Parenting adolescent girls with type 1 diabetes: parents' perspectives

OBJECTIVE: To explore parents' perceptions of the impact of type 1 diabetes mellitus (DM) on the family and to better understand parent-child conflict, parental worries, and coping strategies related to the management of DM in adolescence. METHODS: Semistructured interviews were conducted with the parents of 30 adolescent girls who had DM for at least 1 year. Using standard procedures for content analysis, themes were identified from the parents' discussions. RESULTS: Although parents reported worries, conflicts, and negative impacts of the DM on their family, they also recognized positive aspects of the DM (e.g., it promotes adolescent responsibility) and had strategies to cope with its challenges (e.g., letting go of perfectionism in disease management, keeping a positive attitude). CONCLUSIONS: Findings from this study can be used by clinicians to assess parents' concerns about DM and to help them discover ways to cope with their worries and stay involved with the disease's management. Considering the parents' perspective will likely lead to parents feeling understood by the health care team and will help to reduce their worries.     

Loss of Bim allows precursor B cell survival but not precursor B cell differentiation in the absence of interleukin 7

Interleukin (IL)-7 is a stromal cell-derived cytokine required for the survival, proliferation, and differentiation of B cell precursors. Members of the Bcl-2 family of proteins are known to have profound effects on lymphocyte survival, but not lymphocyte differentiation. To distinguish the relative dependence on IL-7 of B cell precursor survival versus B cell differentiation, the combined effects of lack of IL-7 and lack of the proapoptotic Bcl-2 relative, Bim, were studied. Bim is expressed to varying degrees in all B cell precursors and B cells. Lack of Bim compensated for lack of IL-7 in the survival of pro-, pre-, and immature B cells; however, lack of Bim did not substitute for the requirement for IL-7 in B cell precursor differentiation or B cell precursor proliferation. Precursor B cell survival is more dependent on sufficient levels of IL-7 than precursor B cell differentiation because the number of B cells and their precursors were reduced by half in mice heterozygous for IL-7 expression, but were restored to normal numbers in mice also lacking Bim. Hence, Bim and IL-7 work together to control the survival of B cell precursors and the number of B cells that exist in animals.     

Patterns of functional brain organization and migraine

The purpose of this study was to examine the relationship between the patterns of functional organization of the brain, as evaluated by the number of anomalous brain conditions or phenomena (ABCP), and the prevalence of migraine in a group of 434 women with lifetime major depressive disorder. ABCP are conditions or phenomena which are clearly related to brain function whose prevalence significantly deviates from the statistical mean for the general population. Eighteen ABCP (e.g. mixed or left handedness, enuresis after age 5, learning and speech disorders) were used in this study as 'markers' for their associated patterns of functional brain organization. The relationship between the number of ABCP and the prevalence of migraine was highly significant. The correlation between the number of ABCP and the prevalence of migraine was 0.36 (P < 0.0001, confidence interval 0.26, 0.43). The prevalence of migraine in patients with no ABCP (n = 11) was 9%, while that of those with eight or more ABCP (n = 40) was 85%. This supports the hypothesis that there is a relationship between patterns of functional brain organization and migraine prevalence.     

'Making the move': relatives' experiences of the transition to a care home

Despite a growing awareness of the significance of helping a relative to relocate to a care home as a key phase in the caregiving career, relatively few studies in the UK have explored this experience in depth. The research on which the present paper is based sought to better understand experiences of nursing home placement from the viewpoint of relatives. The study was informed by a constructivist perspective. Data were collected in 37 semi-structured interviews involving 48 people who had assisted a close relative to move into a nursing home. Data analysis revealed three phases of the transition from the relatives' perspective: 'making the best of it'; 'making the move'; and 'making it better'. The relatives' experiences across these phases were understood in terms of five continua, reflecting the extent to which they felt they were: operating 'under pressure' or not; 'working together' or 'working alone'; 'supported' or 'unsupported', both practically and emotionally; 'in the know' or 'working in the dark'; and 'in control of events' or not. This paper reports on the findings which relate to the second phase of the transition, 'making the move', which relates to experiences around the time of relocation to the care home environment. The findings suggest that health and social care practitioners have enormous potential to influence relatives' experiences of nursing home entry. Experiences are enhanced if family carers perceive that they are able to work in partnership with care staff in order to ease the transition for the older person.     

