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PubMed1991

[Therapy of borderline personality disorder].

A short clarification of the diagnosis "Borderline Personality Disorder" is followed by a review of different therapeutic concepts. The patients usually have many social problems, therefore social rehabilitation can be the most important therapeutic measure. The concept of family-therapy is deemed important to counteract splitting phenomena in the triangle patient-family-medical doctor. Various pharmacological treatments are discussed. In the process of psychotherapy the physician should learn how to deal with impulsivity, unstable and intense interpersonal relationships, affective instability, and the tendency for physically self-damaging behavior in his patients.

Borderline Personality Disorder↗
PubMed1986

Recent aspects of alcoholism in Sri Lanka--an increasing health hazard.

Eighty-five patients (81 males and 4 females) with significant alcoholic histories were studied. Alcohol misuse was directly or indirectly responsible for about 5-10% of hospital admissions in Sri Lanka. Prevalence of alcoholism in patients below 40 years (43% of cases) or with a strong family history (56% of cases) were demographic features simulating trends in developed nations. Although rarely an occupational hazard, the majority in this lower socio-economic group drank illicitly-manufactured brews with high alcohol content while many consumed a mixture of beverages. Lone drinkers were predominant (86%); features of psychological interest were sleep disturbance (64%), emotional problems (42%) and loneliness (34%); domestic problems (36%), social problems (24%) and financial problems (34%) were also noted. Many such factors, either singly or in combination, initiated or perpetuated the drinking habits of the patients. Drug misuse and suicidal tendencies were not observed. Severe hepatic damage was noted in 63% of 42 patients where the histology was demonstrated, and who usually presented with significant hepatomegaly; about 50% of patients below the age of 40 had hepatic damage of a serious or irreversible nature. Direct toxicity of ethanol, toxic contamination during the preparation of illicit brews and nutritional factors appear pertinent to hepatic damage in developing nations. Nutritional factors may cause variations in relation to abnormalities in liver function tests and also liver size among the population studied when compared to findings from the western world.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Measuring quality in general practice. Pilot study of a needs, process and outcome measure.

1. As part of the Scottish Shadow Fundholding Evaluation (1990-92), quality of care was assessed in 6 practices with 49 general practitioners using a pre-consultation health needs questionnaire, consultation length as a process measure (previously shown to be a proxy measure for quality) and a post-consultation satisfaction/outcome measure which contained a subset of six questions assessing whether patients felt enabled by their consultation. This report describes secondary analysis of the available dataset undertaken to explore whether the approach used to evaluate quality of care for patients with specific clinical problems could be extended to the generality of general practice consultations. 2. Chapters 1 and 2 of the report describe earlier work developing both the concepts and instruments used in the Shadow Evaluation, and general findings already reported. The reliability and the construct validity of the measure of enablement are examined and found to be satisfactory. 3. Strong correlations between more time at consultations and more enablement for more patients are found at population level for patients with psychological problems, with social problems and with physical problems. More complex problems require more time to achieve equal benefit. 4. Mean consultation length and mean enablement score correlate well with each other and can be used as summary statistics of quality. Where trends require explanation or exploration, other measures of the use of time and the level of benefit gained are more helpful; both sets of analyses can be derived from the same datasets (Chapter 3). 5. Analyses at practice level show that practices which spend more time at consultations enable patients more whatever the nature of problems presented. The rank orders of time spent at consultation and of enablement are highly correlated (Chapter 4). 6. Analyses at doctor level show that doctors who spend more time at consultations enable patients more and that those who spend less time enable patients less. The numbers of patients available for study were not sufficient to explore this association within subgroups of clinical presentations. As in previous studies, we found that doctors who take longer time are likely to be more patient centred, and those who take less time are likely to be less patient centred. Case-mix varies between doctors, but seems to be independent of whether a doctor is more or less patient centred (Chapter 5). 7. The methods developed in this study give useful insights into the definition and delivery of quality of care in general practice (Chapter 6). The measures now need to be tested in different clinical, cultural and organizational settings and results compared with those found using routinely available NHS data on prescribing and achievement of other clinical and management targets (Chapter 7).

Communication↗
PubMed2005

Extensions of errorless learning for social problem-solving deficits in schizophrenia.

