Dialectical behavior therapy for patients with borderline personality disorder.

This study examined the effectiveness of dialectical behavior therapy (DBT) in the treatment of people diagnosed with borderline personality disorder (BPD). The frequency of self-injurious behaviors of 15 women hospitalized on a DBT unit was traced over a 4-week period. Data on self-injurious behaviors and the use of the DBT approach were collected from a review of incident reports and patients' charts. The self-injurious behaviors decreased by almost 50%. In addition, four RNs, who were involved on the DBT unit both before and after the institution of the treatment approach, were interviewed. Semi-structured interviews were conducted to determine the nurses perceptions of the effectiveness of DBT. Their responses were uniformly positive. The most commonly occurring phrase was "it works."     

Internal family systems therapy for children in family therapy

This article presents a developmentally supported implementation of Internal Family Systems Therapy for school-age children and their families. Relevant developmental characteristics of children are described. Suggestions for working with parents, child-oriented interventions, and a case example are presented.     

The program effect of batterer programs in three cities

Recent meta-analyses and experimental designs of batterer program evaluations suggest little or no program effect. This finding may be compromised by a variety of analytical issues. Instrumental variable analysis addresses some of these issues, especially the relationship of program dropout to batterer reassault. This method of analysis was, therefore, used to test for program effect in a multi-site evaluation. The sites were three well-established batterer programs using a gender-based, cognitive-behavioral approach (n = 640). Completing a batterer program reduced the likelihood of reassault by 44% to 64%, depending on the specification used. Completing a 3-month program appeared to be as effective as completing a 5 1/2- or 9-month program. This moderate effect is an accomplishment considering the problems associated with the program participants and the inconsistency in the criminal justice system at the research sites. The findings remain tentative because of weak instrumental variables for reassault, but do confirm the need for more complex analyses of program effect.     

Outbreaks of acute gastroenteritis associated with Norwalk-like viruses in campus settings

Norwalk-like viruses (NLVs) are transmitted by fecally contaminated food, water, fomites, and person-to-person contact. They are a leading cause of acute gastroenteritis epidemics in industrialized countries. NLV outbreaks are characterized by a 12- to 48-hour incubation period; nausea, vomiting, and diarrhea for 24 to 72 hours; and high secondary attack rates. NLV infections spread rapidly on college and university campuses because of close living quarters, shared bathrooms and common rooms, many food handlers, popular self-service salad bars in dining halls, and person-to-person contact through sports and recreational activities. The illness is generally mild and self-limited but an outbreak can strain the resources of campus health services and cause high absenteeism among both students and staff. Treatment is primarily through antiemetic medication and oral rehydration. Prevention and control of NLV outbreaks rests on promoting hand washing; enforcement of strict hygiene in all food preparation areas; and prompt, rigorous cleaning of potentially contaminated areas where someone has been ill.     

Family therapy saves the planet: messianic tendencies in the family systems literature

It is not unusual occasionally to hear individual family therapists describe their work as an effort to "save the world." The messianic notion that family therapy should be the world's salvation is not simply a fancy of individual clinicians, but is deeply imbedded in several of our field's most fundamental theories. This article explores messianic arguments in the work of some of family therapy's most important thinkers, including von Bertalanffy, Bateson, and Keeney, and then discusses the implications that these arguments have for the clinical and theoretical development of our field.     

Juvenile male sexual offenders: the quality of motivation system of assessment and treatment issues

A group of juvenile male sexual offenders (n=100) completed the Quality of Motivation Questionnaire (QMQ) upon entry into a residential treatment facility. The concepts of Quality of Motivation (QM) Theory are presented to explain the QMQ scores. The scores include Disclosure Level, Sources of Motivation, Life Style Characteristics and Power. The results indicate abnormal motivation scores in the area of Disclosure Resistance, Depression, Primary and Learned Sources of Motivation, and all of the Maladaptive Skills Scores. Recommendations of treatment issues for therapists are prioritized according to QM Theory and presented in a treatment plan format called the Personal Development Plan (PDP). Implications for further research with the QMQ include outcome measurement of changes and comparison with non-offender groups.     

Parkinson's disease

In this case study, we describe the symptoms, neurological examination, test results, and brain pathology of a man with Parkinson's disease (PD). PD commonly presents with tremor or changes in one's ability to walk or move. Other major difficulties caused by this disease include rigidity of the body, slowness of movement, and postural imbalance. The disease symptoms principally result from the degeneration of a specific population of neuronal cells in the brain stem, in a region called the pars compacta of the substantia nigra. Pathology shows the loss of these cells and the appearance of characteristic neuronal cytoplasmic inclusions called Lewy bodies, which are composed principally of aggregated alpha-synuclein protein.     

A longitudinal analysis of the distinction between for-profit and not-for-profit hospitals in America

Have changes in the hospital industry forced not-for-profit hospitals to become more like for-profit hospitals in measures of efficiency and community service? As a result, are not-for-profit hospitals moving away from their community service missions? In recent years researchers have asserted that the once-salient distinctions between not-for-profit and for-profit hospitals are quickly eroding and that this convergence threatens the community service that not-for-profit hospitals have historically provided. Neo-institutionalists explain that regulatory changes often force differing organization types to pursue similar strategies (Fligstein 1991, 1985; DiMaggio and Powell 1983). Guided by this theory, the present research analyzes if regulatory changes and the implementation of similar strategies result in not-for-profit and for-profit hospitals having similar efficiency and community service outcomes.     

Neighborhood disadvantage, stress, and drug use among adults

This paper explores the relationships among neighborhood disadvantage, stress, and the likelihood of drug use in a sample of adults (N = 1,101). Using the 1995 Detroit Area Study in conjunction with tract-level data from the 1990 census, we find a positive relationship between neighborhood disadvantage and drug use, and this relationship remains statistically significant net of controls for individual-level socioeconomic status. Neighborhood disadvantage is moderately associated with drug related behaviors, indirectly through increased social stressors and higher levels of psychological distress among residents of disadvantaged neighborhoods. A residual effect of neighborhood disadvantage remains, net of a large number of socially relevant controls. Finally, results from interactive models suggest that the relationship between neighborhood disadvantage and drug use is most pronounced among individuals with lower incomes.