Developing practice in cancer rehabilitation.

This module explores the concept of rehabilitation and supportive care in a cancer context. It examines policy and practice that inform rehabilitation in cancer care in England and considers how rehabilitation and supportive care issues can be addressed in clinical practice.

Assessment of dysfunctional working models of self and others in schizophrenic patients: a summary of data collected in nine nations. International Research Group.

OBJECTIVE: To investigate the cross-cultural feasibility of a new scale for assessing dysfunctional working models of self and others, and to evaluate its discriminative power. METHOD: Schizophrenic patients (N=351), non-psychotic patients (N= 86) and non-clinical subjects (N= 511) collected in 10 centres completed the DWM-S. Current psychopathology was assessed by means of the BPRS. RESULTS: Alpha coefficients were high in all samples. Mean scores on the DWM-S appeared to be comparable in all countries, suggesting cross-national generalizability. No significant correlation was found with sex, age, levels of psychopathology and duration of illness. Discriminant analyses showed that more than 70% of the schizophrenic patients are correctly classified. CONCLUSION: The DWM-S is an easily administered self-report instrument which allows to pinpoint internal dysfunctional working models of self and others in various types of patients. It is a useful tool for case conceptualization, especially when psychotherapeutic interventions are part of the treatment programme.

Transhistorical variations in personality and their association with experiences of parental rearing.

A population sample comprised of 765 subjects (367 males and 398 females), in the age range of 15-81 years, completed the EMBU, a reliable questionnaire aimed at assessing experiences of parental rearing, and the TCI, a self-report questionnaire aimed at assessing dimensions of temperament and character. The study had three main aims: 1) to verify, on a larger scale, previous findings suggesting the occurrence of significant associations between experiences of parental rearing and aspects of temperament and character, 2) to assess possible variations in temperament and character in cohorts of subjects who have grown up in different historical epochs, and 3) to investigate to what extent transgenerational differences in parental rearing are detectable in different associations with various dimensions of personality. Several, albeit small, significant and meaningful associations between experiences of parental rearing and both temperament and character dimensions have been found, adding support to the robustness of previously reported results obtained in an independent smaller series. Also, several significant differences among subjects in different age groups have been found, both concerning temperament variables and character dimensions. Finally, the results show that associations between experiences of parental rearing and dimensions of temperament and character are most pronounced in subjects belonging to the youngest cohort and almost nil in the cohort comprising the oldest subjects.

Development and preliminary application of a new scale for assessing dysfunctional working models of self and others (DWM-S) in severely disturbed patients.

Although several suggestions have been made concerning the content and characteristics of cognitive/emotive schemata held by people with different disorders, there is still a scarcity of suitable instruments for verifying or measuring such constructs. This is particularly true of schemata postulated to be present in patients with personality disorders or a schizophrenic disorder. This article deals with the development of a new scale for assessing dysfunctional internal working models of self and others (DWM-S) in psychiatric patients. Preliminary results obtained in a sample of patients (n=110) and healthy subjects (n=40) suggest that the scale has a highly satisfactory internal consistency (Cronbach's alpha=0.97), and satisfactory test-retest reliability (rho coefficient=0.90 in healthy subjects and 0.86 in patients). Moreover, the DWM-S is able to discriminate between patients and healthy subjects and between patients suffering from various disorders. Further studies are in progress to assess the cross-national generalizability of the findings obtained so far.

Perceived parental rearing behaviour in patients with a schizophrenic disorder and its relationship to aspects of the course of the illness.

A total of 57 patients of both sexes (27 women and 30 men) with a definite diagnosis of a schizophrenic disorder completed the EMBU, a Swedish instrument designed to assess the experience of parental behaviour, that has been extensively used in cross-national studies. As in previous studies in different patient populations, three factors, 'rejection', 'emotional warmth' and 'overprotection', have been taken into account. The results obtained in the patient group were compared with those obtained in a control sample of healthy Swedish subjects. Schizophrenic patients rated both parents higher than controls on the factor 'rejection', and rated their mothers lower on the factor 'emotional warmth'. No correlation was found between EMBU score and age at the first hospitalization, or number of rehospitalizations within 1 year after discharge at the index episode. The present results cross-validate those obtained by other authors in other cultural settings, and suggest that negative experiences of parental rearing might be an important factor contributing to the development of 'vulnerability' in a person who will subsequently develop a schizophrenic disorder.

Cognitive therapy in the treatment of patients with borderline personality disorders.

Cognitive therapy, originally conceived for the treatment of emotional illnesses, has been successively used also in treating patients with more severe mental disorders. In this article, the results obtained by Shearin & Linehan (this volume) in a few controlled trials of dialectical behavior therapy in patients with borderline personality disorders are discussed. Differences between the treatment approach followed by Shearin & Linehan, which focuses on the modification of specific behaviors, and that favored by the author, which is aimed at restructuring dysfunctional working models of self and environment, are highlighted. In the conclusion it is emphasized that the use of a structured, didactic and cognitive-behaviorally oriented approach focused on personal growth might represent an important and much wanted breakthrough in the treatment of the most disturbed patients with a borderline personality disorder.

Cognitive therapy with schizophrenic patients.

