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PubMed1999

Methodological pluralism: a framework for psychotherapy research.

A new level of sophistication is advocated for psychotherapy research--methodological pluralism. This pluralism recognizes the number of unexamined and untested assumptions that are embedded within any method, including traditional scientific methods. These assumptions restrict the questions that can be asked and the variables that can be tested before any investigation of psychotherapy has occurred. Such premature closure is ultimately unscientific and hinders truly creative investigations of psychotherapy. Consequently, a framework is described that allows multiple methods--with multiple underlying philosophies--to complement one another in psychotherapy research. Five essential benefits of this pluralistic framework are shown: advancement of science, increased objectivity, a level playing field, greater scientific freedom, and an end to the burgeoning "method wars" of psychotherapy research.

Cultural Diversity↗
PubMed2001

Multiple sclerosis: empirical literature for the clinical health psychologist.

This article reviews the empirical literature related to clinical health psychology in multiple sclerosis (MS). MS is a disease in which the immune system attacks the central nervous system. As such, the interactions between medical and psychological variables are complex, and potentially of considerable importance to patients. Common neuropsychological and psychological problems associated with MS and their etiologies are reviewed. The effects of stress and depression on MS exacerbation are discussed, including clinical, immune, endocrine, and neuroimaging findings. The types of coping common in MS and their effects on adjustment are discussed. The empirical literature on psychological and neuropsychological intervention is reviewed. The small literature on caregiving in MS is also summarized.

Adaptation, Psychological↗
PubMed2005

[Polytraumatized burn injury victims].

Most polytraumatized burn injury persons aged 30-40 years who have suffered a burn or a burn-like injury are stigmatized by serious functional deficits, temporary loss of their social independence, injury-associated psychological reactions of different levels, and unusual reversible deficits in their higher cortical functions. The result is a prolonged stage of acute treatment and rehabilitation as well as very often the lifelong need for highly specialized care by physicians and other medical professionals. Accordingly, the deficits in any individual case are high and in spite of the low case rate (approximately 300-400 cases/ year) these accidents have a high impact on society as a whole, resulting in a significant financial burden for the social security system, insurance funds, and pension funds.

Adolescent↗
PubMed1998

Treatment of severe injuries caused by attempted suicide: pattern of injury and influence of the psychiatric disorder on the postoperative course.

OBJECTIVE: To assess the influence of psychiatric disorders on the treatment and postoperative course of patients severely injured as a result of attempted suicide. DESIGN: Retrospective case study. SETTING: University hospital, Germany. SUBJECTS: 36 patients who had multiple injuries after attempting suicide during the five year period 1991-95. INTERVENTIONS: Operative and psychiatric treatment. MAIN OUTCOME MEASURE: Functional results assessed with the Trauma Outcome Profile (TOP) score, psychiatric state, and risk of further suicide attempts. RESULTS: 30 of the 36 patients attempted suicide by jumping from a height, and the most common injuries were fractures of the spine (n = 33) and lower limbs (n = 43). All patients had a psychiatric disorder, and 18 had previously attempted suicide at least once though had inflicted only minor injuries. 29 of the 36 were receiving psychiatric care at the time of the suicide attempt. Five patients died. 27 of the 31 survivors were available for follow up and 26 of them had good or excellent functional results. 30 of the 31 underwent psychiatric assessment (one refused) and none was judged to be at risk of a further attempt. CONCLUSIONS: The functional results were better than we expected. The psychological effect of severe injuries and a long hospital stay seems to reduce the risk of a further attempt, so all treatment (both surgical and psychiatric) is worthwhile.

Adult↗
PubMed1996

A putative poststreptococcal case of OCD with chronic tic disorder, not otherwise specified.

A 12-year-old girl presented with an atypical, recurrent, increasingly treatment-resistant case of obsessive-compulsive disorder and chronic tic disorder associated with profound separation anxiety, learning difficulty, and intermittent upper respiratory symptoms. In addition to detailed reviews of history and findings from many clinical caretakers from the prior 7 years, current pediatric, psychiatric, neuropsychological, neuroimaging, and clinical laboratory data were also available. Treatment options were considered from multiple perspectives: psychoanalytically oriented psychotherapy, conventional pharmacotherapy, family interventions, cognitive-behavioral therapy, and learning-supportive strategies. Psychological, neuropsychiatric, and neuroimmunological formulations of etiology were considered. Subsequent treatments included supportive psychotherapy, neuroleptic augmentation of selective serotonin reuptake inhibitors, prophylactic penicillin, and a course of six sessions of plasmapheresis over a 2-week period. The case raises questions for ongoing consideration that juxtapose dynamic, neuropsychiatric, and neuroimmunological perspectives.

Antibiotic Prophylaxis↗
PubMed1990

Inpatient treatment for depressed children and adolescents: preliminary evaluations.

Reported are the results of two uncontrolled outcome studies that evaluate the effectiveness of inpatient psychiatric treatment of children and adolescents suffering from clinical depression. Study 1 employed a sample of 7 children and measured outcome with the Depression Self-rating Scale (DSRS), the Hopelessness Scale for Children (HSC), and the Global Asssessment of Functioning (GAF) scale, which were administered to each child upon admission and again at discharge. Inpatient treatment involved multiple interventions, including individual psychotherapy, medication, milieu therapy and token economy, and other procedures. At discharge, statistically significant improvements were found on the patients' GAF and HSC scores, but not on their DSRS scores. Study 2 used a sample of 15 adolescents, also admitted for clinical depression. Administered at each patient's admission and discharge, the Beck Depression Inventory (BDI), Generalized Contentment Scale (GCS), and Index of Self-esteem (ISE) were used to measure outcome. The multi-modal treatment program offered to the sample in Study 2 was similar to that offered the sample in Study 1. At discharge all three outcome measures reflected statistically significant improvements in the patients studies; therefore, these results provide addmtional support for the inpatient treatment of depressed children and adolescents.

Adolescent↗