Hope in the Supervision of Therapy of Patients with Psychotic Disorders

Abstract

Psychotherapeutic interventions for individuals diagnosed with psychotic disorders have been extensively reviewed and studied (Fromm-Reichmann, 1950; Searles, 1965; Rosenfeld, 1988) and have recently received further attention (Kanwal, 1997; Silver, 2001; Spinelli, 2001). Nevertheless, there are almost no updated articles on the supervision of this therapy. This article addresses the issue, focusing on the importance of a sense of hope among therapists working with individuals who have psychotic disorders.     

Predictors of Service Utilization Among Youth Diagnosed with Mood Disorders

In this study, I investigated patterns and predictors of service utilization for children with mood disorders. The Behavioral Model for Health Care Utilization was used as an organizing framework for identifying predictors of the number and quality of services utilized. Hierarchical regression was used in secondary data analyses of the Multi-Family Psychoeducational Psychotherapy study (MF-PEP), a randomized controlled trial of 165 children aged 8–12 with mood disorders. The children were using an average of two services, with pharmacotherapy and school services as most frequent. Children with bipolar disorders used significantly more and higher quality services than children with depressive disorders. Parent knowledge of mood disorders, area of residence, and perceived need for treatment were all related to the number of services families were utilizing. Parent knowledge of mood disorders and treatment, child’s age, and mood symptom severity were all predictors of the quality of services being utilized. Findings highlight the impact of non-need factors on service utilization and the potential to decrease disparities caused by these factors. For example, increasing efforts to educate both the general public and individual families coming in for treatment about children’s mental health may improve service utilization patterns in this population.     

Three Phases of Treatment with Borderline and Psychotic Patients

Three distinct, yet overlapping, phases of treatment emerge when working with some borderline and psychotic patients. This are patients who test the ordinary limits of psychoanalysis, but can profit from its deep exploration. The first phase is colored by acting out, interpersonally and intrapsychically. An analytic envelope of containment is necessary to sustain the treatment. Interpretive holding and containing help the patient find a psychic receptacle capable of detoxifying violent projections. Many of these patients terminate prematurely. The second phase is centered around the patient's defensive use of the death instinct to extinguish or destroy certain parts of their mental functioning. This difficult standoff between parts of the patient's mind becomes replicated in the transference. The third phase reveals the more fundamental problem of paranoid～schizoid anxieties of loss and primitive experiences of guilt. These include fears of persecution and annihilation. Some patients abort treatment in the first or second phase and never work through the phantasies and feelings of loss. Nevertheless, much intrapsychic and interpersonal progress is possible. Given the instability and chaotic nature of these patient's object relations, the analyst must be cautiously optimistic in their work and realize the potential to help the patient even when presented with less than optimal working conditions.     

Formulation and Treatment of Chronic Suicidality in Patients with Developmental Trauma

Although the psychodynamic literature has examined some of the links between developmental trauma and suicidal thinking and behavior, much of this scholarship focuses on the management of chronic suicidality in the treatment of patients with borderline personality disorder. In this paper, we examine the relationship between complex trauma and the broad spectrum of chronic self-destructive thoughts and behaviors commonly seen in clinical practice. We incorporate perspectives from psychodynamic theory with an emphasis on attachment theory in our understanding of the underlying mechanisms involved. We describe how we use this developmental understanding to address chronic suicidality in ongoing clinical treatment beyond management and safety planning, by providing psychoeducational, cognitive, behavioral and affect-focused strategies that serve to enhance the treatment alliance.     

Factors Associated with Suicidality Among a National Sample of Transgender Veterans

Correlates of past‐year suicidal ideation and lifetime suicide risk among a national sample of transgender veterans were examined. An online, convenience sample of 212 U.S. transgender veterans participated in a cross‐sectional survey in February–May 2014. We evaluated associations between sociodemographic characteristics, stigma, mental health, and psychosocial resources with past‐year suicidal ideation and lifetime suicide plans and attempts. Participants reported high rates of past‐year suicidal ideation (57%) as well as history of suicide plan or attempt (66%). Transgender‐related felt stigma during military service and current posttraumatic stress disorder and depressive symptoms were associated with suicide outcomes as were economic and demographic factors.     

