青少年强迫症患者父母人格及家庭功能研究

目的 探讨青少年强迫症患者父母的人格特征及家庭功能特点,了解强迫症患者的成长环境,为早期预防及家庭治疗提供依据.方法 采用病例对照研究,对56名青少年强迫症患者及其父母进行艾森克人格问卷及家庭功能问卷的评定,对所得数据进行t检验及Pearson相关分析.结果 研究组的精神质、神经质得分高于对照组(t=4.461,P＜0.01),外向性得分低于对照组(t＝—2.337,P＜0.05);研究组和对照组父亲人格各因子的差异无统计学意义,母亲的神经质得分高于对照组(t＝3.708,P＜0.01);研究组家庭功能在角色、情感反应情感介入、行为控制方面得分高于对照组(t＝3.161,P＜ 0.05).结论 青少年强迫症患者的母亲存在高神经质特点,其家庭功能有较多问题,可能对青少年强迫症患者的人格有较大影响.     

男性青少年罪犯防御方式及家庭环境的对照研究

目的研究男性青少年罪犯的防御方式、家庭环境及其相互关系,为预防和矫正青少年违法犯罪提供参考依据。方法采用防御方式问卷（DSQ）及家庭环境量表中文版（FES—CV）评估300例男性青少年罪犯（研究组）及243例男性青少年学生（对照组）。结果研究组成熟型防御机制的得分高于中间型和不成熟型,且差异具有统计学意义（P〈0．01）。研究组不成熟型防御机制得分（4．61±0．89）明显高于对照组（4．32±0．79）,成熟型防御机制得分（5．06±1．02）则明显低于对照组（5．33±1．27）,且差异均具有统计学意义（P〈0．05）。家庭环境方面,研究组在FES—CV亲密度、情感表达、组织性等3个因子上的得分显著低于对照组,而在矛盾性因子上的得分显著高于对照组,且差异均具有统计学意义（P〈0．05）。不成熟型防御机制与FES—CV的亲密性、矛盾性和组织性等因子呈负相关,中间型防御机制与FES—CV的知识性因子呈弱正相关,成熟型防御机制与FES—CV成功性和组织性因子呈弱正相关（P〈0．05）。结论男性青少年罪犯虽运用成熟型防御机制为主,但仍较普通青少年运用较多不成熟及中间防御方式。男性青少年罪犯家庭呈现高矛盾性,低亲密性、情感表达及组织性的特点。这样的家庭环境将可能阻碍其防御机制的发展和成熟。     

中山市儿童青少年心理健康状况调查及相关因素分析

目的了解中山市儿童青少年心理健康状况及相关影响因素,为提高其心理健康水平提供科学依据。方法采用分层整群随机抽样方法,抽取中山市小学和初中共4所学校的2281名学生,采用Achenbach儿童行为量表(CBCL)、父母教养方式量表(EMBU)及儿童青少年一般情况调查表进行问卷调查。结果 2281名学生中行为问题检出率为18.76%(428名),其性别差异无统计学意义(P0.05)。非父母抚养组及低收入组外化性行为得分分别高于父母抚养组及中高收入组[(7.08±6.41)vs.(6.12±7.10);(6.63±6.72)vs.(5.93±7.59),P均0.05],非家庭和睦组在内化性行为得分、外化性行为得分及行为问题总分上都高于家庭和睦组(P均0.01)。Pearson相关分析显示,儿童青少年内化性行为得分、外化性行为得分及行为问题总分均与父、母的温暖理解因子得分呈负相关(r=-0.18~-0.13,P均0.01),与父母的惩罚严厉、拒绝否认、过度保护干涉等因子得分呈正相关(r=0.11~0.24,P均0.01)。进一步logistic回归分析显示儿童青少年行为问题相关因素依次是:家庭氛围、父亲温暖理解、母亲过度保护及干涉(P均0.05)。其中,家庭氛围越紧张,父亲温暖理解得分越低,母亲过度保护及干涉得分越高,儿童青少年越倾向于出现行为障碍(P均0.05)。结论中山市儿童青少年行为问题较突出,紧张的家庭氛围、母亲过度保护干涉及缺乏父亲温暖理解的教养方式对行为问题的发生有不利影响。     

