Showing papers on "Psychological intervention published in 1990"

The value of assessing falls in an elderly population. A randomized clinical trial.

Abstract: OBJECTIVE: To measure the effects of a specialized postfall assessment intended to detect causes and underlying risk factors for falls, and to recommend preventive and therapeutic interventions. DESIGN: Randomized, controlled trial. SETTING: A long-term residential care facility for elderly persons. SUBJECTS: Within 7 days of a fall, 160 ambulatory subjects (mean age, 87 years) were randomly assigned to receive either a comprehensive postfall assessment (intervention group, n = 79) or usual care (control group, n = 81). INTERVENTION: The postfall assessment included a detailed physical examination and environmental assessment by a nurse practitioner; laboratory tests; electrocardiogram; and 24-hour Holter monitoring. Probable cause or causes for the fall, identified risk factors, and therapeutic recommendations were given to the patient's primary physician. MEASUREMENTS AND MAIN RESULTS: Through use of the assessment, many remediable problems (for example, weakness, environmental hazards, orthostatic hypotension, drug side effects, gait dysfunction) were detected. At the end of the 2-year follow-up period, the intervention group had 26% fewer hospitalizations (P less than 0.05) and a 52% reduction in hospital days (P less than 0.01) compared with controls. Patients in the intervention group had 9% fewer falls and 17% fewer deaths than controls by 2 years, but these trends were not statistically significant. CONCLUSIONS: Our study suggests that falls are a marker of underlying disorders easily identifiable by a careful postfall assessment, which in turn can reduce disability and costs. Language: en

Recognition, management and outcome of psychological disorders in primary care : a naturalistic follow-up study

Abstract: This article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and the association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS). Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 'new' patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrollment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders. Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.

Depression in Marriage: A Model for Etiology and Treatment

Abstract: By utilizing a marital discord model of depression, therapists can tap the power of the marital relationship to promote growth and healing rather than work against the powerful forces of the marital dyad. Offering precise guidelines for assessment, intervention, and management, Depression In Marriage provides useful clinical measurement tools and uses case vignettes to illustrate practical issues. Interventions are described in detail, with references to the relevant research literature. Whether marital therapy is the primary treatment modality, or an adjunct to individual or somatic interventions, Depression In Marriage will help identify useful, practical intervention strategies.

Severe Behavior Problems: A Functional Communication Training Approach

Abstract: Functional Communication Training involves teaching children how to communicate those basic wants and needs that they now express through problem behavior. This book provides the practitioner with step-by-step instructions for implementing this effective approach. A variety of assessment strategies are reviewed and described to assist in determining appropriate interventions. Numerous case examples throughout illuminate both the assessment and intervention strategies.

Enhancement of social learning family interventions for childhood conduct disorder.

Abstract: Social learning family intervention (SLFI) is the treatment of choice for young children exhibiting severe conduct disorder and antisocial behavior. Despite the reported success of this intervention, high levels of resistance, poor engagement, and inadequate maintenance of improvements are observed for a substantial proportion of distressed families. These obstacles have inspired enhancement efforts to improve basic social learning family-intervention models. The present review identifies promising approaches for maximizing treatment gains for the conduct-disordered child. Relevant studies were organized into 3 approaches: enhancements and expansions (a) within a dyadic (parent-child) interaction model, (b) within a broad-based model that acknowledges a wider range of family influences, and (c) through a multisystems model. SLFI enhancements within the dyadic model have centered on either the strengthening of parental skills already included in the SLFI regimen or the adding of new interactional strategies. Some gains, but only partial success, have been achieved with the dyadic model supplements. SLFI expansions from a broad-based model have focused on parental adjustment, parental expectations during treatment, and social-environmental stressors. The multisystems adjuncts to SLFI include cognitive-behavioral interventions to affect peer relations and ecological approaches to sweep across domains. The broad-based and multisystems expansions have produced promising but undertested treatment regimens. Related areas of investigation included therapy process research, medication combined with SLFI, and the involvement of fathers in treatment. Recommendations are offered for improvement of SLFI research. The apparent theoretical crossroads for SLFI treatment of childhood conduct disorder are discussed.

Stress at work and mental health status among female hospital workers.