OBJECTIVE: There is a clear need to develop psychosocial rehabilitation methods that compensate for neurocognitive deficits common to persons with severe and persistent mental illness. Errorless learning, a compensatory training intervention, has been successful in teaching entry-level job tasks. However, errorless learning's applicability to broader, more complex functions is unknown. The present study tested the extension of errorless learning for deficits in social problem-solving skills in patients with schizophrenia. METHOD: Sixty clinically stable outpatients with schizophrenia or schizoaffective disorder were stratified by gender and level of memory impairment before being randomly assigned to one of two training programs: errorless learning or symptom management. Groups were matched for training time, format and structure of training, and types of teaching aids used. Social problem-solving ability, measured by the Assessment of Interpersonal Problem-Solving Skills, was assessed at baseline, within 2 days of training completion, and after 3 months. Dependent measures were the scores for the receiving, processing, and sending skills areas from the Assessment of Interpersonal Problem-Solving Skills. RESULTS: A repeated-measures analysis of covariance was conducted for each dependent measure with baseline Assessment of Interpersonal Problem-Solving Skills score entered as a covariate. For all three skills, there was a significant training group effect favoring errorless learning. Durability of errorless learning training effects extended to the 3-month follow-up assessment for processing and sending skills but not receiving skills. CONCLUSIONS: Results support the extension of errorless learning to complex functions such as social problem-solving skills in the rehabilitation of persons with schizophrenia.

Adult↗
PubMed1995

The perceived social context of AIDS: study of inner-city sexually transmitted disease clinic patients.

The present study investigated perceptions of AIDS as a social problem relative to 10 other problems in a sample of 194 inner-city sexually transmitted disease (STD) clinic patients. Within-subjects analyses showed that AIDS was viewed as a more serious problem than housing, alcoholism, and child care, while AIDS was less of a problem than employment, drug abuse, crime, discrimination, and teen pregnancy, and no different from transportation and health care. Factor analysis was used to identify the interrelationships among social problems as perceived by STD patients. For men, factor analysis showed that AIDS was most closely related to crime, drug abuse, teen pregnancy, and discrimination, with these problems constituting the first factor and accounting for most of the variance in the analysis. Men also placed AIDS with alcoholism and child care on the third factor accounting for little variance. For women, however, AIDS clustered most closely with alcoholism and child care, accounting for a minimal amount of variance in the analysis. Results further showed that perceptions of social problems among women correlated with HIV-risk-related behaviors. The structural context of social problems, within which AIDS is embedded, is discussed with reference to HIV-AIDS-prevention interventions.

Acquired Immunodeficiency Syndrome↗
PubMed2002

A cognitive therapy model of social anxiety problems: potential limits on its effectiveness?

Cognitive therapy formulations of, and interventions for, social phobia are increasingly influential. In this article, relevant studies are reviewed and lead to a tentative conclusion that purely 'cognitive' interventions may, in fact, fail to provide optimum help for a large number of people likely to present to mental health services with problems of social anxiety.

Cognitive Behavioral Therapy↗
PubMed1989

Eugenics and American social history, 1880-1950.

Eugenics, the attempt to improve the human species socially through better breeding was a widespread and popular movement in the United States and Europe between 1910 and 1940. Eugenics was an attempt to use science (the newly discovered Mendelian laws of heredity) to solve social problems (crime, alcoholism, prostitution, rebelliousness), using trained experts. Eugenics gained much support from progressive reform thinkers, who sought to plan social development using expert knowledge in both the social and natural sciences. In eugenics, progressive reformers saw the opportunity to attack social problems efficiently by treating the cause (bad heredity) rather than the effect. Much of the impetus for social and economic reform came from class conflict in the period 1880-1930, resulting from industrialization, unemployment, working conditions, periodic depressions, and unionization. In response, the industrialist class adopted firmer measures of economic control (abandonment of laissez-faire principles), the principles of government regulation (interstate commerce, labor), and the cult of industrial efficiency. Eugenics was only one aspect of progressive reform, but as a scientific claim to explain the cause of social problems, it was a particularly powerful weapon in the arsenal of class conflict at the time.

Attitude to Health↗
PubMed1988

Evaluation of a social problem-solving skills program for third- and fourth-grade students.

The effects of a social problem-solving (SPS) training program for entire classrooms of third- and fourth-grade children were examined in two studies. In the first study, experimental children showed significantly greater improvement in knowledge and performance of SPS skills than control children. However, both positive and negative effects of the intervention (varying by classroom) were found on measures of behavioral adjustment, self-efficacy, and peer acceptance at a 6-month follow-up. The second study compared two different intervention strategies: (a) SPS training with teacher-student dialoguing, peer pairing, and self-monitoring, and (b) SPS training with dialoguing only. It was found that children in both the experimental and control groups improved significantly in performance of SPS skills but no differences between the groups were found for changes in behavioral adjustment, self-efficacy, and peer acceptance. The limitations of cognitively mediated interventions for young children were discussed.

Affect↗
PubMed2005

Difficult-to-engage patients: a specific target for time-limited assertive outreach in a Swiss setting.