青少年拒绝上学行为与气质性格、父母气质性格的关系研究

目的探讨青少年拒绝上学行为与气质性格及父母气质性格相关因素的关系。方法以年龄和性别为条件1∶3配对病例对照研究,选取就诊于盛京医院心理门诊,存在拒绝上学行为(SRB)的青少年及其父母为研究组,选取学校没有SRB的青少年及其父母为对照组,两组青少年完成一般信息调查表、儿童青少年气质性格量表(JTCI-S),父母完成气质性格量表(TCIR140)中文版。使用SPSS17.0统计分析。结果 (1)研究组包括106例SRB青少年,57位父亲和100位母亲。对照组包括318位正常青少年,232位父亲和276位母亲。(2)研究组非常态家庭类型所占比例高于对照组,差异具有显著性(=4.782,P0.05)。(3)研究组青少年伤害避免得分高于对照组,差异具有显著性(P0.001),新奇刺激寻找、奖励依赖、坚持性、自我定向和合作性得分均低于对照组,差异具有显著性(P0.05)。(4)研究组父亲奖励依赖得分低于对照组,差异具有显著性(P0.05)。研究组母亲奖励依赖和自我超越得分均低于对照组,差异具有显著性(P0.01)。结论 (1)拒绝上学青少年气质性格、父母气质性格与对照组存在差异。(2)非常态家庭类型、青少年高伤害避免是SRB产生危险因素;青少年高新奇刺激寻找、奖励依赖、合作性、母亲高奖励依赖是拒绝上学行为保护因素。     

厌学儿童自我意识及行为问题研究

目的厌学儿童自我意识及行为问题状况,为有针对性的干预提供参考。方法收集门诊8~14岁厌学儿童86例为研究对象,同一时间段按同年龄、性别及受教育程度匹配的原则随机抽取佛山市某中小学的在校学生86例为对照组。采用自制一般情况调查表、Piers-Harris儿童自我意识量表(CSCS)、Conner's儿童行为父母问卷对两组进行测评。结果研究组0~3岁主要带养人为父母所占比例、父母文化水平均低于对照组(P0.05或0.01),父母婚姻状况中紧张、离异及其他高于对照组(P0.05)。CSCS中研究组在行为、智力与学校情况、躯体外貌与属性、焦虑、幸福与满足5个因子评分均低于对照组(P0.01)。Connor's量表中品行问题、学习问题、躯体问题、焦虑、冲动、多动指数因子评分高于对照组(P0.05)。结论厌学儿童家庭情况不良、自我意识水平较低,存在较多的不良行为问题。     

精神分裂症患者家庭关系和父母教养方式的对照研究

目的 研究精神分裂症患者家庭人际关系和父母教养方式的特点。方法 采用家庭环境量表中文版和父母养育方式评价量表,对处于缓解期的100例精神分裂症患者（研究组）与按1：1配对原则挑选的100名正常人（对照组）进行测试。结果 （1）与对照组比较,研究组的家庭关系表现为低亲密度、低情感表达、低成功性及低组织性,以及高矛盾性及控制性差（P＜0．05或P＜0．01）。（2）在教养方式上,患者的父亲表现为低情感温暖、高惩罚严厉、过分干涉和拒绝否认（P＜0．01或P＜0．05）;患者的母亲表现为低情感温暖、高拒绝否认和惩罚严厉（P＜0．01）。（3）Logistic回归分析,研究组的家庭环境及父母教养方式的风险因素为家庭成员的控制性差,以及父亲的过分干涉、拒绝及否认（P＜0．01－P＜0．05）。结论 精神分裂症患者的家庭人际关系和父母养育方式存在多方面问题,可能对精神分裂症的发病起重要作用。     

物质依赖（滥用）个体的家庭特征研究

物质依赖(滥用)个体的原生家庭特点和成长于物质依赖(滥用)家庭的个体所表现出的特点两方面,对家庭因素与物质滥用个体之间存在的相互关系进行综述。揭示了与个体物质依赖(滥用)行为有明显相关的家庭因素,包括:较差的教养行为、低社会经济地位、不良教育环境、"专制式"的家庭氛围、家庭结构松散,缺乏凝聚力、父母存在物质滥用问题等;而成长于物质滥用家庭中的儿童则会表现为:受到更多虐待、执行功能能力下降、高攻击性、反社会人格等。在对从20世纪80年代开始的在物质依赖(滥用)个体的家庭特点的相关性研究基础上,进而探讨了物质依赖(滥用)家庭的代际传承的模型。     

