Measurement of transference interpretations.
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The authors present a cost-efficient process rating scale for detailed measurement of how much transference interpretations and related therapist interventions are used in brief dynamic psychotherapy. Theoretical and methodological considerations on how to operationalize and quantify such therapeutic interventions are discussed. The scale had highly satisfactory interrater reliability for three raters, who rated 60 whole sessions from an ongoing randomized study of two manualized forms of brief dynamic psychotherapy. In one treatment group, moderate emphasis on transference analysis was intended. In the other, minor or no use of the studied component was intended. The two treatment groups differed significantly in the use of transference interpretations and related interventions. There was no significant difference in therapists' general therapeutic skill or use of supportive interventions. The treatment differentiation was consistent with the manuals. (+info)
Psychological sequelae of elective abortion.
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A mild, short, depressive and guilt ridden period following abortion is quite common, but a severe psychological reaction is rare. The indication for the abortion and the preabortal psychological state of the patient are the two most important factors. Almost all reported instances of postabortion psychoses have occurred in patients who had severe preabortal psychiatric problems. Women undergoing abortion for socioeconomic or psychosocial indications appear to be at minimal risk for long-term negative psychological sequelae. In contrast, women in whom abortion is carried out because of exposure to rubella and the risk of fetal malformation, maternal organic disease or the prenatal diagnosis of a genetically defective fetus are at greater risk and may need supportive psychotherapy. (+info)
Confirmation of a two-factor model of premorbid adjustment in males with schizophrenia.
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Because schizophrenia is considered to be a neurodevelopmental disorder, premorbid adjustment is of particular interest. Premorbid adjustment is probably not a unitary construct but rather is expressed across a number of developmental domains. The current investigation examined the validity of a two-factor model that differentiated premorbid adjustment across social and academic domains and evaluated relationships between these premorbid adjustment domains and other variables of interest. Participants with schizophrenia (n = 141) underwent evaluation of premorbid adjustment (using the Premorbid Adjustment Scale), intellectual functioning, and psychiatric symptoms. Using confirmatory factor analysis, a two-factor model of premorbid adjustment was identified that included an academic domain and a social domain. The social domain was associated with symptom variables, while the academic domain was associated with measures of intelligence. Results provide evidence for at least two domains of premorbid adjustment in schizophrenia. Distinguishing between these two premorbid domains may be theoretically important because of potential differences in incidence rates and deterioration courses; some individuals with schizophrenia may exhibit adequate academic adjustment but poor social adjustment, while others may exhibit the opposite pattern. (+info)
Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation.
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PURPOSE: To determine the prevalence of psychiatric disorders during hospitalization for hematopoietic stem-cell transplantation (SCT) and to estimate their impact on hospital length of stay (LOS). PATIENTS AND METHODS: In a prospective inpatient study conducted from July 1994 to August 1997, 220 patients aged 16 to 65 years received SCT for hematologic cancer at a single institution. Patients received a psychiatric assessment at hospital admission and weekly during hospitalization until discharge or death, yielding a total of 1,062 psychiatric interviews performed. Psychiatric disorders were determined on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Univariate and multivariate linear regression analyses were used to identify variables associated with LOS. RESULTS: Overall psychiatric disorder prevalence was 44.1%; an adjustment disorder was diagnosed in 22.7% of patients, a mood disorder in 14.1%, an anxiety disorder in 8.2%, and delirium in 7.3%. After adjusting for admission and in-hospital risk factors, diagnosis of any mood, anxiety, or adjustment disorder (P =.022), chronic myelogenous leukemia (P =.003), Karnofsky performance score less than 90 at hospital admission (P =.025), and higher regimen-related toxicity (P <.001) were associated with a longer LOS. Acute lymphoblastic leukemia (P =.009), non-Hodgkin's lymphoma (P =.04), use of peripheral-blood stem cells (P <.001), second year of study (P <.001), and third year of study (P <.001) were associated with a shorter LOS. CONCLUSION: Our data indicate high psychiatric morbidity and an association with longer LOS, underscoring the need for early recognition and effective treatment. (+info)
A 12-year prospective study of the long-term effects of early child physical maltreatment on psychological, behavioral, and academic problems in adolescence.