Cognitive therapy has emerged as a feasible and valuable complement to the treatment of patients suffering from a schizophrenic disorder. It can be carried out at various levels and with different goals in mind and its use is not in conflict with concomitant and strictly individualized medication. In the article some of the approaches most commonly used are pointed out and some of the results of various approaches are highlighted.

Determinants of recall of parental rearing behavior. The influence of age or loss of parents by separation or death.

In a study of 562 psychiatric inpatients and 251 healthy controls, relationships between age of proband and related life events (divorce of parents, death of a parent) and the perceived parental rearing have been investigated. The inverse relationships obtained could be explained by the higher number of divorced parents among younger subjects with negatively experienced parental rearing practices on the one hand and an idealization of the parents who had died on the other hand. In psychiatric patients these relationships and differences were more pronounced pointing to the importance of parental rearing as a vulnerability factor for mental problems during adulthood. The necessity to control for age in studies of perceived parental rearing became obvious by the present results.

The distinction between unipolar and bipolar mood disorders. A 25-years perspective.

The paper deals with a critical appraisal of the state of art of the distinction between bipolar (manic-depressive) and unipolar recurrent affective disorders. However already propounded several years earlier by Leonhard, a distinction between bipolar and unipolar affective disorders has first been taken into general consideration during the last quarter of a century. It is currently firmly established in the most widely accepted international classification systems, and is taken into account in the major psychiatric textbooks. Looking back at the evolution of this distinction, to which research work by the present author has greatly contributed, there are reasons to feel both satisfied and unsatisfied at the same time. Satisfaction arises from the fact that a distinction between bipolar and unipolar affective disorders has contributed to advance our understanding of the nosology of the depressive states, hence, contributing to a higher degree of homogeneity in the populations of patients in research. Dissatisfaction, instead, is born by the ever increasing widening of the scope of the concept of bipolar and unipolar to which current classification systems greatly contribute.

An interactionistic integrating view of depressive disorders and their treatment.

The development of a depressive disorder is often considered from the perspective of biological causation, mental processes, or with a focus on possible social determinants, even though the possible concomitance of factors belonging to the different domains is generally acknowledged. In this article, a further development of an interactional model previously described is presented. The model is focused on the concept of individual vulnerability, which is assumed to result from a continuous interplay of the individuals with their environment, and from the effect of factors belonging to different domains that interact. A closer definition of individual vulnerability suggests that it consists of the interaction of biological characteristics of the person and a basically dysfunctional self-schema. Empirical studies in support of some of the hypotheses which can be derived from the model are briefly reviewed, and the implications of the model for the treatment of depression is underscored.

[The EMBU project--a multinational study of the importance of parental child rearing behavior for the development of psychopathologic phenomena]. / Das EMBU-Projekt--eine multinationale Untersuchung zur Bedeutung elterlichen Erziehungsverhaltens für die Entwicklung psychopathologischer Phänomene.

The influence of childhood experience on psychological development is discussed from various scientific viewpoints. Against this background, the origin of the cross-cultural, multinational EMBU Project on the relationship between upbringing in the family and psychopathology is described. It becomes obvious that a systematic, cross-cultural, and theory-orientated approach can bring significant material for the development of psychiatric theory.

Patterns of course in patients with a cross-sectional diagnosis of schizoaffective disorder.

The authors conducted a longitudinal study on two samples of patients, fulfilling Research Diagnostic Criteria for schizoaffective disorder and for major affective disorder, respectively. The long-term course in patients defined cross-sectionally as schizoaffective was very heterogeneous. Ten different patterns of course were identified. In schizoaffectives showing a bipolar course with the occurrence of pure affective episodes, the outcome was not different from that in patients with a cross-sectional diagnosis of major affective disorder, whereas in schizoaffectives whose course was characterized by the occurrence of schizodepressive episodes only, or of schizodepressive and schizophrenic episodes, the outcome was significantly poorer than in patients diagnosed as affective.

The importance of Karl Leonhard's classification of endogenous psychoses.

In this paper the author highlights the importance that the classificatory work carried out by Leonhard has had for recent international developments in the classification of mental disorders. In particular, the diagnostic relevance of a distinction between bipolar and unipolar affective disorders and the separation of the cycloid psychotic disorders from other major psychoses is underscored.

Cross-national generalizability of dimensions of perceived parental rearing practices: Hungary and The Netherlands; a correction and repetition with healthy adolescents.

In a previous study, an attempt was undertaken to examine whether dimensions of parental rearing style as measured with the Egna Minnen Beträffande Uppfostran (EMBU) on dimensions of Rejection, Emotional Warmth, Overprotection, and Favoring Subject can be generalized from Dutch adult samples, for whom they were originally interpreted from factor analyses, to an Hungarian adult sample. The findings suggested either differences in the meaning of the constructs between Hungarians and the Dutch or the presence of errors of translation in the Hungarian version. To rule out the possibility of inadequate translation, the Hungarian item-content was cross-checked by our Hungarian coworkers and, after reformulating several items, used for obtaining new data with a sample of adolescents. On the whole, negative findings with the old version disappeared with the new; clear evidence was found here for qualitative similarity/identity of the Rejection, Emotional Warmth, and Overprotection dimensions across the Dutch and Hungarian samples. Further studies with Hungarian persons are needed to examine whether these dimensions generalize from (nonpatient) adolescent to adult samples.