Young offenders' experiences of traumatic life events: a qualitative investigation.

This investigation aimed to look at how a group of young offenders attending an inner-city youth offending team experienced adverse and traumatic life events. A qualitative approach was used and semi-structured interviews were conducted with eight young offenders about their perceptions of difficult experiences and the effects of such events. The interviews were analysed using Interpretative Phenomenological Analysis (Smith, Jarman, & Osborn, 1999). Analysis of the accounts yielded a number of themes. Young offenders experienced violence at home, in the community and in custody. Instability and transitions emerged as important themes in relation to school and home. Deprivation was experienced both in terms of poverty and the literal and emotional absence of parents. A variety of cognitive, emotional and behavioural responses to adverse/traumatic experiences were identified, including a blocking out of painful experience and aggression to self and others. There were barriers to seeking or making use of professional support. Custody appeared to offer an opportunity to reflect on and re-evaluate life trajectory. The study concluded that greater consideration of trauma when carrying out assessments would enable ;at risk' young offenders to be identified using clinical interviewing along side standardized measures to aid assessment of the complexity and uniqueness of the response to trauma.

Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia.

OBJECTIVE: The authors systematically reviewed the literature on psychological approaches to treating the neuropsychiatric symptoms of dementia. METHOD: Reports of studies that examined effects of any therapy derived from a psychological approach that satisfied prespecified criteria were reviewed. Data were extracted, the quality of each study was rated, and an overall rating was given to each study by using the Oxford Centre for Evidence-Based Medicine criteria. RESULTS: A total of 1,632 studies were identified, and 162 satisfied the inclusion criteria for the review. Specific types of psychoeducation for caregivers about managing neuropsychiatric symptoms were effective treatments whose benefits lasted for months, but other caregiver interventions were not. Behavioral management techniques that are centered on individual patients' behavior or on caregiver behavior had similar benefits, as did cognitive stimulation. Music therapy and Snoezelen, and possibly sensory stimulation, were useful during the treatment session but had no longer-term effects; interventions that changed the visual environment looked promising, but more research is needed. CONCLUSIONS: Only behavior management therapies, specific types of caregiver and residential care staff education, and possibly cognitive stimulation appear to have lasting effectiveness for the management of dementia-associated neuropsychiatric symptoms. Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research (only nine level-1 studies were identified). More high-quality investigation is needed.

What causes problems in Alzheimer's disease: attributions by caregivers. A qualitative study.

OBJECTIVE: To gain insight into caregivers' understanding of the causes of behaviours they find problematic in people with Alzheimer's disease in order to inform the development of educational strategies. METHODS: A qualitative, semi-structured interview was used. Participants were 205 caregivers for a person with Alzheimer's disease, all of whom were aware of the diagnosis and who had been recruited as part of a larger longitudinal study. Participants were from inner-city and suburban London/semi-rural Essex. The main outcome measures were caregivers' understanding of: the cause of problematic behaviour; the ability of the person with dementia to control this behaviour; the prognosis of the illness. RESULTS: Most carers attribute the cognitive, behavioural and psychological symptoms of dementia to causes other than dementia; many believe that the person with dementia has control over their behaviour and substantial numbers believe the person with dementia will return to normal. CONCLUSIONS: This study suggests that providing facts about the illness to caregivers is not enough, as caregivers may not understand that the symptoms they observe are related to the diagnosis. Education by clinicians should focus on the understanding of caregivers and in particular explore the caregivers' attributions of the symptoms which are present in the person for whom they care.