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Comorbidity in compulsive hoarding: a case report.

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.

Attention Deficit Disorder with Hyperactivity↗

Connecting the dots: children's use of a systematic figure to facilitate mapping and search.

Organizing locations into a systematic figure was predicted to facilitate children's use of spatial relations in a mapping task. In Study 1, 3-, 4-, and 5-year-olds used a map to find a sticker hidden under 1 of 27 locations. The search locations formed a systematic figure, the outline of a dog. Half of the children were shown that the locations formed a dog. Seeing the dog pattern facilitated the performance of 5-year-olds but not that of the younger children. Study 2 indicated that children had to see a systematic figure to gain an advantage; adding lines to an unsystematic figure did not convey an advantage. Study 3 indicated that a verbal label alone could not convey an advantage. Study 4 revealed that seeing the dog pattern could also facilitate performance when the map was rotated relative to the represented space. The importance of organizing spatial information to facilitate relational thinking and mapping is discussed.

Child↗

Goal orientation: effects on backing up behavior, performance, efficacy, and commitment in teams.

The author examined the predictive validity of goal orientation in teams on both team process and outcome variables. Results indicate that when mean goal orientation scores were used as a way of describing team members' inputs, learning orientation was related to backing up behavior, efficacy, and commitment. The relationships between performance orientation and efficacy and commitment, however, were more complex and were clarified when task performance was also taken into account. Performance orientation had a negative effect on efficacy when task performance was low and a positive effect on commitment when task performance was high. The implications of these findings for theory and research on goal orientation in teams and team staffing are discussed.

Adult↗

A secure base: responsive support of goal strivings and exploration in adult intimate relationships.

A theoretical framework is proposed for examining the interpersonal processes involved in the support of a relationship partner's goal strivings, personal growth, and exploratory behavior, and for examining consequences of receiving either responsive or unresponsive support in this domain. These processes were examined using both observational and experimental methods. In Phase 1, couples were videotaped as they discussed personal goals for the future. In Phase 2, support behavior was experimentally manipulated to examine immediate effects on the recipient. Results indicated that responsive (nonintrusive) support of a relationship partner's goal strivings and explorations have important implications for the recipient's happiness, self-esteem, and perceived likelihood of achieving specific goals. The importance of research examining this type of support is discussed.

Adolescent↗

Staff activities and behaviour are the source of many feelings: relatives' interactions and relationships with staff in nursing homes.

Family members do not give up their involvement in the life of their older relatives when they move to an institution. Relatives feel that it is they who take the initiative to establish a working relationship with the staff at the nursing home. Relatives want more spontaneous information from staff, particularly about residents' daily lives, and there is a need for relatives to have opportunities to talk with staff under relaxed conditions. Staff behaviour and activities towards residents and relatives are a source of many feelings for relatives. Relatives' understandings of the challenges faced by staff are not communicated to staff, nor are positive or negative experiences explicitly passed on to staff.

Adult↗

Creating optimal healing environments for patients with cancer and their families: insights, challenges, and lessons learned from a decade of experience.

Optimal cancer care balances the need for scientific knowledge, statistical analysis, and rational thought with the need for wisdom, kindness, compassion, and love. Finding and maintaining this balance is one of the most important challenges inherent in creating optimal healing environments (OHEs) for cancer care. This new medical paradigm, which promotes awareness, healing, and transformation at the deepest levels of the body, mind, heart, and spirit for patients and their families, must make an equal commitment to developing the health, well-being, awareness, and communication skills of medical and other staff members. This paper articulates the insights, challenges and lessons gleaned from the author's experience in creating and directing an OHE with a scientifically based, sensitive, and compassionate approach to healing for patients with cancer and their loved ones.

Adaptation, Psychological↗

The complex gastrointestinal patient and Jean Watson's Theory of Caring in nutrition support.

The care of the patient with gastrointestinal disease is complex and challenging. The reasons for the complexity are varied and different for each patient. Any of these variables can affect the nutritional health of the patient, an essential element of care that supports healing, recovery, and improved quality of life. A nutritional assessment, an evaluation of the patient's nutritional status, can be used to establish the patient's weight history, dietary habits, tolerances, and likes and dislikes. Intake and output values from this assessment provide information relating to the patient's ability to meet his or her nutritional requirements orally or whether alternate methods for nutrition support need be considered, such as a feeding tube or a central intravenous catheter. Parenteral nutrition is the intravenous nutrition supplementation required when the oral or enteral route for nutrition support is unavailable or impossible. In this article, a clinical case scenario for a 34-year-old man with a history of cancer and an extensive bowel resection will be presented to better explore the decision-making process for determining appropriate nutrition support. In addition, various issues the health practitioner needs to consider when managing the nutritional health of the complex gastrointestinal patient will be explored, relative to Jean Watson's Theory of Caring.

Adult↗

Pivotal moments in the therapeutic relationship.

It is perhaps conventional wisdom that the therapeutic relationship is a cornerstone of psychiatric nursing. It is almost a sine qua non. However, while its importance may be widely recognized, it is notoriously undefined and even those who profess to practise or utilize it, or those who advocate it most strongly, have difficulty in saying exactly what it is. This report details a study carried out with six experienced psychiatric nurses to explore and describe perceptions and understandings of pivotal moments within therapeutic relationships. The nurses were asked, in a series of one-to-one interviews, to consider relationships with clients that they would themselves describe as therapeutic and meditate on those moments at which everything seemed to change and the relationship became qualitatively different. Among the factors the nurses reported as being significant were empathy, uniqueness, meaning and purpose, and appropriate self-disclosure (although many of those terms may require clarification). This paper will consider the implications of these and others for nursing practice and the identity of psychiatric nursing practice.

