Showing papers on "Psychological intervention published in 1992"

The concept of mental disorder: On the boundary between biological facts and social values.

Abstract: Although the concept of mental disorder is fundamental to theory and practice in the mental health field, no agreed on and adequate analysis of this concept currently exists. I argue that a disorder is a harmful dysfunction, wherein harmful is a value term based on social norms, and dysfunction is a scientific term referring to the failure of a mental mechanism to perform a natural function for which it was designed by evolution. Thus, the concept of disorder combines value and scientific components. Six other accounts of disorder are evaluated, including the skeptical antipsychiatric view, the value approach, disorder as whatever professionals treat, two scientific approaches (statistical deviance and biological disadvantage), and the operational definition of disorder as "unexpectable distress or disability" in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987). The harmful dysfunction analysis is shown to avoid the problems while preserving the insights of these other approaches.

Evidence for the effectiveness of CME. A review of 50 randomized controlled trials.

Abstract: Objective. —To assess the impact of diverse continuing medical education (CME) interventions on physician performance and health care outcomes. Data Sources. —Usingcontinuing medical educationand related phrases, we performed regular searches of the indexed literature (MEDLINE, Social Science Index, the National Technical Information Service, and Educational Research Information Clearinghouse) from 1975 through 1991. In addition, for these years, we used manual searches, key informants, and requests to authors to locate other indexed articles and the nonindexed literature of adult and continuing professional education. Study Selection. —From the resulting database we selected studies that met the following criteria: randomized controlled trials; educational programs, activities, or other interventions; studies that included 50% or more physicians; follow-up assessments of at least 75% of study subjects; and objective assessments of either physician performance or health care outcomes. Data Extraction. —Studies were reviewed for data related to physician specialty and setting. Continuing medical education interventions were classified by their mode(s) of activity as being predisposing, enabling, or facilitating. Using the statistical tests supplied by the original investigators, physician performance outcomes and patient outcomes were classified as positive, negative, or inconclusive. Data Synthesis. —We located 777 CME studies, of which 50 met all criteria. Thirty-two of these analyzed physician performance; seven evaluated patient outcomes; 11 examined both measures. The majority of the 43 studies of physician performance showed positive results in some important measures of resource utilization, counseling strategies, and preventive medicine. Of the 18 studies of health care outcomes, eight demonstrated positive changes in patients' health care outcomes. Conclusion. —Broadly defined CME interventions using practice-enabling or reinforcing strategies consistently improve physician performance and, in some instances, health care outcomes. (JAMA1992;268:1111-1117)

Clinical Validation of the Quality of Life Inventory: A Measure of Life Satisfaction for Use in Treatment Planning and Outcome Assessment

Abstract: This study details the psychometric evaluation of the Quality of Life Inventory (QOLI), a measure of life satisfaction that may complement symptom-oriented measures of psychological functioning in evaluating the outcome of interventions aimed at ameliorating mental disorders, disabling physical illnesses, and community-wide social problems

Common mental disorders : a bio-social model

Abstract: Acknowledgements. Foreword. 1: Models for mental disorder. 2: The five levels. 3: Filters on the pathway to care. 4: Common mental disorders as categories. 5: A dimensional model for neurosis. 6: Vulnerability and resiliance. 7: Destabilisation. 8: Restitution. 9: Mind and body. 10. Public health implications.

Psychological Interventions for Cancer Patients to Enhance the Quality of Life

Abstract: Although the thrust of the nation’s cancer objectives for the year 2000 is prevention and screening, each year approximately 1 million Americans are diagnosed and must cope with the disease and treatments. They do so with the aid of family, friends, and the health care system, but accumulating data suggest that psychological interventions may be important for reducing emotional distress, enhancing coping, and improving “adjustment.” Experimental and quasi-experimental studies of psychological interventions are reviewed, and discussion of treatment components and mechanism is offered. A final section discusses future research directions and challenges to scientific advance.

Early childhood intervention. A promising preventative for juvenile delinquency.

