The future of cognitive and behavioral therapies in the prevention and early management of psychosis: Opportunities and risks

Behavioral and cognitive interventions for people with psychosis have a long and distinguished history, although the evidence for their application to young people remains limited. We anticipate that the next decades will show substantial research into psychological intervention for this population. Important targets will include the management of environmental stressors, reduction of substance misuse, and promotion of early treatment. Psychological management of positive symptoms, depression, and suicidal behavior will continue to be critical objectives. Important secondary prevention goals will be the retention of cognitive functioning, vocational options, social skills, and social network support, including appropriate family support. We expect primary prevention to include both universal programs and interventions for adolescents at particularly high risk. Technical innovations will include increasing use of Internet-based intervention and behavior cueing devices. Pressures for intervention brevity will continue, as will problems with the systematic delivery of effective procedures.

Adherence with naltrexone prescription advice in hospital outpatient alcohol rehabilitation programme

Background: The anti-craving drug, naltrexone, is used as a pharmacotherapeutic adjunct in the treatment of alcohol dependence. In addictive disorders, compliance issues remain central. There are limited data on compliance with naltrexone treatment regimens within formalized rehabilitation programs and even less data that identifies factors that have an impact on this. Objective: To study patient adherence to naltrexone medication regimens and examine whether patients' reported pre-treatment alcohol use, dependence severity and measures of psychological health are predictive of medication compliance. Method: Fifty outpatients meeting DSM IV criteria for alcohol dependence enrolled in 12-week rehabilitation programme. This included cognitive behavioural therapy (CBT) and naltrexone, 50 mg orally daily. Measures included: pharmacy prescription pick-up including number of tablets dispensed, programme attendance and patient pre-treatment alcohol use variables. Measures of psychological health included somatic symptoms, anxiety, social dysfunction and depression as measured by the General Health Questionnaire (GHQ-28). Results: Classifying the sample into compliant (greater than or equal to 90% medication pick-up) and less compliant groups, 66% of subjects were naltrexone-compliant. Pre-treatment alcohol use variables were not predictive of compliance. Although social dysfunction and depression tended towards poorer prescription filling, measures of psychological distress (GHQ-28) did not identify factors predictive of medication non-compliance. One patient withdrew from treatment because of naltrexone-induced dysphoria. Conclusion: Patients with alcohol dependence demonstrated high levels of anti-craving medication compliance, good rehabilitation programme participation and favourable outcomes. Naltrexone was well tolerated. Medication compliance in this study group compared well with those of other hospital populations with chronic disorders. Factors predictive of anti-craving medication compliance in alcohol dependence require further study.

Client resistance in outreaching social work in Hong Kong

This paper reports the survey findings of a study on the outreaching social workers' perceptions of client resistance. In light of their social work practice 10th youth-at-risk in Hong Kong, resistance is generally recognised as a natural phenomenon in the counselling process and to a certain extent, is an obstacle to engaging in purposeful worker-client relationship as well as effecting behavioural changes. On Pipes and Davenport's (1990) classification, the respondents were more likely to classify client resistance as innocuous behaviours like missing appointments and refusing to discuss problems than disarming and proactive behaviours. The implications of these findings are discussed.

Scoring occupational categories for social research: A review of current practice, with Australian examples

The scoring of occupational categories has along history. After reviewing the historical background, we develop and discuss the properties of two new Australian scales based on current theorising in stratification research. The first is based on the operation of the labour market and scores occupations to reflect their central role in converting educational credentials into market income. The second is based on patterns of social interaction and scores occupations to reflect the choices that people make in marriage markets. While these two scales are not theoretically or empirically equivalent, they are closely related and provide equally valid, but alternative, ways of measuring the underlying stratification order of modern societies.