精神分裂症患者家庭环境、父母教养方式以及亲密度和适应性的调查分析

目的　探索精神分裂症患者的家庭环境、父母教养方式以及亲密度和适应性的特点。方法　采用家庭环境量表 (中文版 ) ) (FES -CV)、父母教养方式评价量表 (EMBU)及家庭亲密度和适应性量表 (中文版 ) (FACESII-CV)对 110例精神分裂症患者 (研究组 )进行评定 ,并与 110例正常受试者 (对照组 )加以比较。结果　①同正常对照组相比 ,患者家庭表现为低亲密度、低情感表达、低成功性、低组织性以及高矛盾性和控制性差 (P <0 0 5或P<0 0 1)。②在教养方式上 ,患者父亲表现为低情感温暖、高惩罚严厉、过分干涉和拒绝否认 (P <0 0 1) ;而母亲表现为低情感温暖、高拒绝否认、惩罚严厉和偏爱被试 (P <0 0 5和P <0 0 1)。③在亲密度和适应性方面 ,患者家庭的实际亲密度、实际适应性、理想亲密度和理想适应性均较对照组为差 (P <0 0 1)。结论　患者的家庭环境、父母教养方式以及亲密度和适应性方面均存在着诸多方面的问题 ,可能对精神分裂症的发病起重要作用。     

酒依赖患者自尊水平及其家庭功能的研究

目的　探讨酒依赖患者自尊水平及其家庭功能受损情况。方法　采用自尊量表 (SES)及家庭功能问卷(FAD)对 6 0例酒依赖及 6 0例正常受试者进行了评定 ,并将测评结果加以比较。结果　酒依赖组的SES评分明显低于正常对照组 (P <0 0 1) ;家庭功能方面 ,酒依赖组在沟通、角色、情感反应、情感介入、行为控制等方面评分和FAD总分均明显高于正常对照组 (P <0 0 1)。结论　酒依赖组的自尊水平降低 ,有效的家庭功能受损。     

精神疾病患者家庭环境及其一级亲属人格特征

目的探讨精神疾病患者的家庭环境及其一级亲属人格特征,为改善精神疾病患者康复环境进行有针对性的心理干预提供参考。方法将2014年1月-5月在郑州大学第一附属医院精神医学科住院的190例符合《国际疾病分类(第10版)》(ICD-10)精神与行为障碍诊断的患者作为病例组,进行家庭环境量表中文版(FES-CV)测评,对179名精神疾病患者一级亲属进行艾森克人格问卷(EPQ)测评,同期选取181名健康志愿者作为对照组,对所有入组的健康志愿者进行FES-CV和EPQ测评。结果病例组FES-CV中矛盾性和控制性因子评分均高于对照组[(3.58±2.02)分vs.(2.80±1.64)分,(3.43±2.08)分vs.(2.96±1.49)分,t=4.14、2.52,P0.05或0.01];病例组FES-CV中亲密度、情感表达、娱乐性、组织性评分均低于对照组[(5.91±2.20)分vs.(6.57±1.20)分,(4.56±1.82)分vs.(5.31±1.44)分,(3.43±2.29)分vs.(4.40±1.95)分,(4.75±2.06)分vs.(5.31±1.99)分,t=-3.07、-4.39、-4.43、-2.65,P0.05或0.01]。病例组一级亲属EPQ中精神质和神经质评分均高于对照组[(52.71±9.90)vs.(42.71±10.59)分,(54.44±11.97)分vs.(45.96±11.49)分,t=9.26、6.84,P均0.01]。结论精神疾病患者的家庭环境存在低亲密度、低情感表达、低娱乐性及低组织性特征,同时矛盾性和控制性在患者的家庭氛围中比较明显,且精神疾病患者的一级亲属多具有神经质和精神质的人格特点。     

Integrating Services for Schizophrenia and Substance Abuse

Over the past decade, several studies have attempted to determine whether integrating psychiatric and substance abuse treatment leads to better outcome for patients with comorbid schizophrenia and substance use disorders. A recent (1999) Cochrane Review (1) analyzed the effectiveness of prospective randomized studies of integrated treatment approaches, and concluded that there was no clear evidence for superiority of integrated treatment. This paper describes one such integrated treatment approach, in Beth Israel Medical Center's COPAD (Combined Psychiatric and Addictive Disorders) program. We summarize findings from an initial outcome study and a recent replication study; and describe clinical and research issues relevant to this population. Our data suggests the benefits of integrated treatment for patients with addictive disorders and schizophrenia, at least with regard to treatment retention. Clinical issues for such patients include identification of patients at risk, proper assessment and treatment planning, decision-making about mainstreaming vs. referral to specialized programs, and the importance of initial engagement and ongoing reengagement in successful treatment.     

