自我保护性医疗的伦理扫描--论患方知情同意与医方规避风险

自我保护性医疗是近年来医方为应对医患关系重构而采取的一种行为模式,其本身和影响具有全新特点,充满价值冲突;这种行为模式,客观上是对应医疗风险尤其是重大医疗风险的;主观上同医方免责期待的张扬以及对知情同意的解读直接相关;因而,正当的自我保护性医疗既取决于医方合理的免责期待,以及改变对知情同意的误读,更依赖于自身的医学伦理综合素质的打造和完善。     

Modification of Cognitive-Behavioral Techniques in the Treatment of a Five Year-Old Girl with Social Phobia

Social phobia is a debilitating anxiety disorder that often goes undetected in young children, but can be effectively treated with cognitive-behavioral interventions. For children and adolescents, treatment usually includes education, social skills training, cognitive restructuring, relaxation training, and exposure. However, for very young children who present with social phobia, it is necessary to adapt treatment to the developmental level of the child. A case illustration demonstrates the way in which cognitive behavioral treatment (CBT) was modified for the treatment of a five year-old girl with social phobia. Several modifications were made, including utilizing novel exposure techniques and emphasizing parent management training in order to promote generalization of treatment gains outside of session.     

Barriers to evidence-based treatment: developmental psychopathology and the interdisciplinary disconnect in school mental health practice

Reframing the role of school psychologists and related school professionals in a public health and primary prevention model represents a proactive antidote to their more traditional reactive stance to mental health problems. Two additional concepts, developmental psychopathology and complex comorbidity, are suggested as critical to complete this transition, and illustrations of these concepts for more effective school mental health services are provided.     

Personality characteristics of women with alcohol addiction: A Rorschach study of women in an early treatment programme

This study identifies personality characteristics in a group of Swedish women (N=60) attending their first treatment for alcohol problems.The treatment programme specifically addressed women in an early phase of their drinking career, and was called "Early Treatment of Women with Alcohol Addiction" (EWA). Rorschach personality profiles of the 60 women differed significantly in almost all investigated aspects in a psychopathological direction from norms reported by Exner for a reference group of female non-patients. The findings are consistent with the assumption that, although the EWA women were socially well-functioning and fairly early in their drinking career, they nevertheless reveal serious underlying psychopathology. Clinical implications of the findings are discussed.     

Personality characteristics in primary benzodiazepine-dependent patients: Comparison with controls and polydrug users

The present study applied Karolinska Scales of Personality (KSP) to study (i) if patients with benzodiazepine dependence have a characteristic personality profile, (ii) if the personality characteristics in patients with benzodiazepine dependence differ from those of polydrug users and normal controls, (iii) if differences in treatment outcome existed between the groups, and (iv) if the possible difference in treatment outcome was associated with any particular personality characteristic shown by the patients. The personality characteristics of primary benzodiazepine dependent patients (BDZ) and a group of polydrug users (MIX) were studied initially (during the first week in project as an inpatient) and approximately one year after drug discontinuation, and a comparison was made with healthy controls on both test occasions. The results showed that the personality of both groups of patients differed significantly from the Controls in the following characteristics: Detachment, Socialization, Somatic Anxiety, Muscular Tension, Psychic Anxiety, and Psychasthenia. Significant differences existed between the polydrug and benzodiazepine users in Somatic and Psychic Anxiety as well as in Socialization. The MIX group differed significantly from the BDZ group and from the Controls in Suspicion. Results of treatment outcome indicated that the benzodiazepine dependent patients were significantly more successful in quitting their drug use compared to polydrug users. Further, the results demonstrated that patients scoring high in the investigated personality characteristics are those who fail the treatment goal of quitting their drug use, especially the patients with a high level of anxiety and detachment.     

Time-Varying Treatments in Observational Studies: Marginal Structural Models of the Effects of Early Grade Retention on Math Achievement

One of the main objectives of many empirical studies in the social and behavioral sciences is to assess the causal effect of a treatment or intervention on the occurrence of a certain event. The randomized controlled trial is generally considered the gold standard to evaluate such causal effects. However, for ethical or practical reasons, social scientists are often bound to the use of nonexperimental, observational designs. When the treatment and control group are different with regard to variables that are related to the outcome, this may induce the problem of confounding. A variety of statistical techniques, such as regression, matching, and subclassification, is now available and routinely used to adjust for confounding due to measured variables. However, these techniques are not appropriate for dealing with time-varying confounding, which arises in situations where the treatment or intervention can be received at multiple timepoints. In this article, we explain the use of marginal structural models and inverse probability weighting to control for time-varying confounding in observational studies. We illustrate the approach with an empirical example of grade retention effects on mathematics development throughout primary school.     

