Religious coping and caregiver well-being in Mexican-American families

Objective: We sought to explore the association of religious and spiritual coping with multiple measures of well-being in Latinos caring for older relatives with long-term or permanent disability, either with or without dementia.

Methods: Using a multi-dimensional survey instrument, we conducted in-home interviews with 66 predominantly Mexican-American Catholic family caregivers near the US–Mexico border. We assessed caregivers’ intrinsic, organizational and non-organizational religiosity with the Duke Religiosity Index, as well as Pargament's brief positive and negative spiritual coping scale to determine the association of religiosity with caregivers’ mental and physical health, depressive symptomatology and perceived burden.

Results: Using regression analysis, we controlled for sociocultural factors (e.g. familism, acculturation), other forms of formal and informal support, care recipients’ functional status and characteristics of the caregiving dyad. Intrinsic and organizational religiosity was associated with lower perceived burden, while non-organizational religiosity was associated with poorer mental health. Negative religious coping (e.g. feelings that the caregiver burden is a punishment) predicted greater depression.

Conclusion: Measures of well-being should be evaluated in relation to specific styles of religious and spiritual coping, given our range of findings. Further investigation is warranted regarding how knowledge of the positive and negative associations between religiosity and caregiving may assist healthcare providers in supporting Latino caregivers.     

Expressed emotion and schizophrenic outcome among Mexican-American families

This study has demonstrated that among low-income, relatively unacculturated Mexican-American households, a high level of expressed emotion on the part of key relatives significantly increases the risk of relapse for remitted schizophrenics who return home to live with their families after hospital discharge. This cross-cultural replication of earlier research findings in London and southern California suggests that critical, hostile, or emotionally overinvolved attitudes and behaviors may be general major stressors that adversely influence the fragile adaptation of schizophrenic individuals in diverse cultural settings. The finding of a lower prevalence of high levels of expressed emotion among Mexican-American compared to Anglo-American and British households lends support to the hypothesis that intrafamilial behaviors may account for different schizophrenic outcomes in different cultures.     

Coping with a child with Dravet syndrome: insights from families

Dravet syndrome is a truly catastrophic childhood-onset epilepsy. Families are faced with repeated episodes of status epilepticus, intractable seizures, mental handicap, behavior disorders, and a life of dependency; understandably, coping with Dravet syndrome is very difficult. Twenty-four families with a child with Dravet syndrome were interviewed and identified some practical suggestions to improve their daily life. These included inserting an indwelling venous access device, creating a portable microenvironment, writing an emergency department protocol, establishing emergency routines for the family, assigning a parent on call to lessen the effect on siblings, creating personal time to decrease parental stress, finding respite care, and contacting an Internet support group. Unresolved and common issues included transition to adult care, the utility of early diagnosis, and social isolation. These solutions and issues may be helpful to many families with a child with Dravet syndrome and possibly other severe childhood-onset epilepsies.     

Molecular genetics studies in Polish Charcot-Marie-Tooth families

Charcot-Marie-Tooth (CMT) disorders are the extremely heterogeneous group of diseases of the peripheral nervous system in humans with a prevalence of 1: 2500. Up to date mutations in 30 genes have been reported in various CMT forms. In numerous CMT types only locus is known and some CMT forms were shown not to be linked with any known locus. Genetic studies in CMT disorders cover a wide spectrum of problems ranging from identification of novel mutations through studies of pathogenic nature of mutations to genotype-phenotype correlations. The aim of this study was to present the main directions of genetic analysis performed in Polish families with CMT disease.     

Genetic linkage studies in Alzheimer''s disease families

Alzheimer's disease is a devastating neurological disorder and the leading cause of dementia among the elderly. Recent studies have localized the gene for familial Alzheimer's disease to chromosome 21 in a series of early onset AD families (mean age of onset less than 60). Familial late onset AD (mean age of onset greater than 60) is a more common clinical form of the disorder. Thirteen families with multiply affected Alzheimer's disease family members were identified and sampled. Ten of these families were of the late onset Alzheimer's disease type. Simulation studies were used to evaluate the usefulness of these pedigrees in linkage studies in familial Alzheimer's disease. Linkage studies undertaken to test the localization of both early onset and late onset Alzheimer's disease families to chromosome 21 failed to establish linkage and excluded linkage from a large portion of the region where the early onset Alzheimer's disease gene was localized. These findings suggest that more than one etiology may exist for familial Alzheimer's disease and indicate the need for continued screening of the genome in familial Alzheimer's disease families.     

Case studies in confidentiality

Although a fundamental principle of psychiatric practice in general and psychotherapy in particular is that interactions and communications between clinician and patient are private, there are certain instances in which there is an affirmative obligation to break confidentiality, or in which such a breach is at least legally (if not ethically) permitted. The author examines the various situations in which a psychiatrist's obligation to maintain confidentiality is modified or even completely overridden by some other competing clinical, legal, or ethical principle or obligation. He reviews the duty to protect third parties (Tarasoff warnings), situations in which a psychiatrist's loyalties are divided between the patient and some other entity, person, or principle (dual agency issues), the release of information in emergencies, and the reporting of abuse. He also discusses the circle of confidentiality and which individuals are deemed to be inside and outside that circle. Guidelines for the use of clinical material in presentations and publications are reviewed. The author also considers how psychiatrists should deal with knowledge of past criminal behavior that they may obtain during the course of treatment. Finally, the author discusses the need to carefully document the rationale for whatever course of action is taken.     

