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1 – 10 of 15Peter Robert Diamond and Claire Delaney
There is a growing evidence base for cognitive behavioural therapy (CBT) as a treatment for psychogenic non-epileptic seizures (PNES) in the general population. Despite the…
Abstract
Purpose
There is a growing evidence base for cognitive behavioural therapy (CBT) as a treatment for psychogenic non-epileptic seizures (PNES) in the general population. Despite the relatively high proportion of individuals with PNES who have an intellectual disability (ID) there is a paucity of literature on the use of CBT for PNES in this population. The purpose of this paper is to describe the use of an adapted CBT approach to treat PNES in a woman with mild ID.
Design/methodology/approach
The intervention used a CBT approach that included both the client and her mother, her primary care giver, throughout the therapy sessions. It involved 13 1-hour sessions over 20 weeks.
Findings
Over the course of the intervention the client experienced a reduction in seizure activity. Both the client and her mother reported increases in her perceived ability to cope with the seizures.
Originality/value
This report describes an adapted CBT-based intervention for individuals with PNES in the context of ID. It is the first report to include the involvement of a care-giver in adapting this approach for individuals with ID.
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Catherine I. Atnas and Tessa Lippold
This case report aims to describe the treatment of a woman (Rachel) in her twenties who was referred to the community team for people with an intellectual disability by her…
Abstract
Purpose
This case report aims to describe the treatment of a woman (Rachel) in her twenties who was referred to the community team for people with an intellectual disability by her neurologist as she wanted help with reducing the frequency of psychogenic non‐epileptic seizures (PNES).
Design/methodology/approach
CBT was used as the therapeutic approach. The first stage of intervention focussed on reducing the frequency of PNES through relaxation and distraction techniques. Graded exposure was then used to enable Rachel to achieve her goal of going on the bus alone. The intervention process was completed over 12 sessions.
Findings
Outcome was measured using self‐report of seizure frequency. Rachel has successfully reduced the frequency of PNES from seven to two‐three per week, and has managed to successfully complete several bus journeys on her own, working through the hierarchy the authors had developed. The authors also completed pre and post therapy measures for anxiety and depression. Her scores on the Glasgow Anxiety Scale for Intellectual Disability reduced from 23 to 19 whilst she scored sub‐clinically on the Glasgow Depression Scale for Intellectual Disability.
Originality/value
This case report seeks to add to the evidence base of CBT as a viable treatment for PNES whilst also demonstrating that the approach can be adapted to meet the needs of clients with intellectual disabilities.
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The purpose of this paper is to provide health professionals with novel psychoactive substances (NPS) clients with up to date information relating to the background, clinical…
Abstract
Purpose
The purpose of this paper is to provide health professionals with novel psychoactive substances (NPS) clients with up to date information relating to the background, clinical pharmacology and, when possible, clinical management for each of these categories.
Design/methodology/approach
The world of NPS is complex and diverse, including a range of different molecules such as: psychedelic phenethylamines; synthetic cannabinoids, cathinone derivatives; novel stimulants; synthetic opiates/opioids; tryptamine derivatives; phencyclidine-like dissociatives; piperazines; GABA-A/GABA-B receptor agonists; a range of prescribing medications; psychactive plants/herbs; and a large series of performance and image-enhancing drugs. These molecules are sought by users for their psychactive effects.
Findings
The NPS categorization and classification provided here is an attempt to identify and better understand some of these substances. Given the vast range of medical and psychopathological issues associated with the NPS described it is crucial for health professionals to be aware of the effects and toxicity of NPS. The EU-MADNESS project aims to both better understand the pharmacology of the available/forthcoming NPS and to disseminate the most current NPS-related information to practising and training health professionals.
Research limitations/implications
Further studies are required to identify a range of evidence-based, NPS-focused, clinical management and treatment strategies.
Social implications
The rapid pace of change in the NPS online market constitutes a major challenge to the provision of current and reliable scientific knowledge on these substances.
