Current treatment of generalized anxiety disorder

Generalized anxiety disorder is the most common anxiety disorder and is second only to depression as the most common disorder diagnosed in primary care. Because it is potentially disabling due to its high comorbidity with other psychiatric conditions, psychiatric nurses must accurately diagnose GAD and formulate individualized treatment plans that promote positive outcomes for clients with this disorder.     

Parents and patients: Members of an interdisciplinary team on an adolescent inpatient unit

In a six-year study on a locked psychiatric hospital unit for adolescents, first patients and then their families became integrated into the interdisciplinary treatment team. The results were universally beneficial. After initial resistance and some fine tuning of their skills, the staff became strong supporters of the program. Parents, no longer one down, developed a close working relationship with the therapists and milieu staff. Treatment planning and implementation was enriched by the interaction and dissension was minimized. Most important of all, the adolescents improved more rapidly and hospital stays were significantly shortened.     

Children and Parents Deserve Better Parental Discipline Research: Critiquing the Evidence for Exclusively “Positive” Parenting

This article critiques the scientific evidence for the emerging view in nonclinical parenting research and in popular books that parents should use only positive methods of parenting and rarely resort to any disciplinary consequences. Four methodological fallacies pervade research used to support this viewpoint: the correlational fallacy (inferring causation from correlations), the trumping fallacy (permitting correlational conclusions to trump stronger causal evidence), the extrapolation fallacy (extrapolating favorable comparisons of under-usage versus over-usage to zero usage), and the lumping fallacy (lumping inappropriate and appropriate usages together). Conclusions based on any of these methodological fallacies are premature at best and counterproductive at worst. These fallacies would incorrectly make many medical procedures appear to be harmful, such as radiation treatment. Premature conclusions supporting exclusively positive parenting may partially explain the immigrant paradox in the United States and escalating criminal assaults against minors according to Swedish criminal records (where positive parenting is most prominently advocated). Exclusively positive parenting needs to be supported by stronger research, including randomized trials with oppositional defiant children, before being accepted as definitive. We also need research to understand how the parental management skills featured in effective clinical treatments for young oppositional defiant children generalize to parenting in nonclinical families.     

Assessment & treatment of persons with pedophilia

1. Like any other form of major mental disorders, pedophilia is an AXIS-I diagnosis that warrants psychiatric treatment. 2. The combination of anti-androgenic medications and individual/group psychotherapy are common treatments for pedophilia. 3. The social stigmatization of pedophilia brands mental health professionals who provide treatment for pedophiles as supporters of illegal sexual acts against children rather than as professionals treating a psychiatric disorder.     

Teaching hospitalized patients with serious, persistent mental illness.

1. Although patient teaching is an important nursing function, minimal research was found related to education of patients with schizophrenia. Teaching psychiatric patients about illness, treatment, and rehabilitation has not received the same attention in psychiatric nursing as it has in other nursing specialties. 2. Eighty percent of the patients who participated in patient education classes would recommend the program to others. Treatment teams reported that some patients asked more questions about their treatment and became more active in ward groups following the classes. 3. The use of nurses as patient educators facilitates professional nursing practice and effectively ensures that patients' general physical health and psychiatric education needs are systematically addressed.     

Misgivings of medicine?: African Americans' skepticism of psychiatric medication

Research has consistently documented black-white differences in rates of voluntary psychiatric treatment that cannot be reduced entirely to differences in either need or access. A variety of explanations have been offered for the gap that remains, but the empirical testing of alternative propositions has thus far been minimal. Using the 1998 General Social Survey's Pressing Issues in Health and Medical Care module (n = 1,387), I find consistent and substantial black-white differences in a variety of beliefs about psychiatric medications, one of the most common treatments for mental illness, and the predisposition to use them. Specifically, blacks express less willingness to use psychiatric medications themselves or to administer them to a child for whom they are responsible. Neither socioeconomic status, knowledge, religious involvement, nor trust in medicine appears to explain this reluctance. Rather, it stems almost entirely from blacks' beliefs about psychiatric medications' efficacy and side-effects. The results indicate, first, that researchers should not assume that African Americans will use psychiatric medications at rates similar to whites if offered equal access. Second, the results indicate that blacks' skepticism of psychiatric medications may be rooted in specific beliefs about psychiatric medications, rather than general ideologies about medical practice. Health beliefs about psychiatric treatment, therefore, will continue to play an important role in understanding race differences in the use of psychiatric medications.     

