A qualitative and quantitative study of psychotherapists’ congruence in Singapore

Abstract

This study explores the phenomenological world of 11 Satir-based Singaporean Chinese therapists with regard to their experience of congruence. A mixed qualitative-cum-quantitative research method was used in this study. A phenomenological methodology was used to explore (a) the phenomenological world of therapists with regard to their lived experience of congruence in their personal or inner lives, (b) how this congruence is used in psychotherapy, and (c) how therapists can enhance their level of congruence. Quantitative findings include (a) significant nonparametric correlations among the intrapersonal, interpersonal, and transpersonal levels of congruence with overall congruence; (b) significant nonparametric correlation between intrapersonal congruence and interpersonal congruence; (c) significant nonparametric correlations between overall congruence and interpersonal congruence with self-esteem and life satisfaction; and (d) significant nonparametric correlations between intrapersonal congruence and self-esteem. These results may have research and clinical implications for the practice of psychotherapy.     

Practices in diagnosis,disclosure and pharmacotherapeutic management of dementia by general practitioners – a national survey

Objectives: To explore the practice patterns of general practitioners (GPs) for the diagnosis, disclosure and pharmacological management of individuals with dementia. We also investigated whether the number of years working in general practice is a determinant factor associated with the responses obtained.

Method: A national survey was sent to all registered GPs in the Maltese islands. The return rate was 54.2% with the majority of respondents having 15 years or more working experience in general practice. Chi-square analysis of variance was used to determine any relationship effects.

Results: Although the majority of GPs indicated lack of competence in diagnosing dementia, only a small percentage showed a preference towards specialist referral. Lack of training was mostly envisaged by physicians with the least number of years in general practice. Significant differences in pharmacotherapeutic prescribing were noted depending on the stage of disease progression and the number of years working as a GP. Disease disclosure was not routinely carried out even though GPs were aware of the fact that disclosure may help individuals with dementia and their caregivers or relatives with future planning.

Conclusion: The findings show notable shortcomings in various aspects of dementia management by GPs. This highlights the need of providing continued educational support and training opportunities to enhance not only GPs’ clinical competence, but also their role as key players in providing quality support to individuals with dementia in the primary care setting.     

The clinical utility of qualitative electroencephalography during tilt table testing – A retrospective study

Objective

To assess electroencephalography (EEG) changes during tilt table testing in syncope and other orthostatic syndromes.

Attempted suicide—A comparative study of psychopathic and general hospital patients

Psychiatric Quarterly -     

Mortality and risk of dementia in normal-pressure hydrocephalus: A population study

Introduction

We examined mortality, dementia, and progression of hydrocephalic symptoms among untreated individuals with idiopathic normal-pressure hydrocephalus (iNPH) in a population-based sample.

Are there differences in perceptions,preferences and attitudes towards disclosure of genetic testing for Stroke? A qualitative study among stroke-free SIREN-SIBS genomics study participants

ObjectiveThis study explored perceptions, preferences and attitudes towards disclosure of genetic testing results for stroke among stroke-free controls (and their family members) in the SIREN-SIBS Genomics Study, healthcare providers and policymakers.Materials and MethodsWe conducted a qualitative thematic analysis of key informant interviews with 61 participants recruited from community advisory boards (30) and health care providers (31) across seven sites in Nigeria and Ghana.ResultsMajor findings illustrate differences in the knowledge of genetic testing with superior knowledge among health care professionals. Relatives and religious leaders were opined as the best to receive the disclosure as they would be able to break the news to the patient in a culturally sensitive manner to reduce the likely resultant emotional outburst. Poor level of awareness of national guidelines for disclosing genetic results exist. Key facilitating factors for disclosure are education, enabling environment, involvement of religious and community leaders, campaigns, and possible treatment options. Disclosure inhibitors include inadequate information, fear of marital break-up or family displacement, fear of stigmatization, fear of isolation, religious beliefs, health worker attitude, and lack of preparedness to accept results.ConclusionsThese necessitate culturally sensitive interventions for continuing education, increased awareness and sustained engagement to equip all stakeholders in genetic testing disclosure process.     

Executive function and attention in young adults with and without Developmental Coordination Disorder – A comparative study

The current research aimed at examining the executive function (EF) of young adults with Developmental Coordination Disorder (DCD) in comparison to young adults without DCD. The study used a randomized cohort (N = 429) of young adults with DCD (n = 135), borderline DCD (n = 149) and control (n = 145), from a previous study. This initial cohort was asked to participate in the current study three to four years later. Twenty-five individuals with DCD (mean age = 24 years, 1 month [SD = 0.88]; 18 males), 30 with borderline DCD (mean age = 24 years, 2 month [SD = 0.98]; 18 males) and 41 without DCD (mean age = 25 years, 2 months [SD = 1.91]; 20 males) participated in this study. Participants completed the BRIEF-A questionnaire, assessing EF abilities and the WURS questionnaire, assessing attention abilities. The DCD and borderline DCD groups had significantly lower EF profiles in comparison with the control group but no significant differences were found between the DCD and borderline DCD groups. While a high percentage of attention problems were found in both DCD groups, the executive functioning profiles remained consistent even when using the attention component as a covariate. The study results suggest that young adults with DCD have EF problems which remain consistent with or without attention difficulties.     

