The Brief Multidimensional Assessment Scale (BMAS): A Broad Measure of Patient Well-Being.

OBJECTIVE: This article discusses the development and initial clinimetric and psychometric properties of the Brief Multidimensional Assessment Scale (BMAS). The BMAS is an ultrabrief multidimensional measure of global patient well-being that can be used at every clinic visit to assess several facets of patients' perception of themselves, regardless of their diagnosis, at a moment in time and over the course of treatment. METHODS: Data were collected from 499 adults in the community as well as from psychiatric and medical inpatient and outpatient settings. Participants completed questionnaires as part of their standard care at inpatient and outpatient medical and psychiatric settings or completed them online (community sample). RESULTS: Results indicate that the BMAS measures four discrete dimensions: the ability to get things done, emotional support in important relationships, quality of life, and sense of purpose in life. The scale demonstrates concurrent validity with other measures and discriminates between nonclinical participants and participants from most clinical contexts. CONCLUSIONS: The BMAS demonstrates promising initial psychometric properties. It offers clinicians a multidimensional measure of their patients' well-being, regardless of diagnosis, that can be used to monitor well-being at each routine appointment and over time.

Genital manifestations of body dysmorphic disorder in men: a review.

Body dysmorphic disorder (BDD) is a serious psychiatric condition that affects approximately 2.5% of the U.S. adult population. BDD occurs when a person develops a debilitating focus and sense of distress about a minor or imagined physical flaw. There is growing awareness that in some men with BDD, the physical preoccupation centers on the appearance of their genitals. This review explores existing research on genital manifestations of BDD in men. PubMed and PsychInfo searches with the key word's genital manifestations of BDD were conducted, which yielded a list of 48 unique articles. Articles that were included in the present review were published in English and focused on men with a formal diagnosis of BDD from a psychiatrist, psychologist, or structured clinical interview. Only five articles met these criteria, and all were conducted by the same research group. The articles are reviewed here, along with thoughts about directions for future research and implications for treatment.

The Brief Assessment of Family Functioning Scale (BAFFS): a three-item version of the General Functioning Scale of the Family Assessment Device.

The purpose of the present study is to compare results from the 12-item General Functioning Scale (GF-FAD) of the Family Assessment Device (FAD) to a three-item version, the Brief Assessment of Family Functioning Scale (BAFFS), designed to be used when brevity is especially important. We used principal components analysis of the GF-FAD, followed by multiple sample confirmatory factor analyses to test the robustness of the BAFFS in different samples. The BAFFS correlated highly with the GF-FAD, and demonstrated good concurrent validity with another measure of global marital functioning, the Dyadic Adjustment Scale-4 in a help-seeking sample. Like the 12-item version, the BAFFS moderately correlated with an objective, interview-based rating of family functioning, the McMaster Clinical Rating Scale. The BAFFS appears to serve as a good proxy for the GF-FAD when an ultra-brief family assessment measure is needed.

The family assessment device: an update.

The current study set out to describe family functioning scores of a contemporary community sample, using the Family Assessment Device (FAD), and to compare this to a currently help-seeking sample. The community sample consisted of 151 families who completed the FAD. The help-seeking sample consisted of 46 families who completed the FAD at their first family therapy appointment as part of their standard care at an outpatient family therapy clinic at an urban hospital. Findings suggest that FAD means from the contemporary community sample indicate satisfaction with family functioning, while FAD scores from the help-seeking sample indicate dissatisfaction with family functioning. In addition, the General Functioning scale of the FAD continues to correlate highly with all other FAD scales, except Behavior Control. The cut-off scores for the FAD indicating satisfaction or dissatisfaction by family members with their family functioning continue to be relevant and the FAD continues to be a useful tool to assess family functioning in both clinical and research contexts.

Using the tenets of the problem-centered systems therapy of the family (PCSTF) to teach the McMaster Approach to family therapists.

This article describes the videoconferencing training of a group of family therapists in the McMaster Approach to evaluating and treating families. A discussion of the key tenets of the McMaster Approach lays the groundwork for how these tenets were applied to training in a residential treatment agency for adolescents. The article serves as an example of how videoconference technology can facilitate extended training, even from a distance.

Comparison of family functioning in families of depressed patients and nonclinical control families in China using the Family Assessment Device and the Family Adaptability and Cohesion Evaluation Scales II.

BACKGROUND: Family functioning influences the course and long-term outcome for patients with depression. It is important to understand the family functioning of depressed patients from the viewpoint both of patients and their family members. The objective of this study was to explore the association between family functioning and depression in a sample of Chinese families, using the Family Assessment Device (FAD) and the Family Adaptability and Cohesion Evaluation Scales II (FACES II). METHOD: This study was conducted in a sample of 61 depressed patients and their family members and 61 nonclinical controls in mainland China. It compared the perception of depressed patients and their family members and evaluated agreement between family members. RESULTS: Results indicate that in mainland China, functioning among families with a depressed family member is poorer than that of control families. Depressed patients reported less satisfaction than did their family members. There were significant differences on 4 of the 7 FAD scales among depressed patients and their family members, whereas no discrepancies were found on the FACES II. For the FAD, low agreement between patients and family members was found on all scales except behavioral control. Moderate agreement appeared on all dimensions of FACES II except for ideal cohesion and dissatisfaction with cohesion for the families of depressed patients. CONCLUSIONS: Depression is associated with impaired family functioning in families in mainland China. When applying the FAD and FACES II to samples of Chinese families, clinicians should be aware that the FAD may be more sensitive to detecting problems in some areas than the FACES II.