An integrative approach to threat assessment and management: security and mental health response to a threatening client

Workplace violence threat assessment and management practices represent an interdisciplinary approach to the diversion of potentially dangerous employees and clients. This case study illustrates such an intervention in a complex situation involving a social service agency and its client. Following a curtailment of services and an arrest, the client developed an escalating homicidal anger toward the agency administrator. Once a Tarasoff warning was received, the agency contacted a security company who organized a threat assessment and management plan involving interdisciplinary collaboration. Information developed in the course of the assessment was presented to prosecutors, who facilitated the client's arrest and involuntary psychiatric commitment until he was judged to be no longer dangerous. This case ultimately involved an integration of the services of security, law enforcement, mental health professionals, prosecutors, the courts and the state mental health system in leading to a successful diversion of the client from a path of intended violence.     

THE MYTH OF THE UNFEELING STRATEGIC THERAPIST

This paper explores what the authors consider to be a widespread myth: that strategic therapists ignore, avoid, or neglect client feelings in treatment. This myth is promulgated by trainers' admonitions and strategic theorists' injunctions against dealing with client affect. It is also cultivated by omission of this topic in the strategic literature. The myth is destructive in that it misrepresents what strategic practitioners actually do in a therapy session. Seven elements of the myth are delineated and the corresponding fallacies are illustrated.     

Evolutionary Psychology: Toward a New View of Human Nature and Organizational Society

The paper argues that evolutionary psychologyoffers a radical and challenging new perspective onhuman nature and organizational society. Its roots in aconvergence of insights and scientific discoveries from diverse natural and human sciences aredescribed, and how it seeks to avoid common fallacies ofearlier biological reasoning about human society.Recurrent themes in human nature and theirmanifestations are summarized, including sex and personalitydifferences, cognitive and affective biases, socialorientations, and preferred modes of social exchange.The paper concludes that we suffer the consequences of poor fit between our inherited natures andmany of the constructed environments in organizationalsociety, but that new emerging forms of organization maypresent us with the opportunities for social relations closer to the ancestral paradigms ofour psychology.     

Detecting suicide risk in adolescents and adults in an emergency department: a pilot study

The investigators conducted a pilot study to detect suicide risk in adolescents and adults seeking treatment in an emergency department, as well as to test the reliability and validity of the 4-item Risk of Suicide Questionnaire (RSQ). This study expanded the implementation of the RSQ beyond its initial use with children and adolescents with psychiatric symptoms who were seeking treatment in a pediatric emergency department to include adolescent and adult patients in a Level I trauma center. An advanced practice psychiatric nurse verbally administered the RSQ to a convenience sample of 104 emergency department patients ages 12 to 82. Psychometric analysis demonstrated an adequate degree of reliability and criterion-related validity for the RSQ. Approximately 30% of all patients who participated screened positive for suicide risk. The results support the continued use of the 4-item RSQ with all adolescents and use of a reduced 2-item form of the RSQ with adults exhibiting psychiatric chief complaints to determine imminent risk of suicide in patients who seek treatment in the emergency department. Nurses in all health care settings need to initiate suicide screening and implement nursing interventions directed toward suicide prevention.     

Benefits of psychosocial rehabilitation programming in a treatment mall

Psychiatric patients need educational interventions that help them recover and increase their ability to live and work independently following discharge from the hospital. The psychosocial rehabilitation treatment mall model is designed to meet this educational need. Treatment malls are a new approach to psychosocial rehabilitaion for patients in state psychiatric hospitals. Treatment malls provide psychoeducation and skill-building activities in a centralized, school-like setting for participants from all patient care units. It differs from traditional strategies that use decentralized one-on-one or unit-based models. Treatment malls provide a self-directed learning experience that meets the person-centered needs of participants. Evidence is increasing that this psychosocial educational model can provide lasting benefits for psychiatric patients, including symptom management, reduced psychiatric hospital readmission rates, and improved quality of life.     

Mental health literacy beliefs. A comparison of psychiatric trained nurses and enrolled nurses in Singapore

The views of mental health professionals may influence diagnosis and management options. This study reports nurses' views about the management of three common psychiatric disorders--schizophrenia, depression, and mania. Results demonstrate the effect of greater psychiatric education and training, received by psychiatric trained nurses, on mental health literacy.     

The clinical social worker and current psychiatric drugs: Some introductory principles

This paper persents some common social work clinical and case management issues with respect to psychiatric drug treatment. The roles of the psychiatrist and the social worker are distinguished. Three types of negative treatment drug effect are described-physical, psychological, and social-with case examples. Techniques to prevent or reduce negative drug effects are presented. The paper emphasizes the need for greater social work professional attention being paid to drug therapy.     

