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2.
Crim Behav Ment Health ; 29(2): 111-121, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30697842

RESUMO

BACKGROUND: Motivation and readiness to change are important drives for forensic patients accessing interventions. It is thought that guilt and shame influence these drives, but to date, their relationship has not been empirically tested. AIMS AND HYPOTHESES: The aim of this study is to investigate associations between guilt, shame, and treatment motivation and readiness in a sample of men in a secure hospital. It was hypothesised that guilt would be positively correlated, and shame negatively correlated, with treatment motivation and readiness. METHODS: Sixty-six adult male patients detained in a secure hospital completed the assessments of experiences of guilt, shame, motivation, and readiness for treatment. Clinician-rated readiness ratings were also collected. RESULTS: Shame proneness showed no significant association with motivation for change or treatment readiness. Guilt proneness and offence-related shame were positively correlated with treatment readiness. Offence-related guilt was positively correlated with both motivation and readiness. Regression modelling indicated offence-related guilt had a significant level of explanatory power. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This first study of the impact of guilt and shame on motivation and readiness for change among offender hospital inpatients found that offence-related guilt may be helpful but did not replicate the potential disadvantage of shame. Further research would be warranted into whether the "newness" or the extent of shame may be more important than shame more generally. Given the probable importance of offence-related guilt, we recommend that guilt attribution is assessed in offender patients to optimise nature and timing of treatment.


Assuntos
Criminosos/psicologia , Culpa , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Vergonha , Adulto , Estudos Transversais , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Transtornos da Personalidade/terapia , Psicoterapia , Reino Unido
3.
Artigo em Espanhol | IBECS | ID: ibc-177353

RESUMO

Las reflexiones que mostraremos a continuación parten de la experiencia asistencial con un caso asistido por los autores del artículo en co-terapia y de las conversaciones inter-sesión. Una gran parte de las reflexiones sobre el caso las hemos podido hacer a posteriori de la experiencia terapéutica. Nuestro objetivo principal es el cuidado y atención de los menores y sus familias. Escribir este artículo permite la elaboración mental del caso y la función de presentarlo es repensarlo para seguir velando por mejorar la asistencia a la salud mental infantil y juvenil desde nuestra institución


The reflections that we are going to show are based on our care experience in co-therapy and on conversations between sessions. A large part of the case reflections has been made after the therapeutic experience. Our main objective is the care and attention of minors and their families. Writing this article allows the mental elaboration of the case and presenting it aims at reconsidering and making our institution keep on improving the mental health assistance of children and youth


Assuntos
Humanos , Feminino , Adolescente , Transtornos da Personalidade/psicologia , Transtornos da Personalidade/terapia , Psicoterapia Psicodinâmica/métodos , Simbiose/fisiologia , Família/psicologia , Narcisismo
4.
BMC Psychol ; 6(1): 43, 2018 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-30180880

RESUMO

BACKGROUND: This protocol describes a study that will test the effectiveness of a 10-week non-clinical psychological coaching intervention for intentional personality change using a smartphone application. The goal of the intervention is to coach individuals who are willing and motivated to change some aspects of their personality, i.e., the Big Five personality traits. The intervention is based on empirically derived general change mechanisms from psychotherapy process-outcome research. It uses the smartphone application PEACH (PErsonality coACH) to allow for a scalable assessment and tailored interventions in the everyday life of participants. A conversational agent will be used as a digital coach to support participants to achieve their personality change goals. The goal of the study is to examine the effectiveness of the intervention at post-test assessment and three-month follow-up. METHODS/DESIGN: A 2x2 factorial between-subject randomized, wait-list controlled trial with intensive longitudinal methods will be conducted to examine the effectiveness of the intervention. Participants will be randomized to one of four conditions. One experimental condition includes a conversational agent with high self-awareness to deliver the coaching program. The other experimental condition includes a conversational agent with low self-awareness. Two wait-list conditions refer to the same two experimental conditions, albeit with four weeks without intervention at the beginning of the study. The 10-week intervention includes different types of micro-interventions: (a) individualized implementation intentions, (b) psychoeducation, (c) behavioral activation tasks, (d) self-reflection, (e) resource activation, and (f) individualized progress feedback. Study participants will be at least 900 German-speaking adults (18 years and older) who install the PEACH application on their smartphones, give their informed consent, pass the screening assessment, take part in the pre-test assessment and are motivated to change or modify some aspects of their personality. DISCUSSION: This is the first study testing the effectiveness of a smartphone- and conversational agent-based coaching intervention for intended personality change. Given that this novel intervention approach proves effective, it could be implemented in various non-clinical settings and could reach large numbers of people due to its low-threshold character and technical scalability.


