摘要:

This study takes preliminary steps to examine the effects of 2 legal mechanisms—outpatient commitment (OPC) and representative payeeship (rep payee)—on perceived coercion and treatment adherence in persons with severe mental illness (SMI). Data were collected in structured interviews from 258 involuntarily-admitted inpatients with SMI who were followed for 1 year after discharge. Subjects’ clinicians and family members were also interviewed. The analyses show that subjects with both OPC and a rep payee perceived their mental health treatment to be significantly more coercive than subjects who did not receive these legal interventions. Duration of OPC and having a newly-appointed rep payee were both significantly associated with increased treatment adherence over the course of 1 year. For treatment-adherent subjects, neither form of legal mechanism was associated with perceived coercion in treatment, whereas subjects who were nonadherent perceived legal mechanisms as significantly more coercive. The data suggest that these legal tools both affect adherence to treatment, but when used together significantly increase the perceived coerciveness of treatment. Questions remain concerning the underlying mechanism of these effects.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Previous research has demonstrated that exposure to community violence tends to have a hazardous impact on the health and well being of youth. In this context, sense of coherence is related to indicators of well being and mental health and is considered crucial for human information processing in resolving conflicts and coping with enduring stress. The aim of the present study was to explore the role of sense of coherence as a potential mediator in the relationships between community violence exposure and psychopathology, controlling for involvement in severe problem behavior. The study was conducted with a group of Russian juvenile delinquents (N= 159; a highly traumatized population with a history of frequent exposure to violence), who completed a set of questionnaires assessing their exposure to community violence, psychopathology, involvement in severe problem behaviors, and sense of coherence. The relationships among the variables of interest were explored using a structural equation modeling approach. Sense of coherence partially mediated the link between victimization and psychopathology. The direct relationships between victimization and psychopathology decreased in size, suggesting that higher levels of sense of coherence can potentially reduce the levels of psychopathology. These results have an important theoretical value and are meaningful for clinical work, suggesting that preventive and therapeutic interventions should aim at increasing sense of coherence, which might be especially valuable in populations at risk.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Impairments in activities of daily living (ADL) are common after stroke and may be related to poststroke depression. We have demonstrated that remission of poststroke major depression was associated with improvement in ADL. The administration of antidepressants within the first 3 months after stroke has been shown to prevent poststroke depression, early administration might also improve recovery of ADL among patients with stroke. This study examines the effect of early versus late treatment with antidepressants on recovery in ADL. Among 62 patients after stroke, the therapeutic effect of a 3-month course of antidepressants begun during the first month after stroke was compared with the effect of treatment begun after 1 month. The severity of impairment was measured using the Functional Independence Measure (FIM) and post-treatment outcome was assessed over the following 21 months. Although both the early and late treatment groups showed improvements in FIM scores during the 3 months of treatment, the early treatment group improved significantly more than the late treatment group. After the treatment, the early treatment group maintained this improvement over 2 years while the late treatment group deteriorated over time. There were no significant differences in the 2 groups that would explain the findings. Recovery in ADL impairment after stroke appeared to be enhanced by the use of antidepressant medication if treatment was started within the first month after stroke. These findings are consistent with the hypothesis that there may be a time-related therapeutic window in the treatment of physical impairment associated with poststroke depression.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Treatment outcomes for psychiatric inpatients with a primary diagnosis of a depressive or anxiety disorder who completed a cognitive behavior therapy (CBT) program while inpatients or when discharged were examined. Of 340 inpatients, 197 had been discharged to day patient status before the end of the CBT program, and 143 remained as inpatients. Data were collected before and after the CBT program and at 3-month follow-up. There was a significant improvement by posttreatment in self-esteem, locus of control, anxiety, depression, and stress, and these gains were maintained at 3-month follow-up. In addition, anxious, but not depressed, patients who completed CBT as day patients demonstrated greater improvements from after the CBT program to follow-up than those treated as inpatients. Possible reasons for the beneficial effects of completing the CBT as a day patient rather than an inpatient are discussed, and threats to the validity of this naturalistic study are considered.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The use of antidepressants continues to increase, yet relatively little is known about their precise subjective effects, and there is growing concern about subtle psychological side effects. One novel investigative approach to these problems may be to use introspectively trained subjects such as meditators. Experienced meditators recently taking antidepressants rated antidepressant effects on multiple dimensions of experience and reported significant emotional, motivational, and cognitive effects and benefits. This study suggests that a) meditators may benefit both clinically and meditatively from antidepressants, b) meditators may provide significant novel information on antidepressant effects, c) meditators may prove valuable for phenomenological investigations of psychopathology, drug effects, and therapies, d) meditation may prove a helpful maintenance therapy for depression, and e) enhanced equanimity may contribute to the broad therapeutic efficacy of antidepressants.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Several recent studies have provided direct evidence for the link between posttraumatic stress disorder (PTSD) and psychosis. Patients with psychotic disorders are known to be at a higher risk of traumatization and PTSD. Additionally, preclinical and clinical data suggest that the effects of trauma exposure on neural networks may provide a common diathesis for disorders like PTSD and schizophrenia. This article reviews evidence on a) the magnitude of association between PTSD and psychosis, b) the causal mechanisms implicated, and c) treatment considerations relevant to this association. A comprehensive MEDLINE search was conducted, and articles pertinent to epidemiological, clinical, and treatment aspects of comorbid PTSD and psychosis were identified. High rates of PTSD characterize patients with severe mental illness. Psychotic phenomena may also be a relatively common manifestation in patients with chronic PTSD. However, in clinical settings, the diagnosis is often missed, and few systematic guidelines exist for the identification and treatment of these comorbidities. Future neurobiological and treatment studies may be useful in better informing the clinical management of these subgroups.

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0022-3018    

出版商:OVID    

年代:2003

数据来源: OVID