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Biomedical subjects

G Baruch

Publications and source records attributed to G Baruch.

10 recordsLinked to original sources
PubMed2003

Opportunistic screening for Chlamydia at a community based contraceptive service for young people.

PROBLEM: The suspected high prevalence of Chlamydia infection that is undiagnosed and untreated among high risk women who attend a contraceptive service for young people. DESIGN: Cross sectional study from a community screening service. BACKGROUND AND SETTING: An inner city contraceptive and psychotherapy service for young people aged 12-21 years. KEY MEASURE FOR IMPROVEMENT: Prevalence of infection commensurate with or above findings from the national screening pilot (13.8% for > 16 year olds, 10.5% for 16-19 year olds, and 7.2% for 20 to 24 year olds). STRATEGIES FOR CHANGE: Offering testing (of a first catch urine sample) for Chlamydia to all young people using the contraceptive service who were not previously screened; launching a publicity campaign about the new service; training medical staff and reception staff to deliver the service to maximise take up of screening and of treatment by infected cases; and surveying results from testing to monitor significant patterns of infection requiring further action. EFFECTS OF CHANGE: Percentage of clients with infection exceeded targets for each age group, 76% with a positive or equivocal result returned for treatment, 87% of those treated returned for a test of cure, and 99% of tests of cure were negative. Prevention work was initiated in a school with a particularly heavy concentration of infected clients. LESSONS LEARNT: A contraceptive service for young women is a highly acceptable location for effective Chlamydia screening.

Adolescent↗
PubMed2001

Mental health services in schools: the challenge of locating a psychotherapy service for troubled adolescent pupils in mainstream and special schools.

In Part 1, the case is presented for school-based mental health services in terms of the low utilization of community-based clinics and the high dropout rate among young adolescents attending clinics in the community. The advantages and potential pitfalls of school-based services are also assessed. In Part 2, the paper discusses the lessons learned from delivering psychotherapy services in mainstream and special schools to tackle the mental health problems presented by troubled pupils. The author describes the schools and discusses the expectations among teachers of the psychotherapist and psychologist. The role of the psychotherapist and psychologist in the schools is outlined. The types of treatment approach, the setting for treatment, method of referral, parental consent, and links with the wider network of adolescent mental health services and evaluation of outcome are considered. Finally, the author discusses the tensions that can arise between the psychotherapist and psychologist and school staff and ways of overcoming them.

Adolescent↗
PubMed1999

Emotional and behavioural problems in adolescents/young adults receiving treatment at a community-based psychotherapy centre for young people: a preliminary study of the correspondence among adolescent/young adult and significant other reports.

The present study examined the correspondence among adolescent/young adult and parental figure, professional, peer and partner reports, in their rating of emotional and behavioural problems of 195 young people aged between 12 and 25 years who attended a community-based psychotherapy centre. Data from young people were obtained at intake by participants completing the Youth Self Report Form and from significant others by them completing the Significant Other version of the Teacher's Report Form. Professionals rated internalizing (emotional) problems lower than peers, partners or parental figures. Externalizing (disruptive) problems were rated lowest by professionals, highest by partners with parental figures and peers in between. Agreement for internalizing problems was highest between self and professionals and lowest for partners and peers; parental figures were in between these two extremes. For externalizing problems, agreement was highest between self and friends but very low for partners. Professionals' ratings of internalizing problems showed a strong association with clinicians' assessment of global functioning and there was a strong association between partner ratings of total problems and clinicians' ratings of global functioning. The study showed the value of using a wider range of informants for assessing emotional and behavioural problems presented by young people seeking treatment than used in the assessment of pre-adolescents.

Adolescent↗
PubMed1998

Adolescents who drop out of psychotherapy at a community-based psychotherapy centre: a preliminary investigation of the characteristics of early drop-outs, late drop-outs and those who continue treatment.

The present study examined the difference between young people who terminated treatment prematurely and who continued in treatment. One hundred and thirty-four young people (ages 12 to 24 years) who attended a community-based psychotherapy centre for psychoanalytic psychotherapy between 1 April 1993 and 31 March 1996 comprised the sample. It was predicted that drop-outs would consist of younger adolescents who were referred, who show a high score for externalizing problems such as aggression and delinquency and a low score for internalizing problems such as anxiety and depression. It was also predicted that continuers would be older, self-referred and show a high score for internalizing problems and a low score for externalizing problems. The results indicated significant differences between drop-outs and continuers: drop-outs were younger, had greater externalizing problems, school problems and presented with moderate to severe hyperkinetic or conduct disorder. Continuers were older, had fewer externalizing problems, were self-referred and were likely to be treated by supportive therapists. Since age was the most significant predictor of attendance, the sample was separated into younger adolescents and older adolescents and the same analyses repeated. In the younger group ethnic minority status, and being treated by a supportive therapist predicted continuing in treatment and a diagnosis of conduct disorder predicted premature termination. The clinical implications of the present findings for the delivery of psychotherapy services to young people are discussed.