Assuntos
Aconselhamento à Distância/métodos , Tutoria/métodos , Transtornos da Personalidade/terapia , Smartphone/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Motivação , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Terapia Assistida por Computador/métodos
5.
Crim Behav Ment Health ; 28(5): 390-396, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29920809

RESUMO

BACKGROUND: Personality disorder is highly prevalent in offender populations and is associated with poor health, criminal justice, and social outcomes. Research has been conducted into factors that influence offending and health, but, in order to improve (re)habilitation, service providers must also be able to identify the variables associated with social outcomes and the mechanisms by which they operate. AIM: To establish what is known about what influences social outcomes among offenders with personality disorder. METHOD: A systematic review was completed using Cochrane methods, expanded to include nonrandomised trials. Anticipated high heterogeneity informed a narrative synthesis. RESULTS: Three studies met inclusion criteria. Two were qualitative studies including only 13 cases between them. All studies were low quality. CONCLUSIONS: There is insufficient evidence to determine what influences good social outcomes among offenders with personality disorder. Research is required to identify associated variables, to inform the development of effective interventions.


Assuntos
Terapia Comportamental/métodos , Criminosos/psicologia , Transtornos da Personalidade/terapia , Autoeficácia , Comportamento Social , Humanos , Transtornos da Personalidade/psicologia
6.
J Behav Addict ; 7(2): 348-354, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29865864

RESUMO

Background and aims The primary objective of this study was to investigate the prevalence of at-risk gambling in a large, unselected sample of outpatients attending two community mental health centers, to estimate rates according to the main diagnosis, and to evaluate risk factors for gambling. Methods All patients attending the centers were evaluated with the Canadian Problem Gambling Index and the Mini International Neuropsychiatric Interview. Diagnoses were checked with the treating psychiatrists and after a chart review of the university hospital discharge diagnoses. Results The rate of at-risk gambling in 900 patients was 5.3%. In those who gambled over the last year, 10.1% were at-risk gamblers. The rates in the main diagnostic groups were: 4.7% schizophrenia and related disorders, 4.9% bipolar disorder, 5.6% unipolar depression, and 6.6% cluster B personality disorder. In 52.1% of the cases, at-risk gambling preceded the onset of a major psychiatric disorder. In a linear regression analysis, a family history of gambling disorder, psychiatric comorbidities, drug abuse/dependence, and tobacco smoking were significantly associated with at-risk gambling. Discussion and conclusion The results of this study evidenced a higher rate of at-risk gambling compared to community estimates and call for a careful screening for gambling in the general psychiatric population.


Assuntos
Jogo de Azar/complicações , Jogo de Azar/epidemiologia , Assistência Ambulatorial , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Comorbidade , Transtorno Depressivo/complicações , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Progressão da Doença , Feminino , Humanos , Entrevista Psicológica , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/complicações , Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/terapia , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Esquizofrenia/terapia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia
7.
Int. j. psychol. psychol. ther. (Ed. impr.) ; 18(2): 193-205, jun. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-174400

RESUMO

This study examined the possibility that personality would change in the course of a positive psychology intervention, and would add to therapeutic gain. 89 participants were randomly assigned into the intervention group (N= 45) and the waiting-list group (N= 44). The intervention followed 6-week-online-protocol. Participants reported on the Steen Happiness Index (SHI), The Positive Psychotherapy Index (PPTI), and the Satisfaction with Life Scale (SLS) as well as on the temperament scales Harm Avoidance and Persistence, and the character trait Self-Directedness three times: at outset, post-intervention, and four weeks later at follow-up. Hypotheses were tested using growth curve analysis and regression analysis. The intervention group gained in all three happiness measures, in the personality traits Self-Directedness and Persistence and decreased in Harm Avoidance relative to the waiting-list group. Regression analyses revealed that the change in personality traits, and particularly in Self-Directedness mediated the therapeutic gains in the SHI as well as in the PPTI, but not in SLS. Although personality is basically very stable, successful interventions can bring about beneficial changes in personality which may in turn help to maintain therapeutic gains. The role of personality change in psychotherapy should be studied across therapeutic approaches, settings, and psychiatric diagnoses


