Psychosocial adjustment in male-to-female transsexuals: an overview of the research evidence.

Transsexualism has been defined as an extreme gender dysphoria; it refers to unhappiness with one's biological sex and the desire to have the body of the opposite sex and to be regarded by others as a member of that other sex. Transsexualism is not a common condition, but its prevalence is not yet known. A large number of transsexuals receive hormonal treatment and sex reassignment surgery (SRS). In spite of years of poor quality research, due in part to methodological problems, recent research on surgical outcomes has provided important information. However, psychological research into transsexualism has ignored the cognitive style and psychological functioning of transsexuals, and very little effort has been made to incorporate research findings into the development of psychological treatments to improve the quality of life for transsexuals.

The impact of dementia on the sufferer and available treatment interventions: an overview.

An overview of the psychological and behavioral consequences of dementia on sufferers is provided. Psychological interventions for improving the quality of life of patients, difficulties of diagnosis, the role of general practitioners, and th contribution of psychologists in the management of dementia are discussed.

Psychological adjustment and family functioning in a group of British children with sickle cell disease: preliminary empirical findings and a meta-analysis.

Sickle cell disease (SCD) is a family of inherited blood disorders of variable severity which have in common haemolytic anaemia, recurrent painful crises, end-organ failure and the risk of reduced life expectancy. In Britain, the condition predominantly occurs among families of African or Afro-Caribbean origin. This study examines the effects of the condition on the psychological adjustment and family functioning of 39 children with SCD and 24 control children. Participants were assessed on measures of behaviour, depression, self-esteem, IQ and reading skills, family relationships and maternal mental health. Assessment on the Family Environment Scale showed that SCD children came from families who reported more cohesion and less conflict than did the families of controls. Maternal mental health showed no significant differences between the SCD group and controls. Children with SCD showed an IQ deficit of five points, a difference that was not statistically significant. However, a meta-analysis of six studies in the literature, including this one, did show a highly significantly decreased intellectual ability. SCD children did not show significant differences from controls on measures of depression and self-esteem. However, differences in behavioural problems were found between the three groups, with the SC group showing more behavioural problems. Results of regression analyses suggest that maternal mental health is associated with children's behavioural problems.

A review of evidence about factors affecting quality of pain management in sickle cell disease.

OBJECTIVE: To assess the evidence for pharmacological, behavioural, and interpersonal influences on quality of pain management in sickle cell disease. DATA SOURCES: English-language reports from the research literature up to 1995, identified using Medline, Psychlit, and the Bath Information Data Service. STUDY SELECTION: Studies are reviewed that (a) reported quantitative clinical outcomes for particular analgesic methods used to treat painful episodes or (b) provide data on patient factors, interpersonal treatment factors, or levels of drug dependence in relation to pain management in sickle cell disease. DATA SYNTHESIS: Findings vary on the effectiveness of longer-acting opiates, patient-controlled or continuously infused analgesia, and behavioural analgesic techniques, with better results for trials where interpersonal aspects of pain management were also addressed. Risks for poorer pain management are greatest for patients in adverse social circumstances, who are more severely affected by painful episodes and who are poorly adjusted and have less effective personal strategies for coping with pain, but the limited evidence on drug dependence indicates very low levels by comparison with risk and exposure factors. CONCLUSIONS: Analgesic methods and approaches should continue to be developed and evaluated, but conflicting perceptions between patients and staff about pain that is reported and analgesia that is required probably contribute most to poor pain management in sickle cell disease. Promising areas for future research include the assessment of patients' everyday pain coping styles and patterns of drug use in relation to their hospital experiences of pain management, and the evaluation of psychological interventions to improve patients' styles and strategies for coping with pain.

The effects of patient suicide on nursing staff.

Attitudes towards patient suicide, and the effects that this has on nursing staff are rather complex, and should not be viewed on a simple negative/positive continuum. Suicide is a difficult but inevitable incident that affects psychiatric units, and the limited literature on nurses' attitudes to suicide, and the effects that patient suicide has on them has highlighted the need for emotional and professional support from their colleagues, including senior nurses, psychiatrists and managers, to cope better after a patient has committed suicide. Furthermore, the importance of regular meetings and reviews of assessment and prevention policies has also been emphasized. The present study looked at the effects that suicide has on nursing staff, their attitudes, and ways of improving their coping skills. Major findings include the lack of emotional support, the need for training, formal assessment of patients at risk, regular multidisciplinary meetings following a suicide and nursing staff's acceptance of suicide as the patient's personal choice. Recommendations for helping nursing staff during the post-suicide period are suggested.