Post-Discharge Experiences of People with Psychosis Following Partial Hospital Program Completion

Partial hospital programs are day programs which act as a bridge between inpatient and outpatient care for people with severe and persistent mental illness. This study explored the gap that exists in understanding the post-discharge experiences of people who have experienced psychosis. Qualitative interviews were conducted with 8 participants with psychosis, at least 4 weeks after completing partial hospital program. Identified themes included improved sense of wellness, changes in structure/routine, accessing community resources, social support and engagement, engagement in leisure, and impact of medication. Occupational therapists can use these findings to enhance programming at partial hospital programs and other similar programs.     

Predictors of Successful Completion of a Postincarceration Drug Treatment Program

Using secondary analysis, this study compared the characteristics of 1,763 parolees with substance abuse problems who successfully completed a post incarceration drug treatment program with those who did not. Those who completed the program were more likely to be women who had not used drugs 30 days before program admission, had fewer prior treatment experiences, remained in the program longer, and had secured employment and stable living arrangements by the time of discharge. Implications for treatment and program development are discussed.     

A Dimensional Model of Psychopathology Among Homeless Adolescents: Suicidality,Internalizing, and Externalizing Disorders

The present study examined associations among dimensions of suicidality and psychopathology in a sample of 428 homeless adolescents (56.3% female). Confirmatory factor analysis results provided support for a three-factor model in which suicidality (measured with lifetime suicidal ideation and suicide attempts), internalizing disorders (assessed with lifetime diagnoses of major depressive episode and post-traumatic stress disorder), and externalizing disorders (indicated by lifetime diagnoses of conduct disorder, alcohol abuse, and drug abuse) were positively intercorrelated. The findings illustrate the utility of a dimensional approach that integrates suicidality and psychopathology into one model. Kevin A. Yoder and Susan L. Longley made equal contributions to this paper.     

The Experience of Caregiving Among Mothers of Adults Suffering from Psychotic Disorders: Factors Associated with Their Psychological Distress

To identify correlates of psychological distress among multiple indicators, 99 women with adult children suffering from a psychotic disorder were interviewed. The women, who were recruited through hospitals and self-help groups, represented different socioeconomic levels. A face-to-face standardized interview was conducted, mainly in the participants' homes. Multiple hierarchical regression analysis showed that dimensions of burden and social support were strongly associated with distress reported by the participants. The negative interactions that participants had with their main confidant or spouse constituted a more powerful correlate than their perception of the quality of this relationship. Furthermore, a perception of their own health as poorer is a strong correlate of their distress. Since no control group was studied simultaneously, these results suggest, but do not prove, the presence of differences between mothers of adults with psychotic disorders and other mothers.     

精神疾病共病现象的辩证思考

由于大多数精神疾病的病因和发病机制不明,无特异性的生物学诊断指标,临床表现多样,有时很难用一种疾病解释.共病的概念应用于精神科临床,为精神科医生提供了一种辩证的诊断思维方法,对研究共病的本质和指导临床治疗都有重要的意义.     

Changes in Distress Intolerance and Treatment Outcome in a Partial Hospital Setting

Despite the well-established role of distress intolerance (DI) in a wide range of psychological disorders, few studies have examined whether DI improves during treatment and whether these changes are associated with symptom outcomes. Patients (N = 626) enrolled in a brief cognitive-behavioral partial hospital program completed pre- and posttreatment measures of DI. Results indicated that DI decreased significantly during treatment, with more than 30% of the sample exhibiting a reduction of more than 2 standard deviations from the sample mean. Women reported higher DI than men at baseline; however, there were no gender differences in changes in DI over time. Participants also completed a pre- and posttreatment measure of depression and a subset completed a measure of anxiety (n = 167). DI was associated with more severe depression and anxiety at pre- and posttreatment, with participants who reported a decrease in DI also reporting lower depression and anxiety symptoms at post-treatment. These results further highlight the transdiagnostic relevance of DI and suggest that DI may be a relevant factor in treatment outcome for depression and anxiety.     

