Group treatment for dually diagnosed clients

Group treatment is a widely practiced intervention for persons with dual diagnoses. This chapter reviews the rationale for group treatment and discusses four different approaches to group intervention: twelve-step, educational-supportive, social skills, and stagewise treatment.     

Comparison between treatment completers and noncompleters among dually diagnosed substance-abusing adolescents

The psychiatric and demographic characteristics that may distinguish treatment completers from noncompleters among hospitalized adolescents with substance abuse and comorbid psychiatric disorders were examined. Affective and adjustment disorders were more prevalent among treatment completers whereas non-completers were more likely to be assigned a conduct disorder diagnosis. There were no differences between the groups with respect to demographic and legal status, education level and lifetime psychiatric diagnosis in the parents or caretakers, living arrangements, treatment history, and perception of treatment benefits. A higher percentage of treatment completers than noncompleters received psychotropic medications. The factors contributing to treatment termination as well as the clinical and research implications of the findings are discussed.     

Fluoxetine treatment for dually diagnosed methadone maintained opioid addicts: a pilot study

Twenty-two methadone maintained opioid addicts with either depression or persistent cocaine use received open label fluoxetine in addition to their methadone. Fluoxetine significantly decreased depressive symptoms from pre-treatment to endpoint in subjects with depression, while its effect on substance use was inconclusive.     

Empirical assessment of the self-medication hypothesis among dually diagnosed inpatients

The aim of this study was to empirically determine the expected effects of drugs of abuse on the psychiatric symptoms of individuals dependent on alcohol and other drugs to assess the validity of the self-medication hypothesis, defined as motivation of patients to seek a specific drug for relief of a particular set of symptoms. Eight-three inpatients in a large metropolitan hospital with an axis I diagnosis of one drug dependence and an axis II diagnosis of personality disorder completed the Hopkins Symptom Checklist-Revised (HSCL-90-R) and the Neuropsychological Impairment Scale (NIS). They also reported the effect of their drug of choice on each of the symptoms included in both tests. Heroin addicts reported that heroin improved some of their psychiatric symptoms and all of their cognitive dysfunctions. Both cocaine and alcohol users reported that their drug of choice worsened their psychiatric and cognitive symptoms. No relationship was found between frequency or severity of symptoms and drug choice. We concluded that attempts at self-medication may have occurred among heroin addicts, but were unlikely among alcoholics and cocaine addicts. We found no evidence in support of the self-medication hypothesis as a necessary reinforcer of continued drug use.     

Crack cocaine and schizophrenia as risk factors for PPD reactivity in the dually diagnosed

The authors have investigated the clinical role of the soft tissues and of their influence in the planning phase of the orthognathic surgery, with the purpose to emphasize their capital influence in the face armony. Most of the patients really ask for an aesthetic result, that is in a tight relation with the correct prediction of the morphological changes of the soft tissues. The aesthetics excite nowadays the research, especially in all the surgical fields, and so the orthognatic surgery is more than ever from the soft tissues influenced. Subsequently the authors have investigated the principal indications to the bimaxillary surgery and have suggested a personal diagnostic-therapeutic protocol for a correct and opportune evaluation of the soft tissues relations. Finally the authors have described the whole prediction phase and have shown as the maxillary bones influence the whole facial skelett, and as frequently the chin correction and the rhinoplasty are necessary for a better result in the time.     

The Williams-Campbell syndrome diagnosed in an adult female patient

This article outlines the planning and setting up of an advice and discussion group for people with osteoporosis and their families to give a fuller understanding of the condition and how to manage it.     

Spirituality: an important aspect of emergency nursing

Fibrous histiocytoma has a variable, unpredictable behaviour and potential for malignancy. The treatment of choice is wide local excision, which, in the larynx, entails total laryngectomy. A case of fibrous histiocytoma of the larynx, treated successfully by radiotherapy, is presented. A recurrence was treated with cryosurgery and the patient is well at 10-year follow-up. The pathological characteristics of fibrous histiocytoma and the difficulties of classification are reviewed.     

Nursing staff between physician and patient

Departing from a report on today's understanding about nursing, the demanding duties nurses see themselves confronted with are featured in connection with the theme of this meeting. In a second part, difficulties in daily practise are treated. Furthermore, problematic aspects of collaboration within the nursing staff as well as between the disciplines burdening patients are covered. Possible improvements are proposed.     

