Traumafolgestörungen bei Erwachsenen, Kindern und Jugendlichen

Valid diagnostics are an essential foundation of a successful psychotherapeutic treatment. For posttraumatic stress disorders this is not always the case, i.e. when questionnaires are applied that do not completely comply with the criteria of a posttraumatic stress disorder according to the classification systems DSM-IV and ICD-10. In the present review, trauma questionnaires frequently applied in German-speaking areas for adults, children and adolescents are presented with their specificities and are critically discussed. Finally, recommendations for diagnosing posttraumatic stress disorders by means of questionnaires are made.     

Procedural justice and compliance behaviour: the mediating role of emotions

Procedural justice researchers have consistently found that if authorities treat people with trust, fairness, respect and neutrality, people will not only be more willing to cooperate with authorities, but they will also be more likely to comply with authority decisions and rules. New research in this area has gone on to explore the role that emotions play in response to procedural justice and injustice. What this new research has neglected to do, however, is examine whether emotions mediate the effect of procedural justice on subsequent compliance behaviour in real life settings. Using longitudinal survey data collected in two real‐life contexts (Study 1: a taxation dispute (N = 652), and Study 2: workplaces (N = 2366)), the present study will show that perceptions of procedural justice influence the emotions experienced by people, but more importantly these emotional reactions (i.e. anger and happiness) mediate the effect of justice on subsequent compliance behaviour. In other words, it is these positive and negative emotional reactions to perceived justice or injustice that go on to predict who will and will not comply with authority decisions and rules. Copyright © 2008 John Wiley & Sons, Ltd.     

Children’s Psychosocial Problems Presenting in a Family Medicine Practice

Primary care physicians have an important role in identifying, treating, and referring children with psychosocial problems. However, there is a limited literature describing whether and how family physicians address psychosocial problems and why parents may not discuss children’s problems with physicians. The current study examined how family physicians address psychosocial problems and reasons that parents do not discuss children’s psychosocial problems with physicians. Results indicated that there are a variety of reasons involving parents, their perceptions of physicians, and the number of psychosocial problems reported, that may lead to fewer discussions of psychosocial problems.     

“Phobie à deux” and other reasons why clinicians do not apply exposure with response prevention in patients with obsessive–compulsive disorder

Meta-analyses suggest that exposure with response prevention (ERP) is the most efficacious treatment for obsessive–compulsive disorder (OCD) and treatment guidelines for the disorder accordingly recommend ERP. Despite this, many therapists, including those with a cognitive-behavioral therapeutic background, do not perform ERP in patients with OCD. The present study aimed to elucidate the reasons why. German therapists (N = 216) completed an anonymous online survey, the newly developed Reasons for Not Performing Exposure in OCD Scale (REPEX), that inquired whether, to what extent, and how they perform ERP in the treatment of OCD. We also asked their reasons for not applying ERP in the past. Most therapists considered ERP an efficient treatment for OCD. Marked differences emerged between physicians and psychologists, however. The former used exposure less often and for a shorter period, preferred in sensu to in vivo exposure, and conducted exposure less often in the personal environment of the patient than did psychologists. Both groups were familiar with clinical guidelines to a similar extent. A factor analysis of the REPEX scale revealed five factors. Patient lack of motivation, preference for exposure to be self-help as well as alleged organizational difficulties were endorsed most often. The latter was correlated with the age of the therapist and was far more often affirmed by physicians. Fear of side effects was named by a subgroup of clinicians; in the context of patient ambivalence, this may foster “phobie à deux”. Unlike prior research, lack of expertise was rarely identified as a reason not to use ERP. Recommendations for improving adherence to guidelines are discussed.     

USING DIFFERENTIAL REINFORCEMENT TO DECREASE ACADEMIC RESPONSE LATENCIES OF AN ADOLESCENT WITH ACQUIRED BRAIN INJURY

The present study investigated the effects of contingency‐specifying rules and a token economy to decrease the latency to comply with academic instructions by a 16‐year‐old girl with acquired brain injury. Results showed that treatment was successful in reducing academic response latencies. These results replicate previous research in which differential reinforcement was used to decrease slow responding to academic tasks.     

Observations of Muslim Physicians Regarding the Influence of Religion on Health and Their Clinical Approach

Although most patients report wanting their physicians to address the religious aspects of their lives, most physicians do not initiate questions concerning religion with their patients. Although religion plays a major role in every aspect of the life of a Muslim, most of the data on the role of religion in health have been conducted in populations that are predominantly non-Muslim. The objectives of this study were to assess Muslim physicians' beliefs and behaviours regarding religious discussions in clinical practice and to understand the factors that facilitate or impede discussion of religion in clinical settings. The study is based on a cross-sectional survey. Muslim physicians working in a tertiary care hospital in Saudi Arabia were invited to complete a questionnaire that included demographic data; intrinsic level of religiosity; beliefs about the impact of religion on health; and observations, attitudes, behaviours, and barriers to attending to patients' religious needs. Out of 225 physicians, 91% agreed that religion had a positive influence on health, but 62.2% thought that religion could lead to the refusal of medically indicated therapy. Over half of the physicians queried never asked about religious issues. Family physicians were more likely to initiate religious discussions, and physicians with high intrinsic religiosity were more likely to share their own religious views. Residents and staff physicians tended to avoid such discussions. The study results highlight the fact that many physicians do not address patients' religious issues and that there is a need to clarify ethically sound means by which to address such needs in Islamic countries. Medical institutions should work to improve the capacity of medical personnel to appropriately address religious issues. The training of clinical religious advisors is a promising solution to this dilemma.     