No disponible


Assuntos
Humanos , Masculino , Feminino , Psicoterapia/métodos , Transtornos da Personalidade/terapia , Testes de Personalidade/estatística & dados numéricos , Doença Crônica/psicologia , Avaliação de Resultado de Intervenções Terapêuticas , Técnicas Psicológicas/estatística & dados numéricos , Determinação da Personalidade , Resultado do Tratamento , Autorrelato , Qualidade de Vida , Perfil de Impacto da Doença , Reforço (Psicologia)
8.
Psychodyn Psychiatry ; 46(2): 252-264, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29809112

RESUMO

Psychiatric clinicians are faced with the challenge of remaining flexible and psychotherapeutically relevant to the broadening scope of patients with severe narcissistic and borderline personality disorders. Diagnostic sophistication among mental health professionals, increased availability of psychotherapy services, and economic pressures combine to cause the public to expect cost-effective, successful, and shorter duration of treatments. These treatment challenges are particularly poignant with the treatment of those narcissistic and borderline patients who have meager capacity for insight and limited verbal skills. This article describes the use of psychodynamically oriented and informed psychodrama for the treatment of narcissistic and borderline patients.


Assuntos
Narcisismo , Transtornos da Personalidade/terapia , Psicodrama/métodos , Psicoterapia Psicodinâmica/métodos , Adulto , Transtorno da Personalidade Borderline/terapia , Humanos , Masculino , Adulto Jovem
9.
PLoS One ; 13(4): e0195581, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29689051

RESUMO

INTRODUCTION: Most studies on the epidemiology of personality disorders (PDs) have been conducted in high-income countries and may not represent what happens in most part of the world. In the last decades, population growth has been concentrated in low- and middle-income countries, with rapid urbanization, increasing inequalities and escalation of violence. Our aim is to estimate the prevalence of PDs in the Sao Paulo Metropolitan Area, one of the largest megacities of the world. We examined sociodemographic correlates, the influence of urban stressors, the comorbidity with other mental disorders, functional impairment and treatment. METHODS: A representative household sample of 2,942 adults was interviewed using the WHO-Composite International Diagnostic Interview and the International Personality Disorder Examination-Screening Questionnaire. Diagnoses were multiply imputed, and analyses used multivariable regression. RESULTS AND DISCUSSION: Prevalence estimates were 4.3% (Cluster A), 2.7% (Cluster B), 4.6% (Cluster C) and 6.8% (any PD). Cumulative exposure to violence was associated with all PDs except Cluster A, although urbanicity, migration and neighborhood social deprivation were not significant predictors. Comorbidity was the rule, and all clusters were associated with other mental disorders. Lack of treatment is a reality in Greater Sao Paulo, and this is especially true for PDs. With the exception of Cluster C, non-comorbid PDs remained largely untreated in spite of functional impairment independent of other mental disorders. CONCLUSION: Personality disorders are prevalent, clinically significant and undertreated, and public health strategies must address the unmet needs of these subjects. Our results may reflect what happens in other developing world megacities, and future studies are expected in other low- and middle-income countries.


Assuntos
Transtornos da Personalidade/epidemiologia , Brasil/epidemiologia , Cidades/epidemiologia , Comorbidade , Exposição à Violência , Migração Humana , Humanos , Entrevista Psicológica , Análise Multivariada , Transtornos da Personalidade/terapia , Pobreza , Prevalência , Escalas de Graduação Psiquiátrica , Análise de Regressão , Inquéritos e Questionários , População Urbana
10.
Psychiatr Pol ; 52(1): 115-127, 2018 Feb 28.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-29704419

RESUMO

OBJECTIVES: Analysis of changes in ego strength in the course of group psychotherapy in patients treated with neurotic and selected personality disorders (F40-F61, ICD-10). METHODS: 82 patients (61 women and 21 men) participated in the study. They underwent intensive short-term group psychotherapy treatment in a day hospital for neurotic and behavioural disorders. The assessment of the patients' personality functioning was carried out at the onset and the end of the psychotherapy. The assessment was reported as a value on the ego strength scale by means of the MMPI-2 questionnaire. RESULTS: The comparative analysis with the use of the t-Student test for related measurements, which was carried out for the measurement of ego strength values at the onset and the end of the therapy, demonstrated a statistically significant positive change both for the entire examined group and the groups which considered the gender and diagnosis distribution. CONCLUSIONS: Short-term intensive comprehensive group psychotherapy with elements of individual psychotherapy results in obtaining the desired changes in the personality functioning manifested through the increase in ego strength.