Positive Thinking Among Slot Machine Gamblers: A Case of Maladaptive Coping?

Background  Research has demonstrated that optimism and “positive illusions” can be used a coping mechanism among those facing adversity. Gamblers are a little studied group who also experience adversity and uncertainty. They often feel considerable levels of frustration, guilt, anger and a sense of feeling cheated after making significant losses. In order to deal with such feelings it is hypothesized that these individuals will search for positive consequences from their behaviour in order to offset this negative affect. Objectives  To (1) determine whether after gambling, gamblers compensate and reduce negative affect by identifying positive consequences from experiencing a loss, and (2) identify types of strategies which gamblers employ and consider how these should be classified. Materials and Methods  Eighty-seven regular slot machine gamblers were interviewed in a variety of environments housing slot machines. Each participant was asked a series of questions in a semi-structured format, to explore possible styles of positive thinking. Results  Nine types of ‘positive thinking’ experienced by gamblers were identified. These included Comparative thinking, Prophylactic thinking, Biased frequency thinking, Responsibility avoidance, Chasing Validation, Prioritization, Resourcefulness, Thoughtfulness, and Fear Reduction. Gamblers who were positive thinkers experienced significantly less guilt than non-positive thinkers. Conclusions  While reduction of negative affect may be perceived as positive in many other contexts, it is argued that it may counteract efforts to promote responsible gambling. Clinical implications and directions for future research are discussed.     

Coping and stress in families of child psychiatric inpatients: Parents of children with depressive and schizophrenia spectrum disorders

Coping and disruption were examined in parents of children with depressive and schizophrenia spectrum disorders. Parents described disruption in their family lives, relationships, leisure time, and work functioning. High maternal disruption was associated with the absence of intimate relationships and child chronicity. Parents most frequently reported using active cognitive coping strategies, but with the advantage of hindsight, advised seeking community resources for helping their children.This research was supported by a grant from the John D. and Catherine T. Mac-Arthur Foundation as part of their Network on Risk and Protective Factors in the Major Mental Disorders. The authors wish to thank Sondra Perdue, Donald Guthrie, and Gwen Gordon for statistical consultation and computer assistance.     

The Coping Strategies Task: Assessment of Coping in Schizophrenia

Abstract

The current study presents the: 1) conceptual development of a preliminary measure, the Coping Strategies Task (CST), for assessing coping-related cognition in a group of long-term, hospitalized individuals with schizophrenia-spectrum disorders; and 2) preliminary reliability and validation data of the CST. The CST was designed for persons with severe and persistent mental illness, and study participants included thirty-three individuals in comprehensive psychiatric rehabilitation. Reliability analyses revealed that the CST and its subscales demonstrated adequate reliability, although one subscale (Behavioral Reaction) demonstrated less robust split-half and test-retest reliabilities. Concurrent validity was evaluated by analyzing the relationship between the CST and measures of stress, observed behavior, and neurocognition. Correlational analyses revealed that coping attributions, as measured by the CST, were associated with perceived stress, observed behavior, and executive functioning. These preliminary data suggest that the CST could become a valid, clinically useful coping measure in order to further inform psychiatric rehabilitation.     

Case studies in movement disorders

Six cases representing the most commonly encountered movement disorders-restless legs syndrome with periodic limb movements, tics, myoclonus, chorea, essential tremor, and cervical dystonia-are presented. Discussion of each case focuses on a practical approach to recognizing the important clinical features of each movement disorder as well as the current therapeutic options. A detailed discussion of botulinum toxin follows the case on cervical dystonia, focusing on its mechanism of action, clinical indications, side effects, and dosing.     

Recruitment of families for genetic studies of epilepsy

PURPOSE: Study of families containing multiple affected individuals is essential for genetic research on the epilepsies, yet practically nothing has been published about methods for identification and recruitment of families or expected participation rates. Here we describe the strategy used for data collection in a genetic linkage study, to provide guidelines for efficient design of new studies. METHODS: Potentially eligible families were ascertained from private physicians, clinics, and self-referrals. Participation rates were examined at each step of the recruitment process, according to ascertainment source, initial contact method, gender, and ethnicity. RESULTS: Among 320 potentially eligible families identified, only 68 (21%) were successfully enrolled. Contact was established with an index subject in 83% of families, and a screen for eligibility was completed in 88% of these. However, only 54% of screened families were confirmed to be eligible, and of these, only 54% were enrolled. In eligible families, 79% of index subjects agreed to participate; the low family enrollment rates resulted largely from refusals by other family members whose participation was needed for linkage analysis. At each step in the recruitment process, the participation rate was higher in self-referred than in other families. CONCLUSIONS: Recruitment of families for genetic studies is labor-intensive; many potentially eligible families may have to be screened for each family enrolled. Recruitment is easier with self-referred families than with those identified through other methods. The introduction of standardized methods for identification of eligible families from clinical settings can improve efficiency.