Abstract: Programs to reduce or prevent juvenile delinquency have been generally unsuccessful. Apparently the risk factors that make a child prone to delinquency are based in too many systems--including the individual, the family, and community networks--to make isolated treatment methods effective. Surprisingly, longitudinal studies of some early childhood intervention programs suggest they may help to reduce future delinquency. These programs take an ecological approach to enhancing child development by attempting to promote overall social competence in the many systems impacting on children. Not engaging in criminal acts is one indicator of competence that is related to others, such as being successful in school and in personal relationships. Evaluators must gather more data to confirm this unanticipated benefit of comprehensive interventions.

Handbook of mental health and aging

Abstract: Background: B.D. Lebowitz and G. Niederehe, Concepts and Issues in Mental Health and Aging. J.C. Anthony and A. Aboraya, Epidemiology of Selected Mental Disorders in Later Life. D. Gutmann, Culture and Mental Health in Later Life. E.P. Stanford and B.C. Du Bois, Gender and Ethnicity Patterns. M.A. Lieberman and H. Peskin, Adult Life Crises. Neurosciences and Aging: A.B. Scheibel, Structural Changes in the Aging Brain. D.G. Morgan, Neurochemical Changes with Aging Predisposition towards Age-Related Mental Disorders. C.L. Grady and S.I. Rapoport, Cerebral Metabolism in Aging and Dementia. B. Gurland and S. Katz, The Outcomes of Psychiatric Disorder in the Elderly: Relevance to Quality of Life. Behavioral Sciences and Aging: F. Schieber, Aging and The Senses. J.A. Sugar and J. M. McDowd, Memory, Learning and Attention. W.R. Cunningham and K.L. Haman, Intellectual Functioning in Relation to Mental Health. H. Thomae, Emotion and Personality. Psychopathology of Later Life: H.G. Koenig and D.G. Blazer, Mood Disorders and Suicide. J.I. Sheikh, Anxiety and Its Disorders in Old Age. J. Sadavoy and B. Fogel, Personality Disorders in Old Age. P.V. Rabins, Schizophrenia and Psychotic States. M.A. Raskind and E.R. Peskind, Alzheimer's Disease and Other Dementing Disorders. R.M. Atkinson, L. Ganzini, and M.J. Bernstein, Alcohol and Substance-Use Disorders in the Elderly. C.C. Hoch, D.J. Buysse, T.H. Monk, and C.F. Reynolds, Sleep Disorders and Aging. M.M. Seltzer, Aging in Persons with Developmental Disabilities. Assessment, Treatment, and Prevention: E.D. Caine and H.T. Grossman, Neuropsychiatric Assessment. A. La Rue, J. Yang, and S. Osato, Neuropsychological Assessment. B.J. Kemp and J. Mitchell, Functional Assessment in Geriatric Mental Health. N.A. Newton and L.W. Lazarus, Behavioral and Psychotherapeutic Interventions. C. Salzman and J. Nevis-Olesen, Psychopharmacologic Treatment. V. Regnier and J. Pynoos, Environmental Interventions for Cognitively Impaired Older Adults. L.K. George, Community and Home Care for Mentally Ill Older Adults. M.H. Wykle, M.E. Segall, and S. Nagley, Mental Health and Aging: Hospital Care--A Nursing Perspective. B. Liptzin, Nursing Home Care. S. Eth and G.B. Leong, Forensic and Ethical Issues. G. Gottlieb, Economic Issues and Geriatric Mental Health Care. The Future: G.D. Cohen, The Future of Mental Health and Aging. Index.

A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes.

Abstract: Background. Although psychoactive medications have substantial side effects in the elderly, these drugs are used frequently in nursing homes. Few interventions have succeeded in changing this situation, and little is known about the clinical effects of such interventions. Methods. We studied six matched pairs of nursing homes; at one randomly selected nursing home in each pair, physicians, nurses, and aides participated in an educational program in geriatric psychopharmacology. At base line we determined the type and quantity of drugs received by all residents (n = 823), and a blinded observer performed standardized clinical assessments of the residents who were taking psychoactive medications. After the five-month program, drug use and patient status were reassessed. Results. Scores on an index of psychoactive-drug use, measuring both the magnitude and the probable inappropriateness of medication use, declined significantly more in the nursing homes in which the program was carried out (experime...