Adult↗

Mother Teresa versus Ebenezer Scrooge: mortality salience leads proselfs to endorse self-transcendent values (unless proselfs are reassured).

Recently, Jonas, Schimel, Greenberg, and Pyszczynski demonstrated that mortality salience (MS) increased contributions to (an ingroup) charity (i.e., the Scrooge effect). The authors examined whether individual differences in social value orientations would moderate the Scrooge effect. In line with an Ebenezer shift hypothesis, proselfs were less likely than prosocials to endorse self-transcendent values in a dental pain control condition but were indistinguishable from prosocials in an MS condition as proselfs increased endorsement of self-transcendent values under MS (Experiments 1 and 2a). However, when participants gave their impressions of an unfavorable prosocial or a favorable proself prior to the MS manipulation, proselfs were again less likely than prosocials to endorse self-transcendent values (Experiments 2a and 2b), suggesting that proselfs are unlikely to transform into prosocials under conditions of MS when given reasons to disidentify with prosocial values or identify with proself values.

Adult↗

Human becoming practice around the globe: exploring the art of living true presence.

In this column, the human becoming practice methodology is illuminated and some of the questions that people have asked about living the art of human becoming are presented. The human becoming teaching-learning processes are discussed as a way of coming to know what it takes to live true presence, and the role of stories in teaching-learning human becoming practice is explored. Previously published human becoming practice stories are presented as an answer to many of the questions that persons have asked about human becoming-guided practice.

Adaptation, Psychological↗

The Kingston Standardized Behavioural Assessment.

The Kingston Standardized Behavioural Assessment (KSBA), a behavioral screening tool that assesses the behavioral changes associated with dementia, particularly Alzheimer's disease (AD), is introduced. Designed to be user friendly for clinicians not trained in specialized behavioral assessment techniques, it addresses some of the problems of existing scales. A group of patients diagnosed with probable AD, vascular dementia, or mixed (AD and vascular) was assessed using the KSBA. A subgroup was also given the Neuropsychiatric Inventory (NPI). Behavioral profiles and scores were obtained for all subjects. Factor analysis revealed 2 factors described as neuropsychiatric and neuropsychological. The KSBA efficiently collects neuropsychological and neuropsychiatric behavioral symptoms of dementia, is easy to score and interpret, and yields a behavioral profile that helps identify target behaviors for intervention. It can be used to facilitate clinical decision making around level of care and can be easily incorporated into clinically based research.

Aged↗

An evaluation of touch on a large request: a field setting.

The effect of touch on compliance to a request has traditionally been tested with small solicitation (answer to a small questionnaire, give a dime to a confederate ....). In our experiment a larger request was evaluated. Passersby, 53 men and 67 women, were asked by two confederates to look after a large and very excited dog for 10 minutes because each wanted to go into a pharmacy where animals were prohibited. In half of the cases, subjects were touched during the request. Analysis showed that, when touched, 55% of the subjects agreed with the request whereas 35% only in the no-touch control condition agreed. This finding indicates that touch was positively associated with the subjects' compliance (p<.03).

Adolescent↗

Characterizing behavioral and psychological symptoms of dementia (BPSD) among geropsychiatric inpatients.

OBJECTIVE: The purpose of this database analysis was to determine if, upon hospital admission, particular behavioral and psychological symptoms of dementia (BPSD) could be linked to patient characteristics, levels of cognitive or clinical functioning, and/or type of residence before hospitalization. METHODS: Sampled were geropsychiatric inpatients with a primary DSM-IV discharge diagnosis of dementia, who participated in the Mental Health Outcomes, Inc. CQI+(SM) measurement program between January 1, 1996 and December 31, 1999 and who had admission data on all study variables and dementia subtype diagnosis at discharge (N = 2256). BPSD clusters were derived from the 16 behavioral items of the Psychogeriatric Dependency Rating Scale (PGDRS). Subgroups were formed on (1) level of cognitive impairment, (2) depressive symptoms, (3) independence of prior residence, (4) age, (5) gender, (6) race, (7) dementia subtype, and (8) prior psychiatric hospitalization. The relationship of these variables to presence of each PGDRS item was explored with Chi-Square Automatic Interaction Detection (CHAID). A random sample (75% of the patient sample) was used to create the model, with the remaining 25% used for cross-validation. Binary multiple logistic regression was employed to obtain odds ratios for variables significantly related (at < or = 0.01) to PGDRS items. RESULTS: The sample was 66% female, with an average age of 81. The regression analysis revealed that cognitive functioning was significantly associated with 12 of 16 PGDRS items. Odds ratios indicated a 7% to 36% increase in odds of observing the target BPSD for a 3-point difference in MMSE. Also, living in a "dependent" environment (eg, nursing home) before hospitalization was significantly associated with 10 behaviors. Odds of displaying four (active aggression, disruptive behavior, noisy behavior, and verbal aggression) more than doubled for those admitted from a dependent living environment versus an independent one. Finally, age was related to only 1 PGDRS item (socially objectionable behavior). CONCLUSIONS: Findings help identify particular behaviors of dementia associated with being admitted to acute care from a restricted environment such as a nursing home. Treatments effectively targeting these BPSD may impact the intensity and costs of services required.

Journal Article↗