or regulate substance use. Often, there have been many unsuccessful efforts to decrease or discontinue use (Criterion 4). The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 5). In some instances of Substance Dependence, virtually all of the person’s daily activities revolve around the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use (Criterion 6). The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with substance-using friends. Despite recognizing the contributing role of the substance to a psychological or physical problem (e.g., sever depressive symptoms or damage to organ systems), the person continues to use the substance (Criterion 7). The key issue in evaluating this criterion is not eh existence of the problem, but rather the individual’s failure to abstain from using the substance despite having evidence of the difficulty it is causing.
Specifiers
Tolerance and withdrawal may be associated with a higher risk for immediate general medical problems and a higher relapse rate. Specifiers are provided to note their presence or absence:
With Physiological Dependence. This specifier should be used when Substance Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal (Criterion 2).
Without Physiological Dependence. This specifier should be used when there is no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). In these individuals, Substance Dependence is characterized by a pattern of compulsive use (at least three items from Criteria 3-7).”
Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. P. 193-195.
_______________________
PTSD, DID, and EMDR
Posttraumatic Stress Disorder
"The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).
Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase.
The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator).
Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7).
The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
Dissociative Identity Disorder (DID)
"The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play.
Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations.
Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities."
Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
EMDR
Eye Movement Desensitization and Reprocessing
"Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an
information processing therapy and uses an eight phase approach.
During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of
dual attention. This sequence of dual attention and personal association is repeated many times in the session.
Eight Phases of Treatment
The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations.
During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete.
In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions.
After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough
eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.
In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.
The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system.
After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures."
www.emdr.com
__________________
Major Depressive Disorder
“Diagnostic Features
The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B).
The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission).
The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission.
If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369
“Course
Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder).
Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state.
Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes.
Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder.
It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
________________
Major Depressive Disorder
“Diagnostic
Features
The essential feature
of Major Depressive Disorder is a clinical course that is
characterized by one or more Major Depressive Episodes without a
history of Manic, Mixed, or Hypomanic Episodes (Criteria A and
C). Episodes of Substance-Induced Mood Disorder (due to the
direct physiological effects of a drug of abuse, a medication,
or toxin exposure) or of Mood Disorder Due to a General Medical
Condition do not count toward a diagnosis of Major Depressive
Disorder. In addition, the episodes must not be better
accounted for by Schizoaffective Disorder and are not
superimposed on Schizophrenia, Schizophreniform Disorder,
Delusional Disorder, or Psychotic Disorder Not Otherwise
Specified (Criterion B).
The
fourth digit in the diagnostic code for Major Depressive
Disorder indicates whether it is a Single Episode (used only for
first episodes) or Recurrent. It is sometimes difficult to
distinguish between a single episode with waxing and waning
symptoms and two separate episodes. For purposes of this
manual, an episode is considered to have ended when the full
criteria for eh Major Depressive Episode have not been met for
at least 2 consecutive months. During this 2-month period,
there is either complete resolution of symptoms or the presence
of depressive symptoms that no longer meet the full criteria for
a Major Depressive Episode (In Partial Remission).
The fifth
digit in the diagnostic code for Major Depressive Disorder
indicates the current state of the disturbance. If the criteria
for a Major Depressive Disorder are met, the severity of the
episode is notes as Mild, Moderate, Severe Without Psychotic
Features, or Severe With Psychotic Features. If the criteria
for a Major Depressive Episode are not currently met, the fifth
digit is used to indicate whether the disorder is In Partial
Remission or In Full Remission.
If Manic,
Mixed, or Hypomanic Episodes develop in the course of Major
Depressive Disorder, the diagnosis is changed to a Bipolar
Disorder. However, if manic or hypomanic symptoms occur as a
direct effect of antidepressant treatment, use of other
medications, substance use, or toxin exposure, the diagnosis of
Major Depressive Disorder remains appropriate and an addition
diagnosis of Substance-induced Mood Disorder, With Manic
features (or With Mixed Features), should be noted. Similarly,
if manic or hypomanic symptoms occur as a direct effect of a
general medical condition, the diagnosis of Major Depressive
Disorder remains appropriate and an additional diagnosis of Mood
Disorder Due to a General Medical Condition, With Manic Features
(or With Mixed Features), should be noted.” p. 369
“Course
Major Depressive Disorder may begin at any
age, with an average age at onset in the mid-20s.
Epidemiological data suggest that the age at onset is decreasing
for those born more recently. The course of Major Depressive
Disorder, Recurrent, is variable. Some people have isolated
episodes that are separated by many years without any depressive
symptoms, whereas others have clusters of episodes, and still
others have increasingly frequent episodes as they grow older.
Some evidence suggests that the periods of remission generally
last longer early in the course of the disorder. The number of
prior episodes predicts the likelihood of developing a
subsequent Major Depressive Episode. At least 60% of
individuals with Major Depresssive Disorder, Single Episode, can
be expected to have a second episode. Individuals who have had
tow episodes have a 70% chance of having a third, and
individuals who have had three episodes have a 90% chance of
having a fourth. About 5%-10% of individuals with Major
Depressive Disorder, single Episode, subsequently develop a
Manic Episode (i.e., develop Bipolar I Disorder).
Major
Depressive Episodes may end completely (in about two-thirds of
cases), or only partially or not at all (in about one-third of
cases). For individuals who have only partial remission, there
is a greater likelihood of developing additional episodes and of
continuing the pattern of partial interepisode recovery. The
longitudinal course specifiers With Full Interepisode Recovery
and Without Full Interepisode Recovery may therefore have
prognostic value. A number of individuals have pre-existing
Dysthymic Disorder prior to the onset of Major Depressive
Disorder, single Episode. Some evidence suggests that these
individuals are more likely to have additional Major Depressive
Episodes, have poorer interepisode recovery, and may require
additional acute-phase treatment and a longer period of
continuing treatment to attain and maintain a more thorough and
longer-lasting euthymic state.
Follow-up
naturalistic studies suggested that 1 year after the diagnosis
of a major Depressive Episode, 40% of individuals still have
symptoms that are sufficiently severe to meet criteria for a
full Major Depressive Episode, roughly 20% continue to have some
symptoms that no longer meet full criteria for a Major
Depressive Episode (i.e., major Depressive Disorder, In Partial
Remission), and 40% have no Mood Disorder. The severity of the
initial Major Depressive Episode appears to predict
persistence. Chronic general medical conditions are also a risk
factor for more persistent episodes.
Episodes
of Major Depressive Disorder often follow a severe psychosocial
stressor, such as the death of a loved one or divorce. Studies
suggest that psychosocial events 9stressors) may play a more
significant role in the precipitation of the first or second
episodes of Major Depressive Disorder and may play less of a
role in the onset of subsequent episodes. Chronic general
medical conditions and Substance Dependence (particularly
Alcohol or Cocaine Dependence) may contribute to the onset or
exacerbation of Major Depressive Disorder.
It is
difficult to predict whether the first episode of a Major
Depressive Disorder in a young person will ultimately evolve
into a Bipolar Disorder. Some data suggest that the acute onset
of severe depression, especially with psychotic features and
psychomotor retardation, in a young person without prepubertal
psychopathology is more likely to predict a bipolar disorder. A
family history of Bipolar Disorder may also be suggestive of
subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and
statistical manual of mental disorders. 2000. 4th
ed. Washington, D.C.: American Psychiatric Association.
________________
DID-PTSD-EMDR
Dissociative Identity Disorder (DID)
"The essential feature of Dissociative identity
Disorder is the presence of two or more distinct identities or
personality states (Criterion A) that recurrently take control
of behavior (Criterion B). There is an inability to recall
important personal information, the extent of which is too great
to be explained by ordinary forgetfulness (Criterion C). The
disturbance is not due tot eh direct physiological effects of a
substance or a general medical condition (Condition D.). In
children, the symptoms cannot be attributed to imaginary
playmates or other fantasy play.
Dissociative Identity Disorder reflects a failure
to integrate various aspects of identity, memory, and
consciousness. Each personality state may be experienced as if
it has a distinct personal history, self-image, and identity,
including a separate name. Usually there is a primary identity
that carries the individual's given name and is passive,
dependent, guilty, and depressed. The alternate identities
frequently have different names and characteristics that
contrast with the primary identity (e.g., are hostile,
controlling, and self-destructive). Particular identities may
emerge in specific circumstances and may differ in reported age
and gender, vocabulary, general knowledge, or predominant
affect. Alternate identities are experienced as taking control
in sequence, ore at the expense of the other, and may deny
knowledge of one another, be critical of one another, or appear
to be in open conflict. Occasionally, one or more powerful
identities allocate time to the others. Aggressive or hostile
identities may at times interrupt activities or place the others
in uncomfortable situations.
Individuals with this disorder experience
frequent gaps in memory for personal history, both remote and
recent. The amnesia is frequently asymmetrical. The more
passive identities tend to have more constricted memories,
whereas the more hostile, controlling, or "protector" identities
have more complete memories. An identity that is not in control
may nonetheless gain access to consciousness by producing
auditory or visual hallucinations (e.g., a voice giving
instructions). Evidence of amnesia may be uncovered by reports
from others who have witnessed behavior that is disavowed by the
individual or by the individual's own discoveries (e.g., finding
items of clothing at home that the individual cannot remember
having bought). There may be loss of memory not only for
recurrent periods of time, but also an overall loss of
biographical memory for some extended period of childhood,
adolescence, or even adulthood. Transitions among identities
are often triggered by psychosocial stress. The time required
to switch from one identity to another is usually a matter of
seconds, but, less frequently, may b gradual. Behavior that may
be frequently associated with identity switches include rapid
blinking, facial changes, changes in voice or demeanor, or
disruption in the individual's train of thoughts. The number of
identities reported ranges from 2 to more than 100. Half of
reported cases include the individuals with 10 or fewer
identities."
Diagnostic and Statistical Manual of Mental
Disorders.
2000. 4th ed. Washington, D.C.: American Psychiatric
Association.
PTSD, DID, and EMDR
Posttraumatic Stress Disorder
"The essential feature of Posttraumatic Stress
Disorder us the development of characteristic symptoms following
exposure to an extreme traumatic stressor involving direct
personal experience of an event that involves actual or
threatened death or serious injury, or other threat to one's
physical integrity; or witnessing an event that involves death,
injury, or a threat to the physical integrity of another person;
or learning about unexpected or violent death, serious harm, or
threat of death or injury experienced by a family member or
other close associate (Criteria A1). The person's response to
the event must involve intense fear, helplessness, or horror (or
in children, the response must involve disorganized or agitated
behavior) (Criterion A2). The characteristic symptoms resulting
from the exposure to the extreme trauma include persistent
reexperiencing of the traumatic event (Criterion E), and the
disturbance must cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning (Criterion F).
Traumatic events that are experienced directly
include, but are not limited to, military combat, violent
personal assault (sexual assault, physical attack, robbery,
mugging), being kidnapped, being taken hostage, terrorist
attack, torture, incarceration as a prisoner of war or in a
concentration camp, natural or manmade disasters, severe
automobile accidents, or being diagnosed with a life-threatening
illness. For children, sexually traumatic events may include
developmentally inappropriate sexual experiences without
threatened or actual violence or injury. Witnessed events
include, but are not limited to, observing the serious injury or
unnatural death of another person due to violent assault,
accident, war, or disaster or unexpectedly witnessing a dead
body or body parts. Events experienced by others that are
learned about include, but are not limited to, violent personal
assault, serious accident, or serious injury experienced y a
family member or a close friend; learning about the sudden,
unexpected death of a family member or a close friend; or
learning that one's child has a life threatening disease. The
disorder may be especially sever or long lasting when the
stressor is of human design (e.g., torture, rape). the
likelihood of developing this disorder may increase as the
intensity of and physical proximity to the stressor increase.