Abstract: Relations between working conditions and mental health status of female hospital workers were studied in a sample of 1505 women: 43% were nurses, 32% auxiliaries, and 7% ancillary staff; 13% were other qualified health care staff, mainly head nurses; 5% had occupations other than direct health care; 63% worked on the morning, 20% on the afternoon, and 17% on the night shift. Data were collected at the annual routine medical visit by the occupational health practitioner, using self administered questionnaires and clinical assessments. Five health indicators were considered: a high score to the general health questionnaire (GHQ); fatigue; sleep impairment; use of antidepressants, sleeping pills, or sedatives; and diagnosis of psychiatric morbidity at clinical assessment. Four indices of stress at work were defined: job stress, mental load, insufficiency in internal training and discussion, and strain caused by schedule. The analysis was conducted by multiple logistic regression, controlling for type of occupation, shift, number of years of work in hospital, daily travel time to work, age, marital status, number of children, and wish to move house. Sleep impairment was mostly linked to shift and strain due to schedule. For all other indicators of mental health impairment and especially high GHQ scores, the adjusted odds ratios increased significantly with the levels of job stress, mental load, and strain due to schedule. This evidence of association between work involving an excessive cumulation of stress factors and mental wellbeing should be considered in interventions aimed at improving the working conditions of hospital workers.

Psychosocial effects on carers of living with persons with dementia.

Abstract: A survey of members of the Alzheimer's Disease and Related Disorders Society confirmed high rates of psychological morbidity, though not of depression, and social isolation in family carers of persons with dementia. Psychological morbidity in carers was associated with having an affected person at home, the carer being a spouse, demanding problem behaviours, poor physical health in the carer, social isolation, dissatisfaction with social supports, greater use of psychotropic medication, and a deteriorated marital relationship. Carers and patients had high rates of consultations with doctors and other health professionals. There was a vulnerable group of carers who were impaired psychologically, socially and physically. The identification of risk factors to carer morbidity may lead to useful interventions.

Helping the Client: A Creative Practical Guide

Abstract: Introduction Preparation for Helping Client Categories and States Prescriptive Interventions Informative Interventions Confronting Interventions Cathartic Interventions Catharsis and Transmutation Catalytic Interventions Supportive Interventions Basic Interventions Phases and Sequencing Degenerate and Perverted Interventions Six-Category Training Teaching Interpersonal Skills Co-Counselling

Improving medication prescribing and utilization in the nursing home.

Abstract: There is ample and compelling evidence to suggest that medications are frequently used inappropriately in the nursing home. The occurrence of avoidable adverse drug reactions is the most serious consequence of inappropriate prescribing; economic implications are also of interest. With increasing concern over the quality of care in nursing homes, and with the revision of regulations governing such care by the Health Care Financing Administration, it is important to consider the experience thus far in monitoring and improving drug use in nursing homes. A number of studies have investigated approaches designed to reduce inappropriate prescribing and drug utilization in this setting. In contrast to the wide range of approaches that have been evaluated and implemented in the hospital setting, interventions in the nursing home have centered primarily around consultant-pharmacist activities. Although these activities are now federally mandated in all nursing homes, there is little evidence from adequately controlled studies to document their impact or cost-effectiveness. By contrast, face-to-face educational interventions directed at physicians ("academic detailing") have been shown to be effective in improving prescribing for some medications. The prominent role played by the nursing staff in the utilization of many medications in the nursing home implies that an educational intervention excluding nursing staff would be insufficient to influence drug utilization positively in many situations (eg, psychoactive medications and laxatives). Future research efforts must pay greater attention to adequate study design considerations as well as to the clinical outcomes of such interventions and their cost-effectiveness.

A study of the effectiveness of two group behavioral medicine interventions for patients with psychosomatic complaints.

Abstract: This randomized, prospective study investigated the effectiveness of two group behavioral medicine interventions for primary care patients experiencing physical symptoms with a psychosocial component (eg, palpitations, gastrointestinal disturbances, headaches, malaise, sleep disorders) The subjects were 80 volunteers at a health maintenance organization (HMO) in the greater Boston area Both interventions focused on the mind/body relationship and used didactic material, relaxation-response training, awareness training, and cognitive restructuring The two behavioral medicine intervention groups were compared with a group that focused exclusively on information about stress management and its relation to illness Measures of visits to the HMO and of distress from physical and psychological symptoms were obtained before the interventions and again 6 months afterward At the 6-month follow-up, patients in the behavioral medicine groups showed significantly greater reductions in visits to the HMO an

Medication compliance and health education among outpatients with chronic mental disorders.