Patients’ experiences of change in cognitive–behavioral therapy and psychodynamic therapy: a qualitative comparative study

Abstract

Research suggests that different therapeutic approaches produce roughly equivalent outcomes despite their theoretical and technical differences. This study explores whether the quantitative equivalence may conceal differences in patients’ experiences of the quality of change. Thirty-two patients who had terminated cognitive–behavioral therapy or psychodynamic therapy were interviewed about their experiences in psychotherapy. The cases were clustered in four groups depending on type of therapy and whether outcome was judged as satisfactory or not. An outcome narrative was reconstructed for each type. Even though the ratio of satisfactory to unsatisfactory cases was roughly equal in the two types of treatments, there were obvious differences in the kinds or quality of outcome that were reported as well as some experiences common to the two groups of patients. The narratives of the dissatisfied patients underscored the importance of matching the approach to the patient.     

Barriers to and facilitators for making emergency calls – a qualitative interview study of stroke patients and witnesses

Background and objectivesEarly access to hospital for diagnosis and treatment is strongly recommended for patients with acute stroke. Unfortunately, prehospital delay frequently occurs. The aim of the current study was to gain in-depth insight into patient experience and behavior in the prehospital phase of a stroke.MethodsWe conducted qualitative interviews with a purposive sample of 11 patients and six witnesses within four weeks post stroke. The interviews were audio recorded, transcribed, and analyzed utilizing Systematic Text Condensation.ResultsThe material was classified according to two main categories each containing three subgroups. The first category contained the diversity of sudden changes that all participants noticed. The subgroups were confusing functional changes, distinct bodily changes and witnesses’ observations of abnormal behavior or signs. The second category was delaying and facilitating factors. To trivialize or deny stroke symptoms, or having a high threshold for contacting emergency services, led to time delay. Factors facilitating early contact were severe stroke symptoms, awareness of the consequences of stroke or a witness standing by when the stroke occurred.ConclusionsPrehospital delays involved interrelated elements: (1) Difficulties in recognition of a stroke when symptoms were mild, odd and/or puzzling; (2) Recognition of a stroke or need for medical assistance were facilitated by interaction/communication; (3) High threshold for calling emergency medical services, except when symptoms were severe. The findings may be helpful in planning future public stroke campaigns and in education and training programs for health personnel.     

A wish to know but not always tell – couples living with dementia talk about disclosure preferences

Most research on disclosure issues in dementia has focused on what it is like to receive a dementia diagnosis. Little is known about the disclosure preferences that people with dementia and their cohabiting spouses have. In this study, we explore disclosure preferences and focus on what couples living with dementia want to know and tell about the disease. The study is based on 40 qualitative interviews (20 with people with dementia and 20 with their spouses). The analysis revealed five preference patterns regarding what the couples wanted to know and how they felt about sharing information concerning the disease with others. The patterns have been called: (1) want to know and tell (no reservations about it); (2) want to know and tell (some reservations about it); (3) want to know but do not want to tell; (4) want to know but cannot decide if we want to tell and (5) cannot agree on either knowing or telling. They show that couples’ preferences about what they want to know are related to what they are willing to tell. The findings also show that it is usually the preferences of the person that has a dementia diagnosis that guide the stand that couples take as far as disclosure issues are concerned. Thus, the findings show the type of interdependence that exists when one person in a couple has received the diagnosis, and the life of the two people as a couple is challenged as a result of this.     

Can clock drawing test help to differentiate between dementia of the Alzheimer's type and vascular dementia? A preliminary study

OBJECTIVES: the purpose of this preliminary study was to determine if clock drawing performance may help to differentiate between dementia of the Alzheimer's type (DAT) and vascular dementia (VD) patients. METHODS: eighty-eight community-dwelling outpatients were comprehensively evaluated and met DSM-IV criteria for DAT or VD. Cognitive evaluation included the Mini-Mental State Examination (MMSE) and the Cambridge Cognitive Examination (CAMCOG). CAMCOG derived clock drawings were blindly evaluated by the same investigator, according to Freedman's method for clock drawing, and a total score as well as subscores (contour, numbers, hands and center) were determined. RESULTS: There were no significant differences between DAT and VD patients in terms of demographic (age, gender, education) and cognitive (MMSE score, CAMCOG score) characteristics. On the average, the VD group showed slightly poorer performance on each of the clock drawing test (CDT) measures studied. With application of the Bonferroni correction, only Freedman's total score and hands subscore were statistically different between groups (p<0.003, p<0.004, respectively). Stepwise logistic regression analyses showed that the only significant variable was Freedman's total score (B=-0.273, p=0.005). Stepwise discriminant analysis identified Freedman's total score as the only significant predictor of diagnosis (Wilkes' lambda=0.903, p=0.003). This model correctly classified 65.9% overall into the respective DAT and VD groups. CONCLUSIONS: CDT scored according to a comprehensive technique may be of value in differentiating DAT from VD patients. We hypothesize that the classificatory ability of Freedman's method might be attributed to its presumed sensitivity to impaired executive functioning which is more pronounced in VD compared with DAT patients.     