Assuntos
Ego , Transtornos Neuróticos/terapia , Transtornos da Personalidade/terapia , Psicoterapia Breve/métodos , Psicoterapia de Grupo/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Neuróticos/psicologia , Personalidade , Transtornos da Personalidade/psicologia , Autoimagem , Inquéritos e Questionários , Resultado do Tratamento
11.
Psychopathology ; 51(2): 141-148, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29694976

RESUMO

This presentation gives an overview of the methods used for research on the process and outcome of psychotherapy. Possibilities as well as difficulties will be discussed, such as the conflict between internal and external validity and standardized versus individualized procedures as some of the issues deserving particular attention for research on psychotherapy for personality disorder patients. It is argued that good psychotherapy research is also good psychotherapy research for personality disorders, with heterogeneity, ego-syntony, and ambivalent motivation needing special attention. Adaptations of and alternatives for randomized clinical trials will be discussed.


Assuntos
Transtornos da Personalidade/terapia , Psicoterapia/métodos , Humanos , Transtornos da Personalidade/diagnóstico
12.
Orv Hetil ; 159(9): 363-369, 2018 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-29480047

RESUMO

Inflammatory bowel disease (Crohn's disease and colitis ulcerosa) is a chronic, long-term condition that causes chronic inflammation in the digestive tract, and shows an increasing incidence and prevalence worldwide. Changes in disease activity over time affect psychological distress which increases the risk of exacerbations. Beside somatic symptoms (such as abdominal pain, diarrhoea and weight loss), psychiatric comorbidity (in particular major depression, anxiety, social phobia) is common in patients with Crohn's disease. This case study illustrates the management and stabilization of a 21-year-old adult male patient with active Crohn's disease and with severe psychiatric comorbidity. The patient was diagnosed with avoidant personality disorder and dysruptive mood dysregulation disorder based on the results of psychodiagnostics (SCID-II structured clinical interview, MMPI personality inventory and disease-specific clinical questionnaires such as Beck Depression Inventory, Beck Hopelessness Scale, Social Cognition Questionnaire, Anger Expression Scale, Cognitive Emotion Regulation Questionnaire, Rosenberg Self-Esteem Scale). The main aim of psychotherapy is to increase the adherence to pharmacotherapy, to promote psychosocial functioning, to improve well-being and to enhance adaptive coping strategies. Low-intensity cognitive-behavioural psychotherapy was used which included psychoeducation, motivational interview, behavioural activation, patient diary, cognitive restructuring, problem-solving training, and family consulting. Twenty-five sessions were held weekly in outpatient form and 3 sessions of crisis intervention after the surgery at the hospital. The efficacy of the treatment was measured by self-reported questionnaires at baseline and at two follow-up sessions which corroborated a very significant decrease in the severity of depression, hopelessness, while emotional regulation and self-esteem became more adaptive. The remission of the above-mentioned psychiatric symptoms resulted in the improvement of the pharmacotherapy adherence and the quality of life. Low-intensity psychosocial interventions are proven to be an effective way of delivering evidence-based psychotherapy. Orv Hetil. 2018; 159(9): 363-369.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Doença de Crohn/complicações , Doença de Crohn/terapia , Transtornos da Personalidade/complicações , Transtornos da Personalidade/terapia , Adaptação Psicológica , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
13.
Clin Psychol Psychother ; 25(2): 283-291, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29251381

