Lifetime history of abuse,suffering and psychological health

Background: In a representative Swedish sample, we investigated lifetime prevalence of physical, sexual and psychological abuse of women and their current suffering. The relationship between current suffering from abuse and psychological health problems was also studied. Method: The study was cross-sectional and population-based. The Abuse Screening Inventory (ASI), measuring experiences of physical, sexual and psychological abuse and including questions on health and social situation, was sent by mail to 6000 women, randomly selected from the population register. The questionnaire was completed and returned by 4150 (70%) of 5896 eligible women. Results: 27.5% of the women reported abuse of any kind. Of those, 69.5% reported current suffering from abuse. Abused suffering women reported more anxiety, depression and sleep disturbances, and a less advantageous social situation than both non-abused and abused non-suffering women. Also, abused non-suffering women reported more depression than non-abused women. Somatization was reported more often by both abused suffering and non-suffering women than by non-abused women, with no difference between suffering and non-suffering women when adjusted for possible confounders. Conclusion: A majority of abused women, when investigating lifetime history of abuse, report current suffering thereof, which warrants considering abuse an important societal problem. Suffering could be a valuable construct, possibly useful to assess psychological health problems normally not captured by existing diagnostic instruments, although further investigations of the concept are needed.     

Extended‐access,but not limited‐access,methamphetamine self‐administration induces behavioral and nucleus accumbens dopamine response changes in rats

To better understand the neurobiology of methamphetamine (METH) dependence and the cognitive impairments induced by METH use, we compared the effects of extended (12 h) and limited (1 h) access to METH self‐administration on locomotor activity and object place recognition, and on extracellular dopamine levels in the nucleus accumbens and caudate‐putamen. Rats were trained to self‐administer intravenous METH (0.05 mg/kg). One group had progressively extended access up to 12‐h sessions. The other group had limited‐access 1‐h sessions. Microdialysis experiments were conducted during a 12‐h and 1‐h session, in which the effects of a single METH injection (self‐administered, 0.05 mg/kg, i.v.) on extracellular dopamine levels were assessed in the nucleus accumbens and caudate‐putamen compared with a drug‐naive group. The day after the last 12‐h session and the following day experimental groups were assessed for their locomotor activities and in a place recognition procedure, respectively. The microdialysis results revealed tolerance to the METH‐induced increases in extracellular dopamine only in the nucleus accumbens, but not in the caudate‐putamen in the extended‐access group compared with the control and limited‐access groups. These effects may be associated with the increased lever‐pressing and drug‐seeking observed during the first hour of drug exposure in the extended‐access group. This increase in drug‐seeking leads to higher METH intake and may result in more severe consequences in other structures responsible for the behavioral deficits (memory and locomotor activity) observed in the extended‐access group, but not in the limited‐access group.     

Cognitive and mental health difficulties following subarachnoid haemorrhage

Subarachnoid haemorrhage frequently results in disabling psychological trauma, mental health difficulties and cognitive impairments that can persist beyond the first year of discharge. At Salford Royal Hospital NHS Foundation Trust a long-term follow up programme using both neuropsychology and specialist nurses identifies patients in need of neuropsychological intervention for ongoing problems that prevent a return to work and normal life. The result of an audit of patients seen during 2008 reveals that one in three patients requires referral. Of the patients referred who completed both the initial and final outcome measures, clinically and statistically significant improvements can be seen. The results indicate the effectiveness of joint neuropsychology and specialist nurse follow up for subarachnoid haemorrhage patients.     

良性阵发性位置性眩晕的治疗进展及心理评估

良性阵发性位置性眩晕（BPPV）是在头位改变时出现的以短暂眩晕发作为主要特征的外周前庭性疾患,耳石复位治疗具有独特的疗效。体位限制对耳石复位后的治疗及预后是否有效尚未明确。前庭康复对反复发作的BBPV及其预后有一定疗效。BPPV引起的眩晕／头晕、姿势不稳等不适症状明显影响患者心理状态,更多表现为焦虑状态,因此心理评估及心理干预在BPPV的康复治疗中愈显重要。现对良性阵发性位置性眩晕的复位手法、体位限常】、前庭康复及心理评估作一综述。     