Mental Health and Substance Abuse Services in Ten State Medicaid Programs

Program data for 1993 on Medicaid mental health and substance abuse (MH/SA) services and expenditures were developed from Health Care Financing Administration (HCFA) research files for 10 states. These data show that MH/SA service users are 7 to 13% of Medicaid enrollees. The percentage of Medicaid enrollees accounted for by MH/SA users increases with age, reaching a fifth of the 45–64 age group. Across the 10 states, MH/SA spending represents 11% of total Medicaid expenditures. When their expenditures for non-MH/SA services are also considered, MH/SA users account for 28% of total Medicaid expenditures.     

Race,Managed Care,And The Quality Of Substance Abuse Treatment

The adoption of managed behavioral health care by state Medicaid agencies has the potential to increase the quality of treatment for racial minorities by promoting access to substance abuse treatment and creating more appropriate utilization patterns. This paper examines three indicators of quality for white, Black, and Hispanic Medicaid clients who received substance abuse treatment in Massachusetts between 1992 and 1996. It evaluates whether a managed behavioral health care carve-out in FY1993 had a positive or negative effect on access, continuity of care, and 30-day re-admissions. Prior to managed care, access and continuity were worse for minorities than for whites. For all clients under managed care, access and continuity improved between 1992 and 1996. Access improved more for Hispanic clients relative to other racial groups. Continuity improved more for Black clients relative to other racial groups. Although seven-day and 30-day re admissions also increased following managed care, the rate of increase was not significantly greater for minorities. Although managed care had a beneficial impact on the quality of treatment for minority clients, the percent of minority Medicaid-eligible clients who accessed treatment and the percent who achieved continuity of care remained lower than for whites in every year of the study. Managed care reduced, but did not overcome, racial disparities in behavioral health care.Marilyn C. Daley, Ph.D., is a Senior Research Associate at the Schneider Institute for Health Policy in the Heller School for Social Policy and Management at Brandeis University, Waltham, MA. The author would like to acknowledge the important contributions of Donald Shepard, Ph.D., Professor at the Heller School for Social Policy and Management, who was the Principal Investigator on the project, and Yvonne Anthony, Ph.D., who reviewed earlier versions of the paper. Funding for this paper came from the National Institute on Alcohol Abuse and Alcoholism, grant #R01-AA-10880, Managed Care in Michigan and Massachusetts, to Professor Donald Shepard, Ph.D. Address for correspondence: Marilyn C. Daley, Ph.D., Senior Research Associate, Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 035, P.O. Box 9110, 415 South Street, Waltham, MA 02454-9110. E-mail: daley@brandeis.edu.     

The Need for Substance Abuse Training Among Mental Health Professionals

This study examines substance abuse as encountered by practitioners in six major mental health professions, from private practice to organizational settings. Respective national professional associations surveyed representative samples of their members, including psychiatrists, psychologists, professional counselors, social workers, marriage and family therapists, and substance abuse counselors. About one in five clients seen in private practice of mental health professionals had substance abuse disorders, with somewhat higher rates in organized mental health treatment settings. For a large majority of clients, substance abuse was secondary to a mental disorder. A significant minority of these practitioners reported having little or no training to address substance abuse, either from formal graduate education, internships, or continuing education.     

Substance Abuse in an Adolescent Boy: Waking the Object

The analysis of an adolescent boy abusing alcohol, marijuana, and other drugs is used to discuss unconscious object relationships that can underlie substance dependence. Differentiating experimental from dangerous substance use is particularly challenging in the treatment of adolescents. The boy's escalating substance use is viewed both as an effort to numb himself and to “speak” through symptoms of problems he could not yet name. I utilize Rosenfeld's (1960/1966) view of the relationship of drug addiction to an identification with an ill or dead object to explicate the boy's psychodynamics. In this case, my patient was identified with both an ill mother and a neglectful father. Aspects of containment by the analyst that contribute in different ways to an adolescent's capacity to think about their self-destructiveness are discussed, along with the need for confrontation and the meaning of ancillary care when an adolescent's substance abuse become life threatening.     

