Investigation of psychological and neuropsychological factors associated with clinical outcome following a group rehabilitation programme

The present study investigated neuropsychological and psychological factors associated with successful treatment outcome following a group intervention for individuals with acquired brain injury (ABI). Participants were classified into two groups (Clinically Improved and Not Improved) based upon the findings of a previous study (Ownsworth, McFarland, & Young, 2000a). A discriminant analysis was used to predict group membership on three outcome measures (Awareness and Strategy Behaviour indices of the Self-Regulation Skills Interview and the Psychosocial Dimension of the Sickness Impact Profile) between pre-assessment and post-assessment, and between pre-assessment and 6 months follow-up. Neuropsychological factors involved measures of executive functioning and psychological factors were assessed using measures of personality-related denial and coping-related denial. Overall, the results indicated that individuals with impaired executive functioning were most likely to be classified as Clinically Improved on measures of awareness, strategy behaviour and psychosocial functioning. Individuals who deny or minimise their ABI symptoms were less likely to improve their psychosocial functioning following the group intervention. Future research needs to evaluate interventions for enhancing self-regulation skills and improving psychosocial functioning for individuals who employ denial as a main strategy for coping following ABI.

Clinical supervision in school counselling and career counselling: Is it time to develop a new story?

Supervision provides benefits for school counsellors and career counsellors such as support, an opportunity to gain new ideas and strategies, and personal and professional development. Despite this, studies have also shown that school counsellors perceive that the amount of time they participate in supervision is inadequate. In career counselling, there is little evidence that supervision has even been established as a mainstream professional practice. The reasons for this curious situation, whereby little time is spent on a potentially beneficial activity, are uncertain. The present study investigated the supervisory experiences of a group of school counsellors and career counsellors for a six month period following their completion of an intensive supervision training program. Participants recorded their supervisory experiences in a structured diary. Even though the participants were well informed about supervision, the findings of the present study are consistent with those of previous studies. This history of repeatedly similar findings suggests that it may be timely to ask some fundamental questions about supervision in these two professions. Such questions in turn suggest possible new research directions.

Becoming a therapist: Challenging the role of training - An interview with Ernesto Spinelli

Research appears to indicate that the personal qualities of the therapist really count in effective therapy. Brian Sullivan from the University of Queensland asks Professor Ernesto Spinelli for his opinion on the vexing questions that arise when this knowledge is considered in the effective training of therapists. What are the significant personal qualities and how do we identify them? Are good therapists born with the raw material to start with, or can anyone be trained to become a therapist? Is personal development an essential component of any professional therapeutic training? If so, how do you incorporate it into a training program? What are the essential criteria in a successful selection process of trainees? (editor abstract)

Introduction of routine outcome measures: staff reactions and issues for consideration

The aim of this study was to explore clinician reactions to (i) the introduction of routine outcome measures and (ii) the utility of outcomes data in clinical practice. Focus group discussions (n = 34) were conducted with mental health staff (n = 324) at approximately 8 months post implementation of routine outcome measures. A semi-structured interview schedule was used to collect data on two key issues; reactions to the introduction of outcome measures and factors influencing the utility of outcomes data in clinical practice. Data from the discussion groups were analysed using content analysis to isolate emerging themes. While the majority of participants endorsed the collection and utilization of outcomes data, many raised questions about the merits of the initiative. Ambivalence, competing work demands, lack of support from senior medical staff, questionable evidence to support the use of outcome measures, and fear of how outcomes data might be used emerged as key issues. At 8 months post implementation a significant number of clinical staff remained ambivalent about the benefits of outcome measurement and had not engaged in the process. The shift to a service model driven by outcomes and case-mix data will take time and resources to achieve. Implications for nursing staff are discussed.

