ABSTRACT
Rumination syndrome is a functional bowel disorder where stomach contents effortlessly regurgitate into the mouth. It is an entirely separate entity to gastro-oesophageal reflux disease and requires behavioural rather than pharmaceutical management. Symptoms usually respond well to treatment, though in extreme cases, patients may experience significant weight loss and require inpatient admission.
Subject(s)
Gastroesophageal Reflux , Rumination Syndrome , Child , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Humans , Referral and ConsultationABSTRACT
Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a disabling condition known to have a negative impact on all aspects of a child's life. However, little is understood about the impact of CFS/ME on siblings. A total of 34 siblings completed questionnaires measuring depression (Hospital Anxiety and Depression Scale (HADS)), anxiety (HADS and Spence Children's Anxiety Scale (SCAS)) and European Quality-of-life-Youth (EQ-5D-Y). These scores were compared with scores from normative samples. Siblings had higher levels of anxiety on the SCAS than adolescents of the same age recruited from a normative sample; however, depression and quality-of-life were similar. Interviews were undertaken with nine siblings of children with CFS/ME who returned questionnaires. Interview data were analysed using a framework approach to thematic analysis. Siblings identified restrictions on family life, 'not knowing' and lack of communication as negative impacts on their family, and change of role/focus, emotional reactions and social stigma as negative impacts on themselves. They also described positive communication, social support and extra activities as protective factors. Paediatric services should be aware of the impact of CFS/ME on the siblings of children with CFS/ME, understand the importance of assessing paediatric CFS/ME patients within the context of their family and consider providing information for siblings about CFS/ME.
Subject(s)
Fatigue Syndrome, Chronic/psychology , Personal Satisfaction , Quality of Life/psychology , Siblings/psychology , Adolescent , Child , Female , Humans , MaleABSTRACT
This study examines the concerns and beliefs about medication reported by patients with nonmalignant chronic pain encountered within general practice. Two hundred thirty-nine patients with chronic pain took part in this research. Patients completed the Pain Medication Attitudes Questionnaire, a measure of patient concerns and beliefs relating to addiction, withdrawal, side effects, mistrust in doctors, perceived need of medication, scrutiny from others, and tolerance. The data revealed that patient concerns and beliefs predicted general medication nonadherence. In addition, concerns were related to the direction of nonadherence: overuse of medication was related to increased perceived need for medication and greater concern over side effects; underuse was related to decreased concerns over withdrawal and increased mistrust in the prescribing doctor. Analyses also indicated that patient attitudes and concerns about medication were more predictive of nonadherence than both level of pain and the reported frequency of experienced side effects. This research contributes to the increasing evidence that patient attitudes and beliefs about pain medication are associated with adherence behavior. Training general practitioners to identify and address these concerns may reduce concerns, improve adherence, and facilitate the doctor-patient relationship.
Subject(s)
General Practice/statistics & numerical data , Medication Adherence/psychology , Pain/psychology , Adult , Aged , Aged, 80 and over , Analgesics/therapeutic use , Chronic Disease , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Pain/drug therapy , Regression Analysis , Surveys and QuestionnairesABSTRACT
BACKGROUND: Research has demonstrated the effectiveness of computerized cognitive behaviour therapy (cCBT) for depression and anxiety in adults, but there has been little work with children and adolescents. AIMS: To describe the development of a cCBT intervention (Think, Feel, Do) for young people, and preliminary outcomes and feedback from a pilot randomized controlled trial. METHOD: Twenty participants aged 11 to 16 with depression or anxiety were randomized to receive cCBT immediately or after a delay. Standardized measures were used to assess self-reported anxiety, depression, self-esteem and cognitions, as well as parent rated strengths and difficulties. A feedback form was also completed to assess young people's views of the programme. RESULTS: A total of 15 participants completed the pre and post assessments in the trial, and 17 provided feedback on the intervention. Paired samples t-tests demonstrated significant improvements on 3 subscales in the control condition, compared to 7 subscales in the cCBT condition. Feedback showed moderate to high satisfaction for participants. CONCLUSIONS: This study provides encouraging preliminary results for the effectiveness and acceptability of cCBT with this age group.