The traumatic event can be reexperienced in
various ways. Commonly the person has recurrent and intrusive
recollections of the event (Criterion B1) or recurrent
distressing dreams during which the event can be replayed or
otherwise represented (Criterion B2). In rare instances, the
person experiences dissociative states that last from a few
seconds to several hours, or even days, during which components
of the event are relived and the person behaves as though
experiencing the event at that moment (Criterion B3). These
episodes, often referred to as "flashbacks," are typically brief
but can be associated with prolonged distress and heightened
arousal. Intense psychological distress (Criterion B4) or
physiological reactivity (Criterion B5) often occurs when the
person is exposed to triggering events that resemble or
symbolize an aspect of the traumatic event (e.g., anniversaries
of the traumatic event; cold, snowy weather or uniformed guards
for survivors of death camps in cold climates; hot, humid
weather for combat veterans of the South Pacific; entering any
elevator for an woman who was reaped in an elevator).
Stimuli associated with the trauma are
persistently avoided. The person commonly makes deliberate
efforts to avoid thoughts, feelings, or conversations about the
traumatic event (Criterion C1) and to avoid activities,
situations, or people who around recollections of it (Criterion
C2). This avoidance of reminders may include amnesia for an
important aspect of the traumatic event (Criterion C3).
Diminished responsiveness to the external work, referred to as
"psychic numbing" or "emotional anesthesia," usually begins soon
after the traumatic event. The individual may complain of
having markedly diminished interest or participation in
previously enjoyed activities (Criterion C4), of feeling
detached or estranged from other people (Criterion C5), or of
having markedly reduced ability to feel emotions (especially
those associated with intimacy, tenderness and sexuality)
(Criterion C6). The individual may have a sense of a
foreshortened future (e.g., not expecting to have a career,
marriage, children, or a normal life span) (Criterion C7).
The individual has persistent symptoms of anxiety
or increased arousal that were not present before the trauma.
these symptoms may include difficulty falling or staying asleep
that may be to recurrent nightmares during which the traumatic
event is relived (Criterion D1), hypervigilance (Criterion D4),
and exaggerated startle response (Criterion D5). Some
individuals report irritability or outburst of anger (Criterion
D2) or difficulty concentrating or completing tasks (Criterion
D3)."
EMDR
Eye Movement Desensitization and Reprocessing
"Eye Movement Desensitization and Reprocessing
(EMDR)1 integrates elements of many effective
psychotherapies in structured protocols that are designed to
maximize treatment effects. These include psychodynamic,
cognitive behavioral, interpersonal, experiential, and
body-centered therapies2. EMDR is an
information
processing therapy
and uses an eight phase approach.
During EMDR1 the client attends to
past and present experiences in brief sequential doses while
simultaneously focusing on an external stimulus. Then the client
is instructed to let new material become the focus of the next
set of
dual attention.
This sequence of dual attention and personal association is
repeated many times in the session.
Eight Phases of Treatment
The first phase is a history taking session
during which the therapist assesses the client's readiness for
EMDR and develops a treatment plan. Client and therapist
identify possible targets for EMDR processing. These include
recent distressing events, current situations that elicit
emotional disturbance, related historical incidents, and the
development of specific skills and behaviors that will be needed
by the client in future situations.
During the second phase of treatment, the
therapist ensures that the client has adequate methods of
handling emotional distress and good coping skills, and that the
client is in a relatively stable state. If further stabilization
is required, or if additional skills are needed, therapy focuses
on providing these. The client is then able to use stress
reducing techniques whenever necessary, during or between
sessions. However, one goal is not to need these techniques once
therapy is complete.
In phase three through six, a target is
identified and processed using EMDR procedures. These involve
the client identifying the most vivid visual image related to
the memory (if available), a negative belief about self, related
emotions and body sensations. The client also identifies a
preferred positive belief. The validity of the positive belief
is rated, as is the intensity of the negative emotions.
After this, the client is instructed to focus on
the image, negative thought, and body sensations while
simultaneously moving his/her eyes back and forth following the
therapist's fingers as they move across his/her field of vision
for 20-30 seconds or more, depending upon the need of the
client. Athough
eye movements
are the most commonly used external stimulus, therapists often
use auditory tones, tapping, or other types of tactile
stimulation. The kind of dual attention and the length of each
set is customized to the need of the client. The client is
instructed to just notice whatever happens. After this, the
clinician instructs the client to let his/her mind go blank and
to notice whatever thought, feeling, image, memory, or sensation
comes to mind. Depending upon the client's report the clinician
will facilitate the next focus of attention. In most cases a
client-directed association process is encouraged. This is
repeated numerous times throughout the session. If the client
becomes distressed or has difficulty with the process, the
therapist follows established procedures to help the client
resume processing. When the client reports no distress related
to the targeted memory, the clinician asks him/her to think of
the preferred positive belief that was identified at the
beginning of the session, or a better one if it has emerged, and
to focus on the incident, while simultaneously engaging in the
eye movements. After several sets, clients generally report
increased confidence in this positive belief. The therapist
checks with the client regarding body sensations. If there are
negative sensations, these are processed as above. If there are
positive sensations, they are further enhanced.
In phase seven, closure, the therapist asks the
client to keep a journal during the week to document any related
material that may arise and reminds the client of the
self-calming activities that were mastered in phase two.
The next session begins with phase eight,
re-evaluation of the previous work, and of progress since the
previous session. EMDR treatment ensures processing of all
related historical events, current incidents that elicit
distress, and future scenarios that will require different
responses. The overall goal is produce the most comprehensive
and profound treatment effects in the shortest period of time,
while simultaneously maintaining a stable client within a
balanced system.
After EMDR processing, clients generally report
that the emotional distress related to the memory has been
eliminated, or greatly decreased, and that they have gained
important cognitive insights. Importantly, these emotional and
cognitive changes usually result in spontaneous behavioral and
personal change, which are further enhanced with standard EMDR
procedures."
www.emdr.com
1Shapiro,
F. (2001).
Eye Movement Desensitization and Reprocessing: Basic Principles,
Protocols and Procedures (2nd ed.). New York: Guilford Press.
2Shapiro,
F. (2002).
EMDR as an Integrative Psychotherapy Approach: Experts of
Diverse Orientations Explore the Paradigm Prism. Washington, DC:
American Psychological Association Books.
|
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Self-Care
Self-Care
Title: Physical and occupational therapy.
Author(s): Case-Smith, Jane, Ohio State U, Health Sciences Ctr,
School of Allied Medical Profession, Columbus, OH, US
Rogers, Sandra
Source: Child & Adolescent Psychiatric Clinics of North America, Vol
8(2), Apr 1999. pp. 323-345.
Journal URL:
http://www.harcourthealth.com/scripts/om.dll/serve?action=searchDB&searc
hDBfor=home&id=ccap
Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com
ISSN: 1056-4993 (Print)
Language: English
Keywords: role of occupational & physical therapy in psychiatric
evaluation & intervention, young children
Abstract: Occupational and physical therapists emphasize
evaluations and interventions that promote object play and manipulation,
mobility, self-care, and social function. Evaluations typically focus on
underlying performance components, with emphasis on neuromotor function
and the interaction of those components in an environmental context.
This article emphasizes theoretic approaches that are widely used in
occupational and physical therapy practice with children.
Neuromaturational theory, developmental theory, and dynamic systems are
described, and assessments that represent those theories are identified.
Strategies employed for selection and use of evaluation instruments
within these theoretic approaches are defined.
_____
Record: 2
Title: Division of responsibility for asthma management tasks between
caregivers and children in the inner city.
Author(s): Wade, Shari L., Case Western Reserve U School of
Medicine, Dept of Pediatrics, Cleveland, OH, US
Islam, Shaheen
Holden, Gary
Kruszon-Moran, Deanna
Mitchell, Herman
Source: Journal of Developmental & Behavioral Pediatrics, Vol 20(2), Apr
1999. pp. 93-98.
Journal URL: http://www.jrnldbp.com/
Publisher: US: Lippincott Williams & Wilkins
Publisher URL: http://www.lww.com/
ISSN: 0196-206X (Print)
Language: English
Keywords: perceptions of division of responsibility for asthma
management tasks in families, inner city 6-9 yr olds & their caregivers
Abstract: Examined caregiver and child perceptions of the division
of responsibility for asthma management tasks in families. The study
sample included 789 children with asthma, aged 6-9 yrs, who lived in the
inner city. These children and their primary caregivers completed the
Asthma Responsibility Interview. The correlation between the caregiver's
and child's ratings of the child's responsibility was low (.19), with
children rating themselves as more responsible than their caregivers
rated them. Caregiver and child ratings of the child's responsibility
increased with the child's age; however, caregivers' ratings of their
own responsibility remained constant over the age range studied. Kappa
statistics ranged from -.03 to .12, with up to 16% of children reporting
less responsibility for self-care than was indicated by the caregiver.
More than one-third of families reported 4 or more asthma caregivers.
The discrepancy between the caregiver's and child's perceptions and the
involvement of multiple caregivers raise the possibility of
unintentional nonadherence.
Conference: Society for Pediatric Research Meeting, May, 1994,
Seattle, WA, US
Conference Notes: Portions of this article were presented at the
meeting.
_____
Record: 3
Title: The young person's perspective on living and coping with
diabetes.
Author(s): Schur, Helen V., Northern General Hosp, Diabetes Ctr,
Sheffield, England
Gamsu, D. S.
Barley, Valerie M.
Source: Journal of Health Psychology, Vol 4(2), Apr 1999. pp. 223-236.
Publisher: US: Sage Publications
Publisher URL: http://www.sagepublications.com/
ISSN: 1359-1053 (Print)
Digital Object Identifier: 10.1080/135485099106351
Language: English
Keywords: experiences of living & coping with & managing disease,
17-22 yr olds with diabetes
Abstract: Adolescence and young adulthood is a time of significant
psychological and psychosocial development, and for young people with
Type 1 diabetes mellitus it is a time when self-care and metabolic
control of diabetes may become compromised. In order to enhance
services' efforts to meet the complex needs of young people with
diabetes, a qualitative interview study with 8 young people (aged 17-22
yrs) was carried out. Young people identified an inherent vulnerability
associated with having diabetes and feared that diabetes would take
control and overwhelm them. Through learning to live with diabetes, and
learning to manage a relationship with diabetes, the young people had
developed sophisticated, interrelated self-protective strategies to
manage intrapersonal and interpersonal threats from diabetes.
_____
Record: 4
Title: Shame and the fear of feeling.
Author(s): Zupancic, Melissa K., Dept of Veterans Affairs,
Brecksville, OH, US
Kreidler, Maryhelen C.
Source: Perspectives in Psychiatric Care, Vol 35(2), Apr-Jun 1999. pp.
29-34.
Publisher: US: Nursecom
Publisher URL: http://www.nursecominc.com/
ISSN: 0031-5990 (Print)
Language: English
Keywords: group psychotherapy based on family systems model, toxic
shame & fear of feeling, adult survivors of childhood sexual abuse
Abstract: Toxic shame and the concomitant fear of feeling are core
issues needing to be addressed during group therapy with adult survivors
of childhood sexual abuse. This article seeks to increase awareness of
the toxic shame that survivors experience and to describe the impact of
group therapy based on a family systems model, based on the authors'
clinical experiences. Symptom management, repatterning of cognitive
distortions, and the improvement of self-care strategies are identified
as crucial aspects of healing shame-based feelings, and behaviors. Group
treatment offers members the opportunity to cease reenacting family
rules and roles that create toxic shame.
_____
Record: 5
Translated Title: Psychiatric symptoms and living disabilities
related to successful independent discharge of chronic schizophrenics:
Assessment with PANSS and LASMI.
Author(s): Yamashina, Mitsuru, Tokyo Metropolitan Matsuzawa Hosp,
Tokyo, Japan
Anzai, Nobuo
Kazamatsuri, Hajime
Iwanami, Akira
Iwasaki, Shinya
Source: Seishin Igaku (Clinical Psychiatry), Vol 41(4), Apr 1999. pp.
381-387.