Originality/value
The present review will provide an overview of the clinical and pharmacological issues related to a few hundred NPS.
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John Stirling, Rohan Morris and Lauren McCoy
Ketamine intoxication has been mooted as a model of some of the signs and symptoms of psychosis. However, little research has focused on the self‐report experience of ketamine…
Abstract
Purpose
Ketamine intoxication has been mooted as a model of some of the signs and symptoms of psychosis. However, little research has focused on the self‐report experience of ketamine users. The purpose of the current study is to quantify (the frequency of occurrence of) ketamine induced phenomenology in recreational users. The paper also seeks to meaningfully group these experiences into facets and their principal components.
Design/methodology/approach
Respondents completed a checklist of experiences, the Ketamine Experiences Questionnaire (KEQ). Two samples were recruited via opportunity and snowball sampling one in 2009 (n=52) and one in 2010/11 (n=35).
Findings
The “Q‐sort” and principal component analysis (PCA) indicate that there are two factors, factor one representing aversive ketamine experiences (accounting for 48.2 per cent of the variance) and factor two representing appetitive ketamine experiences (accounting for 20.1 per cent of the variance). Ketamine induces a raft of appetitive, aversive and transcendental experiences many of which are illustrated. The data suggest that a decision about whether to continue using ketamine (and if so, how often) depends in part on an intuitive cost‐benefit analysis of the phenomenology that it induces.
Research limitations/implications
There are some notable limitations to the current study; the small sample size to variable ratio necessitated a “Q‐sort” before PCA; the sampling procedure prohibited the generation of a representative sample; and there were no means of independently verifying ketamine use.
Originality/value
This study represents a novel exploration into ketamine phenomenology and the principal components of these experiences.
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Elspeth Bradley, Yona Lunsky, Anna Palucka and Soula Homitidis
The purpose of this paper is to determine: the extent to which an intellectual disability diagnosis meets current diagnostic and statistical manual of mental disorders (DSM…
Abstract
Purpose
The purpose of this paper is to determine: the extent to which an intellectual disability diagnosis meets current diagnostic and statistical manual of mental disorders (DSM) diagnostic criteria; the prevalence of reported autism spectrum disorders (ASD); and the extent to which assessment of developmental issues is central to the diagnosis of psychotic disorder, in patients discharged with a diagnosis of psychotic disorder and intellectual disabilities.
Design/methodology/approach
Of all patients discharged with psychotic disorder during a four‐year period (n=3339), chart reviews were completed on those also diagnosed with intellectual disability or borderline IQ.
Findings
The findings if this paper are threefold: only 39 percent of the 41 individuals discharged with a diagnosis of psychotic disorder and intellectual disability met documented DSM criteria for intellectual disability; the prevalence of reported ASD was much lower than expected; and the average number of different discharge diagnoses per individual over time was 4.8. Schizophrenia diagnoses were made early in the diagnostic process and tended to persist even when ASD concerns were documented.
Originality/value
The results support the need to systematically assess the developmental issues of patients with intellectual disability as part of the psychiatric diagnostic formulation. Differential diagnoses of psychotic‐like behaviours seen in people with intellectual disability, and alternative frameworks for understanding these behaviours, which in turn should guide more effective interventions and treatment, are discussed.
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This study aims to differentiate maladaptive personality domains through crime-related characteristics among convicts incarcerated in central jails of Punjab (CJP). In total, 552…
Abstract
Purpose
This study aims to differentiate maladaptive personality domains through crime-related characteristics among convicts incarcerated in central jails of Punjab (CJP). In total, 552 respondents were taken from nine CJP.
Design/methodology/approach
Data were collected through the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 Short Form (PID-5 SF) (Maples et al., 2015), and forced-choice questions were designed to measure crime-related characteristics.