Effects of psychological treatment on cancer patients : a critical review

Abstract: Twenty-two studies on the effects of psychological treatment on cancer patients are reviewed. Only studies that compared one or more experimental conditions with at least one control group have been considered. The studies were evaluated with respect to a) research methods, b) psychological interventions, and c) results. Tailored counseling has been shown to be effective with respect to distress, self-concept, (health) locus of control, fatigue, and sexual problems. Structured counseling showed positive effects with respect to depression and distress. Behavioral interventions and hypnosis were effective with respect to specific symptoms such as anxiety, pain, nausea, and vomiting. The research methods, interventions and results of the studies are reviewed critically. Several recommendations for future research are made.

Smoking cessation: what have we learned over the past decade?

Abstract: This article discusses developments in understanding smoking and smoking cessation, methodological issues, and intervention approaches over the past 10 years. Although effective multisession clinic interventions have been developed, such programs reach relatively few smokers. This has led to self-help, work site, health care setting, and community interventions aimed at delivering less intensive programs to larger populations. Conceptual and empirical developments and trends within these above delivery contexts are reviewed, and avenues of research are identified. Nicotine replacement strategies have benefited from technological advances (e.g., transdermal patches) and present continuing challenges with respect to integration with behavioral strategies and incorporation into primary care medical settings. Research over the next decade should focus on the development of cost-effective interventions that can reach representative and high-risk smokers.

Major developments in behavioral diabetes research.

Abstract: Over the past decade, there has been a major increase in behavioral diabetes research. This review focuses on 6 areas: self-treatment, psychosocial impact, diabetes-specific assessment, psychological stress, weight loss intervention, and neuropsychological effects. There has been great progress in identifying factors that predict self-treatment behaviors and psychological adjustment. This research has produced a number of diabetes-specific assessment tools. Psychological stress appears to affect both the etiology and the control of diabetes, but underlying mechanisms remain unclear. Weight loss studies demonstrate the potential benefits of behavioral interventions for diabetes management. Both acute and chronic abnormalities in diabetic blood glucose cause neuropsychological impairments and may cause permanent deficits. The challenge for the next decade is to translate these findings into interventions that improve quality of life and physical well-being for individuals with diabetes.

Factors contributing to the subjective quality of life of the chronic mentally ill

Abstract: Although the deinstitutionalization of the seriously mentally ill has been severely criticized, the success of some model community programs shows that community care can enhance patients' quality of life. We lack specific knowledge, however, about the components that make these programs effective, and why. A theoretical framework for identifying these critical components is proposed. Services can enhance life satisfaction by increasing individuals' actual power through economic resources or status, thus enhancing their perceptions of mastery. An internal evaluation of a model program provides support for this hypothesis. One hundred and fifty-seven patients were interviewed about services, quality of life, and perceptions of mastery. Results show that services providing economic resources and an empowerment approach to service delivery are significantly related to overall quality of life. Furthermore, perceptions of mastery account for the impact of these components on life satisfaction. These findings suggest interventions that can be adopted by a wide range of mental health programs for the improvement of the quality of life of the chronic mentally ill.

Cancer: improving early detection and prevention. A community practice randomised trial.

Abstract: OBJECTIVE--To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services. DESIGN--A randomised trial of two interventions alone and in combination. SETTING AND SUBJECTS--Physicians in 98 ambulatory care practices in the United States. INTERVENTIONS--The education intervention consisted of a day long physician meeting directed at improving knowledge, attitudes, and skills relevant to cancer prevention and early detection. The office system intervention consisted of assistance from a project facilitator in establishing routines for providing needed services. These routines included division of responsibilities for providing services among physicians and their staff and the use of medical record flow sheets. MAIN OUTCOME MEASURES--The proportions of patients provided the cancer prevention and early detection services indicated annually according to the US National Cancer Institute. RESULTS--Based on cross sectional patient surveys, the office system intervention was associated with an increase in mammography, the recommendation to do breast self examination, clinical breast examination, faecal occult blood testing, advice to quit smoking, and the recommendation to decrease dietary fat. Education was associated only with an increase in mammography. Record review for a patient cohort confirmed cross sectional survey findings regarding the office system for mammography and faecal occult blood testing. CONCLUSION--Community practices assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services.