Publisher: Japan: Igaku Shoin
Publisher URL: http://www.igaku-shoin.co.jp
ISSN: 0488-1281 (Print)
Language: Japanese
Keywords: psychiatric symptoms & factors predicting successful
independent living, 25-63 yr old discharged schizophrenic patients
Abstract: Studied the factors predicting successful independent
living for discharged chronic schizophrenics. Human Ss: 38 male and
female Japanese adults (aged 25-63 yrs) (chronic schizophrenia)
(inpatients). Ss were assessed during rehabilitation. The
characteristics of the 17 Ss who were discharged and began to live
independently after 1 yr and the 21 Ss who remained hospitalized were
compared. Tests used: The Positive and Negative Syndrome Scale and the
Life Assessment Scale for the Mentally Ill.
_____
Record: 6
Title: The family album.
Author(s): Novey, Pat, Private Practice, Glenview, IL, US
Source: Transactional Analysis Journal, Vol 29(2), Apr 1999. pp.
149-154.
Publisher: US: International Transactional Analysis Assn
Publisher URL: http://www.itaa-net.org
ISSN: 0362-1537 (Print)
Language: English
Keywords: transactional analysis, use of childhood photographs of
clients & their families to bring past memories into present
Abstract: Describes a transactional analysis therapy process in
which childhood photographs of clients and their families can be used to
bring memories of the past into the present. It is argued that early
childhood decisions that led to script and consequently life problems
can be reexamined in the present to assist clients in changing their
self-evaluations, self-care, and problem-solving methods and thus in
leading more constructive and autonomous lifestyles.
_____
Record: 7
Title: The "co-pilot driver syndrome:" A newly-reported driving habit
in patients with Alzheimer's disease.
Author(s): Shua-Haim, Joshua R., UMD School of Osteopathic
Medicine, Ctr of Aging, Straford, NJ, US
Shua-Haim, Vered
Ross, Joel S.
Source: American Journal of Alzheimer's Disease, Vol 14(2), Mar-Apr
1999. pp. 88-92.
Publisher: US: Prime National Publishing
Publisher URL: http://www.pnpco.com
ISSN: 1082-5207 (Print)
Language: English
Keywords: driving habits & community independence &
recommendations, 62-75 yr olds with Alzheimer's disease
Abstract: Present findings from 5 cases of patients with the
diagnosis of Alzheimer's disease (aged 62-75 yrs), their struggle to
drive, and their desire to stay independent in the community. It is
noted that there is confusion regarding the optimal time to recommend
that a patient with AD stop driving. In an attempt to assist caregivers
with this difficult question, guidelines have been issued, although they
frequently have conflicting recommendations in this matter.
_____
Record: 8
Title: Role of mood in outcome of biofeedback assisted relaxation
therapy in insulin dependent diabetes mellitus.
Author(s): McGrady, Angele, Medical Coll of Ohio, Toledo, OH, US
Horner, James
Source: Applied Psychophysiology & Biofeedback, Vol 24(1), Mar 1999. pp.
79-88.
Journal URL: http://www.wkap.nl/journalhome.htm/1090-0586
Publisher: Netherlands: Kluwer Academic Publishers
Publisher URL: http://www.wkap.nl
ISSN: 1090-0586 (Print)
Digital Object Identifier: 10.1023/A:1022851232058
Language: English
Keywords: depression & anxiety & daily hassles, outcome of
biofeedback assisted relaxation, 21-64 yr olds with insulin dependent
diabetes mellitus
Abstract: Stressful life events and negative mood have been
associated with elevated blood glucose and poor self-care in individuals
with diabetes. The purpose of this controlled study was to determine the
effect of mood state, specifically depression, anxiety, and daily
hassles on the outcome of biofeedback assisted relaxation in insulin
dependent diabetes mellitus. 18 Ss (aged 21-64 yrs) completed the study,
9 in biofeedback assisted relaxation and 9 in the control group. There
were no significant group differences in blood glucose between those
receiving biofeedback assisted relaxation and the Ss continuing usual
care. Five of the 9 experimental Ss and 1 of the 9 control Ss were
identified as succeeders according to an arbitrary criterion. Treatment
failures were more depressed, more anxious, and took longer to complete
the protocol than succeeders. Statistically significant correlations
were found between high scores on inventories measuring depression,
anxiety, and hassles intensity and higher blood glucose levels and
smaller changes in blood glucose as a result of treatment. It is
suggested that mood has an important impact on the response to
biofeedback assisted relaxation.
_____
Record: 9
Title: The use of the Canadian occupational performance measure for the
assessment of outcome on a neurorehabilitation unit.
Author(s): Bodiam, Carolyn, Battle Hosp, Neurology, Reading,
England
Source: British Journal of Occupational Therapy, Vol 62(3), Mar 1999.
pp. 123-126.
Publisher: United Kingdom: British Association of Occupational
Therapists
Publisher URL: http://www.cot.co.uk
ISSN: 0308-0226 (Print)
Language: English
Keywords: usefulness of occupational performance measure as
neuropsychological rehabilitation outcome measure, 17-69 yr olds with
neurological disorders with vs without brain damage
Abstract: Assessed the usefulness of the Canadian Occupational
Performance Measure ([COPM], M. Law et al; 1990,1991) as a
client-centered outcome measure on a neurological rehabilitation unit.
17 17-69 yr old clients with a variety of neurological disorders (9 with
physical deficits and brain damage) were assessed using the COPM on
admission, and their occupational therapy incorporated activities that
they identified as important to improve. 46% of the chosen activities
were related to productivity and leisure and 54% were related to
self-care. The COPM was repeated on discharge. The results show a
statistically significant increase in client ratings of performance and
satisfaction. The increase in ratings between initial and final
assessments was higher for satisfaction than for performance in clients
with only physical problems, vs clients with both physical and cognitive
problems where the increases were less marked. The effective use of the
COPM as an outcome measure of occupational therapy in a rehabilitation
setting is shown.
_____
Record: 10
Title: Measuring developmental and functional status in children with
disabilities.
Author(s): Ottenbacher, Kenneth J., U Texas, Medical Branch,
Galveston, TX, US
Msall, Michael E.
Lyon, Nancy
Duffy, Linda C.
Granger, Carl V.
Braun, Susan
Source: Developmental Medicine & Child Neurology, Vol 41(3), Mar 1999.
pp. 186-194.
Journal URL: http://uk.cambridge.org/journals/dmc/
Publisher: US: Cambridge Univ Press
Publisher URL: http://www.cup.org
ISSN: 0012-1622 (Print)
Digital Object Identifier: 10.1017/S0012162299000377
Language: English
Keywords: performance on Functional Independence Measure for
Children vs Battelle Developmental Inventory Screening Test vs Vineland
Adaptive Behavior Scales, 11-87 mo olds with developmental disabilities
Abstract: Compared performance on the Functional Independence
Measure for Children (WeeFIM-super(TM)), the Battelle Developmental
Inventory Screening Test (BDIST), and the Vineland Adaptive Behavior
Scales (VABS) in children with developmental disabilities. The three
instruments were administered to 205 children (aged 11-87 mo) with
identified disabilities. All 205 children were tested using the WeeFIM
instrument. The BDIST was administered to 101 children and the VABS to
the remaining 104 children. Administration was counterbalanced and
randomized across all three instruments. A proportional sampling plan
was used to select the Ss. A variety of medical diagnoses and levels of
severity of motor, cognitive, and communication impairments were
systematically included in the sample. Correlations among subscales for
all 3 instruments ranged from 0.42 to 0.92. Correlations for total
scores ranged from 0.72 to 0.94. Analyses of potential moderator
variables found no significant relation between age and severity of
disability or between SES and severity of disability. Correlations with
age were strongest for those subscale scores involving gross and fine
motor skills. Correlations with SES and subscale scores ranged from 0.03
to 0.18.
_____
Record: 11
Title: Healing the fighting spirit: Combining self-defense training and
group therapy for women who have experienced incest.
Author(s): Anderson, Kristin Marie, U Minnesota, US
Source: Dissertation Abstracts International: Section B: The Sciences &
Engineering, Vol 59(9-B), Mar 1999. pp. 5068.
Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/
ISSN: 0419-4217 (Print)
Order Number: AAM9907493
Language: English
Keywords: effectiveness of self-defense training & group
psychoeducational therapy, women survivors of childhood incest
Abstract: Psychotherapy groups have been found to be an effective
form of treatment for the long-term symptoms resulting from a history of
childhood incest. However, these groups do not deal with the physical
aspects of healing from such a trauma nor do they directly address
prevention of further abuse. To address these points, self-defense
training was added to a psychoeducational therapy group for women
survivors of childhood incest. Upon termination of the group, the
participants were asked to describe their experience of this group
during two-hour, semi-structured, individual interviews. In addition,
all eight participants met in a focus group to further discuss their
experiences. The information gathered from the termination interviews
was abstracted and organized using a modified version of the Consensual
Qualitative Research method. Feedback from the focus group was used to
confirm and expand the categories and domains that arose from the
analysis of the termination interviews. The final version of the
categories and domains were presented to the participants for review.
Their feedback was incorporated. The findings suggest that the
experience was empowering and promoted healing. The self-defense
training added an emotional intensity to the experience through
eliciting anger and fear, and provided an opportunity for memories to
resurface. In general, the group provided participants an opportunity to
reconnect with their bodies and increased their self-protection
confidence, self-esteem, and self-care.
_____
Record: 12
Title: Couples' coping and adherence to prescribed lifestyle behaviors
following a husband's myocardial infarction.
Author(s): Hoffman, Deborah Lee, California School of Professional
Psychology - Berkeley/alameda, US
Source: Dissertation Abstracts International: Section B: The Sciences &
Engineering, Vol 59(9-B), Mar 1999. pp. 5086.
Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/
ISSN: 0419-4217 (Print)
Order Number: AAM9907439
Language: English
Keywords: couples' coping & adherence to prescribed lifestyle
behaviors following husband's myocardial infarction, male myocardial
infarction patients & their wives
Abstract: Non-adherence to prescribed self-care behaviors
following myocardial infarction (MI) is a serious and chronic problem.
Although the risks of reinfarction and associated mortality can
significantly decline upon the reduction of modifiable coronary risk
factors, data suggest that between 20% and 80% of cardiac patients do
not adhere to their physicians' instructions regarding diet,
medications, exercise and smoking, nor management of anger, depression
and stress. Although healthy lifestyle prescriptions are optimally
effective when collectively undertaken by couples, there is little
understanding of how partners mutually influence adherence behaviors in
the post-crisis years following MI. This study examined the association
between a number of marital interaction measures and adherence to
post-MI lifestyle prescriptions in couples an average of six years
post-MI. Male patients and their spouses (total N = 156) from an
outpatient cardiology practice completed measures of adherence to
post-MI lifestyle prescriptions, relationship-focused coping (Protective
Buffering and Active Engagement), styles of anger expression (Anger-In,
Anger-Out), and anger control (Anger Control-In and Anger Control-Out),
depression, spousal overprotection, helpful behaviors, and critical
attitudes. Independent adherence reports were collected from patients,
spouses and a nurse. Results indicated that patients' use of the
relationship-focused strategies (Active Engagement and Protective
Buffering) was significantly and positively associated with the
patients' practice of specific healthy lifestyle behaviors, as well as
to a more stringent measure of adherence to doctors' advice when
appropriate covariates were held constant. Patient Active Engagement was
also significantly associated with patients' increased practice of
specific heart-care behaviors, including stress reduction, relaxation,
healthy diet and taking prescribed medications. Unexpectedly, spousal
protective buffering was negatively associated with patients' practice
of heart-care behaviors (regular exercise, and low-fat and low-salt
diets). Also unexpectedly, spouses' critical attitudes toward their
partners were significantly positively associated with patients'
adherence. Finally, of all of the patient characteristics considered in
this study, regression analyses indicated that anger control and anger
expression were the strongest and most consistent predictors of
adherence. These findings suggest that couple anger-management and
emotional expression are fruitful areas of exploration in post-MI
adherence. Causal models of these findings and clinical implications for
couples who are coping with MI are discussed.
