Newspaper coverage of injuries affecting the Spanish surname population in two counties in Colorado

The present study assessed newspaper reports of injuries affecting individuals with Spanish surnames and compared newspaper reports to hospital injury discharge data in two counties in Colorado. Newspaper reports came from 12 daily and weekly newspapers. Hospital discharge data were obtained from the Colorado Department of Public Health and the Environment. Motor vehicle crashes, assault and legal intervention, and suicide and suicidal acts were counted. A higher proportion of people with Spanish surnames were reported in newspapers than expected based on the hospital discharge data. Motor vehicle injuries were far more frequent based on hospital discharge data than in newspaper reports. Assault and legal intervention injuries were similarly represented by Hispanic ethnicity and absolute numbers in both reporting sources. Suicide and suicidal acts were not often reported in newspapers relative to hospital discharge data; however, the proportion of Hispanics was not significantly different. These findings suggest that the use of newspapers for surveillance of injuries may be helpful, but should not be used in the absence of other data sources.     

Early and continuous action to prevent breakdown in the care of infants and their families after serious neonatal episodes

This paper reports on the experience accumulated over more than 10 years by the multidisciplinary team of a Center for early medico-social action in accompanying infants at risk after they leave a Neonatology Center. The members of this team, located in the same building, came to the conclusion that the difficulties encountered are in part connected directly with the psychological trauma experienced during the infant's stay in the hospital and with a poor elaboration of the affects of this period and inadequate planning for appropriate action during this time. As a result, well before they leave the hospital, arrangements are made for immediate support to the children and their families. The support is determined by the seriousness of the situation, whether it be the disease itself, the long stay in the hospital, or some particular weakness in the family. These activities have been intensified in the past 3 years and have been strengthened with regard to children with broncho-pulmonary dysplasia or ulcero-necrotizing enterocolitis. They also are concerned with infants with severe neurological lesions, particularly porencephalia, and children whose mothers are alcoholics, drug addicts, or psychotics.     

Double Jeopardy: Suicide Rates in Forensic Hospitals

While a number of studies have described high and increasing rates of completed suicide among psychiatric patients, the suicide risk of forensic hospital patients is virtually unknown. This paper reports on the suicides that have taken place in the country's oldest continually operating institution housing persons formerly labeled “criminally insane,” the Bridgewater State Hospital. The results show considerable variation in the suicide rate by historical period, with suicide prior to 1968 a considerably more infrequent event. By contrast, the post-′68 rate of 232 per 100,000 is comparable to data reported in a series of studies of psychiatric suicides, and significantly higher than that found in U.S. studies of correctional populations. These differences are discussed. The results strongly suggest that forensic hospital populations have suicide rates broadly comparable to other psychiatric populations.     

Experiential Research

ABSTRACT: This paper reports a research project that has focused on the inner experience of suicidal depression and its relationship to the social milieu. Adopting a suicidal identity, a clinical anthropologist lived in a psychiatric hospital, and then, along with a clinical psychologist, in several posthospital care facilities for periods from two weeks to a month in each setting. The evidence indicates the researchers were able to establish identities closely resembling those of genuinely suicidal persons. Their experiential accounts along with their observations of the social settings in which they lived provide the core material for analysis. Additional data from hospital records and posttreatment meetings with staff members and fellow patients supplemented the researchers' observations. Data are presented on social situational variables that support and/or undermine feelings of self-worth, the social presentation of a suicidal self, and introspective accounts of suicidal “world views” and styles of thinking. Suggestions are made for suicide prevention in institutional settings on the basis of life-supporting relationships and appropriately designed social-structural features.     

Attention deficit hyperactivity disorder in adults: Clinical issues. A report from the first NHS clinic in the UK

Since 1994 Maudsley hospital has offered the only NHS-service for adult Attention Deficit Hyperactivity Disorder (ADHD) in the United Kingdom. This paper reports on the development of this service, initial referral patterns and assessment issues. Data from a comparison of the first 96 referrals to the clinic are summarized. ADHD patients were more likely to be young men in their early twenties, to have personality disorder and abused psychoactive substances. Developmental milestones were delayed in the ADHD group. Comorbid anxiety and depression were common in both the ADHD group and non-ADHD group. It is clear that with maturity many ADHD adults have complex problems, yet the need for clinical services for this group is not commonly recognized.     