Intervention for men who batter : an ecological approach

Abstract: Introduction A Comprehensive Ecological Approach Ecological Assessment of Men Group Intervention for Men Who Batter Individual and Couple Treatment Social System Interventions Epilogue Toward a Violence-Free Ecology

Psychosocial problems and interventions in diabetes. A review of the literature

Abstract: This article reviews and organizes the recent literature on psychosocial problems and interventions in diabetes to see if it is possible to identify effective modes of treatment for numerous different psychosocial problems. An attempt was made to review extensively the references on psychosocial problems and to review exhaustively the references on psychosocial interventions. The review was organized under four major headings: psychological sequelae of medical crises, psychopathology in diabetes, stress and hassles in living with diabetes, and family dysfunctions. Results of the literature review were similar for all areas: although some studies suggested that these problems are especially severe for people with diabetes, the best-designed studies suggested that this was not so. Regardless of the prevalence of these problems in the diabetic population at large, individuals who suffer from these problems are at special risk for reduced physical and emotional well-being, so they need psychosocial interventions that effectively resolve their difficulties. Unfortunately, the literature on psychosocial interventions in diabetes is meager, and it lacks the systematic, quantitative evaluations necessary to identify effective modes of treatment for different psychosocial problems. It is possible to state tentatively that certain interventions have been used for specific problems with some indication that they can be effective. Issues for future research are identified. Addressing these issues might provide a foundation for making decisions about areas ripe for clinical trials, and ultimately determining which intervention is best suited for treating any given psychosocial problem.

Stress & well-being at work: Assessments and interventions for occupational mental health.

Abstract: This synthesis of empirical research efforts, idiographic inquiries and conceptual reviews brings epidemiological and public health concepts of prevention into the arena of occupational mental health. It is intended as a resource book for those interested in work design and mental health.

Process of forgoing life-sustaining treatment in a university hospital: an empirical study

Abstract: Objectives The difficult decision to forgo (withhold or withdraw) life-sustaining treatment has received extensive commentary. Little attention has been paid to how physicians do, and should, care for dying patients once this decision is made. This study describes the characteristics of patients who forgo treatment, determines the range and sequential process of forgoing treatment, and suggests ethical and public policy implications. Design The charts of all patients who died at the University of Minnesota Hospital during a 2-month period were reviewed. The patient information that was collected included age and sex, diagnoses, mental status, location in the hospital length of hospital stay, method of payment, the timing of the first decision to forgo treatment, and the range and sequence of interventions forgone. Setting All ICUs and general wards in a 586-bed tertiary care university hospital. Patients All patients who died at the University of Minnesota Hospital during May and June 1989. Main results A total of 52 (74%) of 70 patients who died had some intervention withheld or withdrawn before death. Those patients in whom treatment was forgone were more likely to have an underlying malignancy or impaired mental status and longer hospital stays. Thirty-two (62%) of 52 patients who declined some treatment were in an ICU; 26 (50%) of 52 patients required mechanical ventilation. On average, 5.4 separate interventions were forgone per patient. Resuscitation and/or endotracheal intubation were generally the first measures withheld; once a patient required a ventilator, withdrawing the ventilator was a late decision. Precise methods of ventilatory and vasopressor withdrawal varied considerably among patients. Conclusions Forgoing life-sustaining treatment is not a single decision but it often occurs in a sequential manner over several days. A strict analysis of the benefits and burdens of various interventions may be inadequate in deciding what interventions are appropriate in the care of the dying patient.

Families of Schizophrenic Patients: Cognitive Behavioural Intervention

Abstract: Developments in the understanding and management of schizophrenia family environments family intervention studies interventions and the initial assessment of relatives' and patients' needs education stress management and coping responses a constructional approach to problems issues of engaging and maintaining the family involvement the problems of violence and suicide risk other psychological methods useful in the management of schizophrenia working within service organizations.

Psychological factors in rheumatoid arthritis.