Family functioning in depressed and non-clinical control families.

BACKGROUND: Existing studies of depression and family functioning have used western samples to examine how depression and impaired family functioning are related, and to explore levels of discrepancy between depressed patients and their family members. The purpose of the current study is to explore these questions in a Chinese sample. METHOD: This study examined the association between family functioning and depression in a Chinese sample of 60 depressed patients and their family members and 60 non-clinical controls and their family members. The study evaluated levels of agreement between family members on a self-report measure of family functioning (Family Assessment Device) using reliability statistics. It also compared families' self-reported family functioning to that of a trained observer using an observational rating scale (McMaster Clinical Rating Scale). RESULTS RESULT: s indicate poorer family functioning among Chinese families with a depressed family member, high to moderate agreement between patients and family members, moderate to low agreement between non-clinical participants and their family members, and moderate correlations between subjective and objective ratings of family functioning in a mainland Chinese sample. CONCLUSIONS: As in other cultures, depression is associated with impaired family functioning in Chinese families. There is good agreement between family members and a trained evaluator about the family impairments. The Family Assessment Device and the McMaster Clinical Rating Scale are useful for assessing family functioning in Chinese families.

Management of treatment-resistant depression.

Given the limitations of evidence for treatment options that are consistently effective for TRD and the possibility that TRD is in fact a form of depression that has a low probability of resolving, how can clinicians help patients with TRD? Perhaps the most important conceptual shift that needs to take place before treatment can be helpful is to accept TRD as a chronic illness, an illness similar to many others, one that can be effectively managed but that is not, at our present level of knowledge, likely to be cured. An undue focus on remission or even a 50% diminution of symptoms sets unrealistic goals for both patients and therapists and may lead to overtreatment and demoralization. The focus should be less on eliminating depressive symptoms and more on making sense of and learning to function better in spite of them. It is important to acknowledge the difficult nature of the depressive illness, to remove blame from the patient and clinician for not achieving remission, to set realistic expectations, and to help promote better psychosocial functioning even in the face of persisting symptoms. The critical element when implementing such an approach is a judicious balance between maintaining hope for improvement without setting unrealistic expectations. It is important to reemphasize that following a disease management model with acceptance of the reality of a chronic illness is not nihilistic and does not mean the abandonment of hope for improvement. The first step in treating a patient with TRD is to perform a comprehensive assessment of the patient's past and current treatment history to ensure that evidence-based treatment trials have in fact been undertaken, and if not, such treatment trials should be implemented. If the patient continues to have significant residual symptoms, it is important to determine the impact is of these symptoms on the patient's quality of life and ability to function. It is also important to evaluate the factors that may be contributing to the persistence of depressive symptoms such as comorbid personality disorders, somatic disorders, substance abuse, and work and interpersonal conflicts. The treatment of patients with TRD needs to move beyond attempts to modify symptoms without taking into consideration and attempting to modify the patient's personality, coping skills, and social system. Further somatic treatment trials can be undertaken, if desired by the patient and therapist, as a small (5%­15%) percentage of patients may respond and further treatment trials, and this may engender hope. The risk with this approach is that patients and therapists may not work at disease management skills if they believe there may be a resolution of the depression if they could just find the right medication or intervention. Therapists may also feel pressured by patients, families, insurance companies, as well as their own sense of helplessness to escalate treatment in a more and more aggressive manner in an attempt to achieve an elusive remission. A disease management program can provide the therapist and patient with sufficient structure, skills, and goals to encourage ongoing treatment without resorting to unproven measures that may create more side effects and problems. It is particularly important to include the patient's significant others in the reformulation of the patient's problem and thereby learn how to manage the illness more effectively. Significant others and family members can be invaluable in providing support for dealing with the difficult process of acquiring a new skill set. Indeed, they spend significantly more time with the patient than does any therapist. Family members are likely to provide this kind of support only if they have been part of the assessment and treatment process. Patients with a wide range of chronic medical illnesses can and do learn to function effectively and to achieve a satisfying quality of life in spite of their illness. There is no reason to think that patients with TRD should not be able to achieve a similar level of illness management, functioning, and quality of life.

Posttraumatic stress disorder symptoms and functional impairment among OEF and OIF National Guard and Reserve veterans.

The aims of the present investigation were (a) to examine associations between posttraumatic stress disorder (PTSD; diagnosis and symptoms) and different aspects of functioning, severity, and subjective distress among Operation Iraqi Freedom and Operation Enduring Freedom National Guard and Reserve veterans, and (b) to examine the unique contribution of PTSD symptom clusters to different aspects of functioning and distress. Participants were 124 veterans who had returned from war-zone deployment. A PTSD diagnosis and PTSD symptoms were significantly associated with nearly all of the psychosocial functioning and distress measures, controlling for Axis I disorders and other covariates. Of the PTSD symptom clusters, numbing/avoidance symptoms were the strongest predictors of interpersonal and social functioning, and hyperarousal symptoms were the strongest predictors of overall severity and distress.