Findings
Confirmatory factor analysis showed that PID-5 SF exhibited a good to excellent construct validity based on the DSM-5 criteria of using three facets to measure a domain (APA, 2013). Multivariate analysis showed that convicts who have committed different crime types and have criminal records exhibit different personality domains.
Originality/value
In addition to the literature, the data from all CJP, Pakistan, was collected and tested so that need for personality-oriented intervention could be identified for the prison setting. This also highlights that the usefulness of PID-5 SF is not only in identifying maladaptive personality among incarcerated convicts but also in differentiating between different crime-related characteristics.
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Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base is still…
Abstract
Purpose
Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base is still small and largely based on case studies and small trials whose participants mainly have mild to moderate ID. This paper aims to review and critique the literature in regards to the adaptations; and the effectiveness of psychodynamic psychotherapy for those with severe and profound ID.
Design/methodology/approach
A systematic literature search of PsycINFO, Social Policy and Practice, Medline, Cumulative Index to nursing and allied health literature and applied social sciences index and abstracts was conducted. Six studies met inclusion criteria and underwent a quality evaluation and critical review.
Findings
Six papers (all case studies) met inclusion criteria and underwent a quality evaluation and critical review. Some adaptations to therapy were reported, such as a more flexible therapeutic frame and increased use of the physical environment as a therapeutic tool. Due to significant methodological weaknesses of the included studies, it is yet unclear whether psychodynamic psychotherapy is an effective intervention for individuals with severe and profound ID.
Research limitations/implications
Only a small number of case studies met the inclusion criteria. Further research should use more robust outcome measures, larger samples and compare psychodynamic psychotherapy to alternative interventions.
Originality/value
This paper is the first to review the psychodynamic psychotherapy literature with regard to its effectiveness as a treatment specifically for individuals with severe and profound ID and mental health difficulties.
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Research on mental illness stigma in the Arab world has traditionally focused on socio-cultural barriers that deprive persons with mental illness from their fundamental human…
Abstract
Purpose
Research on mental illness stigma in the Arab world has traditionally focused on socio-cultural barriers that deprive persons with mental illness from their fundamental human right for privacy and informed consent. The purpose of this paper is to address the question whether or not mental health legislations in a number of Arab countries effectively safeguard the human rights of people with mental illness and protect them from stigmatizing and discriminatory practices.
Design/methodology/approach
A qualitative review of literature was performed over two rounds of search, targeting published research on mental illness stigma in the Arab world from year 2000 until now and existing national mental health legislations in the Arab world, using English and Arabic databases.
Findings
The review reveals that beyond society and culture, persistence of mental illness stigma in the Arab world may be explained by absent or inefficient monitoring mechanisms of mental health legislations and policies within the health-care setting. Although integration of mental health services into the primary health care system is being gradually implemented as a step toward de-stigmatization of mental illness, more remains to be done to change the stigmatizing behavior of the health personnel toward mental illness.
Originality/value
Mental health authorities in the Arab world need to be more aware of the public perceptions explaining people’s fear and reluctance to seek mental health care, so as to ensure that the control and monitoring mechanisms at both the primary and mental health care levels foster a human rights, culturally competent, patient-friendly and non-stigmatizing model of mental health care.
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Brenda Jones Harden, Brandee Feola, Colleen Morrison, Shelby Brown, Laura Jimenez Parra and Andrea Buhler Wassman
Children experience toxic stress if there is pronounced activation of their stress-response systems, in situations in which they do not have stable caregiving. Due to their…
Abstract
Children experience toxic stress if there is pronounced activation of their stress-response systems, in situations in which they do not have stable caregiving. Due to their exposure to multiple poverty-related risks, African American children may be more susceptible to exposure to toxic stress. Toxic stress affects young children’s brain and neurophysiologic functioning, which leads to a wide range of deleterious health, developmental, and mental health outcomes. Given the benefits of early care and education (ECE) for African American young children, ECE may represent a compensating experience for this group of children, and promote their positive development.
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