_____
Record: 13
Title: Self-care behaviors of children with diabetes in Puerto Rico.
Author(s): Respess, Deedrah Marie, Tulane U, US
Source: Dissertation Abstracts International: Section B: The Sciences &
Engineering, Vol 59(9-B), Mar 1999. pp. 5141.
Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/
ISSN: 0419-4217 (Print)
Order Number: AAM9906600
Language: English
Keywords: self-care behaviors, 6-17 yr olds with diabetes & their
mothers, Puerto Rico
Abstract: Self-care behaviors in a primarily low SES sample of
children with Insulin-dependent Diabetes Mellitus (IDDM; N = 41) from
Puerto Rico were examined using the 24-hour recall interview (Johnson,
Silverstein, Rosenbloom, Carter, & Cunningham, 1986). Children (6-17
years of age) and their mothers were interviewed independently on three
separate occasions concerning daily self-care behaviors. Measures of 11
different adherence behaviors were constructed based on information
obtained from the interviews. Results indicated that children from
Puerto Rico came close to achieving many of the self-care guidelines
recommended by the American Diabetes Association (ADA). For example,
they consumed 29% of their daily calories from fat and 52% from
carbohydrates, achieving the ideal for fat intake and approaching the
ideal for carbohydrate intake recommended by the ADA. In contrast,
Puerto Rican children exercised approximately 18 minutes once a day,
indicating great difficulty attaining ADA recommended exercise goals of
six times daily for approximately 30 minutes each time. Children from
Puerto Rico took their insulin 7.4 minutes before eating, much later
than recommended by the ADA (30-60 minutes before meal). In comparison
to a sample of children from the United States, Puerto Rican children
displayed better self-care behaviors for blood glucose testing
frequency, eating frequency, ideal percentage of calories from fat, and
ideal percentage of calories from carbohydrates. In contrast, the U.S.
sample of children exercised more frequently and for longer periods of
time on average than did children from Puerto Rico. Results indicated
that parent-child agreement for the Puerto Rican sample was strong for 8
of the 11 measures, similar to previous research (Johnson, et al.,
1986). Predictors of self-care behavior in the Puerto Rican sample
indicated that child gender and disease duration significantly predicted
different self-care behaviors, but age did not, contrary to the
literature. Overall, this study provided a description of diabetes
self-care behaviors in a primarily low SES sample of children from
Puerto Rico. Children appeared to meet most of the ADA recommendations,
indicating that despite poor economic conditions in Puerto Rico and the
overburdened health care system, the sample of children in this study
engaged in relatively good self-care.
_____
Record: 14
Title: Prevalence and predictors of the use of self-care resources.
Author(s): Hibbard, Judith H., U Oregon, Dept of Planning, Public
Policy & Management, Eugene, OR, US
Greenlick, Merwyn
Jimison, Holly
Kunkel, Lynn
Tusler, Martin
Source: Evaluation & the Health Professions, Vol 22(1), Mar 1999. pp.
107-122.
Publisher: US: Sage Publications
Publisher URL: http://www.sagepublications.com/
ISSN: 0163-2787 (Print)
Digital Object Identifier: 10.1177/01632789922034194
Language: English
Keywords: prevalence of self-care health resources utilization,
urban vs rural households
Abstract: Examined the prevalence of the use of self-care health
resources and the correlates of use in urban and rural communities. A
random sample of 319,558 households was surveyed using a mail-out
questionnaire. The findings indicate that the use of self-care resources
was high in the 3 community populations. Consulting a self-care book was
the most commonly used resource, followed by telephone advice nurses.
_____
Record: 15
Title: Reasons, health behaviors, and outcomes of no prenatal care:
Research that changed practice.
Author(s): Higgins, Patricia Grant, U New Mexico Health Sciences
Ctr, College of Nursing, Alburquerque, MN, US
Woods, Pamela J.
Source: Health Care for Women International, Vol 20(2), Mar-Apr 1999.
pp. 127-136.
Journal URL: http://www.tandf.co.uk/journals/tf/07399332.html
Publisher: United Kingdom: Taylor & Francis
Publisher URL: http://www.taylorandfrancis.com/
ISSN: 0739-9332 (Print)
1096-4665 (Electronic)
Digital Object Identifier: 10.1080/073993399245836
Language: English
Keywords: reasons for no prenatal care & health behaviors &
perceived & actual neonatal outcomes, urban mothers, New Mexico
Abstract: Examined reasons women received no prenatal care, as
well as changes in health behaviors to ensure positive neonatal outcomes
and actual neonatal outcomes. The following questions were proposed: (1)
What are the reasons reported by women for not receiving prenatal care?
(2) What health behaviors did the women change to ensure a healthy baby?
(3) What are the perceived and actual outcomes for the neonates whose
mothers received no prenatal care? 12 urban New Mexican women who
received no prenatal care were interviewed regarding their reasons for
not receiving care during pregnancy, health behaviors, and perceived
neonatal outcomes. Data on actual neonatal outcomes were taken from the
medical record. Maternal reasons for no prenatal care were
socio-demographic, system related, attitudinal, and outside forces of
job and childcare. To ensure a healthy baby, the women made changes in
their nutrition, self-care activities, substance use, sleep, and
exercise activities. All of the women perceived they had a healthy baby.
Yet 61% of the neonates had complications and 45% were low birth weight.
The research findings were used to develop a care management program
that included case management and utilization management.
_____
Record: 16
Title: Home-based health promotion for chronically ill older persons:
Results of a randomized controlled trial of a critical reflection
approach.
Author(s): McWilliam, Carol L., U Western Ontario, School of
Nursing, Faculty of Health Sciences, London, ON, Canada
Stewart, Moira
Brown, Judith Belle
McNair, Susan
Donner, Allan
Desai, Kathryn
Coderre, Patricia
Galajda, Joanne
Source: Health Promotion International, Vol 14(1), Mar 1999. pp. 27-41.
Journal URL: http://heapro.oupjournals.org/
Publisher: United Kingdom: Oxford Univ Press
Publisher URL: http://www.oup.com/
ISSN: 0957-4824 (Print)
1460-2245 (Electronic)
Digital Object Identifier: 10.1093/heapro/14.1.27
Language: English
Keywords: health promotion intervention, 65+ yr olds discharged
from hospital to home care for chronic medical conditions, 22 wk & 1 yr
followup
Abstract: Tested a health promotion intervention for people over
65 yrs of age discharged from hospital to care at home for chronic
medical conditions. At discharge from hospital, 298 seniors were
randomized to receive the usual home care plus the intervention, or to
an attention control group receiving the usual home care. The
intervention was comprised of approximately 10 weekly hr-long sessions
in which a nurse facilitated critical reflection on life and health.
Data collected by personal interview at baseline, 22 wks, and 1 yr later
were analyzed using ANOVA and logistic regression, controlling for age,
gender, living arrangements, accommodation, number of chronic medical
problems and baseline differences. Those who received the intervention
had significantly greater independence and perceived ability to manage
their own health and significantly less desire for information
immediately post-intervention. At the 1-yr follow-up, the pattern
persisted, although significant differences were limited to independence
and desire for information. At 1-yr, the intervention group had higher
yet more significantly declined self-care agency and locus of authority.
The intervention group had a significantly greater chance of having
higher quality of life immediately post-intervention.
_____
Record: 17
Title: Atypical presentation of frontal lobe tumour--a cautionary tale.
Author(s): Spencer, Greg, Kidderminster General Hosp,
Kidderminster, England
Source: Irish Journal of Psychological Medicine, Vol 16(1), Mar 1999.
pp. 35-36.
Publisher: Ireland: MedMedia
Publisher URL: http://www.ijpm.org/
ISSN: 0790-9667 (Print)
Language: English
Keywords: frontal lobe brain tumor with atypical presentation &
slow deterioration in living skills & depression, 68 yr old male
psychogeriatric assessment ward patient
Abstract: Presents the case of a 68 yr old male with an inoperable
frontal lobe brain tumor that presented as a slow deterioration in
affect, personality, and living skills. He was initially diagnosed with
depression and treated with paroxetine, then admitted to a
psychogeriatric assessment ward after a home visit revealed very poor
self care. Issues discussed include the significance of a long period of
deterioration out of keeping with the degree of overt depression, the
absence of hard neurological signs, the usefulness of neuroimaging when
the history is of long duration and devoid of organic features, and the
need for psychological intervention.
_____
Record: 18
Title: Use of donepezil for vascular dementia: Preliminary clinical
experience.
Author(s): Mendez, Mario F., West Los Angeles VAMC, Neurobehavior
Unit, Los Angeles, CA, US
Younesi, Fargol L.
Perryman, Kent M.
Source: Journal of Neuropsychiatry & Clinical Neurosciences, Vol 11(2),
Spr 1999. pp. 268-270.
Journal URL: http://neuro.psychiatryonline.org/
Publisher: US: American Psychiatric Assn
Publisher URL: http://www.appi.org
ISSN: 0895-0172 (Print)
Language: English
Keywords: donepezil, cognitive & behavioral symptoms, 70-81 yr old
patients with vascular dementia, 6 mo follow up
Abstract: Examined the effects of donepezil, an
acetylcholinesterase inhibitor, on the cognitive and behavioral symptoms
of patients with vascular dementia. Eight outpatients (aged 70-81 yrs)
with subcortical lesions and mild to moderate cognitive impairment
received donepezil for 6 mo. During this period, cognitive measures
remained stable and caregivers reported improved patient activity,
engagement, and self-care.
_____
Record: 19
Title: Context of residence of adults with severe mental retardation
and their learning of a vocational task.
Author(s): Singhal, Sushila, Jawaharlal Nehru U, School of Social
Sciences, Zakir Husain Ctr for Educational Studies, New Delhi, India
Mani, Bala
Address: Singhal, Sushila, Jawahar Lal Nehru U, New Delhi, India,
110 067
Source: Journal of Personality & Clinical Studies, Vol 15(1-2), Mar-Sep
1999. pp. 13-18.
Publisher: India: Journal of Personality & Clinical Studies
ISSN: 0970-1206 (Print)
Language: English
Keywords: mental retarded adults; residential home; learning
strategies; time on task; context of residence; activities of daily
living; emotional balance; prevocational skills; discipline; task
training
Abstract: Compared the data on a vocational task taught through
auditory and visual modes to 20 adults (aged 18-35 YRS) having severe
mental retardation living in a residential home with another group of 30
comparable adults living with families but coming to day schools for
task training. Different factors in their context of living have been
searched that may account for variations in their learning strategies
and time taken. The task used was the assembly of a ball point pen, with
parts arranged in a sequential order, and administered within the
framework of a A×B×A×B research design. Results showed that the learners
residing in group homes took less time and made fewer errors in
performing the task irrespective of the mode of teaching than those
living with families and attending day schools. The differentiating
factors found in the context of residence were-discipline, structure and
training in activities of daily living, opportunities of interaction
with instructors and peers, achieving emotional balance, independence,
encouragement, family acceptance, cooperative learning, group
recreational activities, opportunity to train in prevocational skills,
motivation and persistence, regularity, participation in routine
activities of upkeep, sincerity etc.
_____
Record: 20
Title: Quality of life assessment in patients with breast carcinoma.
Author(s): Shukla, Vijay K., Inst of Medical Sciences, Dept of
Surgery, Varanasi, India
Singh, Shailesh
Singh, S. P.
Behere, P. B.
Roy, S. K.
Singh, Nikhel
Pandy, Manoj
Address: Shukla, Vijay K., Inst of Medical Sciences, Varanasi,
India, 221005
Source: Journal of Personality & Clinical Studies, Vol 15(1-2), Mar-Sep
1999. pp. 47-51.
Publisher: India: Journal of Personality & Clinical Studies
ISSN: 0970-1206 (Print)
Language: English
Keywords: quality of life; breast cancer; fear of death; social
life; recreation; family relations; mobility; self-care; physical
activities; sleep
Abstract: Examined quality of life assessment in patients (aged
<25-75+ yrs) with breast cancer. Emotional disturbances occur in
patients suffering from malignant disease even after the treatment,
specially because of fear of death, altering the quality of life.
