Patients’ expectations for the functional and psychosocial outcomes of orbital decompression surgery for thyroid eye disease: a qualitative study

Patients with appearance-altering conditions may be dissatisfied with the outcomes of reconstructive surgery due to unmet expectations. This study explored patients’ expectations of orbital decompression surgery for thyroid eye disease (TED) and whether these were met. Semi-structured interviews were conducted at two times: (1) in the weeks after patients were listed for decompression surgery and before surgery; (2) up to 12 months after surgery. Thematic analysis was performed for each time point, to identify themes within the data. Fourteen adults with TED were interviewed prior to surgery and five were followed up after surgery. Thematic analyses found: (1) Prior to surgery, patients had formed expectations through online information about the procedure, consultations with physicians, the impact TED had on their lives, and speaking to relevant others. Patients had specific expectations about the procedure, the recovery, post-operative appearance and post-operative vision. (2) After surgery, patients generally felt their appearance and well-being had improved. However, dissatisfaction was linked to unanticipated specific aspects of surgical care, recovery, or appearance. Dissatisfaction can arise from unmet expectations for the outcomes of reconstructive surgery. Physicians should be aware of the processes by which patients form expectations, for example different types and quality of online information. Ensuring that preoperative expectations are realistic could enhance satisfaction after surgery.     

Rhizomatic affective spaces and the therapeutic potential of music in prison: a qualitative meta-synthesis

Research literature supports that music programmes in prisons can have a therapeutic effect in prisoners’ lives that could promote personal development and assist the process toward desistance. The authors use a meta-synthetic approach to examine 12 qualitative articles published worldwide to explore the therapeutic potential of such programmes. The findings suggest that music programmes in prison are perceived by participating prisoners as a liberating process, which encourages participation and allows for noncoercive personal development. The therapeutic potential of music programmes is located in the combination of the benefits emanating from the effect and practice of music and the creation of mental, spatial and temporal zones of free expression and those that derive from the egalitarian and nonauthoritative approach employed by the facilitators. These findings are discussed along with aspects involved in the provision of offender treatment as well as factors that affect treatment response and engagement.     

The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts

Panic disorder is a common mental disorder. Guided Internet-based cognitive behavioural therapy (Guided Internet-based cognitive behaviour therapy (ICBT)) is a promising approach to reach more people in need of help. In the present effectiveness study, we investigated the outcome of guided ICBT for panic disorder after implementation in routine care. A total of 124 patients were included in the study, of which 114 started the treatment. Large within-group effect sizes were observed on the primary panic disorder symptoms (post-treatment: d = 1.24; 6-month follow-up: d = 1.39) and moderate and large effects on secondary panic disorder symptoms and depressive symptoms at post-treatment and follow-up (d = .55–1.13). More than half (56.1%) of the patients who started treatment recovered or improved at post-treatment. Among treatment takers (completed at least five of the nine modules), 69.9% recovered or improved. The effectiveness reported in the present trial is in line with previous effectiveness and efficacy trials of guided ICBT for panic disorder. This provides additional support for guided ICBT as a treatment alternative in routine care.     

COGNITIVE AND SOCIOEMOTIONAL FUNCTIONING AT 4½ YEARS IN CHILDREN BORN TO MOTHERS WHO HAVE RECEIVED TREATMENT FOR SUBSTANCE‐ABUSE PROBLEMS WHILE PREGNANT

Cognitive and socioemotional functioning at 4½ years of age were examined in children born to mothers with substance‐abuse problems (n = 22) recruited from residential treatment institutions while pregnant, and then compared to children born to mothers with mental health problems (n = 18) and children from a low‐risk group (n = 26). No significant group differences in cognitive functioning were found, but the children born to mothers with substance‐abuse problems showed more caregiver‐reported socioemotional problems than did the low‐risk children, like the children born to mothers with mental health problems. Birth weight had an effect on internalizing problems at 4½ years and mediated the relation between group and socioemotional problems, although not when controlling for caregiver education, single parenthood, and anxiety and depression. At 4½ years, 7 children born to mothers with substance‐abuse problems were placed in foster care. These children had lower birth weight and higher caregiver‐rated internalizing problems. In addition to emphasizing the importance of the quality of the prenatal environment, this study suggests that families with previous substance abuse are in need of long‐term follow‐up to address socioemotional problems and enhance further positive child cognitive development. The foster‐placed children may be in particular need of long‐term follow‐up.     

