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At least 595 records · Page 33Linked to original sources
PubMed2005

The developmental line of autonomy in the etiology, dynamics, and treatment of borderline personality disorders.

Borderline personality disorder (BPD) is considered as a disorder of autonomy, and is related to both predisposing vulnerabilities and social relationships that fail to support basic psychological needs. Autonomy, which is defined within the self-determination theory as the capacity for self-endorsed action based on integrative, reflective awareness, is discussed as a developmental line that is dependent on specific supports from caregivers. Unresponsiveness, invalidation, or abuse by caregivers is argued to impair the capacity for autonomy and to catalyze an array of processes, both biological and psychological, which impact subsequent development and, in vulnerable individuals, can lead to BPD. Aspects of treatment, including the emphases on validation and acceptance of the patient's experience, and the cultivation of more reflective or mindful regulation of behavior, can be deduced, from this analysis of autonomy disturbance, and these in turn have appeared as the cornerstones of effective treatments for BPD.

Adolescent↗
PubMed2002

Reflections on determining competency.

Psychiatrists are the health care professionals most frequently called upon to determine the competence of a patient to refuse treatment. The motives for determining competency vary in morally significant ways. This paper explores what I term 'the ideal motivational situation' for determining a patient's competency: a desire to respect the patient's autonomy, a desire to promote the patient's overall best interests, and a belief that when these two motives conflict the patient's autonomy should not be dismissed out of hand as a partial patient interest which is naturally outweighed by the totality of his or her interests. I claim that in a liberal, democratic society autonomy ought to trump best interests and be the sole criterion of patient competence. I conclude by offering an essentially aesthetic criterion for determining autonomy.

Health Personnel↗
PubMed2006

Psychological factors in people at ultra-high risk of psychosis: comparisons with non-patients and associations with symptoms.

BACKGROUND: There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis and provides the opportunity to investigate psychological mechanisms that may confer vulnerability to psychosis. METHOD: Fifty-eight patients at ultra-high risk of developing a first episode of psychosis were compared with 56 non-patients matched for age and occupational status on measures of meta-cognition, schizotypal traits, dysfunctional attitudes and distress. RESULTS: Analyses of covariance revealed that people at high risk of developing psychosis scored higher on measures of cognitive vulnerability, including negative meta-cognitive beliefs, beliefs about rejection and criticism from others, and discrepancies in self-perception, schizotypal traits and general mental distress. Correlational analyses revealed that negative meta-cognitive beliefs, dysfunctional attitudes and beliefs about rejection and criticism from others were positively associated with several dimensions of symptomatology in at-risk mental states (ARMS) patients. CONCLUSIONS: Cognitive and personality factors appear to characterize people at high-risk of developing psychosis and are associated with their distressing experiences. The clinical implications of these findings are discussed.

Adult↗
PubMed2005

Patient satisfaction with diabetes care.

AIM: The aim of this paper is to report the findings of a study that elucidated the experiences and reflections of people with type 2 diabetes about clinical encounters. BACKGROUND: Several patient satisfaction surveys have focused on privacy, cheerfulness and amenities rather than on how the care was delivered. A great deal of research has also focused on communication and various consultation styles, particularly within health promotion and diabetes care, but how these factors tie up with patient satisfaction has rarely been discussed. This study was performed in order to elucidate patients' perspectives about clinical encounters in diabetes care. METHOD: Interviews were carried out during 2001 with 44 patients with diabetes. The transcribed interviews were analysed using qualitative content analysis. RESULTS: Five themes were connected to patient satisfaction and dissatisfaction, namely 'being in agreement vs. in disagreement about the goals'; 'autonomy and equality vs. feeling forced into adaptation and submission'; 'feeling worthy as a person vs. feeling worthless'; 'being attended to and feeling welcome vs. ignored'; and, lastly, 'feeling safe and confident vs. feeling unsafe and lacking confidence'. CONCLUSION: Despite efforts to individualize diabetes care and find ways to communicate with patients, many people have experiences of clinical encounters that they find dissatisfying. Experiences of dissatisfying encounters have elements that may threaten their perception of self and identity, while elements included in satisfying encounters are those characterizing patient-centred care.

Adult↗