Significant deterioration was observed in health related parameters such
as recreation, social life, family relation, mobility, self-care,
physical activities and sleep. Social life, self-care and recreation
were found most important parameters influencing the quality of life in
patients with breast cancer.
_____
Record: 21
Title: Finnish physicians' opinions of vaginal estriol in self-care.
Author(s): Hemminki, Elina, National Research & Development Ctr for
Welfare & Health, Health Services Research Unit, Helsinki, Finland
Sihvo, Sinikka
Source: Maturitas, Vol 31(3), Mar 1999. pp. 241-247.
Journal URL:
http://www.elsevier.com/inca/publications/store/5/0/5/9/5/4/
Publisher: Netherlands: Elsevier Science
Publisher URL: http://elsevier.com
ISSN: 0378-5122 (Print)
Digital Object Identifier: 10.1016/S0378-5122(99)00010-9
Language: English
Keywords: opinions on over the counter status of vaginal estriol &
related problems & suitability for self-care, general practitioners &
gynecologists, Finland
Abstract: Investigated what Finnish physicians think about the
fact that vaginal estriol does not require a prescription, and if they
have found any problems resulting from this. A questionnaire survey was
sent to gynecologists and general practitioners (n = 341, 77% response
rate) in Finland in 1996. 60% of the physicians considered vaginal
estriol to be suitable for over-the-counter (OTC) status, and to be much
more suitable than the other estrogen containing drugs (contraceptive
pill and drugs for emergency contraception) asked about in this study.
Opinions varied by specialty, work experience and reported problems
relating to OTC status. The most common reasons given for suitability
referred to increased access, and those given for unsuitability referred
to general dangers of self-care. Of all physicians 12%, and of private
gynecologists (n = 33) 49% reported having observed problems with the
OTC status, mostly in care-seeking and indications; some gynecologists
mentioned adverse effects of the drug itself. 39% of the physicians
thought that the best person to provide information about vaginal
estriol is a physician. Pharmacological literature and physicians'
opinions suggest a re-evaluation of the role of physician surveillance
of vaginal estriol drugs.
_____
Record: 22
Title: Constructions of self-neglect: A multiple case study design.
Author(s): Lauder, William, U Stirling, Dept of Nursing &
Midwifery, Inverness, Scotland
Source: Nursing Inquiry, Vol 6(1), Mar 1999. pp. 48-57.
Journal URL:
http://www.blackwell-science.com/~cgilib/jnlpage.asp?Journal=xninq&File=
xninq
Publisher: United Kingdom: Blackwell Publishing
Publisher URL: http://www.blackwellpublishing.com
ISSN: 1320-7881 (Print)
1440-1800 (Electronic)
Digital Object Identifier: 10.1046/j.1440-1800.1999.00006.x
Language: English
Keywords: intention & psychiatric disorders & treatment &
perceptions of self-neglect, patients & professionals & relatives
Abstract: Examined 4 research questions: (1) Do patients,
relatives and professional carers share perceptions of what constitutes
self-neglect? (2) Is self-neglect intentional or unintentional? (3) What
is the relationship between psychiatric disorders and self-neglect? and
(4) How do professionals and patients treat self-neglect? Five cases
were examined. Data were collected by means of focused interviews, field
notes recording the researcher's observation of household circumstances
and conversations with Ss, and other documentary evidence including
casenotes and medical records. The assumptions which underpin D. E.
Orem's Theory of Self-Care (1991) and the medical model construction of
self-neglect are explored and it will be suggested that there are
limitations in understanding self-neglect using these theoretical
frameworks.
_____
Record: 23
Title: The effects of shaping classes on academic skills, self care
skills and on-ward behavior with persons who are cognitively impaired
and chronic psychiatric inpatients.
Author(s): Bellus, Stephen, State U New York, Buffalo Psychiatric
Ctr, Buffalo, NY, US
Kost, Peter
Vergo, Joseph
Gramse, Ronald
Weiss, Kerri
Source: Psychiatric Rehabilitation Skills, Vol 3(1), Spr 1999. pp.
23-40.
Publisher: United Kingdom: Taylor & Francis
Publisher URL: http://www.taylorandfrancis.com/
ISSN: 1097-3435 (Print)
Language: English
Keywords: shaping classes, academic & self care skills & onward
behavior in rehabilitation, persons who are cognitively impaired or
psychiatric inpatients, 9 & 20 mo followup
Abstract: Described 2 studies centering around improvements in
cognitive skills with multiply-impaired individuals (mean age 39 yrs)
with psychiatric disabilities residing in a rehabilitation program based
on G. Paul and R. J. Lentz' (1977) social learning approach. In Study 1,
the authors compared improvements in reading and mathematics skills of 2
groups of inpatients over a 9-mo period; 1 group was of lower
functioning individuals seen in academically oriented shaping classes,
the other was a higher functioning group seen in more traditional
academic classes. Results show Ss in shaping classes tend to demonstrate
significant improvements in both basic reading and mathematics skills,
while Ss in the traditional classes made modest gain in reading skills
only. Study 2 investigated the relationship between academic skills,
self-care skills and on-ward behavior of a group of individuals with
pervasive psychiatric disabilities, who received 6-8
academically-oriented shaping classes per week, over a 20-mo period. It
was found that these individuals demonstrate continued improvements in
both reading and mathematics skills, while showing a more gradual
reduction of problematic behaviors. Improved self-care skills, once
attained, were exhibited at a relatively steady rate over the 20-month
period.
_____
Record: 24
Title: Women of the "sandwich" generation and multiple roles: The case
of Russian immigrants of the 1990s in Israel.
Author(s): Remennick, Larissa I., Bar-Ilan U, Dept of Sociology &
Anthropology, Graduate Program in Medical Sociology, Ramat Gan, Israel
Source: Sex Roles, Vol 40(5-6), Mar 1999. pp. 347-378.
Journal URL: http://www.wkap.nl/journalhome.htm/0360-0025
Publisher: Netherlands: Kluwer Academic Publishers
Publisher URL: http://www.wkap.nl
ISSN: 0360-0025 (Print)
Digital Object Identifier: 10.1023/A:1018815425195
Language: English
Keywords: experiences with multiple roles, 35-55 yr old Jewish
females who immigrated to Israel from former Soviet Union
Abstract: It has been suggested that adding elder care to the list
of women's multiple roles may significantly jeopardize their well-being
and mental health. This study explored the experiences with multiple
roles among Jewish women who immigrated to Israel from the former Soviet
Union in the early 1990s with their extended families. The 30 informants
(aged 35-55 yrs) for the study represented a variety of pre-emigration
backgrounds. Their common denominator was in multiple roles (employment
and caregiving to both children and aging parents) coupled with the
challenges of resettlement in a country swept by the mass influx of
immigrants. Facing downward social mobility, marital distress, and
problems with adolescent children, the women of this "sandwich"
generation also had to support their uprooted parents. The growing
dependency and declining health of the elders significantly burdened the
women and hindered their occupational upgrading and social integration
in Israel. Exhaustion and tight time budgets led to somatization and
poor self-care among middle-aged women. Social services' role in elder
care was minimal. The informants' social networks were mainly co-ethnic,
and their coping tools drew on Israeli-Russian subculture.
_____
Record: 25
Title: When pleasure causes pain: Living with interstitial cystitis.
Author(s): McCormick, Naomi B., Allen Memorial Hosp, Waterloo, IA,
US
Source: Sexuality & Disability, Vol 17(1), Spr 1999. pp. 7-18.
Journal URL: http://www.wkap.nl/journalhome.htm/0146-1044
Publisher: Netherlands: Kluwer Academic Publishers
Publisher URL: http://www.wkap.nl
ISSN: 0146-1044 (Print)
Digital Object Identifier: 10.1023/A:1021447612079
Language: English
Keywords: age & ethnicity & sex & SES & experience of living with
interstitial cystitis, adults
Abstract: Interstitial cystitis (IC) is a chronic inflammatory
condition of the bladder wall associated with genital and bladder pain,
urgency, and dyspareunia. Characterized by sterile urine culture, IC is
poorly understood and resistant to treatment. This article
contextualizes patients' experiences from the standpoint of age,
ethnicity, gender, socioeconomic status, and the experience of
concomitant disease. More than 90 percent of interstitial cystitis
patients are women, an alarming number of whom have been misdiagnosed as
having psychiatric disorders. Medical diagnosis and treatment are
discussed from a feminist perspective. The sexual functioning of persons
with IC is discussed in depth. Topics touched upon include menstrual
cycle variations and pregnancy, sexual desire, pain during sexual
activity, sexual side-effects of medications, sexual history, and sexual
self-care.
_____
Record: 26
Title: Clinical and cost effectiveness of post-acute neurobehavioural
rehabilitation.
Author(s): Wood, R. Ll., Brain Injury Rehabilitation Trust, Milton
Keynes, England
McCrea, J. D.
Wood, L. M.
Merriman, R. N.
Source: Brain Injury, Vol 13(2), Feb 1999. pp. 69-88.
Journal URL: http://www.tandf.co.uk/journals/tf/02699052.html
Publisher: United Kingdom: Taylor & Francis
Publisher URL: http://www.taylorandfrancis.com/
ISSN: 0269-9052 (Print)
1362-301X (Electronic)
Digital Object Identifier: 10.1080/026990599121746
Language: English
Keywords: efficacy & cost-effectiveness of community based
neurorehabilitation, patients (mean age 27 yrs) with severe brain injury
Abstract: The value of post-acute, community based social and
behavioural rehabilitation for people with serious neurobehavioural
disability has been the subject of a dispute for a number of years. This
paper attempts to assess both the clinical and cost effectiveness of
such rehabilitation on a group who have suffered serious brain injury
and display behaviour problems and cognitive deficits which prevent them
from living as independent members of the community. The discharge and
follow-up data on 76 people (mean age 27 yrs) who have received
rehabilitation indicates that, with a minimum of 6 mo rehabilitation,
many severely damaged individuals can progress to less dependent
placements in the community, and maintain higher levels of social
activity (independence) with fewer hours of care support. The cost
effectiveness of rehabilitation was greatest for those who received
treatment within 2 years of injury. However, those who received
rehabilitation at later stages also achieved significant social outcomes
and savings on care hours. It is concluded that post-acute
neurorehabilitation carried out in community based units can reduce the
social handicap consequent upon severe brain injury.
_____
Record: 27
Title: Association of Diogenes syndrome with a compulsive disorder.
Author(s): Grignon, Sylvain
Bassiri, Dideh
Bartoli, Jean Luc
Calvet, Patrick
Source: Canadian Journal of Psychiatry, Vol 44(1), Feb 1999. pp. 91-92.
Journal URL: http://www.cpa-apc.org/Publications/cjpHome.asp
Publisher: Canada: Canadian Psychiatric Assn
Publisher URL: http://www.cpa-apc.org
ISSN: 0706-7437 (Print)
Language: English
Keywords: comorbid Diogenes syndrome & compulsive disorder,
48-yr-old female
Abstract: Describes the association of Diogenes syndrome, a state
of gross personal neglect associated with rubbish hoarding and social
isolation in elderly individuals of higher than average intelligence,
with a compulsive disorder. The S was a 48-yr-old woman who exhibited
gross personal neglect and hand washing compulsions during psychiatric
evaluation after her 12-yr-old child was placed in foster care. The
authors suggest that cases of Diogenes associated with dementia or
psychosis be distinguished from other (or unspecified) psychiatric
diagnoses for a higher heuristic value. Management is often difficult.
Although nonconformity to social standards does not warrant compulsory
care, the increasing recognition of the syndrome in adults raises the
question of the well-being of dependents such as elderly parents or
children.
_____
Record: 28
Title: Effects of formalized transition planning for youth with
disabilities on successful integration to adult life.
Author(s): Kovacs, Pamela L., Duquesne U, US
Source: Dissertation Abstracts International Section A: Humanities &
Social Sciences, Vol 59(8-A), Feb 1999. pp. 2926.
Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/
ISSN: 0419-4209 (Print)
Order Number: AAM9901882
Language: English
Keywords: formalized transition planning/services, successful
integration to adult life, youth with disabilities enrolled in special
education programs
Abstract: This study was designed to examine the effects of
formalized transition planning/services for youth with disabilities on
their successful integration to a variety of post-school settings
including employment, independent living and a better quality of life.
The ultimate goal for all youth with disabilities is competitive
employment, independence and maximum involvement in community living.
This research examined a follow-up study of former special education
students selected throughout the forty-two school districts in Allegheny
County, Pittsburgh, Pennsylvania who graduated in May, 1995. The sample
was composed of 242 youth with disabilities enrolled in special
education programs for all or part of their school day. Gender was
specified for 240 students, with 145 males and 95 females in the sample
and included youth with disabilities from various categories of special
education. Data collection for this research was two-fold:
administration of a follow-up questionnaire through a telephone
interview process one year following graduation; focus group interviews.
These methods of data collection tested the following hypothesis: What
are the effects of formalized transition planning/services for youth
with disabilities on successful integration into adult life? Statistical
analysis of the data did not support a relationship between formalized
transition planning and successful integration to adult life. Results
indicate that the transition process for youth with disabilities did not
improve higher levels of employment, educational attainment,
independence and successful community adjustment leading to a better
quality of life. Findings of this research indicated the need for future
study. If the efficacy of special education is determined by the quality
of life of its graduates and the ultimate goal for all youth with
disabilities is competitive employment, independence and maximum
involvement in community living, obviously the educational system is
falling short of its goal and a need exists for the development of a
transition process that guarantees a higher rate of success among
graduates.
_____
Record: 29
Title: Functional independence in adolescents with spina bifida.
Author(s): Inman, Barbara Jeanne, U Texas Southwestern Medical
Center at Dallas, US
Source: Dissertation Abstracts International: Section B: The Sciences &
Engineering, Vol 59(8-B), Feb 1999. pp. 4466.
Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/
ISSN: 0419-4217 (Print)
Order Number: AAM0599394
Language: English
Keywords: intelligence & executive functioning & emotional
adjustment & family environment & medical & sociodemographic factors,
functional independence, 12-18 yr olds with spina bifida & caregivers
Abstract: Forty-eight adolescents (12 to 18 years) diagnosed with
spina bifida and shunted hydrocephalus and caregivers were evaluated in
order to examine the relationship of individual and family variables to
functional independence. Functional independence refers to self-reliance
in managing tasks related to self-care and mobility in home, community,
and school. Variables included intelligence, executive functioning,
emotional adjustment, family environment, medical factors, and
sociodemographic information. Previous research has explored
intelligence, executive functioning, emotional adjustment, and family
environment. However, research on functional independence in adolescents
with spina bifida has been neglected. Adolescents completed the age
appropriate Wechsler intelligence test, and the Trailmaking and Category
(CAT) tests of the Halstead-Reitan Neuropsychological Test Battery.
Caregivers completed the Child Behavior Checklist (CBCL), Family
Environment Scale (FES), and responded to the WeeFIM, a structured
interview measuring functional independence. There were two phases of
data analyses. First, adolescents were ordered by functional
independence score, and the bottom and top third were selected to form
two groups, one having a low level of functional independence (n=16) and
the other, a high level (n=16). Group comparisons indicated that the
group with a low level had lower mean scores for intelligence, CAT, FES
Independence, CBCL Externalizing scale, and a higher ratio of lumbar to
sacral lesions. In the second phase of data analyses, all 48 subjects
were included. Stepwise multiple regression examined which combination
of variables best predicted functional independence score. Results
indicated that (a) FES Independence x CAT, (b) lesion level, and (c)
CBCL Externalizing scale x CAT accounted for 51% of the variance. These
findings have implication for interventions which address issues
relevant to independence in self-care. Intelligence testing alone is not
sufficient for school, home, and community planning. Beside the
immutable impact of lesion level, information regarding executive
functioning in combination with (a) family emphasis on independence, and
(b) externalized emotional adjustment is important. Weak executive
functioning along with less family emphasis on individual independence
is associated with poorer outcome in terms of functional independence.
Emotional adjustment of an externalized nature in adolescents with
adequate executive functioning is also associated with poorer functional
independence.
_____
Record: 30
Title: Psychotherapist self-care: Beliefs, practices, and outcomes.
Author(s): Shoyer, Beth Gia, U Missouri - Columbia, US
Source: Dissertation Abstracts International: Section B: The Sciences &
Engineering, Vol 59(8-B), Feb 1999. pp. 4485.
Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/
ISSN: 0419-4217 (Print)
Order Number: AAM9901280
Language: English
Keywords: self-care beliefs & practices, psychological adjustment,
psychotherapists
Abstract: This study expanded the body of knowledge related to
therapist self-care beliefs, practices, and outcomes. Psychotherapists
in two small to medium Midwestern cities were asked to participate in a
survey. Eighty-nine respondents (58%) returned the completed survey
which included a demographic questionnaire, COPE (Carver, Scheier &
Weintraub, 1989), Psychotherapist Self-Care Measure (Shoyer, 1998),
Maslach Burnout Inventory (Maslach & Jackson, 1981), TSI Beliefs Scale
(Pearlman, 1995), and Satisfaction With Life Scale (Diener, Emmons,
Larsen & Griffen, 1985). Study results demonstrated an association
between psychotherapist self-care and positive psychological adjustment.
All of the psychological adjustment measures in this study were related
to some aspect of self-care such that greater self-care was related to
more positive adjustment. Also, this study supported the notion that
Self-Care Completeness is more closely related to psychological
adjustment than is Self-Care Variety alone. In addition, the most
important self-care subscale for predicting psychological adjustment
appeared to be Self-Care Beliefs. Self-Care Beliefs was predictive of a
significant amount of the variance for five out of the six psychological
adjustment scales that were employed. Overall, therapists in this study
demonstrated a high level of belief and participation in self-care
activities. Implications of these findings are discussed.
_____
Record: 31
Title: The relationship of mothers' self-esteem to their perceptions of
social support and the functional independence of their young children
with disability.
Author(s): Kim-Sung, Kaewon, The George Washington U, US
Source: Dissertation Abstracts International: Section B: The Sciences &
Engineering, Vol 59(8-B), Feb 1999. pp. 4538.
Publisher: US: Univ Microfilms International
Publisher URL: http://www.il.proquest.com/umi/
ISSN: 0419-4217 (Print)
Order Number: AAM9905146
Language: English
Keywords: mothers' self-esteem & perceptions of social support,
children's functional independence, mothers & their 2-5 yr old children
with disability who attend special education public preschools
Abstract: This study was designed to investigate the relationships
between the degree of mothers' self-esteem and their perceptions of
social support and functional independence level of their young children
with disability (CWD). The participants consisted of 57 mothers whose
children, ages of 2 to 5 years, attend special education public
preschools in Fairfax County, Virginia. The Self-Help/Social Profile of
the AGS Early Screening Profiles (ESP) was employed to assess the levels
of functional independence of the CWD. Mothers' perception of the levels
of social support was measured by Part II of the Personal Resource
Questionnaire (PRQ-85); the Adult Form of the Coopersmith Self-esteem
Inventory (SEI) was used to assess the levels of participants'
self-esteem. Descriptive data from the participants were gathered using
a demographic form developed by this researcher. Inferential and
descriptive statistics including correlation coefficient and one-way
ANOVA were used to test the hypotheses generated from the research
questions. The findings of the study indicate statistically significant
positive relationships between: (1) participants' perceptions of the
levels of social support and the levels of their self-esteem; (2)
educational attainment levels and the levels of self-esteem of the
participants; and (3) the age of the participants and their levels of
self-esteem. The conclusions of the present study affirm the need for a
multifaceted psychosocial approach toward the relationship between
mothers and their young children with disabilities.
_____
Record: 32
Title: Promoting well-being and independence for people with dementia.
Author(s): Woods, Bob, U Wales, Inst of Medical & Social Care
Research, Bangor, Wales
Source: International Journal of Geriatric Psychiatry, Vol 14(2), Feb
1999. pp. 97-105.
Journal URL: http://www.interscience.wiley.com/jpages/0885-6230/
Publisher: US: John Wiley & Sons
Publisher URL: http://www.wiley.com/WileyCDA/
ISSN: 0885-6230 (Print)
1099-1166 (Electronic)
Digital Object Identifier:
10.1002/(SICI)1099-1166(199902)14:2<97::AID-GPS941>3.3.CO;2-O
Language: English
Keywords: research on improvement of well-being & independence &
self-care skills, patients with dementia
Abstract: Reviews research evidence relating to nonpharmacological
interventions with people with dementia aiming to improve well-being and
independence. There have been a number of attempts to improve the
person's level of independent functioning through programs training and
supporting self-care skills, mobility, continence, orientation, and
participation in activities. Well-being has been less often directly
addressed, although recently studies have begun to specifically target
aspects of it. Increased independence does not necessarily lead to
greater well-being, and it is clear that the greatest potential for
increasing function is in tackling the excess disability which many
caregiving situations in effect impost on the person with dementia. In
carrying out research in this area, the limitations of randomized
controlled trials are evident, and there is much to be said for the
reporting of a series of carefully controlled single-case studies in
addition to group studies. Further development of methods of measuring
well-being in people with dementia is also required.
_____
Record: 33
Title: "Promoting well-being and independence for people with
dementia": Commentary.
Author(s): O'Carroll, Ronan, U Stirling, Dept of Psychology,
Stirling, Scotland
Source: International Journal of Geriatric Psychiatry, Vol 14(2), Feb
1999. pp. 105-107.
Journal URL: http://www.interscience.wiley.com/jpages/0885-6230/
Publisher: US: John Wiley & Sons
Publisher URL: http://www.wiley.com/WileyCDA/
ISSN: 0885-6230 (Print)
1099-1166 (Electronic)
Digital Object Identifier:
10.1002/(SICI)1099-1166(199902)14:2<105::AID-GPS942>3.0.CO;2-B
Language: English
Keywords: quantitative vs qualitative & single-case vs group
research on improvement of well-being & independence & self-care skills,
patients with dementia, commentary
Abstract: Comments on B. Woods's (see record 1999-10881-002)
literature review regarding the promotion of well-being and independence
among patients with dementia. The author discusses the importance of
qualitative vs quantitative research design and single-case vs group
study designs, and argues that memory aids should be evaluated more in
dementia. The author notes that psychosocial researchers have a
responsibility to produce clear, well-controlled, ecologically valid
research proposals that are likely to produce results which will lead to
greater independence and well-being for people with dementia.
_____
Record: 34
Title: "Promoting well-being and independence for people with
dementia": Commentary.
Author(s): Mitchell, R., Joint Dementia Initiative, Social Work
Services, Adult Provision, Falkirk Council, Falkirk, Scotland
Source: International Journal of Geriatric Psychiatry, Vol 14(2), Feb
1999. pp. 107-109.
Journal URL: http://www.interscience.wiley.com/jpages/0885-6230/
Publisher: US: John Wiley & Sons
Publisher URL: http://www.wiley.com/WileyCDA/
ISSN: 0885-6230 (Print)
1099-1166 (Electronic)
Digital Object Identifier:
10.1002/(SICI)1099-1166(199902)14:2<107::AID-GPS943>3.3.CO;2-U
Language: English
Keywords: research on improvement of well-being & independence &
self-care skills, patients with dementia, commentary
Abstract: Comments on B. Woods's (see record 1999-10881-002)
literature review regarding the promotion of well-being and independence
among patients with dementia. Noting that much of Woods's paper
concentrated on measurement in the area of physical independence, the
author discusses a person-centered approach to dementia, which view
people in a more holistic way, with empowerment at the heart of its
philosophy. The author comments on several issues in Woods's discussing,
including the need to research therapy effectiveness, the promotion of
independence and well-being in the institutional setting, and the need
for preventive work. The author also argues the research needs to keep
up with new developments to ensure that they are cost-effective and can
be generalized. Research needs to tell researchers whether knowing the
diagnosis and receiving information, support and counseling in the early
stages of dementia can impact a person's sense of well being and
independence in the short and long term.