Abstract: Medication noncompliance occurs among as many as one-third to one-half of all medical and psychiatric outpatients. Noncompliance has serious consequences for individuals diagnosed with schizophrenia, often resulting in higher rates of relapse and rehospitalization, and poorer community adjustment. H

Parental injury prevention endeavors: a function of health beliefs?

Abstract: Investigating parents' beliefs about injury prevention may yield important information for planning preventive interventions. A comprehensive description of parents' beliefs about injury prevention is presented in this study, and effects of child age and sex are described. In addition, a health belief model was successfully used to predict parent-reported teaching of safety skills and preventive environmental interventions. The model successfully cross-validated the prediction in two independent samples. Parents reported low feelings of susceptibility or worry about injury. The variables most associated with parental preventive endeavors were the belief that intervention can avoid injury, a realistically high appraisal of the amount of time involved, and feelings of high knowledge and competence to teach safety skills. Implications of these data for designing more effective behavioral interventions are described.

Poverty and early childhood parenting: toward a framework for intervention

Abstract: The relationship between poverty and child rearing has been a persistent source of social concern in the United States. Drawing on available literature, this paper seeks to establish a conceptual approach to the interaction of these two complex variables. Appropriate interventions and strategies for their implementation are considered.

Effect of reactive pharmacy intervention on quality of hospital prescribing

Abstract: OBJECTIVE--To evaluate the medical impact of reactive pharmacy intervention. DESIGN--Analysis of all interventions during 28 days by all 35 pharmacists in hospitals in Nottingham. SETTING--All (six) hospitals in the Nottingham health authority (a teaching district), representing 2530 mainly acute beds, 781 mental illness beds, and 633 mainly health care of the elderly beds. PATIENTS--Hospital inpatients and outpatients. INTERVENTIONS--Recording of every important intervention made by pharmacists to prescriptions for both inpatients and outpatients when they perceived inadequacies of drug prescription or administration, including characterisation of the problem, coding of outcome, recording of time taken to initiate and resolve intervention, and grade of prescribing doctor. The problems were independently assessed for their potential to cause medical harm. RESULTS--769 Interventions (about 2.9% of prescriptions) were made, of which 60 concerned prescriptions rated as having a major potential for medical harm. The commonest problems concerned dosage, which was wrong in 280 prescriptions (102 for antibiotics) and not stated in 50 (one for antibiotics), especially those associated with a major potential for medical harm (32 prescriptions). These concerned sedatives; analgesics; cardiovascular drugs or diuretics; and iron, vitamin, or mineral preparations. Also common were overprolonged prescription of antibiotics (48 prescriptions), confusion of drug names (nine), and inadvertent coprescription of excessive quantities of aspirin or paracetamol in plain and compound preparations (seven). The pharmacist's recommendation was accepted in 639 instances (86%), and the prescription was altered in 575, leading to an appreciable (246 cases) or minor (231 cases) improvement. Interventions had little effect on costs; 427/646 had no effect and 130 produced savings less than 50p. Pharmacy intervention (730/769 interventions) occupied on average 41 minutes per pharmacist per week. CONCLUSIONS--Most reactive pharmacy interventions concerned prescribing errors with a limited potential for medical harm, but a small number of detected errors with a major potential for medical harm; cost savings were not appreciable.

Substance Abuse Prevention: Theory, Practice, and Effectiveness

Abstract: Interventions developed to reduce or prevent substance use have taken many forms, including school-based prevention/education programs, mass media campaigns, youth clubs and activities designed as alternatives to substance use, and community-based movements. Evaluation studies indicate that these interventions have frequently increased knowledge and awareness and have occasionally had an impact on attitudes and other drug-related variables. However, rarely have any of these interventions had an impact on substance-use behavior. A major exception is a class of school-based primary prevention approaches that focus on the key psychosocial factors promoting adolescent substance use. These approaches include either resistance-skills training alone or in combination with life-skills training. Although the evolution of these programs is an encouraging development in a field replete with failures, the extant empirical and theoretical literature suggests the need for a comprehensive prevention strategy that combin...

