Advance directives for psychiatric treatment: A view from the trenches.

Medical advance directives for end-of-life decisions at times that patients cannot express their preferences have become a major trend in recent state and federal legislation. The author argues that an extension of directives to cover future psychiatric treatment are fraught with both practical and ethical dilemmas. Although the potential for increasing patient autonomy is certainly positive, the potential for implementing covert ideological agendas has been present from the beginning, and the significant differences between medical end-of-life decisions and ongoing treatment of psychiatric patients must weigh against psychiatric advance directives unless major changes are made in existing procedures. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Advance directives for mental health care: An analysis of state statutes.

State statutes enabling individuals to draft written durable advance directives for health care have approached future decisions about mental health care and treatment in several quite different ways. While some states incorporate mental health care into the generic advance directive law, others exclude some kinds of mental health care from the generic law, and a growing number of states have established distinct processes for mental health directives. The author surveys the state statutes and examines the extent to which the statutes may create barriers to the use of advance directives by people with mental illness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

What's wrong with believing in repression?: A review for legal professionals.

Some courts in recent years have tarnished their credibility by willingly and blindly adopting the theory of repressed memory. Such acceptance can destroy the reputations of falsely accused individuals, and, by failing to pay due attention to scientific evidence, gives credence to pseudoscience and demeans the scientific method. This paper was written to inform judges and attorneys about the relevant evidence, which shows that: (a) the concepts of repressed and recovered memory are not generally accepted in the psychological and psychiatric community; (b) the studies cited to support these concepts reveal significant flaws; (c) much empirical evidence has been accumulated against the theory of repression; (d) the studies using the best methodology offer the least support for the repression hypothesis; and (e) there is no evidence that recovered memories accurately reveal the specifics of long-ago events. Repressed- and recovered-memory theory is not supported by science. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"A place like that": Advance directives and nursing home admissions.

Decisions about admitting a mentally incapacitated person to a nursing home raise a variety of difficult legal, ethical, and public policy issues. A strategy for anticipating and addressing this contingency prospectively, by encouraging execution of formal advance planning directives while the individual is still capable, may mitigate some of the dilemmas associated with these issues. The author discusses the contours and feasibility of such a strategy, analyzing the possible uses of advance directives both for prospectively authorizing nursing home admission on one's own behalf and for refusing such admission, or placing explicit conditions on such admission, in advance of the time that the actual decision must be made. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Completing advance directives for health care decisions: Getting to yes.

The concept of advance directives for health care decision making has been judicially condoned, legislatively promoted, and systematically implemented by health care institutions, yet the execution rate of advance directives remains low. Physicians should discuss with their patients advance care planning generally and end-of-life issues specifically, preferably when patients are in good health and not when they face an acute medical crisis. The physician–hospital relationship poses particular challenges for the optimal implementation of advance directives that must be addressed. Hospital administrators must improve education of patients and physicians on the value of such documents as well as internal mechanisms to ensure better implementation of directives. Health insurance plans may be better able to ensure optimal gathering and implementation of directives. Patients must become more familiar and more comfortable with advance care planning and the reality of death and dying issues. Full acceptance of the value of directives ultimately rests on achieving full participation of all involved—providers, patients, families, and payors—in this most profound process. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Advance directives, AIDS, and mental health: TJ preventive law for the HIV-positive client.

Unfortunately, the possibility of future incapacity to engage in health care decision making remains one of the many potential legal problems faced by HIV-positive clients. Consequently, proactive legal planning, including the use of advance directives, is widely recognized as an important element in avoiding legal crisis for HIV-positive persons. The author suggests that, in light of the emotional and psychological difficulties that an HIV-positive client may face, considerations of psychological well-being ought to be explicitly recognized as one priority among many in legal planning. By integrating principles of therapeutic jurisprudence and preventive law, a lawyer can both protect an HIV-positive client's legal rights by planning for legal contingencies and enhance the client's psychological well-being by making emotional concerns one priority in that planning process. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Biofeedback as therapy: Some theoretical and practical issues.

Gives examples of the use of biofeedback in individual therapy from basic research on self-regulation of blood pressure and heart rate and from clinical research on essential hypertension and Raynaud's disease. Patient motivation is a critical variable, since its absence may hamper long-term success in therapy, as indicated by case histories. The use of cognitive and somatic mediators as an aid to self-regulation, both with and without feedback, is illustrated. It is concluded that biofeedback, in conjunction with other medical and psychological techniques, may prove effective for a selected group of motivated patients having acute rather than chronic organ damage. A combined behavioral-biological model, emphasizing (a) the natural relations between responses; (b) the exact manner in which the feedback and reward is given; and (c) biological, cognitive, and environmental constraints, is offered as a potential means of predicting whether biofeedback training will be clinically significant for a given patient. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles for mental health professionals in critical law enforcement incidents: An overview.