A pathology of the animal spirits - the clinical neurology of Thomas Willis (1621-1675) Part I - Background, and disorders of intrinsically normal animal spirits

Thomas Willis (1621-1675), author of the classical work Cerebri Anatome (1664), was arguably the father of the modem era of neurology. As compared with his neuroanatomy, relatively little attention has been paid to Willis' clinical neurology, as described in his Pathologiae Cerebri (1667) and Do Anima Brutorum (1672), where he gave a structured account of disease of the nervous system as it was known in his day. His account was largely derived from personal observations and not from traditional authorities and was based around his concept of the animal spirits, a fictitious entity in many ways analogous to the present day idea of the nerve impulse. This concept allowed him to develop a pathology of the animal spirits which embraced the whole content of the clinical neurology and psychiatry of his times. The anatomical and physiological background to Willis! concepts of animal spirit dysfunction, and those disorders he regarded as due to disturbed function of intrinsically normal animal spirits (mainly headache, disorders of consciousness, apoplexy and palsy) are dealt with in the present paper. The disorders he attributed to inherently abnormal animal spirits are considered in a second part of the paper. (C) 2002 Elsevier Science Ltd. All eights reserved.

ESTRUTURA E DINÂMICA DO FUNCIONAMENTO PSÍQUICO DE MULHERES ENVOLVIDAS EM VIOLÊNCIA CONJUGAL REITERADA

Apesar das campanhas de combate à violência de gênero e a legislação elaborada para promover o aumento da segurança de mulheres envolvidas pelo fenômeno, trabalhos realizados demonstram que muitas mulheres agredidas por seus companheiros, mesmo após tentativa de separação, retornam a conviver com os agressores. Com base nessas informações, o objetivo desta pesquisa foi estudar a estrutura e a dinâmica do funcionamento psíquico de cinco mulheres envolvidas em violência conjugal reiterada. Trata-se de um estudo clínico-qualitativo, cujas participantes foram selecionadas por conveniência e fazem parte de um grupo de mulheres vítimas de violência conjugal, atendidas por uma organização não governamental, com processos em trâmite numa Vara Criminal da Grande São Paulo. Utilizou-se como instrumentos de investigação um Roteiro de Entrevista semiestruturado; a Escala da Associação Brasileira de Institutos de Pesquisa de Mercado (ABIPEME); e o Teste de Relações Objetais de Phillipson (TRO). Os resultados apontam que as participantes apresentam ego fragilizado, pouco integrado e superego rígido, pouco indistinguível de seus impulsos destrutivos e de seus perseguidores internos, resultado de introjeções e deflexões para o exterior carentes. Essa dinâmica mental se desenvolveu a partir de processos primários de cisão muito violentos, com predominância de impulsos destrutivos e da pulsão de morte sobre a pulsão de vida. Ademais, percebeu-se que as participantes se mantém predominantemente na fase esquizo-paranóide do desenvolvimento, sem conseguir alcançar de forma adequada a posição depressiva de reparação, assim, elas utilizam de mecanismos primitivos de defesa para manterem o equilíbrio psíquico como: a identificação projetiva, a negação, a idealização e a paralização. Espera-se que os resultados desta pesquisa possam auxiliam na elaboração de propostas de atendimento a mulheres em situação de violência conjugal reiterada.

COMPARAÇÃO DA UTILIZAÇÃO DAS TÉCNICAS WATSU E RELAXAMENTO AQUÁTICO EM FLUTUAÇÃO ASSISTIDA NOS SINTOMAS DE ANSIEDADE, DEPRESSÃO E PERCEPÇÃO DA DOR