A conceptual framework for developing and evaluating behavior change interventions for injury control

Abstract: This paper addresses issues and research needs in the domain of behavior modification for injury control. Although much of the discussion focuses on traffic safety, the concepts and principles are applicable to all areas of injury control (e.g. on the job and in the home). Field research that has increased safety belt use is reviewed briefly to illustrate a tripartite classification of injury control factors (i.e. environmental, individual, or behavioral variables), and to introduce a heuristic framework for categorizing and evaluating behavior change strategies. A multiple intervention level hierarchy depicts a progressive segmentation of the target population as more effective (and costly) interventions are implemented; and a taxonomy of 24 behavior change techniques includes a scoring system for predicting short and long term effects of intervention programs. It is presumed that more risk-prone individuals require higher-level interventions, which are those that provide specific response information and extrinsic controls, while also eliciting active participant involvement, social support, and perceptions of autonomy. Although extrinsic controls increase the immediate impact of an intervention program, these techniques may jeopardize response maintenance when the program is withdrawn.

Dual Diagnosis: Counseling the Mentally Ill Substance Abuser

Abstract: Mental health professionals and case managers working with dually diagnosed clients; students in psychology, psychiatry, social work, addictions counseling, and related fields.Updated for today's health care climate, the revised and expanded second edition of this popular volume offers a thorough introduction to clinical work with this difficult-to-treat population. Updated to DSM-IV, the second edition includes discussions of the latest developments in treatment, sample treatment plans, increased coverage of ways to incorporate 12-step concepts into mental health interventions, and a new section on trauma-based disorders in addicted female adolescents.

Medical problems of adults who were sexually abused in childhood.

Abstract: The aim of the study was to see whether adults who had been sexually abused in childhood were vulnerable to physical symptoms and therefore investigation and intervention. The case histories of seven patients who were aged 22-39, were under the care of three consultant psychiatrists, had experienced childhood sexual abuse, and had a history of medical or surgical intervention were surveyed. The patients had had a mean of 18 contacts with non-psychiatric consultant teams and a mean of eight operations, with a high rate (66-70%) of normal findings. They had experienced many somatic symptoms, which led to investigations and interventions in the specialties of gynaecology, obstetrics, gastroenterology, urology, rheumatology, haematology, orthopaedics, neurology, and neuropsychiatry. The history of childhood sexual abuse was recognised only in the later stages of this medical and surgical intervention. The possibility of childhood sexual abuse should be considered earlier in such cases to prevent further unnecessary intervention.

When social support fails: The homeless

Abstract: The social support networks of residents of a temporary shelter for the homeless were examined. Participants (N = 125) were interviewed to obtain detailed information concerning resources of support, specific types of support, and subjective appraisals of support. Seven meaningful subgroups of homeless persons were identified using a cluster analysis technique. These groups varied along the dimensions of transiency, psychiatric history, criminal victimization, and criminal activity. As expected, this population had relatively small social networks, although most clearly had some sources of support, particularly from family members. Few differences on social support variables were revealed between subgroups. The differences between the homeless and other nonclinical populations are discussed, and implications for interventions are addressed.

Comparative Effectiveness of Individual and Group Interventions to Support Family Caregivers

Abstract: The comparative effectiveness of individual and group interventions in supporting family caregivers of frail older people was examined. An individual intervention produced more positive effects on caregiver psychological functioning and well-being than did a group intervention, whereas a group intervention produced greater improvements in caregivers' social supports. Participants in both interventions experienced significant improvements in coping with caregiving stress. Process differences are proposed as an explanation for the differential effects of the two intervention modalities. Psychological issues respond best to individual intervention, and social support issues respond best to group intervention. Therefore, the most appropriate type of intervention might be determined by the types of problems and issues specific to an individual caregiver.

Family-Based Interventions for Helping Drug-Abusing Adolescents

Abstract: This article describes the efficacy of two family-oriented, outpatient drug interventions for 84 adolescents who had used and abused drugs. Together, the two brief drug interventions appeared to si...

"Comorbidity" in Child and Adolescent Psychiatry: Categorical and Quantitative Perspectives

Abstract: Apparent comorbidity may arise as an artifact of conceptual or diagnostic models that impute inappropriate boundaries between disorders. To draw firm conclusions about comorbidity, each disorder must be clearly distinguishable from others. Few behavioral or emotional disorders of childhood have been validated as separate diagnostic entities that can be reliably distinguished from one another. Rather than accepting reports of comorbidity at face value, we need to understand how particular conceptual and diagnostic schemas affect the perceived relations among disorders. Categorical and quantitative models offer potentially complementary approaches to differentiating between disorders more effectively, a process that is essential for improving our knowledge of etiology and our assessment of the risks and benefits of particular psychopharmacological interventions.

Four psychosocial theories and their application to patient education and clinical practice.

