ABSTRACT
The way in which the family copes with and adapts to illness of one of its members has a strong impact on the physical and psychosocial well-being of all members and on the shape and duration of the clinical course of the illness itself. The family doctor therefore should be able to evaluate the families' adaptation to illness and to promote successful coping strategies where necessary. This review illustrates how the family doctor's evaluation of the illness impact on family functioning is facilitated by a family developmental approach and by the use of a psychosocial classification scheme of illnesses.
Subject(s)
Adaptation, Psychological , Disease/psychology , Family Practice , Family/psychology , Physician's Role , Sick Role , Acute Disease , Chronic Disease , Health Promotion , Health Services Needs and Demand , Human Development , Humans , Quality of LifeABSTRACT
While the effects of short-term benzodiazepine treatment have been extensively studied in several well-designed, controlled, clinical trials, further information is needed on the value and risks of anxiolytic drugs when administered over months to maintain chronic patients. Clinical trials on the effects of long-term benzodiazepine treatment present several methodological problems. The aim of this paper is to discuss these problems in relation to samples, drugs and dosage, duration, measures and experimental design.
Subject(s)
Benzodiazepines/therapeutic use , Anxiety Disorders/drug therapy , Benzodiazepines/administration & dosage , Clinical Trials as Topic , Humans , Research Design/standardsABSTRACT
1. Twenty-four anxious inpatients were treated with diazepam, amylobarbitone sodium and placebo in flexible dosage for 1 week. They each received all three treatments according to a fully-balanced design, using double-blind procedures. 2. The clinical and the psychological effects of the drugs were assessed by the comprehensive battery of psychiatrist's ratings, subjective and psychological tests before treatment and at the end of each week of treatment. The tests included self-rating of anxiolytic and hypnotic effects, reaction-time, card sorting, coding and cancellation tasks, arithmetic and tappin. 3. Diazepam improved significantly subjective anxiety and insomnia, while amylobarbitone improved only the self-rated quality of sleep. Occasion effects were absent on clinical measures, indicating that the patients did not respond to non-specific temporal factors. Performance on motor tasks improved over time because of the expected practice effect, but an impairment relative to placebo was detected on two motor tests after the barbiturate and on four other tests with a cognitive component after the benzodiazepine.
Subject(s)
Amobarbital/therapeutic use , Anxiety/drug therapy , Diazepam/therapeutic use , Adult , Amobarbital/adverse effects , Clinical Trials as Topic , Diazepam/adverse effects , Double-Blind Method , Female , Humans , Male , Middle Aged , Motor Skills/drug effects , Placebos , Psychiatric Status Rating Scales , Reaction Time/drug effects , Sleep Initiation and Maintenance Disorders/drug therapyABSTRACT
A six-item predictive scale for parasuicide repetition was retested on a second sample of Italian parasuicides. All the patients firstever admitted after a deliberate self-harm to the psychiatric department of a general hospital during the period April 1973-March 1976 were interviewed and followed-up after an interval of 1 year. The scale showed the same predictive power found in the first sample (1970-73) and gave a range of probability of repetition within 1 year of 15% at a score of 0 up to 44.8% at the scores 3, 4, 5, and 6. Moreover it discriminated between repeaters and non-repeaters at a significant level. Only two items (diagnosis of sociopathy and change of domicile in the last year) of the five items which discriminated repeaters from non-repeaters in the first study were still significantly associated with repetition, while four additional items (previous in-patient psychiatric treatment; previous parasuicide resulting in hospital admission; unemployment; criminal record) appeared as new discriminating factors. In spite of these changes the rate of repetition remained constant over the years at around 26%.
Subject(s)
Suicide, Attempted , Follow-Up Studies , Humans , Risk , Self-Injurious Behavior , Suicide, Attempted/prevention & controlABSTRACT
A six-point prodictive scale for parasuicide repetition developed by Buglass and Horton (1974a) was tested on a group of patients admitted for parasuicide to a psychiatric ward of one of the city hospitals of Verona. The scale gave a range of probability of repetition within 12 months of 15 per cent at a score of o up to 45-5 per cent at the scores 3, 4, 5 and 6. Moreover the scale discriminated significantly between repeaters and non-repeaters. Items significantly associated with repetition in the Italian sample, which are not represented by the six-point scale were: previous parasuicide not admitted to hospital, violence received, alcohol taken at time of act, less than one year at the present address.