A family support service for homeless children and parents: users' perspectives and characteristics

The objective of the present study was to establish the psychosocial characteristics and perspectives of 49 consecutive homeless families who received input from a new designated family support worker (FSW) post at a large statutory hostel for homeless parents and children. The FSW provided: assessment of social, educational and health needs; support and parent training; and liaison with and referral to specialist services. Measures included quantitative questionnaires (i.e. the Hospital Anxiety and Depression Scale, the Parenting Daily Hassles Scale, the Eyberg Child Behaviour Inventory, and the Health of the Nation Outcome Scales for Children and Adolescents), and a qualitative (semistructured) interview on service experiences and satisfaction. The psychosocial measures indicated high rates of parenting difficulties, mental health and related needs among children and their parents. Parenting difficulties were associated with child behaviour problems. Parents expressed satisfaction with the service whilst they were residents at the hostel, but they were often not clear about the objectives of agencies and interventions. Family support interventions have a key role in service provision for homeless and other vulnerable families by providing direct parenting interventions and ensuring that specialist agencies are appropriately involved. Family support worker involvement needs to continue when families are re-housed in the community.     

Attitudes and roles of general practitioners in the treatment of schizophrenia compared with community mental health staff and patients

Abstract. Background: Most general practitioners (GPs) are currently treating a small number of patients with schizophrenia; however, little is known about GPs experiences in this area. This paper examines the attitudes and roles of Australian GPs in the treatment of schizophrenia and their relationships with specialist services. Methods: A total of 192 GPs ratings of possible sources and forms of help for patients with schizophrenia were compared with the ratings of 50 mental health services (MHS) staff and 129 patients. Comparisons within the health professionals were also made in relation to diagnostic and treatment confidence, perceived roles, and typical problems encountered. Results: Perceived helpfulness ratings were reasonably consistent across groups. However, patients tended to rank close family members as more helpful. GPs and MHS staff reported complementary roles, with a shared responsibility for early detection and relapse prevention. Treatment compliance, and communication and accessibility to specialist agencies were identified as major problems. Conclusions: GPs fulfil a valuable role in the treatment of schizophrenia, which could be enhanced through improved training. Mental health services need to work more effectively with GPs in treating schizophrenia and acknowledge their complementary roles.     

Bipolar disorder. III: Harm avoidance a risk factor for suicide attempts

OBJECTIVES: The aim of the study was to examine whether personality, i.e. temperament and character influence suicide attempts in bipolar patients. METHODS: Bipolar patients were recruited from lithium dispensaries. Temperament and character inventory (TCI) was administered to 100 euthymic bipolar patients and 100 controls. RESULTS: Age of onset was significantly lower in patients with suicide attempts in the total bipolar group (I and II) and bipolar I patients compared with patients without suicide attempts. Bipolar (I and II) and bipolar I patients with suicide attempts were significantly higher in harm avoidance (HA) and reward dependence compared with patients without suicide attempts. Patients (I and II) with suicide attempts had significantly more anticipatory worry, fatigability and asthenia than patients without suicide attempts. Bipolar I patients with suicide attempts had significantly more fatigability and asthenia and were more dependent than patients without suicide attempts. HA was lowest in patients with no suicide attempts and no family history of suicide, higher in patients with family history of suicide or patients with suicide attempts, and significantly highest in patients with suicide attempts and family history of suicide. Patients with suicide attempts and family history of suicide had more anticipatory worry, fatigability and asthenia. Bipolar disorder was significantly correlated to HA and suicide attempts to HA and PS. Family history of suicide and gender were significantly correlated to suicide attempts. CONCLUSIONS: Age of onset, HA, PS, gender and family history of suicide had a moderate to very strong effect on suicide attempts in bipolar patients.     

Context-Oriented Model Development in Psychotherapy Planning ('COMEPP'): a useful adjunct to diagnosis and therapy of severe personality disorders

OBJECTIVE: Pathogenous interpersonal (e.g. interfamilial) relationships and reference styles can compromise treatment efforts in severely disturbed (i.e. psychotic or borderline) patients. The integration of family- and individual-centred starting points may be useful in establishing interdisciplinary treatment concepts in these patients. Context-Oriented Model Development in Psychotherapy Planning (COMEPP) represents a diagnostic and therapy planning process, integrating both systemic and psychoanalytic conceptualizations. METHOD: COMEPP is exemplified by the case of a young man with psychotic personality disorder who had previously been unresponsive to pharmacological and psychological treatment. RESULTS: After psycho-dynamical conflicts (i.e. primitive projective processes from the patient's mother to her son) had been elucidated during the COMEPP process, a sufficient treatment setting could be established. CONCLUSION: COMEPP provides a psychotherapeutical approach to treatment planning on case-specific premises and may serve as an adjunct to concomitant pharmacological and psychological treatment strategies in so-called 'therapy refractory' patients.