Schizophrenia family work: mental health nurses delivering an innovative service.

1. Mental Health Nurses (MHNs) have an unique role in providing care to the mentally ill. The Thorn Nurse Initiative designed to prepare and evaluate the work of MHNs has been successful in providing nurses with the skills of Family Work for Schizophrenia. 2. The effectiveness of family work in improving MHNs' knowledge of and attitudes about schizophrenia has been demonstrated, and there is increasing evidence of the efficacy of MNHs in delivering family work. 3. The impact of schizophrenia on families tends to go unrecognized, and there is an urgent need to train nurses in family work to help families cope with this illness. 4. Families are extremely valuable and a positive resource for clients. The emphasis of family work is to promote and support all families in improving their knowledge of schizophrenia, and its effects, and in developing their coping skills.

The effects of chronic illness on children and their families: an overview.

Between 10% and 20% of children suffer from chronic illness, the severity and impact of which vary considerably. Treatment aims to reduce the potentially negative effects of the illness on the child and the family and to help them achieve a normal life style. It is increasingly clear that the way in which children cope with chronic illness appears to be influenced by the illness, the child's personality, and characteristics of the family and social environment. Recent theoretical approaches suggest that the risk of maladjustment increases when stress increases. More sophisticated methods of sampling and measurement have resulted in recent research that presents a less negative picture of the psychosocial implication of chronic illness. In this article, I give an overview of the effect of chronic illness on children and their families, and I suggest directions for future research.

The effects of family work training on mental health nurses' attitude to and knowledge of schizophrenia: a replication.

The association between expressed emotion and the outcome of schizophrenia is well established, and the efficacy of family work for schizophrenia has been demonstrated. Mental health nurses are an expanding group in mental health service provision but their training does not include family work. Although there is some evidence that training mental health nurses in schizophrenia family work increases their knowledge of, and changes their attitudes towards schizophrenia, very little research has been conducted in this area. This paper replicates a previous study, and investigates whether mental health nurses can change their attitude and beliefs, and increase their knowledge about schizophrenia. Knowledge increased and attitudes changed during the initial period (3 months), and the gains were maintained throughout the 9-month course. However, in order to incorporate the skills learnt into their routine practice, mental health nurses will continue to need ongoing recognition, support, and enthusiasm from colleagues and managers.

Increasing awareness for higher quality care. Measuring knowledge of sickle cell disease in adult patients.

1. Research suggests there is some confusion about the significance of sickle cell trait among patients, healthcare professionals and the general population. 2. Educational programmes should be available to patients who need or want to know about sickle cell disease. 3. More sickle cell centres are needed, especially in areas where there is a high incidence of sickle cell disease. 4. Lack of awareness and knowledge of sickle cell disease, especially among GPs, limits the provision of a good quality service.

Psychosocial aspects of sickle cell disease (SCD) in childhood and adolescence: a review.

This paper reviews the literature on the psychological and social aspects of Sickle Cell Disease (SCD) and discusses the clinical implications of its impact on children and their families. Sickle Cell Disease is a family of blood diseases including sickle cell anaemia (SS), SC disease (SC), and sickle B thalassaemia (SBThal). Research on the psychological and social aspects of SCD, particularly in the UK, has been limited and of varying methodological quality. The psychosocial adaptation of children and adolescents with SCD and their families has been associated with the personality and developmental stage of the child, family attitudes and behaviour, socioeconomic status, and social and environmental support. Concerns about the quality of interpersonal relationships within families have also led to investigations of family characteristics and social networks, and some research studies have pointed to different ways of coping associated with specific network and family structures.

Family and social issues in sickle cell disease.

Sickle cell disease (SCD) in Britain affects some 150 babies a year, born mainly to Afro-Caribbean and West African families. Like every chronic illness, it can have major psychosocial and practical consequences. Kenny Midence and Polly Shand describe the condition and the problems facing people with SCD and their families.