Self-appraisal and coping in out-patients with chronic disease

Self-appraisal, coping efforts, muscle function, and activity and severity of disease were examined in out-patients with rheumatoid arthritis, osteoarthrosis or diabetes mellitus. Factor analysis of a 31-item self-appraisal and coping questionnaire yielded eight factors (self-appraisal, acceptance, minimization, planful problem-solving, avoidance, persistence, attribution of responsibility, and support seeking). For the factors of avoidance, minimization, and persistence, as well as for measures of activity and severity of disease, significant differences between the diagnostic groups were found. For patients with rheumatic arthritis, hierarchical regression analysis indicated disease duration to be associated with acceptance and with attribution of responsibility, and disability measures to be associated with self-appraisal. For patients with osteoarthrosis, they showed disability in muscle function to be associated with avoidance, and more negative self-appraisal as well as lower levels of support seeking to be associated with long disease duration. Results are discussed in terms of structural and adaptive defence forms and of adherence to a coping model ("medical model") which tends to foster acceptance and dependency.     

Negative social interactions,distress, and depression among those caring for a seriously and persistently mentally III relative

Investigated both positive and negative social interactions and their effect on mental health for 106 individuals caring for a seriously mentally ill family member. Results from mixed-model (hierarchial and stepwise) multiple regression analyses in which caregiver age, socioeconomic status, caregiving demand, and severity of patient symptoms was controlled showed that negative social interaction accounted for a significant portion of variance in the caregivers' feelings of distress and depression. Moderated multiple regression analyses showed that under conditions of high negative interaction, the relationship between demand and distress was intensified. Implications of these findings for the conceptualization and measurement of negative social interaction as well as its clinical implications were discussed. The research for this paper was supported by funds from the Provost's office, University of Pittsburgh, School of Social Work. The authors thank the Pennsylvania Alliance for the Mentally Ill for their support of, and participation in, the study.     

教师解决结构不良问题策略的发展研究

以成人期个体解决结构不良问题的有关认知加工理论为框架,运用多因素设计的方法,对９０名不同年龄的教师在解决教育和教学实践中常见的三种冲突情景下使用策略的情况进行了探讨。结果发现,教师在解决结构不良问题时,从总体上说不存在年龄差异,但在处理教师与教师、教师与家长等较为复杂的冲突问题时,随着年龄的增长,更趋向于使用元认知和认识论认知策略。该研究对教师培训中如何根据不同年龄特点来进行教育机智训练有一定的理论意义和应用价值。     

The effect of prompting and reinforcement of activity in elderly demented inpatients

On a ward for 24 psychogeriatric patients, 18 were randomly assigned to three groups with different experimental conditions. The first group was prompted and reinforced for different activities; the second was only prompted; and the third served as a control group. Activities, both the trained ones and others, were continuously monitored throughout the five week study. The results showed a clear increase in the trained activities after training. The prompting condition was effective, and the addition of reinforcement did not add any to the effects. There was no generalization to untrained activities, and the effects did not last at the 1 hr or 21 hr assessments, but was clearly visible at 5 min after training. Time seemed to be more important than place, i.e. the effect ceased with elapsed time, not because of changes in the situation.     

DISCRIMINATIVE CONTROL OF THERAPISTS' PERFORMANCE1

In order to examine therapists' discriminative responding to normal and idiosyncratic patient responses, naive subjects were presented with a simulated “patient” for treatment. The subjects were made to believe they were reinforcing normal verbalizations emitted by this patient In fact, they were listening to a tape on which normal and idiosyncratic verbalizations had been recorded. Different probabilities of normal and idiosyncratic “patient” verbalizations could be presented to the subjects by means of a digital programming unit. In one of a number of conditions, the subjects' accurate reinforcing responses were followed by an increased probability of the patient's normal verbalizations. Accurate reinforcing responses emitted by the subjects were brought under the control of normal and idiosyncratic patient responses, by use of contingent feedback, change in patient responding, and monetary reinforcers. When the patient's normal verbalizations increased in probability, so did the subjects' accurate reinforcing responses following the patient's normal verbalizations, and to a lesser degree, the subjects' inaccurate reinforcing responses following the patient's idiosyncratic verbalizations. When the patient's idiosyncratic verbalizations increased in probability, the subjects' accurate and inaccurate reinforcing responses decreased in probability. The clinical implications of these tendencies are discussed.     

What is told when the story is retold? Consistency of victimization reports in psychiatric patients

The use of retrospective self‐reports is a major methodological concern when ascertaining the occurrence of victimization experiences, with additional concerns when assessing psychiatric patients. The test for consistency can overcome some of these concerns, increasing the confidence in the information reported. Our aim was twofold: (1) to know the consistency of victimization reports; and (2) to test the role of changes on emotional distress in predicting report discrepancies, in a sample of 34 adult psychiatric patients. Participants were assessed twice, with a year interval. Sexual abuse was the experience that presented the higher level of consistency for childhood victimization, while assault with a weapon had the higher consistency level for adolescent and adult victimization. We found that increases on emotional distress predicted report discrepancies, and more specifically, increases in the report of victimization. Our results displayed acceptable consistency levels, suggesting some stability in the reporting of victimization over time. Considering that inconsistencies tended either to increases and decreases in the reporting of victimization, it would be important to consider the impact of such experiences when intervening with psychiatric patients.     

末期癌症患者的临终关怀

临终关怀与末期癌症关系密切,末期癌症患者是临终关怀的主要对象,这也是姑息医学的主要内容。作为发展中的学科,本文对临终关怀的发展、目的、内容及其在末期癌症患者中的实施作一综述。     

台湾地区姑息医学制度的建立及法律实践

姑息治疗在提高晚期癌症患者生活质量、实施临终关怀、给予病人及其家属全面周到的照顾诸方面起着重要作用。在台湾,已为姑息治疗立法并实施了10年,积累了丰富的经验。这项法律本身及其细则、附件等配套文件使姑息治疗更加规范可行。研究规范的姑息治疗及台湾的相关法律可以帮助我们更好的理解姑息治疗的理念,帮助发展大陆同道构建有效实用的...     

急性创伤青年患者的心理健康水平与小组干预

为了探讨急性创伤青年患者的心理健康水平及小组干预对策,采用三种国际通用量表（SCL-90、HAMA、HAMD）对160例急性创伤青年患者进行测评,在给予传统心理护理的同时,进行小组干预,然后比较患者干预前后心理健康水平;并以既往同种病例为对照,比较治疗效果。结果显示,86．25％的急性创伤青年患者存在有不同程度的心理障碍。通过小组干预后,患者心理健康水平明显提高;患者的临床疗效明显改善。因此小组干预可显著改善急性创伤青年患者的心理应激水平,提高临床疗效。     

Decreasing entry into a restricted area using a visual barrier

Wandering is a difficult-to-manage behavior problem for individuals with cognitive impairments that can jeopardize safety if an individual enters a hazardous area or becomes lost. This study investigated the effects of a cloth barrier on entry into an unsafe area. The cloth barrier reduced entry into the restricted area and had high treatment acceptability.