Interdisciplinary agendas in visual research: re-situating visual anthropology

In this article I review recent literature on visual research methods in the social sciences to explore two questions. First, I examine how recent interdisciplinary exchanges have portrayed the founding disciplines in visual research and representation through a focus on visual anthropology (and to a lesser degree visual sociology). Second, I critically survey the common aims and interests of academics promoting visual methods from/for their disciplines. As we delve into the “new” visual research literature, it becomes clear that contemporary visual researchers from different disciplines have common interests: reflexivity; collaboration; ethics; and the relationship between the content, social context and materiality of images. I shall argue for a more collaborative interdisciplinary approach to visual research whereby disciplines might learn from each other without seeking narrative foils to assert the supremacy of their own discipline at the expense of others.     

Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who disclosed sexual abuse/attack were more likely to disclose physical abuse, psychological problems, psychological treatment, psychiatric medication, and psychiatric hospitalization. Among bariatric surgery patients who disclosed sexual abuse/attack, females were more likely to disclose suicidal ideation. A logistic regression found that for females, physical abuse and suicidal ideation reliably predicted abuse/attack status. For males, psychological problems, psychiatric medications, hospitalization, and suicidal ideation, reliably predicted abuse/attack status.     

Effectiveness of a psychosocial intervention model for persons with chronic psychiatric disorders in long-term hospitalization

The article describes a psychosocial model of intervention with psychiatric patients in long-term hospitalization in a psychiatric ward in Israel and reports the findings of the evaluation conducted of its effectiveness. The model was aimed at maintaining or improving the patients' functioning in four main areas: personal hygiene, environmental maintenance, occupational competency, and social and recreational activities. For each patient, an individualized intervention program was designed and implemented by a personal case manager appointed from the ward's clinical staff. The programs involved family and ward staff as well as the patients themselves. The evaluation, based on comparison of monthly data for 4 months before and 12 months during the intervention, showed significant improvement in all but two areas of functioning: social functioning and psychiatric status. The findings, although in need of confirmation in larger, representative samples of patients in Israel and elsewhere, hold promise for effective intervention with patients whose treatment today consists largely of medication.     

Towards Interdisciplinary Community Collaboration and Development

SUMMARY

This article looks at the conceptualization and practice of interdisciplinary community collaboration and development (ICCD) in Israel and the US. It is based on the work of two interdisciplinary professional groups which were initiated by social workers—one in Israel and one in the US. This article presents a mapping of key issues and concepts, including distinguishing between mono-, multi-, and inter-, trans-disciplinary and inter-perspectives. The article addresses the issues of multiple professional identities, identification of a common core knowledge base and skills among disciplinary specializations for community development practice, and an understanding of inter-organizational perspectives. A qualitative methodology was used to conduct a content analysis of data from dialogues among professional practitioners in the Israeli and the US groups. Despite differences in the purpose, frequency and intensity of the two forums, there is an underlying belief in the importance of these discussions and in the commitment to interdisciplinary practice. Both groups believe that multiple types of expertise are needed, alongside new models of both inter-organizational and interdisciplinary relationships as well as professional-community interactions. Recommendations include the need for further examination of interdisciplinary community collaboration and development.     

Traumatic brain injury and suicide

A number of psychiatric and neurological problems may occur following traumatic brain injury (TBI). Anxiety and depression are common. There is evidence that there may be a correlation between TBI and increased risk of suicide. This article will explore current literature on the risk of suicidal behavior in people who have experienced TBI. Risk factors for suicide, recognition and assessment of suicidal behavior, and treatment issues will be discussed.     

Treatment issues pertaining to pathological gamblers with a comorbid disorder

Evidence of an increased risk for various psychiatric disorders among pathological gamblers far exceeds our understanding of the impact that this psychiatric comorbidity has on the outcome of treatment for pathological gambling. One major source of the problem is that treatment efficacy and effectiveness studies for pathological gambling typically have not addressed comorbidity's impact on outcome. This paper discusses epidemiological, clinical, health service delivery, and research issues pertaining to the intersection of pathological gambling treatment outcome and comorbid psychiatric disorders. It is argued that this topic suffers from major knowledge gaps in terms of the nature of comorbidity of pathological gambling and other psychiatric disorders and the role of client characteristics on treatment outcome for pathological gambling. Research priorities are identified.     

Borderline personality disorder: Psychosocial considerations and rehabilitation implications

The article describes the medical and psychosocial aspects of borderline personality disorder, a common and sometimes severe psychiatric condition marked by emotional instability and problems with interpersonal relationships. Medication, psychosocial and other treatment issues are discussed within the context of the rehabilitation counselor's role in providing vocational services for people with borderline personality disorder.