A comparative study of caregivers’ perceptions of health-care needs and burden of patients with bipolar affective disorder and schizophrenia

Abstract

Background: Although many studies in schizophrenia have evaluated health-care needs, there is a lack of data on the needs of patients with bipolar affective disorder (BPAD), with only occasional studies evaluating them, and no study has evaluated the relationship of health-care needs of patients with caregiver's burden. Aim: To study the relationship of caregiver's burden and needs of patients as perceived by caregivers of patients with BPAD and schizophrenia. Method: Caregivers of patients with BPAD and schizophrenia were assessed using the Camberwell Assessment of Needs – Research version (CAN-R) and Supplementary Needs Assessment Scale (SNAS), the Family Burden Interview schedule (FBI) and the Involvement Evaluation Questionnaire (IEQ). Results: Mean total needs of patients on CAN-R were 7.54 (SD 3.59) and 7.58 (SD 4.24) for BPAD and schizophrenia respectively. Mean total needs for SNAS were 7.24 (SD 3.67) and 7.68 (SD 5.02) for BPAD and schizophrenia groups, respectively. Total objective and subjective burden as assessed on FBI was significantly more for the schizophrenia group. Caregivers of patients with BPAD perceived significantly less disruption of routine family activities and lower impact on the mental health of others. On IEQ, the mean score on the domain of supervision was significantly higher for the BPAD group. In the schizophrenia group, positive correlations were seen between the total number of unmet and total (met and unmet) needs and certain aspects of burden, but no such correlations emerged in the BPAD group. Conclusion: There is no correlation between number of needs and burden in the BPAD group; however, in the schizophrenia group the number of needs correlated with the perceived burden. Accordingly, orienting services to address needs of patients with schizophrenia can lead to reduction in burden among caregivers.     

DemTect®– effective to asses MCI and dementia – validation study of the Polish language version

Objectives: To validate DemTect®, a highly sensitive psychometric screening tool – designed to identify patients with mild cognitive impairment (MCI) and patients with dementia (AD).

Method: A prospective cohort/cross-sectional study was designed. The data were collected from a group of 224 subjects, including 85 patients with MCI, 109 with Alzheimer's disease (AD) and 30 healthy control (HC) subjects. All subjects underwent a detailed neuropsychological assessment including CT, the assessment of biological parameters and a psychometric examination using DemTect®, MMSE, TYM, CDT and FAS.

Results: Subjects ranged in age from 55 to 94 years, with a mean age of 71.42 ± 9.86 years. Classification rates of DemTect® were superior for both the MCI and AD groups compared with the MMSE, with high sensitivities of 90% (cut-off ≤15) and 96.8% (cut-off < 10), respectively. The DemTect® Polish language version proved to be independent of age and education level.

Conclusion: The Polish language version of the DemTect® scale is easy to administer. It may be seen as a superior cognitive screening tool in day-to-day practice as it achieves more accurate differentiation between HC/MCI/AD compared with MMSE.     

Parental PTSD and school performance in 16-year-olds – a Swedish national cohort study

Abstract

Aim: Posttraumatic stress disorder (PTSD) in parents can have severe consequences also for their children. Prevalence of PTSD is high among refugees. Refugee children have been reported to perform poorly in school. The aim of this study was to investigate the impact of PTSD in refugee and native Swedish parents on children’s school performance and to compare the impact of PTSD with that of other major psychiatric disorders.

Methods: Register study where multiple regression models were used to analyse school performance in 15–16-year-olds in a national cohort (n?=?703,813). PTSD and other major psychiatric disorders (bipolar, depression and/or psychotic disorders) were identified from out- and in-patient hospital care.

Results: Maternal and paternal PTSD were associated with lower grades, with adjusted effects of 0.30–0.37 SD in refugee and 0.46–0.50 SD in native Swedish families. Impact of PTSD was greater than that of other psychiatric disorders and comorbidity to PTSD did not increase this impact. Although the impact of PTSD on grades was greater in children in native Swedish families, consequences with regard to eligibility to secondary education were greater for children in refugee families, where 35% of these children were ineligible.

Conclusions: Parental PTSD has major consequences for children’s school performance and contributes to the lower school performance in children in refugee families in Sweden. Identification and treatment of PTSD in refugee parents is important for offspring educational achievement. Psychiatric clinics and treatment centres need to have a strategy for support, including educational support, to the offspring of their patients with PTSD.