_____
Record: 35
Title: Memantine in severe dementia: Results of the -sup-9M-Best study
(benefit and efficacy in severely demented patients during treatment
with memantine).
Author(s): Winblad, B., Huddinge University Hosp, Karolinsa Inst,
Dept of Clinical Neuroscience & Family Medicine, Div of Geriatric
Medicine, Huddinge, Sweden
Poritis, N.
Source: International Journal of Geriatric Psychiatry, Vol 14(2), Feb
1999. pp. 135-146.
Journal URL: http://www.interscience.wiley.com/jpages/0885-6230/
Publisher: US: John Wiley & Sons
Publisher URL: http://www.wiley.com/WileyCDA/
ISSN: 0885-6230 (Print)
1099-1166 (Electronic)
Digital Object Identifier:
10.1002/(SICI)1099-1166(199902)14:2<135::AID-GPS906>3.3.CO;2-S
Language: English
Keywords: NMDA antagonist memantine, tolerance & functional
improvement & care dependence & activities of daily living ability,
patients with vascular dementia or dementia of Alzheimer type:
Abstract: Assessed the clinical efficacy and safety of the
uncompetitive N-methyl-D-aspartate (NMDA) antagonist memantine in
moderately severe to severe primary dementia. Dementia was defined by
Diagnostic and Statistical Manual of Mental Disorders-III-Revised
(DSM-III-R) criteria, and severity was assessed by the Global
Deterioration Scale and the Mini-Mental State Examination. Primary
endpoints were the Clinical Global Impression of Change (CGI-C) and the
Behavioural Rating Scale for Geriatric Patients (BGP). Secondary
endpoints included the modified D-Scale. 166 dementia patients were
treated with either memantine (n = 82) or placebo (n = 84). Dementia was
49% of the Alzheimer type and 51% of the vascular type. A positive
response in the CGI-C was seen in 73% vs 45% in favor of memantine,
independent of the etiology of dementia. Results in the BGP subscore
(care dependence) were 3.1 points improvement under memantine and 1.1
points under placebo. Secondary endpoint analysis of the assessment of
basic activities of daily living functions supports the primary results.
_____
Record: 36
Title: Avaliação de um hospital dia psicogeriátrico: valor da duração
média das hospitalizaçãoes.
Translated Title: Geriatric psychiatric day hospital: The length
of stay as criteria of evaluation.
Author(s): Mendonça Lima, C. A., Hôpital de Jour Psychogériatrique,
Service Universitaire de Psychogériatrie, Prilly-Lausanne, Switzerland
Camus, V.
Lharras, N.
Rubeli, M.
Ramseier, F.
Source: Jornal Brasileiro de Psiquiatria, Vol 48(2), Feb 1999. pp.
61-69.
Publisher: Brazil: Univ Federal do Rio de Janeiro Inst de
Psiquiatria
ISSN: 0047-2085 (Print)
Language: Portuguese
Keywords: patient origin & postdischarge destination & diagnosis &
degree of independence & length of hospital stay, geriatric psychiatric
patients
Abstract: Studied clinical and other factors associated with
duration of hospital stay in a geriatric psychiatric day hospital. Human
Ss: 262 male and female Brazilian elderly adults (geriatric psychiatric
patients). Data on admissions, diagnosis, hospitalization, length of
stay, and discharge were obtained from patient records. The results were
evaluated according to origin of patients, destination after discharge,
diagnosis, reduction of degree of independence. Statistical tests were
used. (English abstract)
_____
Record: 37
Title: After-school supervision and adolescent cigarette smoking:
Contributions of the setting and intensity of after-school self-care.
Author(s): Mott, Joshua A., U Illinois, Health Policy & Research
Ctrs, Chicago, IL, US
Crowe, Paul A.
Richardson, Jean
Flay, Brian
Source: Journal of Behavioral Medicine, Vol 22(1), Feb 1999. pp. 35-58.
Journal URL: http://www.wkap.nl/journalhome.htm/0160-7715
Publisher: Netherlands: Kluwer Academic Publishers
Publisher URL: http://www.wkap.nl
ISSN: 0160-7715 (Print)
Digital Object Identifier: 10.1023/A:1018747602026
Language: English
Keywords: after school supervision, cigarette smoking, 9th graders
in after-school self care
Abstract: Examines the independent contributions of the setting
and the intensity of after-school self-care to the cigarette smoking
behaviors of 2,352 ninth graders using several self-report measures. We
controlled for a variety of correlates of adolescent cigarette smoking
that have not been accounted for in existing research. Results indicated
that the intensity of the self-care experience was significantly
associated with adolescent smoking behavior irrespective of the typical
setting of the adolescents' after-school activities. Our findings also
indicated that a nonpermissive parenting style, family rule-setting
about cigarettes, and especially, in absentia parental monitoring may
reduce the likelihood of cigarette smoking among latchkey and
nonlatchkey adolescents alike. Latchkey youth were not any more
sensitive to these aspects of parenting than other adolescents. This is
consistent with the notion that targeting these aspects of the home
lives of all adolescents has the potential to reduce smoking behaviors
among latchkey as well as nonlatchkey children.
_____
Record: 38
Title: The outcome of clinical goal setting in a mental health
rehabilitation service. A model for evaluating clinical effectiveness.
Author(s): Macpherson, Rob, Wotton Lawn, Gloucester, England
Jerrom, Bill
Lott, George
Ryce, Maureen
Source: Journal of Mental Health (UK), Vol 8(1), Feb 1999. pp. 95-102.
Journal URL: http://www.tandf.co.uk/journals/carfax/09638237.html
Publisher: United Kingdom: Taylor & Francis
Publisher URL: http://www.taylorandfrancis.com/
ISSN: 0963-8237 (Print)
1360-0867 (Electronic)
Digital Object Identifier: 10.1080/09638239917670
Language: English
Keywords: model for evaluating outcomes of clinical goal setting
in psychiatric multidisciplinary mental health rehabilitation service,
rehabilitation patients (ages 21-77 yrs)
Abstract: Examined outcomes of clinical goal setting in a mental
health rehabilitation service. In a standard care planning cycle, all
139 patients (ages 21-77 yrs) on the Gloucester Rehabilitation Register
were involved in multi-disciplinary care programme approach assessment,
generating 366 formal treatment goals (mean 2.6 goals per patient). At
review 1 year later, 68% of goals were fully and 11% partially achieved.
Goals were no more likely to be achieved in any care setting (i.e. with
professional supervision/living independently) or any particular
diagnosis. However, goals targeting the drug treatment of psychiatric
syndromes were most likely to be fully successful (84%) while approaches
to self-care skills, side effects, physical/medical problems, and family
relationships were moderately successful. Least successful were the
attempts to promote structured day care/activities, and to treat
substance abuse, fully successful in 39% and 17%, respectively. Possible
reasons for treatment success in different areas, including the positive
impact of the introduction of "atypical" antipsychotic drugs, were
discussed. The present model of evaluating clinical outcome may have
wider application in a health service which increasingly values
evidence-based clinical practice.
_____
Record: 39
Title: Promoting psychology in diabetes primary care.
Author(s): Feifer, Chris, Family Health Ctr, Los Angeles, CA, US
Tansman, Mara
Source: Professional Psychology: Research & Practice, Vol 30(1), Feb
1999. pp. 14-21.
Journal URL: http://www.apa.org/journals/pro.html
Publisher: US: American Psychological Assn
Publisher URL: http://www.apa.org
ISSN: 0735-7028 (Print)
Digital Object Identifier: 10.1037//0735-7028.30.1.14
Language: English
Keywords: integrated assessment & psychotherapy for management of
disease & improved glucose control & integration of psychology into
primary care, adults with diabetes
Abstract: Better diabetes management can be achieved by adding an
explicit psychological component to diabetes treatment. Three cases are
presented that illustrate how integrated assessment and psychotherapy
can improve glucose control through three mechanisms: increasing patient
acceptance of a disease state, enabling behavior change for self-care,
and removing psychological barriers to disease control. Guidelines are
suggested for standardized integration of psychology into diabetes care.
The explicit treatment of psychological barriers to diabetes
self-management would enhance standard medical practice, which normally
relies on education to overcome treatment adherence problems.
_____
Record: 40
Title: Women's responses to battering: A test of the model.
Author(s): Campbell, Jacquelyn C., Johns Hopkins U, School of
Nursing, Baltimore, MD, US
Soeken, Karen L.
Source: Research in Nursing & Health, Vol 22(1), Feb 1999. pp. 49-58.
Journal URL: http://www.interscience.wiley.com/jpages/0160-6891/
Publisher: US: John Wiley & Sons
Publisher URL: http://www.wiley.com/WileyCDA/
ISSN: 0160-6891 (Print)
1098-240X (Electronic)
Digital Object Identifier:
10.1002/(SICI)1098-240X(199902)22:1<49::AID-NUR6>3.0.CO;2-F
Language: English
Keywords: model of women's physical & emotional health responses
to battering, 18-52 yr olds
Abstract: A volunteer community sample of 141 well-educated,
economically heterogeneous, primarily urban African American (80%),
battered women (aged 18-52 yrs) was used to test a model of women's
responses to battering. The model, based on D. E. Orem's theory (1991),
was developed previously with an independent sample. The major
independent variables were physical and nonphysical abuse, and self-care
agency. The outcomes were physical and emotional health. Using
structural equation modeling techniques, there was sufficient support
for the model structure to conclude preliminary support for the overall
model. There was both a direct effect of abuse on health and an indirect
effect mediated through self-care agency as a protective factor. Thus,
findings supported this model of women's health responses to battering.
_____
Record: 41
Title: Evolución a largo plazo de la discapacidad en pacientes
esquizofrénicos en tratamiento de mantenimiento con risperidona.
Translated Title: Long term evolution of the incapacity in
schizophrenic patients in maintenance treatment with risperidone.
Author(s): Bobes, J., U de Oviedo, Area de Psiquiatriá, Oviedo,
Spain
González, M. P.
Giblert, J.
Gutiérrez, M.
Herráiz, M. L.
Source: Actas Españolas de Psiquiatría, Vol 27(1), Jan-Feb 1999. pp.
1-7.
Journal URL:
http://db.doyma.es/cgi-bin/wdbcgi.exe/doyma/mrevista_info.sobre?pident_r
evista=104
Publisher: Spain: Grupo Ars XXI de Comunicacion, S.A.
Publisher URL: http://www.ArsXXI.com
ISSN: 1139-9287 (Print)
Language: Spanish
Keywords: long-term disability in personal care & functioning,
schizophrenia patients treated with maintenance risperidone
Abstract: Determined the evolution of the degree of long term
disability (8 mo) among 354 patients with schizophrenia undergoing
monotherapy with risperidone. Patients completed a series of
questionnaires (BPRS, CGI, and WHO/DAS-S) at baseline, and at 2-, 4-,
and 8- mo. Results show a significant decrease in both the global scores
and in each of 4 ares of disability. Improvement in disability depended
to a large degree in the improvement of the disorder as shown on the
BPRS and CGI. After 8 mo, those patients with paranoid subtype and the
less severe ones showed a considerably lesser degree of disability. The
final level of disability is narrowly related to the baseline level of
disability, the 3 clusters of the final BPRS, the final CCGI, gender,
and subtype of schizophrenia.
_____
Record: 42
Title: Caregiver health behavior: Review, analysis, and recommendations
for research.
Author(s): Connell, Cathleen M., U Michigan, School of Public
Health, Dept of Health Behavior & Health Education, Ann Arbor, MI, US
Gallant, Mary P.
Source: Activities, Adaptation & Aging, Vol 24(2), 1999. pp. 1-16.
