Psychiatry in the age of neuroscience: the impact on clinical practice and lives of patients

Due to the progress being made in the neurosciences, higher expectations for the use of medication, even against the patient’s will, are arising in mental hospitals. In this article, we will discuss whether the neurosciences and new psychopharmacological solutions really support patients who suffer from mental illnesses. To answer this question, we will focus on the perspective of patients and their experiences with psychiatric (coercive) treatments. The analysis of one person’s story shows that other issues besides appropriate medication are important for recovery from a mental illness. In daily life, issues such as coping, rehabilitation and social support are of major importance for a patient suffering from psychiatric disease. Thus, although progress in the neurosciences is a positive development for clinical practice, it does not mean that (coercive) medication alone will carry a patient into recovery. A patient’s recovery is dependent, not only upon the process of finding the appropriate medication and trust between the psychiatrist and the patient, but also upon relational aspects, such as being recognised as a person, belonging, accepting responsibilities, developing friendships and trusting others. These findings lead to the conclusion that dealing with psychiatric diseases is more complex than what the biomedical model of neuroscience suggests and that one should include the social context of the patient in the recovery process.     

Getting down to business: defining competencies for entry-level youth workers

In January 2004, the National Collaboration for Youth approved a list of core competencies needed by entry-level youth development workers for effective youth development practice. This chapter provides an overview of these competencies, explaining why and how the list was created, outcomes, and recommendations for next steps.     

Treatment of incarcerated, sexually-abused adolescent females: an outcome study

This study examined the psychosocial functioning of 100 adolescent females (ages 12-17) sentenced to secure care in a southeastern state and the impact of gender-specific, cognitive-behavioral therapy (CBT) intervention on the psychosocial functioning of subjects who reported a history of sexual abuse. The Multidimensional Adolescent Assessment Scale (MAAS) was used to assess psychosocial functioning. Pre-test scores on the MAAS revealed significantly higher scores on 12 of 16 dimensions of psychosocial functioning and higher rates of serious criminal behavior for youth who subsequently disclosed sexual abuse histories as compared to those without such histories. At post-test, statistically significant improvements in psychosocial functioning were observed on 14 of 16 MAAS subscales for those who received the CBT intervention. Thus, incarcerated female adolescents who reported a history of sexual abuse demonstrated more impairment in their functioning as compared to those without a reported history of sexual abuse and responded positively to gender-specific, CBT-based intervention.     

Refugees: Challenges to Protection

By the end of the year 2000, the Office of the United Nations High Commissioner for Refugees will have been in existence for 50 years – which is probably some sort of record for an organization originally set up with just a three‐year mandate. There were many reasons for so limiting the successor agency to the International Refugee Organization, but it is doubtful whether anyone seriously thought that refugee problems would be resolved so quickly, or indeed that UNHCR would develop into the highly operational, visible and extensively funded entity that we see today. Fifty years of experience nevertheless suggests that it is high time for an audit, for an evaluation of strengths, weaknesses and achievements, and a little strategic thinking about the future.     

GOES-8 X-ray sensor variance stabilization using the multiscale data-driven Haar–Fisz transform

Summary.  We consider the stochastic mechanisms behind the data that were collected by the solar X-ray sensor (XRS) on board the GOES-8 satellite. We discover and justify a non-trivial mean–variance relationship within the XRS data. Transforming such data so that their variance is stable and its distribution is taken closer to the Gaussian distribution is the aim of many techniques (e.g. Anscombe and Box–Cox). Recently, new techniques based on the Haar–Fisz transform have been introduced that use a multiscale method to transform and stabilize data with a known mean–variance relationship. In many practical cases, such as the XRS data, the variance of the data can be assumed to increase with the mean, but other characteristics of the distribution are unknown. We introduce a method, the data-driven Haar–Fisz transform, which uses the Haar–Fisz transform but also estimates the mean–variance relationship. For known noise distributions, the data-driven Haar–Fisz transform is shown to be competitive with the fixed Haar–Fisz methods. We show how our data-driven Haar–Fisz transform method denoises the XRS series where other existing methods fail.     

Challenging Professional Roles: Lay Carers' Involvement in Health Care in the Community

The bulk of care in the community is carried out by lay carers. Recent policy initiatives to support them in the United Kingdom are outlined. There remains evidence of significant gaps in support from professional health and social‐care workers including community nurses. This paper reports three studies of lay carers: those caring for older people, carers of technology‐dependent children, and home‐care workers involved in the “direct payments” scheme. Findings are reported in the areas of decisions about appropriate caring roles, the lay–professional boundary, training and respite opportunities and the expertise of lay carers. Recommendations for policy and practices are made.