Multidisciplinary Treatment for Adults with Autism Spectrum Disorder and Co-Occurring Mental Health Disorders: Adapting Clinical Research Tools to Everyday Clinical Practice

ABSTRACT

In California, individuals with autism and co-occurring mental disorders, and their families, face two serious barriers when attempting to access the mental health services they need. The first is that the State Mental Health Specialty Service guidelines specifically exclude autism as a qualifying primary diagnosis for eligibility for mental health treatment and funding. The second is the lack of understanding and awareness regarding the challenges faced by individuals with classic autism and co-occurring mental disorders and their families. These two barriers, combined with the absence of a clear protocol for referral and assessment, have made access to services for clients and their families difficult. The Adult Autism Spectrum Disorder and Co-Occurring Mental Health Disorders project was an opportunity to study potential assessment tools and referral guidelines. We evaluated the use in a clinical setting of the Schedule for the Assessment of Psychiatric Problems Associated with Autism—a research instrument designed specifically for the psychiatric evaluation of patients with autism—to assist in diagnosing co-occurring mental health disorders. The experience gained in this study helped identify effective treatment options as well. After the assessment, clients were offered choices among several possible treatments fitting their specific needs. Our experience indicates that while adapting a research tool to everyday clinical service may encourage a more rigorous standardized approach to clinical assessment and evaluation, it may be difficult to employ such a tool in a clinical setting because of service needs and managed care constraints of serving a large and diverse population.     

Expectations and Experiences of Treatment in Eating Disorders

The present study presents the development of a self-report measure of treatment expectations and experiences for eating disorder patients. Patients participating in a Swedish multi-center study ( N = 461) who had been followed-up 6 months after initial assessment were examined on the Eating Disorder Patient's Expectations and Experiences of Treatment Questionnaire (EDPEX). The scale consists of 14 items comprising three subscales (Support, Control, and Insight). Separate versions were used for measuring expectations and subsequent experiences of treatment interventions. Inter-item reliability was satisfactory, and principal components analysis reflected the scale structure. When treatment experiences and change in eating disorder and psychiatric symptomatology were used to predict treatment satisfaction, experiences of support alone predicted 22% of the variance in treatment satisfaction one year later. The EDPEX can be a useful and economical measure for assessing treatment expectations and experiences among eating disorder patients.     

Nutritional Counseling in the Treatment of Eating Disorders

Abstract

Skin Deep, by Disney Studios in conjunction with the National Anorexic Aid Society. 26 minutes; available in VHS and ¾″ u-matic formats; order from Coronet/MTI-Film and Video, Inc., 108 Wilmot Road, Deerfield, IL 60015.     

Treatment Implications of Axis-II Comorbidity in Eating Disorders

In this article, we review the clinical research on the implications of comorbid personality disorders (PDs), pathological personality traits, and the expression and response to treatment of those with eating disorders (EDs) (i.e., anorexia and bulimia nervosa, and binge eating disorder). Obsessive-compulsive PDs and related traits, such as perfectionism and rigidity, appear to be clear-cut risk and maintenance factors for anorexia nervosa. In bulimia nervosa, trait impulsivity seems to be related to early termination from therapy and, according to at least some indices, poorer responses to treatment. Dramatic-Erratic PD features, generally more characteristic of binge-purge ED variants, clearly predict a protracted course for general psychiatric symptoms, but may have less prognostic value for eating symptoms. Recent guidelines from two influential bodies—the American Psychiatric Association (APA, 2000) and the United Kingdom's National Institute for Clinical Excellence (NICE, 2004)—both include the concept that “trait-oriented” interventions, targeting personality-linked components like perfectionism, affective instability, impulsivity, and interpersonal disturbances, may optimize treatment effects. In general, the literature supports the recommendation that clinicians should apply well-validated, symptom-focused therapies for the EDs; in addition, clinicians may wish to incorporate trait-focused interventions in patients in whom personality pathology contributes to suboptimal response.     

抗抑郁治疗对2型糖尿病痛性神经病变的影响

目的观察抗抑郁治疗对2型糖尿病痛性神经病变患者情绪障碍及疼痛的影响。方法将35例2型糖尿病痛性神经病变患者随机分为治疗组(20例)和对照组(15例)。收集患者一般临床资料和糖尿病控制情况,对照组常规给予降糖药、神经营养药、止痛药、改善微循环药物治疗。治疗组在此基础上加用抗抑郁药物西酞普兰20mg,1次/d,共14d。采用汉密尔顿抑郁量表(HAMD-17)评定患者治疗前后抑郁程度的变化,采用数字疼痛分级法(NPIS)评估疼痛改善情况,同时记录镇痛药物的等级,并检测糖化血红蛋白(HbA1c)以评价糖尿病控制情况。结果治疗前两组患者的临床一般情况、HbA1c及HAMD评分差异无统计学意义;治疗组治疗后第14天HAMD评分(17.69±7.45)显著低于治疗前(26.82±9.66)及同期对照组(24.71±8.92)(P<0.05),抑郁症状明显改善;治疗组第14天NPIS评分(2.5±0.8)显著低于同期对照组(4.8±1.1)和治疗前(6.0±2.2)(分别为P<0.05,P<0.01),镇痛药物的等级亦显著低于对照组(P<0.01)。结论抗抑郁治疗不仅可缓解患者的抑郁症状,还有益于疼痛的缓解。     

Women and Eating Disorders

This paper presents a view of eating disorders that highlights the interdependent nature of: the subordinate position of women in our society; our culture's emphasis on thinness and dieting; the way these cultural extremes are reflected in eating disordered families; and finally the way these extremes are reflected in the internal processes of anorexic and bulimic women. This multi-level perspective is illustrated with a case example.