Current Status of Psychosocial Intervention Research for Pediatric Outpatient Surgery

We reviewed 20 published studies of psychosocial interventions (i.e., preoperative preparation, parental presence) for children undergoing outpatient surgical procedures. The effectiveness of different intervention strategies on child and parent outcomes is summarized. Few positive effects were found for any of the psychosocial interventions. However, only a small number of randomized controlled trials were conducted and many of the studies using quasi-experimental designs had significant methodological problems that limited the interpretation of their findings. Research recommendations are described such as strengthening methodological rigor, making intervention strategies relevant to outpatient surgery, and using developmentally appropriate intervention strategies.     

Interdivisional Healthcare Committee: Speaking with One Voice on Cross-Cutting Issues in Health Care Psychology

One of the greatest challenges facing psychology in health settings today is the need for unification on critical issues of client access, workforce oversupply, education and training, and outcomes evalutions. Health care psychology specialty areas can no longer afford to operate in parallel. A unified vision is needed to overcome threats to the viability of the profession and to maximize the potential for achieving common goals. The current paper describes the formation of the Interdivisional Healthcare Committee (IHC), whose purpose is to establish a common agenda for promoting the professional, educational, and scientific goals of health care psychology. The IHC's initiative to develop new CPT codes for increasing access to psychologists' services in health care settings is outlined.     

The psychological treatment of memory impairment: A review of empirical studies

Memory impairment is a frequent effect of many different forms of brain dysfunction. Memory impairment is also a frequent focus of treatment interventions, and there have been many different treatment methods suggested. The suggested methods include direct retraining, the use of spared skills in compensating for the impairment (alternate functional systems), and the use of behavioral strategies to circumvent the manifest memory dysfunction (behavioral prosthetics). Unfortunately, there are very few studies comparing the various suggested treatment methods. The present paper evaluates the empirical evidence related to the treatment of memory dysfunction and suggests directions for future investigations. Although the evidence is not conclusive, it appears that some forms of treatment may be helpful in remediating certain types of memory impairment. An approach likely to be productive would include some consideration of the impaired neurological and psychological mechanisms responsible for the manifest memory deficit as well as a consideration of the etiology of the injury thought to be causally related to the memory deficit. As yet, there have been no rigorous empirical evaluations of these considerations.     

Ecological Neuropsychology: An Alternative to the Deficit Model for Conceptualizing and Serving Students with Learning Disabilities

The present paper contends that children with learning disabilities are better served when assessment and intervention are conceptualized within an ecological neuropsychology perspective than within the traditional deficit model perspective, which is the predominant approach to intervention in medical and educational settings. The deficit method conceptualizes problems as within the child, and the major consequence of this approach is that little time is spent analyzing the learning environment or other systems that might impact the child's ability to be successful in an academic setting. Therefore, rehabilitation efforts have had limited success. In contrast, ecological neuropsychology is a strength-based approach that considers the child, as well as the systems within which he/she interacts, when assessing, diagnosing, and intervening with students who are experiencing learning difficulties.     

Psychosocial Issues That Face Patients With Charcot-Marie-Tooth Disease: The Role of Genetic Counseling

Charcot-Marie-Tooth (CMT) disease is a hereditary debilitating progressive muscular atrophy and sensory neuropathy of the distal extremities. CMT is usually nonlife threatening. Signs of the disease usually present in childhood or in young adulthood and the level of disability can be variable within and between families. Research addressing specific psychosocial and emotional issues faced by individuals with CMT is limited. Fourteen adults with a clinical and/or molecular diagnosis of CMT (ages 32–74 years) consented to an audio taped interview. The format of the interview was based around an informal questionnaire to prompt and guide the interviewee to describe their experiences of living with a disabling genetic disorder. The interviews focused on their experiences of first symptoms and diagnosis, their life experience with CMT, their limitations due to disability and the role of genetic counseling. This study identifies and explores life issues that individuals with CMT may face, specifically grief over the loss of independence, emotional pain and stress such as embarrassment and guilt of passing on a gene mutation, impact on quality of life, the impact of wearing orthopedic devices, and fear of progressive disability. Our findings suggest that that there are emotional and psychosocial issues specific to affected individuals at different life stages and genetic counselors need to be aware of these issues in order to provide age appropriate support and advice to individuals affected by CMT.     

