Motherhood in Women with Serious Mental Illness

This study aimed to determine the prevalence of motherhood among inpatient females at a large state psychiatric hospital in suburban New York, as well as develop an understanding of the characteristics and needs of this unique population. Data on motherhood status was gathered from October 2010 through April 2011 via medical records. Data on custody status, frequency of contacts with children, and effect of mental illness on parenting was assessed through patient surveys and focus groups. 38.5 % of female inpatients were found to be mothers, almost half of whom reported at least weekly contact with children despite their inpatient status. The majority of identified mothers reported having maintained custody of their minor children and expressed great pride at being primary caretakers for their children, yet also emphasized the challenging effects of stigma associated with mental illness and parenting. A significant proportion of women at this psychiatric hospital were found to be mothers. Although acknowledged by some clinicians at the individual level, motherhood appears to remain a forgotten role systemically. Determining motherhood status and recognizing the varied roles our patients have is one more way mental health providers can model and promote recovery-oriented care.     

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.     

Teasing and Disordered Eating Behaviors in Spanish Adolescents

The purpose of this study is to investigate the associations between peer teasing and body dissatisfaction (BD), emotional symptoms, drive for thinness (DT), and abnormal eating behaviors, as well as to analyze the mediating role of gender and body mass index (BMI) in such disorders. We screened 57,997 school children between 13 and 16 years of age. Scores in weight-related teasing and competency-related teasing were higher among girls, as well as overweight or obese individuals. Weight-teasing correlated more strongly with abnormal eating attitudes and behaviors, whereas competency-teasing correlated with emotional symptoms. Multiple linear regression analysis showed that weight-teasing is significantly and independently associated with BD, especially in boys. Multivariate analysis revealed a significant association between weight-teasing and abnormal eating in girls, although its predictive value was very low (Exp(B) = 1.009). Mediation analysis and Path analysis showed the mediating role of DT in this association. Interventions on teasing do not seem to be a priority in eating disorder prevention programs.     

The role of therapist adherence,therapist competence,and alliance in predicting outcome of individual drug counseling: Results from the National Institute Drug Abuse Collaborative Cocaine Treatment Study

Abstract

This study tested hypotheses related to linear and curvilinear relations among adherence, competence, and outcome and interactions of these effects with the quality of the therapeutic alliance among patients (N=95) who received individual drug counseling as part of the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Results support a hypothesized curvilinear relation between adherence and outcome as well as an interaction between this curvilinear effect and alliance early in treatment. For patients with a strong therapeutic alliance, counselor adherence to the treatment model was essentially irrelevant to treatment outcome. When the alliance was weaker, by contrast, a moderate (vs. high or low) level of counselor adherence was associated with the best outcome. The current results suggest that studies of the relation between therapist's adherence to models of treatment and outcome may need to take into account the complex moderating effect of therapeutic alliance.

Diese Studie testete Hypothesen bezüglich linearer und kurvilinearer Beziehungen zwischen vorgabegetreuem Vorgehen, Kompetenz und Erfolg, sowie der Interaktion zwischen diesen Variablen und der Qualität der therapeutischen Allianz bei Patienten (n?=?95), die individuelle Drogenberatung im Rahmen der gemeinsamen Drogenabhängigkeits-Behandlungs-Studie des Nationalen Instituts zur Kokain-Abhängigkeit erhielten. Die Ergebnisse unterstützten die vorhergesagte kurvilineare Beziehung zwischen vorgabegetreuem Vorgehen und dem Ergebnis, sowie einer Interaktion dieses kurvilinearen Effekts und der Allianz zu einem frühen Zeitpunkt der Behandlung. Für Patienten mit einer starken therapeutischen Allianz war das vorgabengetreue Vorgehen des Beraters zum Behandlungsmodell für das Behandlungsergebnis ohne Einfluss. Dagegen zeigte ein moderat vorgabengetreues Vorgehen des Beraters (im Vergleich zu einem hohen oder niedrigen Festhalten an den Vorgaben) den besten Erfolg, wenn die Allianz schwächer war. Die vorliegenden Ergebnisse legen nahe, dass Studien zur Beziehung zwischen einem Vorgehen des Therapeuten konform zu den Behandlungsrichtlinien und dem Ergebnis den komplexen Moderatoreffekt der therapeutischen Allianz berücksichtigen müssen.

Cette étude a testé des hypothèses au sujet de relations linéaires et curvilinéaires entre adhérence, compétence et résultat, et des interactions de ces effets avec la qualité de l'alliance thérapeutique chez des patients (N?=?95) qui avaient reçu du counseling individuel pour abus de drogues dans le cadre de l'Etude en Collaboration de l'Institut National pour l'Abus de Drogues sur le Traitement de la Cocaïne. Les résultats apportent du soutien à l'hypothèse d'une relation curvilinéaire entre adhérence et résultat ainsi que d'une interaction entre cet effet curvilinéaire et l'alliance en phase précoce du traitement. Pour les patients avec une alliance thérapeutique forte, l'adhérence du conseiller au modèle de traitement ne jouait pas de rôle essentiel pour le résultat du traitement. En cas d'alliance plus faible, par contre, un niveau modéré (versus haut ou bas) d'adhérence du conseiller était associé avec le meilleur résultat. Ces résultats suggèrent que des études de la relation entre l'adhérence du thérapeute à un modèle de traitement et le résultat devraient tenir compte l'effet de modération complexe de l'alliance thérapeutique.