Adolescent↗
PubMed1998

Some challenges in working with older adolescents in psychoanalysis.

Detailed clinical material is presented in order to illustrate the challenges associated with carrying out analytic work with disturbed adolescents, and to investigate whether the adolescent's ambivalent responses to analysis are primarily pathological or are inevitable, given the developmental drive to become independent, to find an identity, and to separate from parents. In reviewing the case material in which the adolescent patient's opposition to treatment is primarily treated as a pathological solution, the author suggests that this emphasis was mistaken. Instead, he proposes a perspective that emphasizes the adolescent's healthy propulsion toward autonomy. Finally, the implications for psychoanalytic treatment are considered.

Adolescent Psychiatry↗
PubMed1997

The manic defence in analysis: the creation of a false narrative.

The author presents clinical material from the analysis of a patient who made sense of his chaotic life by creating seamless narratives in the analytic situation. Initially, his experience of meaning was derived from the form of his narrative. He repeatedly constructed the 'perfect' narrative, which he related to as a real object and as an object of reparation. There was a significant change in his narrative style and his experience of meaningfulness when he was able to struggle with the contradictions, ambiguities and inconsistencies in his life. The author argues that the patient's earlier narrative style, which he calls the manic narrative, is an aspect of the manic defence, whereas his later approach, when he relinquished the manic narrative in favour of a genuine experience of meaningfulness, was a move towards accepting depressive anxiety and acknowledging the state of his objects.

Adult↗
PubMed1997

The process of engaging young people with severe developmental disturbance in psychoanalytic psychotherapy: patterns of practice.

The author discusses some of the problems faced by psychoanalytic psychotherapists at a community-based center in engaging in psychotherapy hard-to-reach young people who present with severe developmental disturbance. The difficulties are suggested to arise from a poorly developed capacity, in these young people, to reflect on their own and others' mental states. The technical implications for the therapeutic approach are discussed. Case material is presented that illustrates this approach.

Adolescent↗
PubMed1997

The impact of parental interventions on the analysis of a 5-year-old boy. A clinical account.

In this paper, the author describes the pressure put on the analysis of a 5-year-old boy by his parents, who repeatedly tried to terminate the analysis soon after it had started. Detailed clinical material illustrates the impact this pressure had on the analyst and the boy, including a considerable conflict of loyalty between his parents and the analyst and being overwhelmed by intolerable feelings of violence and persecution. The clinical account also shows how this boy struggled to cope with feelings of destructiveness, badness and being unwanted and with intense pressures and demands placed on him by his parents to grow up, to abandon his infantile self and to control his impulses, particularly his anger. Despite the turbulence of the analysis, he was able to make some moves in the direction of tolerating his feelings of guilt and containing his destructiveness. The discussion focuses on the role of parents in child analysis: their concerns and anxieties, the impact they can have on treatment and the interventions available to help them to allow their child's analysis to proceed.

Child, Preschool↗
PubMed1984

Factors influencing parental participation in a paediatric cardiology outpatient clinic.

Twelve-hundred consultations at a paediatric cardiology outpatient clinic were observed and tape-recorded. A random sample of 102 consultations was selected and an analysis made of the demand for information by parents and the extent to which this was met. Statistically significant differences in numbers of questions asked were found related to stage of treatment, seriousness of condition and outcome of consultation. Most questions were asked either when definitive information was available (i.e. following cardiac catheterisation) or when active intervention was contemplated (i.e. catheterisation or surgery). Contrary to parents' accounts in subsequent home interviews, the number of questions they ask is unrelated to the length of the consultation. Similarly the presence of many medical staff at the consultation, was positively correlated with the number of parents' questions. In general there was a good fit between parental participation and those occasions where most was at stake except at the first outpatient appointment. This was regarded, at least in retrospect, as unsatisfactory by many parents irrespective of its length or content. We suggest that an additional but optional "pre-admission" outpatient appointment where the family visit the wards prior to the child's admission to hospital may help parents cope with their anxieties.

Child↗