Prevalence of Mental Illness and Substance Abuse Disorders Among Incarcerated Juvenile Offenders in Mississippi

The prevalence of psychiatric disorders among incarcerated juveniles in Mississippi was examined. A total of 482 adolescents completed a diagnostic questionnaire and a subset (N = 317) was assessed with face-to-face semi-structured interview. Most of the study participants met criteria for one mental disorder, 71-85% depending on assessment method, one-third have co-occurring mental health and substance abuse disorders. Gender and placement site differences in rates of some psychiatric disorders were also noted. Routine mental health screening should be performed on all juveniles placed in secure detention facilities to identify those who need treatment services.     

Availability of Integrated Care for Co-occurring Substance Abuse and Psychiatric Conditions

The co-occurrence of psychiatric conditions and substance abuse presents significant challenges for behavioral healthcare providers. The need for integrated care has received substantial recent attention from clinical, research, and funding entities. However, the availability of integrated care has been low, carrying potential adverse implications for quality of care and treatment outcomes. This article describes the prevalence and key correlates of the availability of integrated care for co-occurring conditions within public and private-sector addiction treatment programs. Several organizational attributes, caseload characteristics, and service provision patterns were associated with the availability of integrated care.Lori J. Ducharme, Hannah K. Knudsen, and Paul M. Roman are affiliated with the Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research, University of Georgia.     

Treatment for Dual Diagnosis Patients in the Psychiatric and Substance Abuse Systems

The purpose of this study was to describe and compare the extent to which psychiatric and substance abuse programs treating dual diagnosis patients in the residential and outpatient modalities offered the components recommended for this client group. Surveys were completed by managers of 753 programs in the Department of Veterans Affairs that had a treatment regimen oriented to dual diagnosis patients. Programs within both the psychiatric and substance abuse systems had some of the key services of integrated treatment (e.g., assessment and diagnosis, crisis intervention, counseling targeted at psychiatric and at substance use problems, medications, patient education, HIV screening and counseling, family counseling and education). However, compared to psychiatric programs, substance abuse programs were more likely to offer some of these services and other critical components (e.g., a cognitive-behavioral treatment orientation, assignment of a single case manager to each patient). Outpatient psychiatric programs were particularly lacking on key management practices (e.g., use of clinical practice guidelines, performance monitoring of providers) and services (e.g., detoxification, 12-step meetings) of integrated treatment. Generally, differences between psychiatric and substance abuse programs appeared to involve difficulties in developing treatment that is fully oriented toward the co-occurring diagnosis. To improve the provision of high-quality dual-focused care, we recommend planners' use of cross-system teams and applications of recently produced tools designed to increase programs' ability to deliver integrated care to dually disordered individuals.     

A Publicly Managed Medicaid Substance Abuse Carve-Out: Effects on Spending and Utilization

In 1998, Michigan Medicaid "carved out" substance abuse treatment from its medical plans, transferring the management responsibility and substantial financial risk to 15 specialized local entities called coordinating agencies. All these agencies were either non-profit or publicly owned, unlike carve-out entities in many other states. By the second year of the risk-based carve-out (2000), Medicaid payments per eligible were 9.1% lower than in the last year before the carve-out (1998). Reductions were largely achieved by serving fewer clients, not by reducing payments per client. Agencies faced with revenue reductions or small increases were more likely to reduce treatment spending.     

Assessing Administrative Costs of Mental Health and Substance Abuse Services

Increasing competition in the market for mental health and substance abuse MHSA services and the potential to realize significant administrative savings have created an imperative to monitor, evaluate, and control spending on administrative functions. This paper develops a generic model that evaluates spending on administrative personnel by a group of providers. The precision of the model is demonstrated by examining a set of data assembled from five MHSA service providers. The model examines a differential cost construction derived from inter-facility comparisons of administrative expenses. After controlling for the scale of operations, the results enable MHSA programs to control the efficiency of administrative personnel and related rates of compensation. The results indicate that the efficiency of using the administrative complement and the scale of operations represent the lion's share of the total differential cost. The analysis also indicates that a modest improvement in the use of administrative personnel results in substantial cost savings, an increase in the net cash flow derived from operations, an improvement in the fiscal performance of the provider, and a decline in opportunity costs that assume the form of foregone direct patient care.