RESUMO

BACKGROUND: Compassion-focused therapy (CFT) has potential to benefit clients with a personality disorder (PD), given the inflated levels of shame and self-criticism in this population. However, clinical observation indicates that clients with PD may find techniques from this approach challenging. AIMS: The aim of this study is to trial one aspect of CFT, compassion-focused imagery (CFI), with this population, and identify factors that predict clients' ability to generate CFI and experience self-compassion during the task, including type of CFI exercise and, second, to establish whether CFI outcomes increase with practice. METHOD: In Study 1, 53 participants with a diagnosis of PD completed measures of self-compassion, self-reassurance, shame, self-criticism, fear of self-compassion, affect, anxious and avoidant attachment, and mental imagery abilities. Participants were assigned to trial CFI from memory (n = 25) or from imagination (n = 28), then rated their image's vividness, its compassionate traits, and ease of experiencing compassion. A negative mood manipulation was carried out, and CFI tasks and outcome measures were repeated. For Study 2, self-compassion and self-criticism were measured before and after 1 week of daily CFI practice. RESULTS: Study 1 found that negative mood and low mental imagery ability are significant inhibitors to generating compassionate images and affect. The 2 CFI exercises were equally effective. Study 2 suffered from high attrition, but regular practice was associated with significant improvement in self-compassion (though not self-criticism). CONCLUSIONS: CFI appears to be effective in improving self-compassion for some clients. However, it is less effective in the presence of negative affect. Clients with low mental imagery ability may benefit more from alternative CFT techniques.


Assuntos
Empatia , Imagens (Psicoterapia)/métodos , Transtornos da Personalidade/psicologia , Transtornos da Personalidade/terapia , Psicoterapia/métodos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
14.
Depress Anxiety ; 35(3): 239-247, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29212135

RESUMO

BACKGROUND: No studies of psychotherapies for panic disorder (PD) have examined effects on comorbid personality disorders (PersD), yet half such patients have a PersD. METHODS: In a randomized trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), PersD was assessed pre-to-post treatment with the Structured Clinical Interview for the Diagnosis of Axis-II Disorders (SCID-II). For patients completing therapy (n = 118, 54 with PersD), covariance between panic and SCID-II criteria improvements was analyzed. SCID-II diagnostic remission and recovery were evaluated. Comparative efficacy of PFPP versus CBT for improving PersD was analyzed both for the average patient, and as a function of PersD severity. RESULTS: 37 and 17% of PersD patients experienced diagnostic PersD remission and recovery, respectively. Larger reductions in PersD were related to more panic improvement, with a modest effect size (r = 0.28). Although there was no difference between treatments in their ability to improve PersD for the average patient (d = 0.01), patients meeting more PersD criteria did better in PFPP compared to CBT (P = .007), with PFPP being significantly superior at 11 criteria and above (d = 0.66; 3 more criteria lost). CONCLUSIONS: PersD presenting in the context of primary PD rarely resolves during psychotherapies focused on PD, and change in PersD only moderately tracks panic improvements, indicating non-overlap of the constructs. Patients receiving panic-focused psychotherapies may require additional treatment for their PersD. PFPP may be superior at improving severe PersD, but replication of this finding is required.


Assuntos
Agorafobia/terapia , Terapia Cognitivo-Comportamental/métodos , Avaliação de Resultados (Cuidados de Saúde) , Transtorno de Pânico/terapia , Transtornos da Personalidade/terapia , Psicoterapia Psicodinâmica/métodos , Adolescente , Adulto , Idoso , Agorafobia/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/epidemiologia , Transtornos da Personalidade/epidemiologia , Adulto Jovem
15.
Curr Opin Psychiatry ; 31(1): 43-49, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29120915

RESUMO

PURPOSE OF REVIEW: To give an update on the most recent studies regarding the role of schema therapy in the treatment of emotion dysregulation related to personality disorders. RECENT FINDINGS: In personality disorders, a lack of emotion regulation can be found. Schema therapy treats emotion dysregulation with a series of techniques, such as imagery rescripting, limited reparenting, chairwork, and cognitive restructuring to remove dysregulatory mechanism. SUMMARY: Schema therapy is one of the most efficient therapies for personality disorders. However, there is a lack of recent studies on how it treats emotion dysregulation. Although the treatment of emotional dysregulation is not the core of schema therapy, it is certainly important inside this theoretical framework. The mode model helps clinicians address their work toward the reduction of dysfunctional modes, whereas fostering functional modes.


