Intensive care unit syndrome: a consideration of psychological interventions.

There is little in the psychological literature to guide clinicians treating ICU patients presenting with the ICU syndrome. Existing psychological models need to be developed and adapted in the management of these cases. This paper describes two clinical cases and offers psychological formulations and descriptions of treatment.

Psychological consequences of road traffic accidents.

Although accident-induced psychopathology was formerly considered as being associated with secondary gain, subsequent reports have refuted this contention. More recent studies have shown that road traffic accident-induced psychopathology can be a persistent and chronic disability, irrespective of whether the victim seeks compensation. This study describes the psychological assessment of 50 potential road traffic accident litigants referred by solicitors. They were all assessed within a hospital setting approximately three weeks after the receipt of the request for a psychological report. All participants completed measures of depression, anxiety, post-traumatic stress and subjective distress, and information was obtained about injuries sustained. The results suggest that the potential litigants who sustained an injury presented with significantly higher post-traumatic distress intrusion and avoidance scores, and that these scores are also influenced by the delay between the accident and the assessment. Furthermore, the sample showed intrusion, avoidance and perceived stress scores above normal population data. Reducing the delay between the accident and assessment has important clinical implications. However, it appears that solicitors rather than general practitioners initiate these referrals. Some implications for assessment prior to treatment are discussed.

Using the partner in the psychosocial treatment of schizophrenia: a multiple single case design.

This report describes the treatment of six couples where one partner had a long psychiatric history and a long-standing diagnosis of schizophrenia. Using a multiple single case design, the effects of providing the couples with information about schizophrenia and systematic family management (comprising problem solving and communication training) were assessed. The results showed that providing information alone had no effect on presenting symptoms but did improve the partners' perception of their ability to cope and solve problems. While a causal effect of treatment on improvement was not conclusively proven, the cycle of readmission and relapse was altered.

Therapist and patient factors in the behavioural treatment of phobic patients.

Thirty-five phobic patients were assessed in order to investigate the specific therapist and patient factors operative within treatment. Although the factors were highly correlated, they did distinguish between those patients who benefited differentially from treatment.

Therapist's and client's perceptions in behaviour therapy: the development and cross-cultural analysis of an assessment instrument.

This paper describes the use of a scale to assess the therapist's perception of the client and the client's perception of the therapist within behaviour therapy. A factor analysis revealed specific therapist and client factors which describe aspects of each participant's activity within sessions. The results suggest that the therapist's interpersonal manner is important in treatment and that attention should be given to this in training behaviour therapists.

A composite formulation of agoraphobia.

Agoraphobia is a disabling disorder with many diverse views about its genesis, maintenance, and treatment. In this paper three perspectives--attachment and misattribution, safety signal, and interpersonal context--are described in a composite formulation of the condition.

Two approaches to family therapy with alcoholics: problem-solving and systemic therapy.

A significant proportion of the alcohol population continues to function within intact families. Two comparative family therapy approaches are described that have been used in treating alcoholics and their families. Problem-solving therapy focuses directly on the drinking and attempts to modify this through the active participation of family members. The Milan systemic approach aims to alter the family system's functioning and so effect change in the problem drinker.

Psychological models of self-mutilation.

The descriptive models of self-mutilation fall into three broad categories. The psychodynamic formulation; the second category includes the anxiety reduction model, the hostility model, the behavioral learning model and the appeal model; the third social learning category includes the group-epidemic model and aspects of the violence and punishment model. The three models support the view that there is no single cause or motive responsible for self-mutilating behavior. Having a number of factors in mind allows for flexibility and enables clinicians to test particular hypotheses during management and gives them the opportunity to alter intervention accordingly. The problems faced by self-mutilating patients are so varied that no single form of treatment is likely to be universally appropriate.