Reliability of self-reported service use: Test-retest consistency of children's responses to the Child and Adolescent Services Assessment (CASA)

This paper reports on the reliability of children's responses on the Child and Adolescent Services Assessment (CASA) — a self-report instrument for use with 8– to 18-year-olds that gathers information about services used to address mental health problems. Findings were based on interviews completed by 77 children at a one week test-retest interval. Results showed that reports of lifetime service use were as reliable as were reports of service use in the preceding three months. Children reported restrictive and intrusive services more reliably than services that were provided in their natural environment. Reliability appeared to be associated more strongly with characteristics of the type of service than with characteristics of the child. Children also could report reliably on some details about their encounters with service providers (e.g., length of stay, number of visits, and onset of service use).     

Loss and change in primary care: Working with organisational anxiety

This paper will consider the identity of an inner voice that is experienced by everyone, but in very different ways. However, when working in the transference with psychotic patients the boundaries of personal identity and the question of choice and volition are so compromised by the illness that the phenomena are so to speak ‘writ large’. This allows the issues to be brought out with great vividness and intensity and it is the struggle with this that has led me to reconsider the identity of the inner voice in a way which I have found useful for the rest of my clinical work.

Prior to 1985, my clinical work with patients with psychotic illnesses was undertaken in the in-patient psychotherapy ward at Shenley Hospital that I was responsible for. With the movement of psychotherapy resources out of Shenley to set up the Willesden Centre, our ability to continue with this work was very compromised because the Centre is entirely an out-patient resource. However, a number of us persevered and gradually worked out ways to be able to continue to offer treatment to patients who had psychotic illnesses. This involved the establishment of a case-manager system to enable the therapist to work in the transference. This evolution has occurred in a specialist workshop that I have been running at the Willesden Centre since 1986.     

Belastungen in der Kindheit und in der Jugend Essgestörter

Depending on definition and sample, a minority of varying size of women with eating disorders report to be victims of sexual and/or physical abuse. These stressful experiences are risk factors for mental disorders in general and not specifically for eating disorders. Parental high expectations and pre-morbid negative self-evaluation seem to be specific risk factors for anorexia nervosa and bulimia nervosa. Probably, patients with bulimia nervosa suffered more childhood adversity than those with restrictive anorexia nervosa. Patients with a history of sexual and/or physical abuse may be more severely ill and more difficult to treat than other patients with eating disorders. Careful questioning about childhood adversity seems advisable. In therapy, maintaining factors—like problems of self-esteem—are more important than predisposing or precipitating factors. For prevention, it is recommended to provide for the safety of children when treating their parents with mental illness—particularly substance use disorders—and to avoid parental high expectations.     

Different origins and meanings of acute acting-out in an inpatient psychotherapeutic setting

In this paper I describe four different sources of acute acting-out behaviour as may be observed in long-term hospitalised patients suffering from severe personality disorders. I hope to demonstrate that acute psychological distress does not happen in a vacuum, but that specific intrapsychic and interpersonal dynamics within the hospital setting are at the root of what appears overtly as nonspecific emotional and behavioural disturbance. I argue that the hospital team's correct insight into the factors underlying acute acting-out is crucial to the implementation of therapeutic interventions aimed to decrease the patient's disturbed state of mind.     

Openness with patients: a categorical imperative to correct an imbalance

This paper examines the concept of ‘openness with patients’ from the stand-point of the limitations of biomedical ethics. Initially we review contemporary critiques of bioethics and, in particular, of principlism; we relate how other; somewhat neglected, forms of medical ethics can yield useful information and provide moral guidance. The main section of the paper then shows how a bioethical approach to openness misses the social context in our example, the viewpoints of patients; we present some of the increasing wealth of research evidence which points towards patients wanting more information and a greater degree of openness. Finally we put forward that a principlist’s objection to active encouragement of openness might be based on the risk of infringing upon the ‘right not to know’. We reject this by arguing how rights can be trumped. Dr. Anthony S. Kessel, BSc, MBBS, Mphil, MSc, is a general practitioner, medical ethicist and currently specialist registrar (Barking & Havering Health Authority)/Honorary lecturer in public health medicine in the Epidemiology Unit, London School of Hygiene & Tropical Medicine, London, UK.     

The Role of Attachment Style in Predicting Repetition of Adolescent Self‐Harm: A Longitudinal Study

This study investigated whether insecure attachment is associated with poorer outcomes at 6‐month follow‐up in adolescents who self‐harm. At baseline the Child Attachment Interview was administered to 52 adolescents (13‐17 years) referred to specialist child and adolescent mental health services and with a recent history of self‐harm. Participants also completed self‐report measures of self‐harm, peer attachment, anxiety, and depression and were administered the means end problem‐solving task. Self‐harm behavior and problem‐solving skills were assessed again at 6‐month follow‐up. At baseline, 14 (27%) were securely attached to their mothers. In the 49 (94%) adolescents followed‐up, those with insecure maternal attachment and insecure peer attachment were more likely to have repeated self‐harm. In addition, securely attached adolescents showed greater improvement in problem‐solving skills. These findings indicate that secure maternal and peer attachments may help recovery from self‐harm, possibly by supporting the acquisition of problem‐solving skills, and highlights the importance of social connections and attachments for youth with a history of self‐harm.     

What Does Psychological Autopsy Study Tell Us About Charcoal Burning Suicide—A New and Contagious Method in Asia?

Charcoal burning suicides in Hong Kong between 2002–2004 in the 15 to 59‐year‐old age group were investigated using the psychological autopsy method. The psychopathological profiles of charcoal burning suicides (N = 53) were compared against “other suicides” (N = 97). The two groups did not differ significantly in the prevalence of DSM‐IV axis I diagnoses with the exception of schizophrenic spectrum disorder which was less frequently associated with charcoal burning suicides. Score on “neuroticism” in the NEO‐five Factor Inventory (NEO‐FFI) was significantly higher in victims of charcoal burning suicide. There was also a trend toward higher score on “conscientiousness” in the NEO‐FFI among charcoal burners than victims of other suicide.