Este estudo teve como objetivo comparar o efeito do método Watsu e do relaxamento aquático em flutuação assistida em piscina, no tratamento da dor crônica. Também objetiva avaliar o efeito dos sintomas de depressão e ansiedade como co-fatores nesses tratamentos. A amostra é constituída por 23 indivíduos de ambos os sexos, acima de 18 anos. No método Watsu são atendidas 13 pessoas, sendo 11 mulheres e 02 homens. Na técnica de relaxamento assistido são atendidas 10 pessoas, sendo 07 mulheres e 03 homens, entre pacientes que procuram tratamento fisioterápico no centro clínico Escola de Fisioterapia da UMESP, com dor crônica. Os dados são colhidos através de entrevista estruturada. Aplicada escala associada para avaliar percepção de dor, questionário de avaliação de sintomas de depressão Beck, de Ansiedade Idate-Estado e Ansiedade Idate-Traço. Devido ao pequeno tamanho da amostra, as comparações entre os dois tipos de tratamento (Watsu e relaxamento) e, como os resultados obtidos são equivalentes em ambos os procedimentos, optou se por apresentar os resultados apenas das análises por métodos paramétricos (teste t de média, regressão linear e análise de variância). Não são observadas diferenças significativas entre os dois grupos em relação aos escores de ansiedade e depressão antes e após a realização da pesquisa. Em relação à comparação entre os dois grupos pesquisados, quanto à percepção de dor, observou-se que tanto o método de Watsu quanto as técnicas de relaxamento mostram um efeito significativo na redução da dor. Esta pesquisa sugere que o método Watsu é tão eficaz para o controle da dor quanto o método de relaxamento, porém, o grupo de pacientes submetidos ao método Watsu é constituído por pessoas com níveis de intensidade de dor iniciais maiores do que o grupo de relaxamento. Com isso, pode-se supor que a demanda por eficácia clinica é maior para o método Watsu. Outro achado interessante é que os níveis de ansiedade ou depressão presentes nos participantes não parecem influenciar a resposta ao efeito do tratamento sobre a dor. Novos estudos do tipo duplo-cego controlados são necessários para, além de confirmar a eficácia do método, ajudar a entender quais detalhes dos procedimentos da técnica Watsu são mais eficazes para cada tipo de dor e de estado afetivo do paciente.

Herbal medicines:physician's recommendation and clinical evaluation of St.John's Wort for depression

Why some physicians recommend herbal medicines while others do not is not well understood. We undertook a survey designed to identify factors, which predict recommendation of herbal medicines by physicians in Malaysia. About a third (206 out of 626) of the physicians working at the University of Malaya Medical Centre ' were interviewed face-to-face, using a structured questionnaire. Physicians were asked about their personal use of, recommendation of, perceived interest in and, usefulness and safety of herbal medicines. Using logistic regression modelling we identified personal use, general interest, interest in receiving training, race and higher level of medical training as significant predictors of recommendation. St. John's wort is one of the most widely used herbal remedies. It is also probably the most widely evaluated herbal remedy with no fewer than 57 randomised controlled trials. Evidence from the depression trials suggests that St. John's wort is more effective than placebo while its comparative efficacy to conventional antidepressants is not well established. We updated previous meta-analyses of St. John's wort, described the characteristics of the included trials, applied methods of data imputation and transformation for incomplete trial data and examined sources of heterogeneity in the design and results of those trials. Thirty randomised controlled trials, which were heterogeneous in design, were identified. Our meta-analysis showed that St. John's wort was significantly more effective than placebo [pooled RR 1.90 (1.54-2.35)] and [Pooled WMD 4.09 (2.33 to 5.84)]. However, the remedy was similar to conventional antidepressant in its efficacy [Pooled RR I. 0 I (0.93 -1.10)] and [Pooled WMD 0.18 (- 0.66 to 1.02). Subgroup analyses of the placebo-controlled trials suggested that use of different diagnostic classifications at the inclusion stage led to different estimates of effect. Similarly a significant difference in the estimates of efficacy was observed when trials were categorised according to length of follow-up. Confounding between the variables, diagnostic classification and length of trial was shown by loglinear analysis. Despite extensive study, there is still no consensus on how effective St. lohn's wort is in depression. However, most experts would agree that it has some effect. Our meta-analysis highlights the problems associated with the clinical evaluation of herbal medicines when the active ingredients are poorly defined or unknown. The problem is compounded when the target disease (e.g. depression) is also difficult to define and different instruments are available to diagnose and evaluate it.