Law enforcement personnel routinely face various critical incidents in the course of their workday including confrontations with irate, violent, and/or mentally challenged individuals. While less frequent, law enforcement personnel also are called in response to hostage incidents, barricaded subject incidents, and attempted suicide/suicide by cop incidents. Over the past 30 years, response strategies utilized by law enforcement personnel have been evolving and have been influenced by mental health professionals. This article briefly reviews the histories of Critical Incident Teams (CITs) and Crisis Negotiation Teams (CNTs), discusses the roles of mental health professionals in the development and continuing evolution of CITs and CNTs, presents some of the obstacles to mental health involvement with law enforcement, and highlights areas in need of more empirical research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A survey on quantitative microdialysis: theoretical models and practical implications

The relationship between the transthylakoid pH-gradient, delta pH, and the velocity of photophosphorylation, Vp, in thylakoid membranes from spinach was investigated using the local anesthetic amine procaine as inhibitor of delta pH. When delta pH was driven by Photosystem (PS) II+I-dependent electron flow, passing through the cytochrome b6/f complex, inhibition by procaine was accompanied by an increase of ATP formation. It appeared that procaine allowed for values of Vp similar to those in controls (without procaine) at a significantly lower delta pH than in the controls. In contrast, when delta pH was driven by cyclic electron flow around PS I or by PS-II+I-dependent electron flow via a bypass around the cytochrome b6/f complex, or by PS II alone, procaine simultaneously caused an inhibition of delta pH and a decrease of ATP formation. Inhibition of delta pH by procaine did not induce an electrical membrane potential gradient that otherwise may have energetically compensated for the observed decline of delta pH. The electron flow capacity was unaffected by procaine. However, inhibition of delta pH did not significantly relax pH-dependent control of electron flux. Procaine accelerated ATP hydrolysis by pre-activated thylakoid ATPase to rates which were observed in the presence of uncouplers and had no direct effect on the activation state of the ATPase. The shift in the relationship between delta pH and Vp towards lower delta pH persisted in thermodynamic equilibrium between the phosphorylation potential and delta pH. The data indicated that the unconventional effect of procaine on photophosphorylation may be related to effects on proton translocation at the cytochrome b6/f complex and that a localized protonic coupling may occur between cytochrome b6/f and thylakoid-ATP-synthase complexes.     

Interpersonal aggression and the Type A coronary-prone behavior pattern: A theoretical distinction and practical implications.

In Study 1, 85 male undergraduates were classified as Type A (coronary prone) or Type B (noncoronary prone) on the basis of scores on the Jenkins Activity Survey. Ss participated in a version of A. H. Buss's (1961) teacher–learner procedure that allowed the isolation of hostile from instrumental acts. Results indicate that a prior task frustration produced greater aggression by Type A's than Type B's, but only under conditions where the aggressive act could not affect a confederate's immediate performance (i.e., hostile aggression). Study 2 examined the representation of Type A's and Type B's among 20 women in treatment for child abuse, 20 women who were victims of spouse abuse, and 20 control women. Findings show that Type A's were more likely than Type B's to exhibit the extreme hostility found in child abuse. Both studies suggest that a lack of control may underlie the greater aggression displayed by Type A's and Type B's. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A theoretical framework for sex-biased parental care

Strong anion-exchange (SAX) chromatography and reversed-phase liquid chromatography (RPLC) followed by different mass spectrometric techniques for the separation and identification of conjugated and unconjugated 14C-labelled eltanolone (5beta-Pregnan-3alpha-ol-20-one) metabolites in biological fluids are presented. Conjugates of estradiol were used as model compounds for the development of a SAX based group separation of neutral steroids, glucuronides, sulfates and di-conjugated steroids. The usefulness of the technique is demonstrated by the analysis of 14C-labelled eltanolone metabolites in dog urine. The analytical SAX column used prior to RPLC improved the capacity to separate the metabolites from each other and from endogenous components, compared to a single reversed-phase system. Liquid chromatography negative ion electrospray-mass spectrometry (LC-ESI-MS) was used for the molecular mass determination of conjugated eltanolone metabolites. Unconjugated metabolites and hydrolysed conjugates were identified using gas chromatography-mass spectrometry with an electron impact ion source (GC-MS) after trimethylsilyl (TMS) derivatization. An unexpected finding in dog urine was the diglucuronide formation of eltanolone (presumably after enolisation of its carbonyl group).     