Abstract: Although the development of theoretically based and empirically verified practice guidelines is now possible, some health education practice still remains uninformed by this research-based knowledge. This article describes four psychosocial theories that have been useful in our practices: self-efficacy, stress and coping, learned helplessness, and social support. The theories are introduced and compared; practical suggestions for their use in the development of health education interventions are then discussed. Skills mastery, modeling, reinterpretation of physical signs and symptoms, and persuasion are presented as ways of enhancing self-efficacy. Some similar strategies are presented as examples of coping techniques, including positive reappraisal or reinterpretation. Other coping strategies such as confronting, distancing, self-care, seeking social support, accepting responsibility, escape avoidance or ignoring, problem solving, activity, distraction, self-talk, and prayer are also introduced. Cognitive restructuring is examined most fully as an example of an intervention strategy derived from learned helplessness theory. And finally, five strategies for fostering positive social support are presented: enhancing personal networks, linking volunteers, establishing mutual aid networks, identifying and supporting neighborhood helpers, and community empowerment.

“Hello, May We Help You?” A Study of Attrition Prevention at the Time of the First Phone Contact with Substance-Abusing Clients

Abstract: The problem of early attrition from treatment is pervasive throughout community mental health and is particularly high for substance-abusing clients. In spite of the severity of this problem and the potential for successful interventions, there have not been many studies that attempt to reduce the dropout rate of drug abusers. The purpose of this research was to test the effectiveness of attrition prevention procedures at the time of the client's first phone contact with the clinic. Callers were either given an appointment or told to come to the clinic the same day. A second variable was the presence or absence of an experimenter-initiated dialogue designed to help subjects predict possible obstacles to attendance and to generate potential solutions to those barriers. Subjects in the same day conditions showed at a higher rate than those given appointments, but the addition of the dialogue had no effect on client behavior. The results are discussed in terms of how mental health professionals can find cost effective interventions that prevent drug abuse treatment dropout.

Depression among elderly residents of local-authority residential homes. Its nature and the efficacy of intervention.

Abstract: Of 390 residents in 12 local-authority homes for the elderly, 93 had evidence of depression on screening and underwent standard clinical assessment. Half had an affective disorder, and a further third had depressive symptoms in the setting of an organic mental disorder. The 93 residents had a high rate of physical illness and disability, undertook little social activity, and were visited infrequently. A range of interventions for depressed residents, the majority social in type, mostly proved difficult to implement. There was no evidence of efficacy of psychiatric intervention at three months; at one-year follow-up a quarter of study participants had died, and 28% of those who were reassessed for depression showed evidence of recovery.

The role of attitudes and interventions in gender-schematic processing.

Abstract: Research on gender-schematic processing has shown that children often forget and/or distort counterstereotypic information. This process may in part explain the limited impact of past intervention efforts in which children were simply exposed to counterstereotypic information. Here we attempt to reduce schematic-processing distortions by first teaching children decision rules about occupational sorting based not on gender but rather on interests and skills. It was hypothesized that this intervention would lead to greater flexibility in children's beliefs about what men and women can do. Assuming this effect was found, the study was designed to provide an experimental test of the hypothesized relation between attitudes and memory that had been demonstrated only correlationally in previous research. As predicted, the experimental intervention with elementary school children led to a reduction of occupational stereotyping. Children's own occupational aspirations were not, however, significantly affected. Consistent with the hypothesized effect of attitudes on memory, children in the experimental intervention showed superior recall of counterstereotypic information in a later memory test. Results are discussed with respect to the utility of cognitive-developmental theory for planning and evaluating future interventions.

Social influence processes and prevention

Abstract: Frameworks for Applying Social Psychological Processes to Social Issues.- Psychosocial Aspects of AIDS Prevention among Heterosexuals.- Social Influence and AIDS-Preventive Behavior.- Understanding and Preventing Teenage Pregnancy and Sexually Transmitted Disease/AIDS.- Implications of Behavioral Decision Theory and Social Marketing for Designing Social Action Programs.- Applying a Social Psychological Model across Health Promotion Interventions.- Heart Health Program.- Social Influence and Antiprejudice Training Programs.- Reducing Aggression in Children through Social Interventions.- The "Psycho-Logic" of Fear-Reduction and Crime-Prevention Programs.- Preventing Injuries and Deaths from Vehicle Crashes.- A Two-Factor Model of Energy and Water Conservation.- Alternative Social Influence Processes Applied to Energy Conservation.- Public Policy and Applied Social Psychology.