Este estudio testeó hipótesis vinculadas con las relaciones lineales y curvilíneas entre adherencia, competencia y resultado así también como interacciones de estos efectos con la calidad de la alianza terapéutica entre pacientes (n?=?95) que recibieron Cunseling individual por drogas como parte del Estudio Colaborativo del tratamiento por cocaína del Instituto Nacional para el Abuso de Drogas. Los resultados apoyaron la hipótesis de la relación curvilineal entre adherencia y resultado, así también como la interacción entre este efecto curvilineal y la alianza temprana. Para los pacientes con una fuerte alianza terapéutica, la adherencia del consejero al modelo de tratamiento fue totalmente irrelevante al resultado. En los casos en los que la alianza fue más débil, en cambio, un nivel de adherencia del consejero (ni alta ni baja) estuvo asociada con el resultado mejor. Estos resultados sugieren que los estudios de la relación entre la adherencia del terapeuta a los modelos de tratamiento y resultado han de tener en cuenta el efecto moderador de la alianza terapéutica.

Let me know pls if this is all. Best, Beatriz

Il ruolo dell'adesione e della competenza del terapeuta ed il ruolo dell'alleanza nella previsione dell'esito del counseling individuale per le droghe: i risultati dall'Istituto Nazionale sull'abuso di droghe in equipe con lo Studio di trattamento della cocaina. Questo studio ha valutato le ipotesi collegate alle relazioni lineari e curvilinee tra adesione, competenza ed esito e le interazioni tra questi effetti con la qualità dell'alleanza terapeutica in pazienti (N: 95) che hanno ricevuto un counseling individuale sulle droghe come parte dello Studio di trattamento della cocaina in collaborazione con l'Istituto Nazionale di abuso di droghe.

I risultati supportano un'ipotizzata relazione curvilinea tra adesione ed esito, così come un'interazione tra questo effetto curvilineo e l'alleanza all'inizio del trattamento.

Per i pazienti con una forte alleanza terapeutica, l'adesione del counselor al modello di trattamento è stata essenzialmente irrilevante rispetto all'esito del trattamento. Quando l'alleanza era pi[ugrave] debole, al contrario, un moderato (verso l'alto o il basso) livello di adesione del counselor è stato associato con un miglior esito.

I risultati attuali suggeriscono che gli studi sulla relazione tra l'adesione del terapeuta ai modelli di trattamento e l'esito potrebbero aver bisogno di considerare il complesso effetto moderatore dell'alleanza terapeutica.

Este estudo estudou as hipóteses de relação linear e curvilínea entre adesão, competência e resultado e as interacç[otilde]es destes efeitos com a qualidade da aliança terapêutica em pacientes (N=95) que receberam aconselhamento individual para toxicodependência como parte do Estudo Colaborativo do Tratamento da Dependência da Cocaína do Instituto Nacional para o Abuso de Drogas. Os resultados apoiaram a relação curvilínea entre adesão e resultado, bem como uma interacção entre este efeito curvilíneo e aliança inicial. Para pacientes com uma forte aliança terapêutica, a adesão do terapeuta ao modelo terapêutico era, essencialmente, irrelevante para os resultados do tratamento. Quando a aliança era mais fraca, em contrate, um nível moderado (vs. baixo ou elevado) de adesão do terapeuta estava associado a melhores resultados. Estes resultados sugerem que estudos da relação entre adesão do terapeuta a modelos de tratamento e resultados terapêuticos podem necessitar de ter em consideração o efeito moderador complexo da aliança terapêutica.

     

An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP)

Introduction

The terminology for female pelvic floor prolapse (POP) should be defined and organized in a clinically-based consensus Report.

Methods

This Report combines the input of members of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of fourteen rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus).

Results

A Terminology Report for female POP, encompassing over 230 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction and POP. Female-specific imaging (ultrasound, radiology and MRI) and conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5–10 year) review is anticipated to keep the document updated and as widely acceptable as possible.

Conclusion

A consensus-based Terminology Report for female POP has been produced to aid clinical practice and research.

     

A pilot randomised controlled trial of the management of systolic blood pressure during endovascular thrombectomy for acute ischaemic stroke

It is unknown whether systolic blood pressure augmentation during endovascular thrombectomy improves clinical outcomes. This pilot randomised controlled trial aimed to assess the feasibility of differential systolic blood pressure targeting during endovascular thrombectomy procedures for anterior circulation ischaemic stroke. Fifty-one eligible patients fulfilling the national criteria for endovascular thrombectomy were randomly assigned to receive either standard or augmented systolic blood pressure management from the start of anaesthesia to recanalisation of the target vessel. Systolic blood pressure targets for the standard and augmented groups were 130–150 mmHg and 160–180 mmHg, respectively. The study achieved all feasibility targets, including a recruitment rate of 3.5 participants per week and median (IQR [range]) of mean systolic blood pressure separation between groups of 139 (135–143 [115–154]) vs. 167 (150–175 [113–188]) mmHg, p < 0.001. Data completeness was 99%. Independent functional recovery at 90 days (modified Rankin Scale 0, 1 or 2) was achieved in 30 (59%) patients, which is consistent with previously published data. There were no safety concerns with trial procedures. In conclusion, a large randomised controlled efficacy trial of standard vs. augmented systolic blood pressure management during endovascular thrombectomy is feasible.