Treatment of Deaf Clients: Ethical Considerations for Professionals in Psychology

Providing therapy to deaf clients raises important ethical considerations for psychologists related to competence; multiple relationships and boundary issues; confidentiality; assessment, diagnosis, and evaluation; and communication and using interpreters. In evaluating and addressing these, psychologists must consider the American Psychological Association’s Ethics Code and other relevant issues (e.g., Americans with Disabilities Act) necessary to provide ethical treatment. The current article provides background, ethical considerations, principles and standards relevant to the treatment of deaf clients, and recommendations to support psychologists, training programs, and the field. Psychologists have the responsibility to guarantee that the benefits of mental health treatment are fairly and justly provided to this traditionally underserved population.     

Context-specific attentional sampling: Intentional control as a pre-requisite for contextual control

Recent work suggests that environmental cues associated with previous attentional control settings can rapidly and involuntarily adjust attentional priorities. The current study tests predictions from adaptive-learning and memory-based theories of contextual control about the role of intentions for setting attentional priorities. To extend the empirical boundaries of contextual control phenomena, and to determine whether theoretical principles of contextual control are generalizable we used a novel bi-dimensional stimulus sampling task. Subjects viewed briefly presented arrays of letters and colors presented above or below fixation, and identified specific stimuli according to a dimensional (letter or color) and positional cue. Location was predictive of the cued dimension, but not the position or identity. In contrast to previous findings, contextual control failed to develop through automatic, adaptive-learning processes. Instead, previous experience with intentionally changing attentional sampling priorities between different contexts was required for contextual control to develop.     

Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study

With limited efficacy of medications for symptom relief, non-medication treatments may play an important role in the treatment of irritable bowel syndrome (IBS), the most common functional gastrointestinal (GI) disorder. This study aimed to evaluate the efficacy of two self-regulation strategies for symptom relief and mood management in IBS patients. Thirty-five adult participants meeting ROME III criteria for IBS were enrolled, 27 of the 35 participants (77%) completed treatment and pre- and post-treatment visits (89% women, 11% men; M (SD) age = 36 (13)), and 20 of the 27 (74%) completed a 6-month follow-up. Participants were randomly assigned to 16 biweekly group sessions of Iyengar yoga or a walking program. Results indicated a significant group by time interaction on negative affect with the walking treatment showing improvement from pre- to post-treatment when compared to yoga (p < .05). There was no significant group by time effect on IBS severity. Exploratory analyses of secondary outcomes examined change separately for each treatment condition. From pre- to post-treatment, yoga showed significant decreases in IBS severity measures (p < .05), visceral sensitivity (p < .05), and severity of somatic symptoms (p < .05). Walking showed significant decreases in overall GI symptoms (p < .05), negative affect (p < .05), and state anxiety (p < .05). At 6-month follow-up, overall GI symptoms for walking continued to significantly decline, while for yoga, GI symptoms rebounded toward baseline levels (p < .05). When asked about self-regulated home practice at 6 months, significantly more participants in walking than in yoga practiced at least weekly (p < .05). In sum, results suggest that yoga and walking as movement-based self-regulatory behavioral treatments have some differential effects but are both beneficial for IBS patients, though maintenance of a self-regulated walking program may be more feasible and therefore more effective long term.     

Psychological adjustment to cleft lip and/or palate: A narrative review of the literature

Objective: Adjustment to cleft lip and/or palate (CL/P) is multifaceted, involving several domains of psychological and social functioning. A substantial increase in research in this area has been evident in recent years, along with a preliminary shift in how adjustment to CL/P is conceptualised and measured. An updated and comprehensive review of the literature is needed in light of the rapidly expanding and changing field.

Design: A narrative review of 148 quantitative and qualitative studies published between January 2004 and July 2015.

Main outcome measures: Findings are presented according to five key domains of adjustment: Developmental Trajectory, Behaviour, Emotional Well-being, Social Experiences and Satisfaction with Appearance and Treatment. Data pertaining to General Psychological Well-being were also examined.

Results: The overall impact of CL/P on psychological adjustment appears to be low. Nonetheless, the review demonstrates the complexity of findings both within and across domains, and highlights recurring methodological challenges.

Conclusions: Research findings from the last decade are considered to be largely inconclusive, although some areas of emerging consensus and improvements in the approaches used were identified. Efforts to collect data from large, representative and longitudinal samples, which are comparable across studies and encompassing of the patient perspective, should be doubled.