Investigating mental health risk assessment in primary care and the potential role of a structured decision support tool, GRiST

Aim: To explore current risk assessment processes in general practice and Improving Access to Psychological Therapies (IAPT) services, and to consider whether the Galatean Risk and Safety Tool (GRiST) can help support improved patient care. Background: Much has been written about risk assessment practice in secondary mental health care, but little is known about how it is undertaken at the beginning of patients' care pathways, within general practice and IAPT services. Methods: Interviews with eight general practice and eight IAPT clinicians from two primary care trusts in the West Midlands, UK, and eight service users from the same region. Interviews explored current practice and participants' views and experiences of mental health risk assessment. Two focus groups were also carried out, one with general practice and one with IAPT clinicians, to review interview findings and to elicit views about GRiST from a demonstration of its functionality. Data were analysed using thematic analysis. Findings Variable approaches to mental health risk assessment were observed. Clinicians were anxious that important risk information was being missed, and risk communication was undermined. Patients felt uninvolved in the process, and both clinicians and patients expressed anxiety about risk assessment skills. Clinicians were positive about the potential for GRiST to provide solutions to these problems. Conclusions: A more structured and systematic approach to risk assessment in general practice and IAPT services is needed, to ensure important risk information is captured and communicated across the care pathway. GRiST has the functionality to support this aspect of practice.

Signposting for diagnosis of Autism Spectrum Disorder using the Diagnostic Interview for Social and Communication Disorders (DISCO)

Recent research has investigated the capability of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) descriptions to identify individuals who should receive a diagnosis of Autism Spectrum Disorder (ASD) using standardised diagnostic instruments. Building on previous research investigating behaviours essential for the diagnosis of DSM-5 ASD, the current study investigated the sensitivity and specificity of a set of 14 items derived from the Diagnostic Interview for Social and Communication Disorders (DISCO Signposting set) that have potential for signposting the diagnosis of autism according to both the new DSM-5 criteria for ASD and ICD-10 criteria for Childhood Autism. An algorithm threshold for the Signposting set was calculated in Sample 1 (n = 67), tested in an independent validation sample (Sample 2; n = 78), and applied across age and ability sub-groups in Sample 3 (n = 190). The algorithm had excellent predictive validity according to best estimate clinical diagnosis (Samples 1 and 2) and excellent agreement with established algorithms for both DSM-5 and ICD-10 (all samples). The signposting set has potential to inform our understanding of the profile of ASD in relation to other neurodevelopmental disorders and to form the basis of a Signposting Interview for use in clinical practice.

Clinical characteristics of patients with epilepsy in a specialist neuropsychiatry service

Neuropsychiatry services provide specialist input into the assessment and management of behavioral symptoms associated with a range of neurological conditions, including epilepsy. Despite the centrality of epilepsy to neuropsychiatry and the recent expansion of neuropsychiatry service provision, little is known about the clinical characteristics of patients with epilepsy who are routinely seen by a specialist neuropsychiatry service. This retrospective study filled this gap by retrospectively evaluating a naturalistic series of 60 consecutive patients with epilepsy referred to and assessed within a neuropsychiatry setting. Fifty-two patients (86.7%) had active epilepsy and were under the ongoing care of the referring neurologist for seizure management. The majority of patients (N = 42; 70.0%) had a diagnosis of localization-related epilepsy, with temporal lobe epilepsy as the most common epilepsy type (N = 37; 61.7%). Following clinical assessment, 39 patients (65.0%) fulfilled formal diagnostic criteria for at least one psychiatric disorder; nonepileptic attack disorder (N = 37; 61.7%), major depression (N = 23; 38.3%), and generalized anxiety disorder (N = 16; 26.7%) were the most commonly diagnosed comorbidities. The clinical characteristics of patients seen in specialist neuropsychiatry settings are in line with the results from previous studies in neurology clinics in terms of both epilepsy and psychiatric comorbidity. Our findings confirm the need for the development and implementation of structured care pathways for the neuropsychiatric aspects of epilepsy, with focus on comorbid nonepileptic attacks and affective and anxiety symptoms. This is of particular importance in consideration of the impact of behavioral symptoms on patients' health-related quality of life.