Is Evidence Able to Persuade Physicians to Discuss Spirituality with Patients?

Patients believe that spirituality informs health; frequently, they wish to share their beliefs with physicians. Although a large number of physicians believe it their responsibility to be aware of patient beliefs, many do not address spirituality because they do not believe it their role to do so. These physicians would perhaps feel differently if presented with evidence that associated spirituality with positive health outcomes. This national sample of family medicine residents were asked if, presented with evidence that spirituality was associated with improved outcomes, they would be more likely to initiate discussions of spirituality with patients. To varying degrees, most residents agreed that they would be more willing to initiate spirituality discussions if presented with good evidence. Geographic region of training, religious preference, and Spiritual Well-Being Scale quartile predicted both strength of agreement and whether a resident would be as responsive to spirituality oriented research as to investigations of traditional therapeutic modalities. Although residents indicated that they would be more responsive to publications on traditional medical therapies, familiarity with the spirituality literature as part of a residency educational curriculum may help break down barriers to addressing this issue with patients.     

Sedation before ventilator withdrawal: can it be justified by double effect and called "allowing a patient to die"

...Recognizing that sedation and ventilator withdrawal have a causal impact on a patient's death does not open the door to active euthanasia but helps resist it by showing clearly where the debate centers. The heart of the euthanasia issue is not whether providers play a causal role in patients' deaths. They obviously often do when they withdraw burdensome or futile treatment or provide comfort, and these actions can be morally justified in appropriate circumstances. The key point is whether we can morally justify physicians playing two stronger causal roles: providing drugs and information for suicide and doing something in order to kill their patients. Before we can agree with those ethicists who argue that one can justify assisted suicide and active euthanasia despite the moral tradition that has shunned these causal roles, they must clearly show that the human good -- the good of the professions and of society at large, as well as the good of patients -- will be better served by physicians assisting in suicide and giving lethal injections....     

The Effect of Praise, Positive Nonverbal Response, Reprimand, and Negative Nonverbal Response on Child Compliance: A Systematic Review

Lack of compliance has both short- and long-term costs and is a leading reason why parents seek mental health services for children. What parents do to help children comply with directives or rules is an important part of child socialization. The current review examines the relationship between a variety of parenting discipline behaviors (i.e., praise, positive nonverbal response, reprimand, negative nonverbal response) and child compliance. Forty-one studies of children ranging in age from 1? to 11?years were reviewed. Reprimand and negative nonverbal responses consistently resulted in greater compliance. Praise and positive nonverbal responses resulted in mixed child outcomes. The findings are discussed based on theory and populations studied. The authors propose a mechanism that may increase children’s sensitivity to both positive and negative behavioral contingencies.     

Unto the Third Generation

Abstract

It is possible to significantly reduce, even eliminate child abuse if we address five obstacles: (1) many mandated reporters fail to comply with the law; (2) most child abuse reports are not investigated; (3) frontline child protection professionals are inadequately trained; (4) we do not address child abuse at the youngest ages; and (5) maltreated children receive an inadequate share of financial resources. Accordingly, we must reform our higher education system to ensure that all child protection professionals have the skills necessary to recognize and respond to abuse. We must provide ongoing training to professionals in the field, have at least one forensic interview-training program in each state, develop prevention programs at the local level, and teach frontline professionals to advocate for children. Finally, we must recruit a second generation that will build on these successes and continue to improve our response until child abuse no longer exists.     

Employment of individuals with mental disabilities: business response to the ADA's challenge

This research examines the response of the business community to the Americans with Disabilities Act (ADA) with specific focus on the employment of those with mental disabilities. The ADA is viewed as an important "rational myth" in that it represents both a legal and normative demand with which businesses are expected to comply. Yet employers' responses will be influenced by their attitudes toward persons with mental disabilities as well as their concern with legal sanction for discriminatory behaviors. A telephone survey was completed in a southern metropolitan area with a random sample of 117 businesses in order to access the knowledge employers have about the ADA (and its inclusion of those with mental disabilities), the compliance with the ADA, the employment practices, and the role played by stigma in the employment of individuals with mental disabilities. In terms of specific practices which indicated compliance with the ADA, a little over one-third of the companies which were surveyed by telephone had a Title 1 implementation plan, 15% had specific policies for hiring those with mental disabilities, and 37.6% had indeed hired such an individual. The role of coercive and normative rationales for compliance to the ADA was examined. It was found that receiving formal information about the ADA, threat of legal sanction, and previous employment of those with mental disabilities were all significant predictors of compliance with the ADA. Stigmatizing attitudes did not predict compliance, though employers did view those with mental disabilities with more discomfort than other types of employees.     

