The mediatory role of maladaptive schema modes between parental care and non-suicidal self-injury.

Non-suicidal self-injury (NSSI) is being increasingly recognised as a behaviour of significant clinical importance. Yet, there remains uncertainty regarding the underlying mechanisms of NSSI. This study aimed to explore the relationship between maladaptive schema modes, parental bonding, and NSSI. Seventy psychiatric outpatients with a history of NSSI completed the Deliberate Self-Harm Inventory, Schema Mode Inventory, and Parental Bonding Inventory. Results revealed that maladaptive schema modes were significantly associated with low parental care and with an earlier age of onset, longer duration, and higher number of methods of NSSI. Maladaptive schema modes also significantly mediated the relationship between parental care and age of onset of NSSI and between parental care and duration of NSSI. Two maladaptive schema modes (namely, Punitive Parent and Angry Child) were also found to be significant mediators in this relationship. The clinical implications of this research are discussed.

The management of inappropriate vocalisation in dementia: a hierarchical approach.

BACKGROUND: Patients with dementia can demonstrate noisy behaviours such as screaming, repetitive speech, moaning and singing. Such behaviours can be grouped under the title of "Inappropriate Vocalisation" which is used in this article to describe any noise making which impacts detrimentally upon patients, families or those in a caring role. Inappropriate vocalisation is notoriously difficult to treat and clinicians may have to rely on a "trial and error" approach when attempting to limit the distress it causes. OBJECTIVES: This paper applies a hierarchical approach to Behavioural and Psychological Symptoms of Dementia (BPSD) in attempting to tackle inappropriate vocalisation systematically. Nine steps are ranked within three stages, with evidence for each intervention being considered sequentially in terms of the likelihood for success as the authors attempt to review the relevant literature. METHODS: The authors performed a search of the medline database using the key words "screaming," "shouting," "persistent vocalisation" and "inappropriate vocalisation" combined with the key word "dementia". Further searches of the references of medline generated articles revealed a second group of articles of use in this review. RESULTS: The search generated 53 reviews, research papers, case studies or letters, 36 of which are referenced in this article and the remaining references drawn from reading by the authors around the subject and related problems. CONCLUSION: Interventions for inappropriate vocalisation in dementia are not limited to medication. Environmental factors and behavioural approaches are considered ahead of pharmacotherapy as the concepts of Underlying Illness, Hidden Meaning and Empirical Treatments are used to structure consideration of important, and sometimes overlooked, issues including pain, depression and overall level of stimulation.