医学上不能解释的慢性疼痛主诉患者临床特征和精神病学诊断

目的观察疼痛科医学上不能解释的慢性疼痛主诉(MUP)门诊患者的临床特征,完善其临床诊断。方法对疼痛科门诊87例MUP患者转诊至心理科门诊进行会诊-联络精神病学研究,记录患者相关疾病信息和疼痛科诊断,进行症状自评量表(SCL-90)和综合性医院焦虑抑郁量表(HAD)测查和面谈并作出精神病学诊断。结果MUP患者的躯体形式疼痛主诉以头、面、口腔部(56.3%)、胸部(49.4%)和腰背部(25.3%)为主,疼痛科诊断以不定陈述综合征(33.3%)、慢性头痛综合征(20.7%)、疼痛原因待查(心因性疼痛,29.9%)为主。男、女性MUP患者的疼痛科诊断存在显著性差异(P<0.05)。MUP患者的SCL-90各因子评分均显著高于中国常模(P<0.05)。HAD(d)评分≥8分为66.7%,HAD(a)评分≥8分为49.4%。MUP患者的精神病学诊断高达96.6%。结论 MUP患者焦虑抑郁情绪明显,躯体化症状多,会诊-联络精神病学研究有助于完善其临床诊断。     

Beyond the tip of the iceberg: Exploring the potential of the meaning extraction method and aftercare e-mail themes

Abstract

The objectives were to examine the relationships among clients' affect regulation capacities, in-session emotional processing, outcome, and the working alliance in 66 clients who received either cognitive–behavioral therapy or process-experiential emotion-focused therapy for depression. Clients’ initial level of affect regulation predicted their level of emotional processing during early and working phases of therapy. Clients’ peak emotional processing in the working phase of therapy mediated the relationship between their initial level of affect regulation and their level of affect regulation at the end of therapy; and clients' level of affect regulation at the end of therapy mediated the relationship between their peak level of emotional processing in the working phase of therapy and outcome. Clients’ affect regulation at the end of therapy predicted outcome independently of the working alliance. The findings suggest that clients' level of affect regulation early in therapy has a significant impact on the quality of their in-session processing and outcome in short-term therapy. Limitations of the study and future directions for research are discussed.     

Alliance ruptures and rupture resolution in cognitive–behavior therapy: A preliminary task analysis

Abstract

An initial ideal, rational model of alliance rupture and rupture resolution provided by cognitive–behavioral therapy (CBT) experts was assessed and compared with empirical observations of ruptures and their resolution in two cases of successful CBT. The initial rational model emphasized nondefensive acknowledgment and exploration of the rupture. Results indicated differences between what therapists think they should do to resolve ruptures and what they actually do and suggested that the rational model should be expanded to emphasize client validation and empowerment. Therapists’ ability to attend to ruptures emerged as an important clinical skill.     

Client resistance predicts outcomes in cognitive–behavioral therapy for panic disorder

Abstract

Objective: Little is known about how therapy processes relate to outcome in cognitive–behavioral therapy (CBT) for panic disorder (PD). This study examined whether client resistance predicts CBT for PD outcomes beyond the effects of established pre-treatment predictors. A secondary aim was to assess the consistency of resistance over treatment. Method: Data were from 71 adults participating in up to 24 biweekly sessions of CBT in a randomized controlled trial. Panic severity was assessed before, during (at Weeks 1, 5, and 9), and at termination of treatment (Week 12) using the Panic Disorder Severity Scale. Trained coders reliably rated resistance in videos of Sessions 2 and 10 using the Client Resistance Code. Results: Resistance was found to be moderately consistent (r?=?.64). Although overall resistance was unrelated to outcomes, hierarchical linear modeling revealed that openly hostile resistance at Session 10 predicted significantly diminished symptom change (r?=?.28, CI_95%?=?[.01, .51]), beyond the effects of pretreatment predictors. Hostile resistance at Session 2 predicted attrition (r_rb?=??.30, p?=?.001), even after established predictors were controlled. Conclusions: Although some forms of resistance may be benign, openly hostile resistance is an important therapy marker that warrants increased clinical and research attention.