Effects of structured writing versus nonstructured writing as an effective and efficient teaching and learning strategy

This research investigated the effectiveness and efficiency of structured writing as compared to traditional nonstructured writing as a teaching and learning strategy in a training session for teachers.^ Structured writing is a method of identifying, interrelating, sequencing, and graphically displaying information on fields of a page or computer. It is an alternative for improving training and educational outcomes by providing an effective and efficient documentation methodology.^ The problem focuses upon the contradiction between: (a) the supportive research and theory to modify traditional methods of written documents and information presentation and (b) the existing paradigm to continue with traditional communication methods.^ A MANOVA was used to determine significant difference between a control and an experimental group in a posttest only experimental design. The experimental group received the treatment of structured writing materials during a training session. Two variables were analyzed. They were: (a) effectiveness; correct items on a posttest, and (b) efficiency; time spent on test.^ The quantitative data showed a difference for the experimental group on the two dependent variables. The experimental group completed the posttest in 2 minutes less time while scoring 1.5 more items correct. An interview with the training facilitators revealed that the structured writing materials were "user friendly." ^

A qualitative study of the clinical practice of graduates of a problem-based physical therapy program

The purpose of this study was to examine the perspectives of three graduates of a problem-based leaning (PBL) physical therapy (PT) program about their clinical practice. The study used the qualitative methods of observations, interviews, and journaling to gather the data. Three sessions of audiotaped interviews and two observation sessions were conducted with three exemplars from Nova Southeastern University PBL PT program. Each participant also maintained a reflective journal. The data were analyzed using content analysis. A systematic filing system was used by employing a mechanical means of maintaining and indexing coded data and sorting data into coded classifications of subtopics or themes. All interview transcripts, field notes from observations, and journal accounts were read, and index sheets were appropriately annotated. From the findings of the study, it was noted that, from the participants' perspectives, they were practicing at typically expected levels as clinicians. The attributes that governed the perspectives of the participants about their physical therapy clinical practice included flexibility, reflection, analysis, decision-making, self-reliance, problem-solving, independent thinking, and critical thinking. Further, the findings indicated that the factors that influenced those attributes included the PBL process, parents' value system, self-reliant personality, innate personality traits, and deliberate choice. Finally, the findings indicated that the participants' perspectives, for the most part, appeared to support the espoused efficacy of the PBL educational approach. In conclusion, there is evidence that the physical therapy clinical practice of the participants were positively impacted by the PBL curriculum. Among the many attributes they noted which governed these perspectives, problem-solving, as postulated by Barrows, was one of the most frequently mentioned benefits gained from their PBL PT training. With more schools adopting the PBL approach, this research will hopefully add to the knowledge base regarding the efficacy of embracing a problem-based learning instructional approach in physical therapy programs. ^

The impact of bandwidth in structured interviewing and criterion stability in predicting and assessing manager performance across transition and maintenance stages

The current study examined the role of three important components in the use of structured employment interviewing in performance prediction: construct bandwidth, observed communication skill, and the stability/dynamicity of performance criteria over time. A matched sample of 242 hospitality managers was derived from a field data set provided by a large hospitality management organization. Interview data and two years of performance appraisal data were provided. Bandwidth analysis demonstrated only minimal differences in prediction between matched predictor-criterion pairs compared with predictor to overall aggregate ratings (unmatched). The communication skill analysis revealed that this interviewer rated observation significantly predicted a number of the individual performance dimensions as well as overall performance over time. Of the five interview items, the strongest overall predictor of performance was interviewer rated communication skill. The stability/dynamicity analyses demonstrated the performance criteria to be generally stable over the two year period examined, which provides support for the long held notion that performance criteria is stabile over time. However, there were two exceptions. The interview dimension customer service orientation had shifting relationships over time with four of the criteria over the two year period. The performance criteria employee development also demonstrated some instability in its relationships with predictors. Thus, some evidence of dynamicity in performance criteria was revealed. Interestingly, both of the most noteworthy findings in the study involved items that were rated differently than the others in the study. The rated interview item communication skill and the rated performance criteria client satisfaction were ratings that involved a more direct level of observation. Additional analyses also revealed evidence of a general factor of performance. These two themes are more fully covered in the discussion.