Journal URL: http://www.haworthpressinc.com/store/product.asp?sku=J016
Publisher: US: Haworth Press
Publisher URL: http://www.haworthpress.com
ISSN: 0192-4788 (Print)
Language: English
Keywords: health behaviors & self care & interventions with health
behavior components, caregivers of relatives with chronic illness
Abstract: Caring for a relative with a chronic illness is an
increasingly common experience among families. Although a great deal of
evidence links caregiving with adverse health outcomes, the mechanism of
this relationship is unclear. One potential mediating factor that has
received relatively little research attention is the health behavior
patterns of caregivers. The goals of the present paper are to (1)
provide a selected review and analysis of the published literature that
examines caregiver health behavior, (2) highlight examples of caregiver
interventions that include a health behavior component, (3) discuss self
care as an appropriate framework for advancing the caregiver literature,
and (4) offer recommendations for future research and for the design and
evaluation of self care interventions for caregivers.
_____
Record: 43
Title: Parents, professionals, and the transition process.
Author(s): Hitchings, W. E., St Ambrose U, Davenport, IA, US
Natelle, Barbara
Ristow, Robert
Source: Adults with disabilities: International perspectives in the
community. Retish, Paul (Ed); Reiter, Shunit (Ed); pp. 77-102. Mahwah,
NJ, US: Lawrence Erlbaum Associates, Publishers, 1999. xiv, 353 pp.
ISBN: 0-8058-2424-3 (hardcover)
Language: English
Keywords: transition from secondary school to employment or
university studies & independent living & impact on individuals &
family, adolescents or young adults with disabilities
Abstract: (from the chapter) Graduation from secondary school,
going on to employment or university, leaving home or the community and
moving to our own place to live: all mark major changes in the lives of
young adults. Each event signals a transition or phase in the transition
process. These transitions impact not only the individual but their
families as well. The impact may be more significant to families who
have adolescents or young adults with disabilities, and this raises
questions about the role of parents in such adolescent's transitions
from secondary school to the adult world (E. Thorin, P. Yovanoff, L.
Irvin, 1996). The parents in the vignettes in this chapter respond to
transition in different ways. Their reactions, and how professionals can
better assist parents during this critical time, are the foci of this
chapter.
_____
Record: 44
Title: Clinical stages of Alzheimer's disease.
Series Title: The encyclopedia of visual medicine series
Author(s): Reisberg, Barry, New York U, School of Medicine, Dept of
Psychiatry, Aging & Dementia Research Ctr, New York, NY, US
Franssen, Emile H.
Source: An atlas of Alzheimer's disease. de Leon, Mony J. (Ed); pp.
11-20. New York, NY, US: Parthenon Publishing Group, 1999. 149 pp.
ISBN: 1-85070-912-2 (hardcover)
Language: English
Keywords: global & functional clinical stages & substages of aging
& Alzheimer's disease
Abstract: (from the chapter) Alzheimer's disease (AD) is a
characteristic process with readily identifiable clinical stages. These
clinical stages can be described in alternative ways. For example, they
can be described globally or they can be described in terms of
constituent elements, or clinical axes. One of these clinical axes,
functioning and self-care, is particularly useful in describing the
progression of AD. A combination of global changes and their functional
concomitants can provide a very clear map of the progress of AD.
Globally, 7 major stages from normality to most severe AD are
identifiable. Functionally, 16 stages and substages corresponding to the
global stages are recognizable. These global and functional clinical
stages and substages of aging and AD are summarized in this chapter.
_____
Record: 45
Title: The Behavioural Assessment Scale: Internal consistency and
factor structure for an elderly psychiatric population.
Author(s): Woodward, Todd S., U Victoria, Dept of Psychology,
Victoria, BC, Canada
Iverson, Grant L.
Source: Applied Neuropsychology, Vol 6(3), 1999. pp. 170-177.
Journal URL:
https://www.erlbaum.com/shop/tek9.asp?pg=products&specific=0908-4282
Publisher: US: Lawrence Erlbaum
Publisher URL: http://www.erlbaum.com/
ISSN: 0908-4282 (Print)
1532-4826 (Electronic)
Language: English
Keywords: reliability & factor structure of Behavioural Assessment
Scale, language & mobility & physical independence & occupation &
orientation & social integration, psychiatric 60-97 yr old patients
Abstract: The subscales of the Behavioural Assessment Scale (BAS)
(Language, Mobility, Physical Independence, Occupation and Orientation
and Social Integration) were designed to measure specific areas of
functioning. The purpose of this investigation was to assess the
psychometric structure of the BAS in a sample of 275 geriatric
psychiatry inpatients aged 60-97 yrs. This psychometric assessment was
carried out using 2 methods: measures of internal consistency and
exploratory factor analysis. The measures of internal consistency
suggested that only the Language and Physical Independence subscales
measured a unified construct. The subsequent factor analysis revealed 3
highly correlated factors that accounted for 65% of the item variance.
These factors were interpreted as Daily Living Skills,
Communication/Social Skills, and Problem Behavior. The high
intercorrelations between the factors were interpreted as a general
sensitivity of the BAS to global decline in functioning associated with
dementia (i.e., severity of illness). The computation of factor-based
subscales and a general functioning aggregate were recommended for
clinical use of the BAS.
_____
Record: 46
Title: Expectations of health, independence, and quality of life among
aging spinal cord-injured adults.
Author(s): McColl, Mary Ann, Queen's U, School of Rehabilitation
Therapy, Kingston, ON, Canada
Address: McColl, Mary Ann, Queen's U,School of Rehabilitation
Therapy, Kingston, ON, Canada, K7L 3N6
Source: Assistive Technology, Vol 11(2), 1999. pp. 130-136.
Publisher: US: RESNA
Publisher URL: http://www.resna.org/
ISSN: 1040-0435 (Print)
Language: English
Keywords: spinal cord injury; aging; mortality; health;
independence; quality of life
Abstract: While our understanding of aging and mortality in spinal
cord injury (SCI) is evolving, precise estimates are still not available
to assist people with SCIs in knowing what to expect as they grow older.
Life expectancy of those with SCI appears to be improving. However,
little is known about the conditions in which individuals may expect to
spend their remaining years of life. This study used information from a
50-yr database on SCI, in combination with national mortality statistics
and new survey information, to estimate the number of remaining years
that individuals could expect to spend in a variety of states of health,
independence, and quality of life. The study shows that expectations of
health are similar to those found in the general population. Regardless
of total life expectancy, individuals could expect to spend about 6 of
their remaining years in poor health, presumably near the end of life.
Expectations of independence varied depending on lesion level. Those
with paraplegia became less independent over time, moving from complete
to modified independence. Those with quadriplegia appeared to have a
greater expectation of independence over time; however, in actuality,
only those who were most independent survived to report outcomes at
older ages.
_____
Record: 47
Title: Everyday competence in old and very old age: Theoretical
considerations and empirical findings.
Author(s): Baltes, Margret M., Free U, Dept of Gerontopsychiatry,
Psychological Gerontology Research Unit, Brussels, Belgium
Maas, Ineke
Wilms, Hans-Ulrich
Borchelt, Markus
Little, Todd D.
Source: Berlin Aging Study: Aging from 70 to 100. Baltes, Paul B. (Ed);
Mayer, Karl Ulrich (Ed); pp. 384-402. New York, NY, US: Cambridge
University Press, 1999. xii, 552 pp.
ISBN: 0-521-62134-8 (hardcover)
Language: English
Keywords: construction of model of basic & expanded level of
competence, 70-103 yr olds
Abstract: (from the chapter) Focuses on the construction of a
model of everyday competence, differentiating between a basic level of
competence (BLC), defined mainly by self-care related activities, and an
expanded level of competence (ELC), reflecting mostly discretionary or
optional activities such as leisure, social and instrumental activities
of daily living. Since BLC encompasses highly automatized and routinized
activities that are necessary for survival, it is thought to be
predicted foremost by health-related resources. In contrast, ELC
encompasses activities that are based on individual preferences, skills,
motivations, and interests, and therefore should be more dependent on
psychosocial resources. To test this model, a multidimensional or
multivariable assessment of the 2 components and their predictors is
necessary.
516 70-103 yr olds participated.
The findings support the model: A total of 91% of the reliable variance
in ELC and 86% in BLC can be explained by the predictors.
_____
Record: 48
Title: Srovnání kvality zivota pred a jeden rok po transplantaci jater.
Translated Title: Comparison of quality of life before and one
year after the liver transplantation.
Author(s): Ptácková, Andrea
Source: Ceskoslovenska Psychologie, Vol 43(4), 1999. pp. 338-348.
Publisher: Czech Republic: Czechoslovak Academy of Sciences/Inst of
Psychology
Publisher URL: http://www.cas.cz
ISSN: 0009-062X (Print)
Language: Czech
Keywords: liver transplantation, quality of life, 14-64 yr old
patients
Abstract: Studied the quality of life of hepatic transplant
patients in the Czech Republic before (1997) and 1 yr after surgery
(1998). 39 male and female Ss were interviewed before surgery, and 36
male and female Ss were interviewed following surgery. Ss were aged
14-64 yrs. Quality of life was assessed with the Czech version of the
SQUALA and the COOP/WONCA Charts (C. van Weel et al, 1995). The results
show that surgery led to statistically significant improvement in the
areas of health, well-being, self-care, rest, physical condition, daily
activities, and social activity. The total score for quality of life
improved significantly only for the COOP/WONCA Charts.
_____
Record: 49
Title: The Family Support Program: Description of a preventive,
community-based behavioral intervention for children with pervasive
developmental disorders.
Author(s): Luiselli, James K., May Inst, May Ctr for Education &
Vocational Training, Norwood, MA, US
Wolongevicz, John
Egan, Patricia
Amirault, Deborah
Sciaraffa, Nancy
Treml, Tania
Source: Child & Family Behavior Therapy, Vol 21(1), 1999. pp. 1-18.
Journal URL: http://www.haworthpressinc.com/store/product.asp?sku=J019
Publisher: US: Haworth Press
Publisher URL: http://www.haworthpress.com
ISSN: 0731-7107 (Print)
Language: English
Keywords: community-based behavioral program, acquisition of
self-care skills & reduction of challenging behaviors, 6.7-16.5 yr old
males with autism &/or related pervasive developmental disorders
Abstract: Described a model of service delivery that seeks to
prevent students at-risk for autism and related pervasive developmental
disorders from being placed residentially and to return those who lived
in residential schools to less restrictive settings. The Family Support
Program incorporated an applied behavior analysis orientation, with
training and intervention implemented in a S's home and neighborhood
community. The organization and critical components of the program are
described, including outcome data for the 7 male Ss (aged 6.7-16.5 yrs).
The analysis focuses on the effects of the Family Support Program on the
acquisition of self-care skills and the reduction of challenging
behaviors. Issues related to educational practices, preventive
interventions, and community-based research are discussed.
_____
Record: 50
Title: On being an ill parent.
Author(s): Altschuler, Jenny, The Tavistock Clinic, Child & Family
Dept, London, England
Dale, Barbara
Source: Clinical Child Psychology & Psychiatry, Vol 4(1), Jan 1999. pp.
23-37.
Publisher: US: Sage Publications
Publisher URL: http://www.sagepublications.com/
ISSN: 1359-1045 (Print)
Digital Object Identifier: 10.1177/1359104599004001003
Language: English
Keywords: parenting concerns & coping, mothers or fathers with
serious illness, clinical implications
Abstract: Limited research and clinical attention has been paid to
the experience of being an ill parent, so that parents are given little
support in preparing for the effect their illness might have on their
children. This article, based on the authors' clinical experience with
ill parents, explores how parents manage being a patient and a parent at
the same time. Three themes are examined: parental fears that illness
renders them less fit to meet the needs of their children; dilemmas
about balancing self-care with the care of others; and how the illness
can evoke feelings that relate to previous trauma, influencing their
responses to their children in the present. How these issues do not
happen in isolation, but in the context of ongoing intimate, family
relationships is highlighted. It is suggested that if they are not
addressed, parents and children are left unprepared to meet the demands
which illness poses. Finally, the implications for clinical work in this
area are examined.
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