Cognitive Appraisal Therapy: A Treatment Plan for “Silvia”

The principles and procedures of Cognitive Appraisal Therapy (CAT) are applied to the case of Silvia. The assessment plan focuses on affective, behavioral, and cognitive aspects of personality. The patient evidences self-pity and anger, and rebellion and withdrawal in her interpersonal relations. Key interventions include encouraging positive methods for comforting her feelings, building self-respect by doing what she deems morally right, eliminating self-defined victim status by active pursuit of her goals, and correcting cognitive distortion of self-image and pessimistic forecasts. Other characteristic CAT interventions are also discussed and illustrated.     

Factors Predicting Attrition Within a Community Initiated System of Care

We designed this study to elucidate child, family, and service level characteristics that may influence attrition from a continuum of care developed and maintained by a community initiated collaboration of local clinics and agencies. Subjects included 117 children and adolescents referred to the Middlesex County system of care from 1992–1999. Data were collected through a retrospective case review. The strongest predictors of attrition from the system of care both before and after the establishment of an individualized service plan included depressed/isolated symptoms, substance abuse, general risk for psychiatric problems, number of referral reasons and urgency status at program intake. Among youth exiting residential placement, those completing recommended services were more likely to be returned home earlier or within the expected time frame than were dropouts. Our study presents important preliminary findings regarding characteristics related to treatment adherence within a community initiated systems of care.     

Recruiting Anxious Older Adults for a Psychotherapy Outcome Study

Although anxiety is a serious problem among the elderly, very little research has been conducted with anxious older adults. One reason is that although anxiety disorders overall are more common than depression in older community samples, many specific anxiety disorders are relatively rare. Furthermore, anxious older adults often do not seek treatment or otherwise come to the attention of mental health researchers. This paper describes the first year of recruitment efforts for a treatment outcome study of psychotherapy for generalized anxiety disorder in adults at least 55 years old. Successful methods included collaborations with hospital-based health education programs and senior centers, as well as notices in local and senior newspapers. Less successful methods included radio public service announcements and mailings to residential facilities, churches and synagogues, and physicians. Recommendations for recruitment of anxious older adults into research projects are discussed.     

全球基本健康研究

在过去的10年间,世界各国的卫生研究意识都在增强,每个国家都很重视基本的国家研究在医疗卫生及医疗卫生系统中的作用。基因组计划将改变我们理解健康和疾病的方式,导致人们对“预防性治疗”的需要,但其带来的负面影响不可忽视。     

Survivors of Torture: Realities, Responsible Care, and Rehabilitation

This paper provides an overview of special issues and challenges for the psychiatrist providing care to a survivor of government sponsored torture. Case examples illustrate cultural concerns, issues of confidentiality, transference, dual loyalties, and provider responsibilities. The author hopes to stimulate interest in others to learn more about working with this challenging and rewarding group of patients.     

Why Do People Stay in Hateful Relationships? The Concept of Malignant Vindictiveness

Why do couples remain in hateful relationships? This article defines theoretically rigorous ways of viewing partners who stay together despite severe strife. A case presentation shows how a relationship of two people, each with his or her character structure and idealized image, creates interpersonal conflict because of opposing demands each makes on self and other. Such conflict requires radical defensive measures including alienation, idealization, and externalization that increase tensions. A vicious circle of malignant vindictiveness cements the relationship. Increasing implacability in the relationship is understood through Horneyan categories of interlocking idealized images, hurt pride reactions, and the externalizing process.