자연주의적 탐구조사(Naturalistic Inquiry)

admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Cognitive Behavioural Therapy (CBT) has established itself as one of the most effective therapies for treating a wide range of psychological disorders. However, research and treatment in this field typically adopts a DSM driven 'disorder-focused' approach - researchers and clinicians target a specific disorder, try to understand its aetiology and maintenance, and try to develop more effective strategies to treat the disorder. This book proposes an insightful and original approach to understanding these disorders, one that focuses on what they have in common. Instead of examining in isolation, for example, obsessive compulsive disorders, insomnia, schizophrenia, it asks - what do patients with these disorders have in common? It takes each cognitive and behavioural process - attention, memory, reasoning, thought, behaviour, and examines whether it is a transdiagnostic process - i.e., serves to maintain a broad range of psychological disorders. Having shown how these disorders share several important processes, it then describes the practical implications of such an approach to diagnosis and treatment. Importantly it explores why the different psychological disorders can present so differently, despite being maintained by the same cognitive and behavioural processes. It also provides an account of the high rates of comorbidity observed among the different disorders. This book provides a novel review and integration of the empirical literature and gives clinicians and researchers a valuable new theoretical base for assessing and treating psychological disorders. Cognitive Behavioural Therapy (CBT) has established itself as one of the most effective therapies for treating a wide range of psychological disorders. However, research and treatment in this field typically adopts a DSM driven 'disorder-focused' approach - researchers and clinicians target a specific disorder, try to understand its aetiology and maintenance, and try to develop more effective strategies to treat the disorder. This book proposes an insightful and original approach to understanding these disorders, one that focuses on what they have in common. Instead of examining in isolation, for example, obsessive compulsive disorders, insomnia, schizophrenia, it asks - what do patients with these disorders have in common? It takes each cognitive and behavioural process - attention, memory, reasoning, thought, behaviour, and examines whether it is a transdiagnostic process - i.e., serves to maintain a broad range of psychological disorders. Having shown how these disorders share several important processes, it then describes the practical implications of such an approach to diagnosis and treatment. Importantly it explores why the different psychological disorders can present so differently, despite being maintained by the same cognitive and behavioural processes. It also provides an account of the high rates of comorbidity observed among the different disorders. This book provides a novel review and integration of the empirical literature and gives clinicians and researchers a valuable new theoretical base for assessing and treating psychological disorders.

Cognitive Behavioural Processes across Psychological Disorders: A Transdiagnostic Approach to Research and Treatment

Delis‐Kaplan Executive Function System

BACKGROUND Body dysmorphic disorder (BDD) consists of a preoccupation with an 'imagined' defect in appearance which causes significant distress or impairment in functioning. There has been little previous research into BDD. This study replicates a survey from the USA in a UK population and evaluates specific measures of BDD.

METHOD Cross-sectional interview survey of 50 patients who satisfied DSM-IV criteria for BDD as their primary disorder.

RESULTS The average age at onset was late adolescence and a large proportion of patients were either single or divorced. Three-quarters of the sample were female. There was a high degree of comorbidity with the most common additional Axis l diagnosis being either a mood disorder (26%), social phobia (16%) or obsessive-compulsive disorder (6%). Twenty-four per cent had made a suicide attempt in the past. Personality disorders were present in 72% of patients, the most common being paranoid, avoidant and obsessive-compulsive.

CONCLUSIONS BDD patients had a high associated comorbidity and previous suicide attempts. BDD is a chronic handicapping disorder and patients are not being adequately identified or treated by health professionals.

Body dysmorphic disorder. A survey of fifty cases.

Body dysmorphic disorder: a cognitive behavioural model and pilot randomised controlled trial

http://sro.sussex.ac.uk/2232/1/wound_healing.pdf

Psychological stress and wound healing in humans: A systematic review and meta-analysis

Background Depot antipsychotic medication is used widely in the treatment and prophylaxis of severe mental illness.

Aims To review the literature on patient and nurse satisfaction with, and attitudes towards, depots.

Method A systematic search of Medline, Embase, PsycINFO, CINAHL and The Cochrane Library was undertaken, along with citation searches. Studies were selected if satisfaction/attitude data were described in the title or abstract and original data were included. Study quality was rated.

Results The search produced 1374 articles; 22 articles met the inclusion criteria, 18 of which were cross-sectional surveys. Of the 12 studies with relevant data, 10 conveyed a positive opinion of depot medication. Five out of six studies comparing depot with oral medication showed patient preference for depot.

Conclusions High-quality data examining patient and nurse attitudes regarding depot antipsychotics are sparse. What data there are show a positive attitude to depots from patients. Future randomised controlled trials should include satisfaction as an outcome.

/pdf/systematic-review-of-patient-and-nurse-attitudes-to-depot-om7ig6atpb.pdf

Systematic review of patient and nurse attitudes to depot antipsychotic medication

Background: Because there is no muscle disease specific measure of quality of life (QoL), we wanted to develop and validate an individualized muscle disease specific measure of QoL for adults suitable for both clinical and research use. Methods: A literature review exploring QoL and its measurement resulted in the development of a theoretical model of QoL. This was used alongside qualitative interviews (n = 41) and a postal survey (n = 252) to design a questionnaire. The psychometric properties, validity (n = 95), reliability (n = 40), and responsiveness (n = 25) of the scale were assessed. Results: The Individualized Neuromuscular Quality of Life questionnaire (INQoL) consists of 45 questions within 10 sections. Four of these focus on the impact of key muscle disease symptoms (weakness, locking [i.e., myotonia], pain, and fatigue), five look at the impact (degree and importance of impact) muscle disease has on particular areas of life, and one section asks about the positive and negative effects of treatment. The questionnaire is structured to allow for variations in the individual characteristics that influence quality of life. Psychometric evaluation established construct validity and test–retest reliability. A preliminary assessment of responsiveness was obtained. Conclusions: The Individualized Neuromuscular Quality of Life is a validated muscle disease specific measure of quality of life developed from the experiences of patients with muscle disease and can be used for individuals or large samples.

Jessica Walburn

Papers

Body dysmorphic disorder. A survey of fifty cases.

Body dysmorphic disorder: a cognitive behavioural model and pilot randomised controlled trial

Psychological stress and wound healing in humans: A systematic review and meta-analysis

Systematic review of patient and nurse attitudes to depot antipsychotic medication

Construction and validation of a quality of life questionnaire for neuromuscular disease (INQoL).