OBJECTIVE: Assertive community treatment (ACT) failed to develop in Europe, and its efficacy is debated. In Lausanne, Switzerland, ACT focuses on difficult-to-engage patients and aims to facilitate linkage with outpatient care through time-limited interventions. This study aimed to evaluate the applicability and efficiency of time-limited ACT. METHODS: We retrospectively assessed social, clinical, and functional outcomes and motivation for treatment in 75 consecutively seen subjects treated between 2000 and 2002. RESULTS: With 70% of the interventions lasting less than 6 months, we observed significant improvement in most clinical and social problems, in collaboration, in motivation for treatment, and in social network support, despite high baseline levels of clinical and social problems. The number of hospitalizations decreased significantly. CONCLUSIONS: Time-limited ACT is a useful treatment for difficult-to-engage patients with severe clinical and social problems, and it facilitates linkage to care. This narrower target for ACT may facilitate its implementation in Europe.

Adolescent↗
PubMed1988

Development and use of a short self-rating instrument to screen for psychosocial disorder.

This paper describes the preliminary testing and use of a short self-report instrument designed to identify psychosocial disorder. It combines a shortened version of the social problem questionnaire with the 12 item general health questionnaire. In a survey of 100 patients attending a health centre in inner London 46% recorded a psychiatric problem on the general health questionnaire compared with 35% identified by the general practitioner. For social problems 54% of patients assessed themselves as having one or more social problem compared with 23% detected by the general practitioner. The instrument normally takes five to 10 minutes for the patient to complete and thus can be filled out in busy situations such as a general practice surgery or a hospital outpatient department.

Adult↗
PubMed1996

What are the functional consequences of neurocognitive deficits in schizophrenia?

OBJECTIVE: It has been well established that schizophrenic patients have neurocognitive deficits, but it is not known how these deficits influence the daily lives of patients. The goal of this review was to determine which, if any, neurocognitive deficits restrict the functioning of schizophrenic patients in the outside world. METHOD: The author reviewed studies that have evaluated neurocognitive measures as predictors and correlates of functional outcome for schizophrenic patients. The review included 1) studies that have prospectively evaluated specific aspects of neurocognition and community (e.g., social and vocational) functioning (six studies), 2) all known studies of neurocognitive correlates of social problem solving (five studies), and 3) all known studies of neurocognitive correlates and predictors of psychosocial skill acquisition (six studies). RESULTS: Despite wide variation among studies in the selection of neurocognitive measures, some consistencies emerged. The most consistent finding was that verbal memory was associated with all types of functional outcome. Vigilance was related to social problem solving and skill acquisition. Card sorting predicted community functioning but not social problem solving. Negative symptoms were associated with social problem solving but not skill acquisition. Notably, psychotic symptoms were not significantly associated with outcome measures in any of the studies reviewed. CONCLUSIONS: Verbal memory and vigilance appear to be necessary for adequate functional outcome. Deficiencies in these areas may prevent patients from attaining optimal adaptation and hence act as "neurocognitive rate-limiting factors." On the basis of this review of the literature, a series of hypotheses are offered for follow-up studies.

Activities of Daily Living↗
PubMed1998

Age-related perception of stature, acceptance of therapy, and psychosocial functioning in human growth hormone-treated girls with Turner's syndrome.

This study evaluated the perception of stature, acceptance of therapy, and psychosocial functioning in relation to age at onset and time on treatment during 2 yr of GH therapy in 31 girls with Turner's syndrome grouped by age (group A: 3.7-5.8 yr, n = 9; group B: 7.2-11.8 yr, n = 13; group C: 12.5-16.4 yr, n = 9). The growth response after 2 yr was significant in the 3 groups when calculated in terms of growth norms for untreated Turner girls (mean increase in height SD score: +1.2, +1.5, and +1.1, respectively). The effect was less marked in terms of growth norms for normal girls, particularly in group B (+0.5 SD score). Height was perceived as a problem by most patients, except in the youngest girls at the start of treatment (group A) and in the majority of the adolescents after 2 yr of GH therapy (group C), without evidence of relation to growth response during therapy. The GH injections were fairly well accepted by all patients, except those younger than 6 yr. In all patients, expected adult height was unrealistic and became more realistic with age, whereas no consistent changes were observed in relation to growth response to GH therapy. The Child Behavior Checklist revealed elevated mean scores at the behavioral subscales of attention problems (group A and B), social problems, withdrawal, and anxiety-depression (most obviously in group B). No significant changes were seen during GH therapy. In group C, an elevated mean social problem score at the Youth Self Report and a low mean social self-esteem score at the Self-Esteem Inventory were observed before therapy and showed a significant improvement during 2 yr of GH treatment. These results, however, might be biased due to an increase in social desirability during therapy. We conclude that the perception of height, acceptance of GH therapy, and psychosocial functioning in girls with Turner's syndrome show important differences between age groups, with only slight changes observed during GH therapy.

Adolescent↗