Abstract: This article provides a review and discussion of recent developments in psychological research related to rheumatoid arthritis (RA). A description of the medical aspects of the disease is followed by an overview of the literature relating psychological variables to pain and disability in RA; a summary evaluating affective reactions, disease-related beliefs, and coping strategies in RA patients; and a discussion of psychological interventions with this patient population. Methodological weaknesses in the literature are noted and directions for future collaborative research between rheumatologists and psychologists are suggested.

Psychological Adjustment of Children with Asthma: Effects of Illness Severity and Recent Stressful Life Events

Abstract: Although children with chronic illness are at greater risk for decreased psychological adjustment than physically healthy children, little is known about the factors that lead to increased risk. Eighty-one children with asthma between the ages of 6 and 14 years and their parents participated in a study to determine the relative contribution of background variables (age, gender, and socioeconomic status), recent stressful life events, and illness severity to psychological adaptation. Overall 11.5% of the children had CBCL Total Behavior Problems scores above the 98th percentile. Multiple regression revealed that lower SES, negative life change, and high illness severity were predictive of less optimal psychological adjustment. The results highlight the need for interventions to improve coping with both disease and nondisease issues.

Help-seeking behavior and attitude of Chinese Americans regarding psychological problems

Abstract: Investigated the help-seeking behavior and attitude regarding psychological problems as mediated by mental health status, acculturation level, and sociodemographic characteristics in a community sample of Chinese Americans. Of the 128 respondents, 17 (13.3%) had consulted professional help for a nervous or emotional problem. Compared to the others, they reported significantly poorer mental health status (i.e., had more physical symptoms, had once come close to experiencing a "nervous breakdown," and had a relative who had been in treatment), and were more likely to be American-born. For those who had not previously sought help, attitude toward help seeking was examined. A positive attitude was mediated by superior English ability, being younger, married, and from a lower SES background. The findings suggested help-seeking behavior is primarily mediated by presence of need, whereas attitude reflected a general propensity. Acculturation was an important predictor of both behavior and attitude, with the less acculturated most in need of education about the utility of mental health service.

Interventions for children of divorce: toward greater integration of research and action

Abstract: A number of child-, family-, and system-focused interventions have been designed to prevent or reduce the negative effects of divorce on children. This article critically evaluates these intervention efforts by examining (a) their relation to basic research on the processes proposed to mediate children's postdivorce adjustment and (b) evaluation studies assessing the effectiveness of various programs. Although interventions address some of the factors proposed to mediate children's adaptation to divorce, the interplay between interventions and basic research on children's postdivorce adaptation is limited. Moreover, some intervention efforts appear to be beneficial, but most lack empirical documentation of their efficacy. This analysis leads to several recommendations for basic and applied research and for improving the response of the mental health field to the problems experienced by many children from divorcing families.

Homeless mentally ill or mentally ill homeless

Abstract: Mainstream psychiatry conceptualizes people who are homeless and mentally ill as distinct from other homeless persons because it is thought that their status stems from their mental disorder and the poor implementation of deinstitutionalization. The authors believe this dichotomy is illusory. They present data indicating that recent socioeconomic and political shifts contributed greatly to homelessness among all groups, regardless of mental illness; that those with and without mental illness have similar biographical and demographic profiles; that high levels of mental distress are common to all homeless persons; and that few mentally ill homeless persons require involuntary hospitalization. This perspective suggests novel responses that de-emphasize clinical solutions and focus on empowerment, consumerism, entitlement, community-level interventions, and closer alliances with other advocates for the homeless.

Clinical factors associated with better quality of life in a seriously mentally ill population.

Abstract: improving the quality of life of persons with chronic mental illness is becoming an important treatment goal. in this study, 101 former acute care psychiatric inpatients with serious mental illness who were living in Mississippi communities were interviewed using portions of Lehman's Quality of Life interview. A particular focus was whether clinical characteristics, such as medication compliance and social skills, that could be changed by interventions were associated with patients' ratings of their quality of life. Self-reports of better quality of life were associated with fewer depressive symptoms, fewer medication side effects, and better family interactions. Results indicate that clinical interventions to improve quality of life in this population should include family psychoeducational programs and better detection, evaluation, and treatment of both depressive symptoms and side effects of medication.