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OBJECTIVE: To determine whether child physical maltreatment early in life has long-term effects on psychological, behavioral, and academic problems independent of other characteristics associated with maltreatment. DESIGN: Prospective longitudinal study with data collected annually from 1987 through 1999. SETTING AND PARTICIPANTS: Randomly selected, community-based samples of 585 children from the ongoing Child Development Project were recruited the summer before children entered kindergarten in 3 geographic sites. Seventy-nine percent continued to participate in grade 11. The initial in-home interviews revealed that 69 children (11.8%) had experienced physical maltreatment prior to kindergarten matriculation. MAIN OUTCOME MEASURES: Adolescent assessment of school grades, standardized test scores, absences, suspensions, aggression, anxiety/depression, other psychological problems, drug use, trouble with police, pregnancy, running away, gang membership, and educational aspirations. RESULTS: Adolescents maltreated early in life were absent from school more than 1.5 as many days, were less likely to anticipate attending college compared with nonmaltreated adolescents, and had levels of aggression, anxiety/depression, dissociation, posttraumatic stress disorder symptoms, social problems, thought problems, and social withdrawal that were on average more than three quarters of an SD higher than those of their nonmaltreated counterparts. The findings held after controlling for family and child characteristics correlated with maltreatment. CONCLUSIONS: Early physical maltreatment predicts adolescent psychological and behavioral problems, beyond the effects of other factors associated with maltreatment. Undetected early physical maltreatment in community populations represents a major problem worthy of prevention. (+info)
Burn morbidity: a followup study of physical and psychological disability.
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Fifty-one burn patients were studied in a retrospective manner to determine the effects of the burn injury on their ability to return to their pre-burn physical and social status. The results of this study indicate that: 1) 79% of the patients were able to return to work or school, though 45% required a change in work and 25% were not able to continue with their peer groups in school; 2) the average time of disability was 6 months; 3) there was a significant psychological morbidity as demonstrated by self-confessed depression, juvenile delinquency and divorce. There is a need for awareness of these problems so that proper counseling can be offered to the burn patient and his family both during his hospitalization and after discharge. (+info)
Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design.
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AIMS: To compare an innovative activating intervention with "care as usual" (control group) for the guidance of employees on sickness leave because of an adjustment disorder. It was hypothesised that the intervention would be more effective than care as usual in lowering the intensity of symptoms, increasing psychological resources, and decreasing sickness leave duration. METHODS: A prospective, cluster randomised controlled trial was carried out with 192 patients on first sickness leave for an adjustment disorder. Symptom intensity, sickness duration, and return to work rates were measured at 3 months and 12 months. Analyses were performed on an intention to treat basis. RESULTS: At 3 months, significantly more patients in the intervention group had returned to work compared with the control group. At 12 months all patients had returned to work, but sickness leave was shorter in the intervention group than in the control group. The recurrence rate was lower in the intervention group. There were no differences between the two study groups with regard to the decrease of symptoms. At baseline, symptom intensity was higher in the patients than in a normal reference population, but decreased over time in a similar manner in both groups to approximately normal levels. CONCLUSION: The experimental intervention for adjustment disorders was successful in shortening sick leave duration, mainly by decreasing long term absenteeism. (+info)
Quality of rehabilitation among workers with adjustment disorders according to practice guidelines; a retrospective cohort study.
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AIMS: To assess the quality of occupational rehabilitation for patients with adjustment disorders and to determine whether high quality of care is related to a shorter period of sickness absence. METHODS: A retrospective cohort study was conducted by means of an audit of 100 files of patients with adjustment disorders who visited their occupational physicians. Quality of rehabilitation was assessed by means of 10 performance indicators, derived from the guidelines for the treatment of employees with mental health disorders. Performance was dichotomised into optimal and deviant care according to explicit criteria. The performance rates were related to time until work resumption during a one year follow up period. Kaplan-Meier survival analyses and Cox proportional hazards analysis were used to study this relation. RESULTS: Four of 10 performance rates were below 50%: continuity of care (34%), interventions aimed at providers of care in the curative sector (39%), assessment of impediments in the return to work process (41%), and assessment of symptoms (45%). The highest performance rate concerned assessment of work related causes (94%). Overall optimal care was found in 10% of the cases. Median time to complete recovery was 195 days (IQR 97 to 365), and 73% of all patients recovered completely after one year. Optimal continuity of care was significantly related to a shorter time to both partial and complete work resumption (hazard ratio (HR) 0.3; CI 0.2 to 0.6) independently of other performance indicators. Performance regarding interventions aimed at the organisation was also related to a shorter time until first return to work (HR 0.5; CI 0.3 to 0.9). CONCLUSIONS: This study shows that the rehabilitation process of employees with adjustment disorders leaves significant room for improvement, especially with regard to continuity of care. Quality of care was partly related to a better outcome. More rigorous study designs are needed to corroborate these findings. (+info)