A Meta-Analysis of Neuropsychological Effort Test Performance in Psychotic Disorders

Neuropsychology Review - Psychotic disorders are characterized by a generalized neurocognitive deficit (i.e., performance 1.5 SD below controls across neuropsychological domains with no specific...     

The Search for Non-Medical Treatment by Patients with Psychiatric Disorders

Patients in Turkey frequently seek help from non-physicians such as hodjas and fortune-tellers. The aim of this study is to assess the prevalence, reasons for and results of the search for non-medical help by patients with psychiatric disorders. It was determined that 42.2% of patients consulted a hodja or a fortune-teller, and many (23.1%) were either the subject of prayers or else were advised to pray themselves as treatment. Considering that a significant number of patients seek non-medical treatment, it is thought that people should be informed about psychiatric disorders, therapies, and how to obtain them.All of the authors are M.D.s at Ondokuz Mayis University in Samsun, Turkey. Dr. Peksen is a Professor and Dr. Sunter an Assistant Professor in the Faculty of Medicine, Department of Public Health. Dr. Ozkan is a Professor and Dr. Güz an Associate Professor in the Department of Psychiatry.     

Cognitive Insight in Inpatients with Psychotic, Bipolar, and Major Depressive Disorders

The Beck Cognitive Insight Scale (BCIS; Beck, Baruch, Balter, Steer, & Warman, 2004) was administered to 42 (28%) inpatients with psychotic disorders, 52 (35%) with a bipolar disorder, and 56 (37%) with a major depressive disorder (MDD). The hypotheses were (a) that the mean level of cognitive insight in a psychotic or a bipolar disorder is lower than that in a MDD, (b) that the mean levels of cognitive insight in psychotic and bipolar disorders were comparable, and (c) that the mean BCIS index score for a bipolar disorder in which the most recent episode had been mania is lower than the mean BCIS index score for a bipolar disorder in which the most recent episode had been mixed or depressed. All three hypotheses were supported. The results were discussed as supporting cognitive insight as a psychological construct that varies predictably according to the nature of a psychiatric disorder.     

The Predictors of Suicidality in Previous Suicide Attempters following Case Management Services

Suicide attempts constitute a serious clinical problem. People who have attempted suicide are at an elevated risk for additional suicide attempts, but there is limited evidence regarding the predictors of suicidality of suicide attempters following case management services. In the present study the indicators of suicidality after case management were examined. A total of 1,056 subjects who had recently attempted suicide were recruited from January 1, 2011, to June 30, 2011. The suicide prevention center of Kaohsiung City in Taiwan provided case management services and followed up on suicide attempt cases for 6 months. The salient factors for repeat suicide attempts were estimated using a logistic regression analysis. The results showed that multiple factors, including a “willingness to receive mental health services during a crisis,” “social support,” “a history of mental disorders,” and “a history of suicide,” could predict repeat suicide attempts with hazard ratios (0.58, 0.54, 3.84, 1.51) and 95% confidence interval (0.39–0.86, 0.36–0.83, 2.41–6.10, 1.03–2.21). The four factors mentioned above were the most accurate predictors of subsequent suicidality when case management services were utilized after 6 months of follow‐up. The findings of our study could help clarify future strategies for suicide prevention.     

Predictors and Outcomes of Psychiatric Hospitalization in Youth Presenting to the Emergency Department with Suicidality

Youth suicide attempters presenting to the emergency department (ED) are frequently admitted to psychiatric inpatient hospitals, yet little is known about how clinicians decide which youths to admit versus discharge to outpatient care. We examine predictors of inpatient hospitalization and describe service use outcomes associated with hospitalization in 181 youths drawn from consecutive ED admissions for suicidality. Predictors of hospitalization include ED site, suicide plan, and parent report of problems. Hospitalization was associated with improved linkage to outpatient treatment and more intensive service use. Future research is needed to understand the best service delivery and treatments for these high‐risk youth.     

Health-Related Quality of Life,Functioning and Social Experiences in People with Psychotic Disorders

Applied Research in Quality of Life - To inform development of a model for health-related quality of life (HRQoL) in people with psychotic disorders, we aimed to assess correlations between...