医疗暴力的危害、原因及对策

医疗暴力事件严重干扰医院正常诊疗秩序,给医疗服务带来许多负面影响,是急待解决的一个重要问题。介绍了部分国内外有关医疗暴力的报道,分析其危害及产生的原因,并提出相关对策。     

EPQ correlates of the personality deviance scale

New patients at a psychiatric day hospital were asked to complete a set of questionnaires, including the Eysenck Personality Questionnaire, and the Personality Deviance Scale of Bedford and Foulds. This paper reports on the resulting correlations between the variables measured by these two inventories. The findings broadly replicate those of Bedford and Foulds with the Eysenck Personality Inventory and the Personality Deviance Scale. The Neuroticism scale of the EPQ was found to correlate with all of the PDS scales, and particularly highly with intropunitiveness. As regards the Psychoticism Scale of the EPQ, this was found to correlate highly with extrapunitiveness, but not with intropunitiveness or dominance. It is concluded that there appears to be some relationship between P and this hostility measure of extrapunitiveness, a finding somewhat in contradiction to recent conclusions by Forbes based on his study of a normal sample.     

Two scales for measuring patients' perceptions for coercion during mental hospital admission

Legal and extra-legal coercion are pervasive in mental hospital admission and there are sharp disputes about its appropriate role. This article presents two scales for measuring psychiatric patients' perceptions of coercion during hospital admission and reports data on these scales' internal consistency. We measure patients' perceptions of coercion by asking questions, in either an interview or questionnaire format, about their experience of lack of control, choice, influence, and freedom in hospital admission. Patients' responses to questions about their perceptions of coercion were highly internally consistent. The internal consistency of the scale was robust with respect to variation in site, instrument format, patient population, and interview procedure. Correspondence analysis was used to construct two numerical scales of perceived coercion.     

Psychosocial factors in outcomes of heart surgery: the impact of religious involvement and depressive symptoms.

This article reports a prospective study of religiousness and recovery from heart surgery. Religiousness and other psychosocial factors were assessed in 142 patients about a week prior to surgery. Those with stronger religious beliefs subsequently had fewer complications and shorter hospital stays, the former effect mediating the latter. Attendance at religious services was unrelated to complications but predicted longer hospitalizations. Prayer was not related to recovery. Depressive symptoms were associated with longer hospital stays. Dispositional optimism, trait hostility, and social support were unrelated to outcomes. Effects of religious beliefs and attendance were stronger among women than men and were independent of biomedical and other psychosocial predictors. These findings encourage further examination of differential health effects of the various elements of religiousness.     

The efficacy of rational-emotive group therapy in psychiatric inpatients

The impact of rational-emotive theory and therapy upon the practice of clinical psychology has been profound, and many purportedly objective experimental tests of its efficacy as a mode of treatment have been reported. Yet the great majority of these reports have failed to utilize actual clinical populations. This study evaluated rational-emotive group therapy with psychiatric inpatients. Results supported the claim that irrational beliefs are related to emotional disturbance. It was also shown that patients undergoing rational-emotive group therapy changed their self-reported irrational beliefs more than did a control group. Finally, there was a trend for the experimental subjects to be more likely to have been discharged from the hospital during the 90-day follow-up period than were control subjects. However, this study failed to demonstrate that change in irrational beliefs was related to improvement in psychiatric symptoms or rates of discharge from the hospital. Some of the difficulties in conducting treatment evaluation research in a psychiatric hospital setting are discussed with respect to these results.     