Review of The therapeutic dialogue: A theoretical and practical guide to psychotherapy.

Reviews the book, The therapeutic dialogue: A theoretical and practical guide to psychotherapy by Sohan Lai Sharma (1986). Sharma has taken on the Herculean task of reviewing the whole of the available literature on psychotherapy, organizing it, and using the data to try to instruct the student therapist in the ways of a fundamentally eclectic, existential-humanistic model of psychotherapy. While I appreciate this effort, and wholeheartedly agree with this as the correct and necessary course for the future survival of psychotherapy, the way has already been more compellingly articulated by such writers as Jung, Rank, Rogers, Perls, R. D. Laing, Szasz, and May. Regrettably, though well-intentioned, Sharma's book lacks the requisite elegance, style, depth, and dynamism needed to help spark the essential resurrection of real psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child care for the 21st century: An overview and commentary.

Contends that the problem of alternative child care in modern society touches on social, cultural, religious, and political attitudes and ideals. In considering proposed solutions, scientists and social policy makers are realizing that providing alternative child care for individual families produces complex repercussions in nearly all spheres of social, economic, and political life. Views are explored on the issue of child care as presented by E. Zigler and P. Ennis; S. Scarr et al; and A. R. Pence (see PA, Vol 76:36300; 36294; and 36288). Prominent psychological trends in the debate on child care, including the decline of the "main effect mentality," the "education vs care" controversy, and the resurgence of the early experience debate are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support: some pragmatic implications for health care professionals

BACKGROUND: Depression affects a significant proportion of the expanding elderly population in the UK. Reports of a poorer prognosis for older than for younger adult patients have been challenged by recent papers. METHOD: The casenotes of 56 adults (mean age 47.8 years) and 54 elderly (mean age 72.9 years) patients with primary depression were assessed one year after receiving hospital treatment. Outcome measures were compared with earlier reported findings and factors possibly influencing outcome were explored. RESULTS: The pattern of outcome in both age groups was broadly similar, thus: adults v. elderly: recovered 44.6% v. 44.4%; relapsed and recovered 23.2% v. 24%; residual symptoms 19.6% v. 13% and chronic depression 7.1% v. 5.5%. In the adults there were two natural deaths and one suicide. In the elderly there were two cases of dementia and five natural deaths, which was double the expected death rate. Predictors of poor outcome were melancholic depression in adults and longer duration of illness at intake and an increasing number of previous episodes of affective disorder in the elderly. CONCLUSION: The outcome of treated depressive illnesses appears similar in elderly and adult patients. Associated physical ill health did not adversely affect outcome in the elderly group.     

Sclerotherapy for the permanent eradication of varicose veins: theoretical and practical considerations

Although sclerotherapy is an established procedure to treat ectatic veins, a wide disparity remains in the reported rates of success, especially for larger varicose veins. This article reviews the venous anatomy of the lower extremity and outlines the indications for sclerotherapy. The historical basis for treatment techniques is explored. The mechanism of action of sclerotherapy is discussed as a basis for treatment guidelines. If the procedure is properly performed, when appropriately indicated, rates of success should approach 100%.     

Measurement of skin color: practical application and theoretical considerations

Quantification of erythema and/or pigmentation is important for in vivo assessment of skin reactions to external stimuli such as ultraviolet radiation. Measurement of lesional color is also useful for quantitative evaluation of the efficacy of therapies for skin lesions. Several types of portable optoelectronic instruments have recently become available for these purposes and have been applied to research in dermatology, physiology, pharmacology, and cosmetic science. As color is not a genuine physical quantity but a sensory perception based on color vision, any colorimetric data obtained for the skin should be interpreted carefully. Erythema and melanin indices derived from skin reflectance data should also be evaluated in relation to the optical properties of the skin to avoid misuse. In this article, various methods for quantifying skin color and related parameters are reviewed and the characteristics of each method are discussed theoretically using an optical model of the skin.     

Population-based primary health care for women. An overview for midwives

This home study program has as its focus population-based care for women. Although clearly significant, concentrating effort solely on the individual does not ensure that the population as a whole is healthier. Experts are encouraging health care providers to consider the population as their "patient" and to begin documenting the incidence and prevalence of its disease. This article addresses the following issues: the definition of population-based health care; the relationship between primary care, women's health care, and population-based health care; the importance of a population-based approach or perspective for midwives; the use of population-based care in the provision of prenatal care; the definition of the populations to whom midwives have historically provided care and the documentation of how those populations are changing; and the research and policy issues for midwives related to population-based health care.