职业精神与弱势病人

医学职业研究所对美国医生的现实行为的调查说明:医生们是相信且赞同职业精神在对待弱势病人方面的关键信条的;增强美国医生的职业精神的努力,也应该包括努力转变医生照顾弱势病人的行为方面。但是,增强职业精神的努力不仅要通过书本上的或理论上的教育,也应该包括致力于制定使医生更容易履行这些义务的实践政策,提供体制上的支持可使医生更容易做他们已经知道其应该做的行为。     

Beyond Credentials: The Effect of Physician Sex and Specialty on How Physicians Are Perceived

The experiment investigated the effect of physician sex and specialty on participants’ perceptions of doctors. Participants (N = 206) viewed a physician profile (male/female orthopedic surgeon or male/female dermatologist) and then evaluated the physician on a survey. While male participants reported they would be more willing to see a female physician and believed female physicians would be more caring, female participants reported they would be more willing to see physicians in counter-stereotypical specialties and rated them as more caring. The study suggests that not only do men and women focus on different things in selecting physicians but also that negative stereotypes of female physicians have dramatically decreased.     

Use of health-related online sites

This report offers recommendations to physicians who provide information or services through online sites. The recommendations maintain that physicians responsible for health-related information should ensure that it is accurate, timely, reliable, and scientifically sound. Also, advice to the online users with whom physicians do not have pre-existing relationships or the use of decision-support programs that generate personalized information directly transmitted to users should be consistent with general and specialty-specific standards. In particular, these standards address truthfulness, protection of privacy, informed consent, and disclosures including limitations inherent in the technology. Finally, physicians who establish or are involved in health-related online sites must minimize conflicts of interest and commercial biases and, if patient specific information is transmitted, they must provide high-level security protections, as well as privacy and confidentiality safeguards.     

Non-response to sad mood induction: implications for emotion research

Experimental induction of sad mood states is a mainstay of laboratory research on affect and cognition, mood regulation, and mood disorders. Typically, the success of such mood manipulations is reported as a statistically significant pre- to post-induction change in the self-rated intensity of the target affect. The present commentary was motivated by an unexpected finding in one of our studies concerning the response rate to a well-validated sad mood induction. Using the customary statistical approach, we found a significant mean increase in self-rated sadness intensity with a moderate effect size, verifying the “success” of the mood induction. However, that “success” masked that, between one-fifth and about one-third of our samples (adolescents who had histories of childhood-onset major depressive disorder and healthy controls) reported absolutely no sadness in response to the mood induction procedure. We consider implications of our experience for emotion research by (1) commenting upon the typically overlooked phenomenon of nonresponse, (2) suggesting changes in reporting practices regarding mood induction success, and (3) outlining future directions to help scientists determine why some subjects do not respond to experimental mood induction.     

Psychopharmacology and the Power of Narrative

This report offers recommendations to physicians who provide information or services through online sites. The recommendations maintain that physicians responsible for health-related information should ensure that it is accurate, timely, reliable, and scientifically sound. Also, advice to online users with whom physicians do not have preexisting relationships or the use of decision-support programs that generate personalized information directly transmitted to users should be consistent with general and specialty-specific standards. In particular, these standards should address truthfulness, protection of privacy, informed consent, and disclosures including limitations inherent in the technology. Finally, physicians who establish or are involved in health-related online sites must minimize conflicts of interest and commercial biases and, if patient specific information is transmitted, they must provide high-level security protections, as well as privacy and confidentiality safeguards.     

Psychology ethics down under: a survey of student subject pools in Australia

A survey of the 37 psychology departments offering courses accredited by the Australian Psychological Society yielded a 92% response rate. Sixty-eight percent of departments employed students as research subjects, with larger departments being more likely to do so. Most of these departments drew their student subject pools from introductory courses. Student research participation was strictly voluntary in 57% of these departments, whereas 43% of the departments have failed to comply with normally accepted ethical standards. It is of great concern that institutional ethics committees apparently continue to condone, or fail to act against, unethical research practices. Although these committees have a duty of care to all subjects, the final responsibility for conducting research in an ethical manner lies with the individual researcher.     

Women and Alcoholism: A Biopsychosocial Perspective and Treatment Approaches

Viewing alcoholism in women from a biopsychosocial perspective reveals a unique set of circumstances and challenges that women alcoholics face when compared with men. Biologically, women react differently to alcohol ingestion than do men. Women reach higher blood alcohol levels and sustain more somatic and cognitive damage than men when consuming equivalent amounts of alcohol. Psychosocially, women alcoholics face societal rebuke and chastisement of a greater magnitude than do men. Finally, barriers to treatment faced by women, such as the need for child care, cost of treatment, familial opposition, denial of alcoholism, and inadequate diagnostic training of physicians, must be overcome to create successful treatment approaches for the female alcoholic. Obstacles to and implications for treatment are also discussed.