Assuntos
Imagem Corporal , Emoções , Transtornos da Personalidade/terapia , Psicoterapia/métodos , Humanos , Transtornos da Personalidade/psicologia , Resultado do Tratamento
16.
Soc Psychiatry Psychiatr Epidemiol ; 53(2): 139-149, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29124290

RESUMO

PURPOSE: Psychiatric readmission is a common negative outcome. Predictors of readmission may differ by sex. This study aimed to derive and internally validate sex-specific models to predict 30-day psychiatric readmission. METHODS: We used population-level health administrative data to identify predictors of 30-day psychiatric readmission among women (n = 33,353) and men (n = 32,436) discharged from all psychiatric units in Ontario, Canada (2008-2011). Predictor variables included sociodemographics, health service utilization, and clinical characteristics. Using derivation data sets, multivariable logistic regression models were fit to determine optimal predictive models for each sex separately. Results were presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI). The multivariable models were then applied in the internal validation data sets. RESULTS: The 30-day readmission rates were 9.3% (women) and 9.1% (men). Many predictors were consistent between women and men. For women only, personality disorder (aOR 1.21, 95% CI 1.03-1.42) and positive symptom score (aOR 1.41, 95% CI 1.09-1.82 for score of 1 vs. 0; aOR 1.44, 95% CI 1.26-1.64 for ≥ 2 vs. 0) increased odds of readmission. For men only, self-care problems at admission (aOR 1.20, 95% CI 1.06-1.36) and discharge (aOR 1.44, 95% CI 1.26-1.64 for score of 1 vs. 0; aOR 1.79, 95% CI 1.17-2.74 for 2 vs. 0), and mild anxiety rating (score of 1 vs. 0: aOR 1.30, 95% CI 1.02-1.64, derivation model only) increased odds of readmission. Models had moderate discriminative ability in derivation and internal validation samples for both sexes (c-statistics 0.64-0.65). CONCLUSIONS: Certain key predictors of psychiatric readmission differ by sex. This knowledge may help to reduce psychiatric hospital readmission rates by focusing interventions.


Assuntos
Hospitais Psiquiátricos/estatística & dados numéricos , Transtornos Mentais/terapia , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Doença Aguda , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Ontário , Transtornos da Personalidade/terapia , Fatores Sexuais , Fatores de Tempo
17.
Int J Psychiatry Clin Pract ; 22(1): 70-76, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28826267

RESUMO

OBJECTIVE: Numerous studies confirm efficacy of psychiatric treatment as well as psychiatric placebo. The aim of the current study was the assessment of improvement rate and factors associated with treatment response in naturalistic group of adolescent inpatients. METHODS: Eighty two consecutive adolescent inpatients were recruited. Each patient at the admission and discharge was assessed with brief psychiatric rating scale (BPRS), eating attitude test (EAT-26), clinical global impression scale (CGI-S) and children global assessment scale (CGAS). Individual and family history was assessed by semi-structured interview. Patients, who improved in at least two interviewer-based scales (IMP, n = 67) were compared to the rest (N-IMP, n = 15). For statistical analysis STATISTICA package was used. RESULTS: The main difference between groups was ICD-10 diagnosis distribution: in the IMP group more anxiety-related disorders (F4), in the N-IMP group more personality disorders (F6). Other differences include history of paediatric hospitalisations and surgery (more in the N-IMP group). Most of the analysed factors did not differ between groups. CONCLUSIONS: The inpatient treatment seems to be most effective in severe mental states and in anxiety-related disorders and least effective in personality disorders. Due to limited inpatient treatment efficacy we believe outpatients services are crucial in adolescent psychiatry.


Assuntos
Hospitalização , Transtornos Mentais/terapia , Avaliação de Resultados (Cuidados de Saúde) , Escalas de Graduação Psiquiátrica , Adolescente , Transtornos de Ansiedade/terapia , Feminino , Humanos , Pacientes Internados , Classificação Internacional de Doenças , Masculino , Transtornos da Personalidade/terapia , Prognóstico
18.
J Pers Assess ; 100(1): 96-106, 2018 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28145735