Values and attitudes: Comparisons between staff and patients at a state hospital.

Administered a 20-item value and attitude scale to 89 male and 90 female professional staff members and ward technicians and 253 male and 162 female alcoholic and psychiatric patients at a state hospital. Self-respect was ranked highest by all except the psychiatric group; male and female psychiatric Ss ranked self-respect 10th and 8th, respectively. With the exception of the professional staff, Ss of both sexes ranked happiness highly. With the exception of the professional staff females, all groups assigned equality a low priority. An exciting life, a world of beauty, pleasure, and social recognition were considered of fairly low importance by all groups. A sense of accomplishment tended to be a relatively high mean choice for all groups. Staff members differed more from psychiatric than alcoholic patients; male staff members differed significantly from alcoholics on only 3 of the 20 items, while females differed on only 1. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A behavioral study of staff attitudes toward mental illness.

65 nurses and aides completed 2 factor analyzed attitude questionnaires. Hospitalized psychiatric patients (N = 188) screened for ability to identify their staff and make valid behavioral ratings, rated their ward staff on a 55-item interpersonal behavior inventory. Relationships between perceived behavior and endorsed attitudes were examined. Restrictive attitudes were consistently related to controlling and restricting behavior. Protective Benevolence was related to such behaviors as aloofness, distance, and dishonesty. Hence, some attitudes were related to behaviors which were congruent with the endorsed attitude, some attitudes were related to seemingly incongruent behaviors, while other attitudes had no significant behavioral correlates. A new attitude area, highly related to outgoing interpersonal behavior, was identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Final report of the Bawnmore Personal Development Programme: staff attitudes and sexuality programme development in an Irish service organisation for people with mental handicap

In this paper, issues on sexuality and mental handicap are reviewed, and recognition of the growing importance of sex education to integration is noted. The development of a sex education programme and staff training provided within a service organisation, with some involvement from other services within an Irish setting, are described, and their evaluation is reported. Attitudes towards involvement prove of particular interest, and factors influencing continuation or discontinuation are identified. The need for attitude change among staff and administration towards the priority given to sex education is highlighted, and a need for structural change in staffing arrangements to facilitate such education is indicated. Failure to recognise sexuality as a research issue in evaluating the success of integration efforts is noted, and such research is recommended as a top priority for the future.     

Use of the University of Rhode Island Change Assessment to measure motivational readiness to change in psychiatric and dually diagnosed individuals.

In this report, the original 4-factor structure of the University of Rhode Island Change Assessment (URICA; C. C. DiClemente & S. O. Hughes, 1990) was replicated, and the scale's internal consistency was found to be acceptable in a sample of 120 psychiatric and dually diagnosed inpatient participants, who had participated in a randomized clinical trial comparing standard treatment (ST) and ST plus motivational interviewing. Contrary to the authors' hypotheses, participants classified as having low motivational readiness to change, based on their URICA scores, demonstrated greater treatment adherence than high-readiness participants, in that they attended a greater proportion of therapy groups while hospitalized (54% vs. 39%; p     

Recognition of depressed affect in hospitalized psychiatric patients: staff and patient perceptions

A comparison of self-report vs. observer rating of depressed mood in a heterogenous inpatient population revealed wide variations in concordance among diagnostic groups. Patients diagnosed as having Affective Psychosis and "Other' illnesses showed the highest correlation between four self-report scales and an observer rating scale. Patients with a diagnosis of depressive Neurosis showed only modest correlation, while Schizophrenics revealed no significant correlation, on these instruments, suggesting inconsistent communication of affect from Schizophrenic patients to observers. In contrast, when self-report scales were intercorrelated, patients in all four diagnostic categories showed highly significant correlations, indicating that they were consistently reporting their affective state on these instruments. The implications of these findings for future research as well as for practical clinical management are discussed.     

A measure of staff attitudes toward care of physically ill patients.

The development of an instrument for measuring staff attitudes toward patient care in general medical and surgical hospitals, called the Philosophy of Treatment Form (POT), is presented. In this development both a general medical and surgical sample and, for comparative purposes, a psychiatric sample were utilized. The POT measures 7 attitude areas for which reliabilities and intercorrelations are presented. Data from a 3rd sample of 350 general medical and surgical staff members indicate that 3 of these areas reliably differentiated among professional groups and 3 reliably differentiated among wards. (PsycINFO Database Record (c) 2010 APA, all rights reserved)