关于患者家属在复苏现场的思考

医疗水平不断地发展和进步使越来越多的疾病可以在医院得到救治。但有研究显示,在医院接受心肺复苏（CPR）的患者中,只有很小的部分能被救治成功。由于CPR的成功率低,在CPR时是否允许有患者的家人陪伴在其身边逐渐成了医患双方共同关注的问题。家人的陪伴,或许能让患者抢救或死亡的过程变得更人性化,同时成为增加医患双方相互理解的渠道。但是这个过程的实施仍然面临许多问题,要让其成为常规制度,还有很长的路要走。     

Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global any use service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.     

论当前医疗纠纷的表现特点,处理及防范对策

报道本教研室４３年３１６例医疗纠纷尸检资料的分析结果,结合实际工作经验与体会,论述当前医疗纠绿的表现特点,处理对策和防范措施。认为近年来医疗纠纷逐渐增多;发生科室以妇产科和外科多见;医疗纠纷中非医疗事故多于医疗事故。处理对策建议是：遵循法律,注意程序,讲究方法,公平合理。指出完善医疗管理是防范医疗纠纷的关键,提高医疗水平是防范医疗纠纷的根本。     

Stability of the internal structure of the millon clinical multiaxial inventory

The Millon Clinical Multiaxial Inventory (MCMI) has become increasingly popular in clinical use. Along with this, there has been more interest in the internal structure of the 20 scales of the original 175-item MCMI-I. The literature reports some agreement on four components, although both three- and five-component solutions have been reported. The degree of similarity of these components across populations remains arguable, as none of the previous studies have used quantitative measures of component similarity. The present study reports on two new samples of psychiatric patients, one of 82 cases from a general hospital and the other of 145 inpatients from a psychiatric hospital. It also reanalyzes the data from nine samples from the literature, using Tucker's coefficient of congruence and ten Berge's analysis of principal component weights (PCW). The congruence analyses showed good agreement of the first three components across samples and notably lower agreement for the fourth. The PCW analyses showed two major types of structure matrices. In the first, there was a large and dominant first component, with three smaller ones. In the second, the variance was distributed more evenly across the four components. The results are discussed in terms of the overlapping scales of the MCMI-I.This work was supported by funds from the Departments of Psychiatry and Psychology, The University of Western Ontario.     

Being ordinary in extraordinary places: Reflective practice of the total situation in a total institution

This paper examines a ‘Foulkesian type’ Balint group for psychiatry trainees set in a high secure forensic hospital. Within a Balint group, group processes and dynamics are not examined. Deviation from this format is construed as resistance, and destructively getting in the way of the primary task.

This paper reports on a case‐based reflective practice group operating on a more Foulkesian group analytic model and argues that the revised principles of method proposed here – paying attention to context; group processes; and creating an atmosphere where group curative factors are in play – can help trainees to sustain an emotional reservoir for their patients. Further, these principles do not get in the way of the primary task but can add to an understanding of the individual transference and counter‐transference issues, and can place these in context within the organization and society. This is particularly important in total institutions such as forensic units.

Clinical material from this group is used to support this claim.     

Mothers and fathers and mothers and babies: Interrelationship among relationships

The relationship between perceived marital satisfaction and early mother-infant interaction was investigated. Seventeen mothers and their three-day-old infants served as subjects. Dyads were observed via a modified time-sampling technique during a hospital feeding session. Then mothers completed a questionnaire concerning their perceptions of the marital relationship. Correlational analyses revealed a significant covariance of positive perceptions of the expressive aspects of the marital relationship and heightened social interaction for mother and infant. An interrelationship was observed between mother-neonate social-visual communication and maternal reports of planned pregnancies, time spent talking with spouse, general ratings of “getting along with spouse,” and positive overall evaluations of the material relationship. Also observed was the interrelationship of mother holding infant away from close bodily contact with reports of decreased love felt toward spouse, less optimal perceptions of ease of emotional expression and spousal interest in maternal daily activities, and less optimal overall ratings of the relationship. Implications of the results and the need for further research are discussed.     