RESUMO

The aim of this study was to examine the factor structure and the psychometric properties of the Psychotherapy Relationship Questionnaire (PRQ; Bradley, Heim, & Westen, 2005 ), a clinician report instrument that measures a wide spectrum of thoughts, feelings, motives, conflicts, and behaviors expressed by patients toward their therapists in psychotherapy. A national sample of psychiatrists and clinical psychologists (N = 314) of different theoretical orientations completed the PRQ, as well as the Shedler-Westen Assessment Procedure-200 (SWAP-200; Westen & Shedler, 1999a , 1999b ) to assess the personality of a patient in their care. Factor-analytic procedures identified 6 transference dimensions that showed excellent internal consistencies: (a) hostile, (b) positive/working alliance, (c) special/entitled, (d) anxious/preoccupied, (e) avoidant/dismissing attachment, and (f) sexualized. Factor scores were significantly related to patients' personality characteristics and psychological functioning, regardless of the clinicians' orientations. The findings support that the PRQ is a valid and reliable tool for evaluating the patients' relational patterns emerging in clinical practice in a clinically coherent and psychometrically robust way. Clinicians' careful understanding of these patterns can be very useful for making accurate diagnostic formulations, as well as for providing a roadmap for effective therapeutic intervention.


Assuntos
Transtornos da Personalidade/terapia , Personalidade , Relações Profissional-Paciente , Psicoterapia/métodos , Inquéritos e Questionários/normas , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Transtornos da Personalidade/diagnóstico , Psicometria , Reprodutibilidade dos Testes
19.
Compr Psychiatry ; 80: 14-23, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28915423

RESUMO

OBJECTIVE: Psychological treatment for patients with personality disorders (PD) is plagued with a high proportion of early dropouts, and attempts to identify risk factors for attrition have generated very few conclusive results. The purpose of the present study is to identify significant predictors of early treatment termination in a long-term psychotherapy program for PD. METHODS: Data was retrospectively retrieved from 174 files of patients who began long-term psychotherapy in an outpatient treatment program in Quebec City, Canada. Socio-demographic, initial disturbance, and diagnostic variables were considered for prediction, along with a measure specifically designed to identify PD patients at risk of dropping out early from psychotherapy, the Treatment Attrition-Retention Scale for Personality Disorders (TARS-PD). Survival analysis using Cox proportional hazard regression was performed to identify significant predictors. RESULTS: Results using univariate Cox proportional hazards regressions revealed that unemployment, Global Assessment of Functioning scores, and recent hetero-aggressive behavior were significant predictors of early dropout in the first six months of therapy. Adjusting for these three confounders, four of the factor scores from the TARS-PD (Narcissism, Secondary gains, Low distress, and Cluster A features) were significantly associated with dropout in univariate Cox proportional hazards regressions. Secondary gains and Narcissism remained significant predictors after entering all five TARS-PD factors in a multivariate Cox proportional hazards regression adjusting for confounders. CONCLUSIONS: Taking into consideration specific treatment prognosis variables, such as those measured by the TARS-PD, might be more useful for dropout prediction in PD patients in comparison with more general demographic and diagnostic variables.


Assuntos
Pacientes Desistentes do Tratamento/psicologia , Transtornos da Personalidade/terapia , Psicoterapia , Adulto , Agressão , Feminino , Humanos , Masculino , Pacientes Ambulatoriais/psicologia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Desemprego/psicologia , Adulto Jovem
20.
Personal Ment Health ; 12(1): 25-37, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29024462

RESUMO

The discourse surrounding personality disorder is largely negative, and the diagnosis is considered to be associated with a degree of stigma. This study aimed to investigate staff attitudes towards personality disorder in high-security and medium-security forensic-psychiatric hospitals in the UK. The Attitude to Personality Disorder Questionnaire was completed by 132 participants who were all current employees with clinical roles. Staff attitudes to personality disorder in the current study were significantly less positive than in comparable studies in similar settings. Having completed staff training surrounding personality disorder and being from a non-nursing professional background were the best predictors of positive attitudes to personality disorder. The findings of this study offer support to the pursuit of improving access to training in personality disorder for those working with this clinical presentation. Copyright © 2017 John Wiley & Sons, Ltd.


Assuntos
Atitude do Pessoal de Saúde , Psiquiatria Legal , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Psiquiátricos , Transtornos da Personalidade , Recursos Humanos em Hospital , Adulto , Feminino , Psiquiatria Legal/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/terapia , Recursos Humanos em Hospital/estatística & dados numéricos , Reino Unido
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