Neighborhood Violence and Psychosocial Adjustment in Low-Income Urban African American Children: Physical Symptoms as a Marker of Child Adjustment

We examined the association between neighborhood violence and three domains of psychosocial adjustment in low-income, urban African American children: internalizing, externalizing, and physical symptoms. Based on anecdotal and empirical evidence, it was hypothesized that, relative to internalizing and externalizing problems, a stronger association would emerge between physical symptoms and neighborhood violence. Mother-reported neighborhood violence was associated with child-reported physical symptoms, but not internalizing or externalizing symptoms. Child-reported neighborhood violence was associated with child-reported internalizing, externalizing, and physical symptoms; however, neighborhood violence accounted for a greater percentage of variance in physical symptoms than the other two symptom domains. Our findings were not moderated by the age or gender of the child. We discuss the importance of physical symptoms as a marker of child adjustment in low-income, urban, African American children, as well directions for future research.     

Psychosocial and Biomedical Predictors of Attention and Memory in End-Stage Renal Disease Patients

This study examined the neurocognitive functioning of 554 end-stage renal disease (ESRD) patients to determine the underlying factor structure of tests of attention and memory and to assess the differential impact of psychosocial and biomedical variables on these factors. Analysis revealed three underlying factors: Sustained Attention, Focused Attention, and Memory Recall. Hierarchical regression analyses revealed that psychosocial and biomedical variables were most strongly related to the Focused Attention factor. Education, vocabulary score, age, race, age by creatinine, creatinine, and renal replacement therapy accounted for 30% of variance in Focused Attention; sex, depression, and hypertension were unrelated. After controlling for demographic and medical variables, type of renal replacement therapy was a statistically, but not clinically, significant predictor of Focused Attention, with peritoneal dialysis associated with better attentional performance relative to hemodialysis. The potential relationship between focused attention and compliance is discussed.     

非失语脑中风患者的神经心理障碍与一年疗效和康复预测的关系

本文以７９例脑中风患者为对象,研究结果如下：１．自编ＡＤＬ,再测信度和结构效度合格。２．一年前后ＡＤＬ、ＤＮＦ及疗效与同期测定的插棍测验、瑞文测验、小棍测验、临摹图形、说同类词及抑郁（一年后）有显著相关。３．初发病时这些指标及图形拼凑测验与一年后ＡＤＬ、ＤＮＦ及疗效也有显著相关。４．ＤＮＦ１和ＡＤＬ１对疗效有明显预测作用,可解释变量的３５％（ＡＤＬ２）、３７％（疗效）和４１％（ＤＮＦ２）。单独心理变量可解释变量的２７％（ＡＤＬ２）、３３％（ＤＮＦ２）和２１％（疗效）。     

Noncompliance in end-stage renal disease: A threat to quality of care and cost containment

Noncompliance to treatment regimen after kidney transplantation is a threat to health outcomes and cost containment. Although there are methodological challenges to obtaining reliable compliance data, the results of noncompliance are increased morbidity and mortality in posttransplant patients. In addition, recent research suggests that patients who incur repeated rejection episodes leading to graft failure have higher levels of medical utilization. Some psychosocial factors related to compliance and medical utilization are potentially modifiable through cognitive-behavioral intervention.     

Personality disorders and psychosocial changes after intensive psychotherapy: A prospective follow-up study of an outpatient psychotherapy project, 5 years after end of treatment*

This report presents the results of a 7-year prospective outcome study designed to examine the psychosocial changes during and after therapy among 25 outpatients suffering from personality disorders and psychoses. The therapeutic approach was based mainly on object relations theory and psychodynamic self-psychology, and focused in particular on affect consciousness, parental images, self-image and interpersonal relations. Twenty patients completed the form which measured psychosocial changes during therapy, and 21 persons participated at follow-up. The data show statistically significant changes in the capacity to tolerate intimate relationships and actually establish such relationships, improved quality of contact in relationships with friends, a general raising of socioeconomic status and reduced use of ordinary health and social services. Both the global psychosocial outcome at follow-up as measured by HSRS and the general level of symptoms measured by SCL-90 suggest that 76% of the sample had reached a level of psychosocial functioning and adaptation that can be defined as “no-caseness”.