Clinical pastoral training in an emergency psychiatric service

Summary This paper reports the utilization of an emergency psychiatric service as a new factor in the clinical pastoral training experience. The usual pattern of clinical setting for these students is the hospital ward, where the patient has already been admitted and is making some adjustment to hospital routine and treatment. In such a setting the student misses the opportunity to see the patient at the crisis point of the illness and does not see the large numbers of individuals troubled enough to require psychiatric help but not sick enough to be hospitalized. The latter group constitute the largest portion seen by the parish minister even before psychiatric referral is arranged. During a twelve-week clinical pastoral training program, each student spent a major portion of his time for two of the weeks working on an emergency psychiatric service with a psychiatrist and social worker and seeing a large variety of patients, most of whom were not hospitalized. The experience provided an opportunity to develop evaluative skills and knowledge of appropriate community resources, and offered some experience in brief counseling under supervision. The clinical pastoral training student and the personnel of the emergency service all felt that this was an experience of mutual value and that it should be for a longer period. It is suggested that other clinical pastoral training programs would find it of value to utilize emergency psychiatric clinic settings where available.     

Mixing qualitative methods versus methodologies: A critical reflection on communication and power in inpatient care

This paper offers an illustrative example to demonstrate one way of combining qualitative methods. The context for the study was a UK inpatient psychiatric hospital. Data set one was collected from weekly ward rounds where inpatient staff met with autistic patients to review medication, listen to patient concerns and make plans or adjustments in light of this. Data set two was reflective discursive interviews with patients and staff. The research objective was to critically consider the potential reasons for discrepancies in dissatisfaction reports from patients in the interviews, compared to relative compliance exhibited by patients in the ward rounds. Utilising a video‐reflexive design and critical discursive psychology approach, both data sets were analysed together. It is possible to simultaneously analyse two different data sets, one naturally occurring and one researcher generated because of the epistemological congruence in the overall design. We have presented an argument for the benefits of mixing two qualitative methods, thereby extending the mixed‐methods evidence base beyond the traditional discussions of quantitative and qualitative paradigms.     

The Effects of Introducing Peer Support to Young People with a Chronic Illness

Peer support groups have been an increasingly popular way of limiting the adverse effects of life with a chronic illness for adolescents although few groups have been rigorously evaluated. This paper reports the findings of a realistic evaluation of a hospital based peer support program Chronic Illness Peer Support (ChIPS), in Sydney, Australia. We collected qualitative interview and focus group data from four participant groups; new ChIPS members, their parents, older members who had been in ChIPS for two or more years, and ChIPS co-ordinators past and present. Results of qualitative data have been aggregated and organised into three categories; program attendance: getting in and staying in; program outcomes for young people: personal growth and development; and social connection. Questionnaires were also administered to fourteen new ChIPS members but no significant changes in distress or self-esteem were recorded between the beginning and the end of the short study period. The ChIPS Introductory Program fulfilled its aim, entering young people with chronic illness into the peer support program. There was evidence of initial personal growth and development in those young people, with potential for enhanced social connection from ongoing participation in ChIPS activities.     

The Evolution of Psychological Testing at the Austen Riggs Center: A Theoretical Analysis

Theoretical perspectives on personality and the development of psychopathology have shifted markedly over the last 7 decades. However, it remains unclear how those changes affect mental health practice. Comprehensive and conscientiously recorded reports of psychological testing provide a clear window on this process because they comprise distinctive records of how patients are assessed and understood. For this study, we conducted an exploratory, qualitative analysis of the narratives of the testing reports over the past 65 years at the Austen Riggs Center, a private psychiatric hospital and residential treatment center, to assess changes over time and to evaluate the influence that various factors had on the reports. The data revealed significant changes in psychologists' ways of assessing and conceptualizing personality and identity, adaptive functioning, and psychological development. Additionally, we evaluated how the evolving theoretical influences, such as institutional, professional, and sociohistorical factors affected the psychologist's model of psychopathology and development. This study raises important questions about how theoretical innovations affect clinical practice over time.