Subject(s)
Anxiety Disorders/therapy , Cognitive Behavioral Therapy/methods , Depressive Disorder/therapy , Emotions , Feedback , Therapy, Computer-Assisted/methods , Thinking , Adolescent , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Child , Computer Graphics , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Follow-Up Studies , Humans , Male , Personality Inventory/statistics & numerical data , Pilot Projects , Psychometrics , Self Concept , Software , Video RecordingABSTRACT
BACKGROUND: Research has begun to examine the effectiveness of computerized cognitive behaviour therapy (cCBT) with children and adolescents. Although cCBT appears promising, the attitudes of clinicians towards this type of intervention with children and young people have not been assessed, yet these are important in determining when and if cCBT will be offered. AIMS: To survey clinicians' attitudes towards cCBT with children and adolescents. METHOD: A self-report questionnaire was completed by 43 mental health professionals attending a conference. RESULTS: Clinicians were cautious but generally positive about the use of cCBT with children and adolescents, particularly for the delivery of prevention programmes and in the treatment of mild/moderate problems. Few felt that cCBT should be available freely online without any professional support. Indeed, the lack of a therapeutic relationship and professional support were identified as the biggest problems, whilst the potential to use cCBT at home was the greatest advantage identified. CONCLUSIONS: This survey suggests that clinicians are generally positive about the use of cCBT with children and adolescents for the prevention and treatment of mild/moderate problems. Further research is required to address clinicians' concerns about the effectiveness of cCBT for more substantial problems and the level of therapeutic support required.
Subject(s)
Anxiety Disorders/therapy , Attitude of Health Personnel , Cognitive Behavioral Therapy/methods , Depressive Disorder, Major/therapy , Internet , Therapy, Computer-Assisted/methods , Adolescent , Anxiety Disorders/prevention & control , Anxiety Disorders/psychology , Child , Data Collection , Depressive Disorder, Major/prevention & control , Depressive Disorder, Major/psychology , Female , Humans , Male , Patient Care Team , Professional-Patient Relations , Surveys and Questionnaires , Treatment Outcome , United KingdomABSTRACT
Research has shown that computerised cognitive behaviour therapy (cCBT) can be effective in the treatment of depression and anxiety in adults, although the outcomes with children and adolescents are unclear. The aim of the study is to systematically review the literature on the effectiveness of cCBT for the prevention and treatment of depression and anxiety in children and adolescents. EMBASE, PsychInfo and Pubmed were searched using specific terms and inclusion criteria for cCBT studies involving young people under the age of 18. A hand search was also conducted, and the authors were contacted to identify additional papers. Ten studies met the inclusion criteria. These included case series and randomised controlled trials concerned with both treatment and prevention. Six different software packages were described that varied in length and the nature and extent of professional contact and supervision. All studies reported reductions in clinical symptoms and also improvements in variables such as behaviour, self-esteem and cognitions. Satisfaction with treatment was moderate to high from both children and parents, though levels of drop out and non-completion were often high. Additional randomised controlled trials are required, as the literature is currently limited. However, preliminary evidence suggests that cCBT is an acceptable and effective intervention for this age group.
Subject(s)
Anxiety Disorders/prevention & control , Anxiety Disorders/therapy , Cognitive Behavioral Therapy/methods , Depressive Disorder/prevention & control , Depressive Disorder/therapy , Therapy, Computer-Assisted/methods , Adolescent , Anxiety Disorders/psychology , Child , Depressive Disorder/psychology , Humans , Patient Acceptance of Health Care/psychology , Patient Dropouts/psychology , Patient Satisfaction , Professional-Patient Relations , Randomized Controlled Trials as Topic , Self Concept , SoftwareABSTRACT
There is an increasing number of studies of acceptance, mindfulness, and values-based action in relation to chronic pain. Evidence from these studies suggests that these processes may be important for reducing the suffering and disability arising in these conditions. Taken together these processes entail an overarching process referred to as "psychological flexibility." While these processes have been studied in people with chronic pain contacted in specialty treatment centers, they have not yet been investigated in primary care. Thus, participants in this study were 239 adults with chronic pain surveyed in primary care, through contact with their General Practitioners (GPs), in the UK. They completed measures of acceptance of chronic pain, mindfulness, psychological acceptance, values-based action, health status, and GP visits related to pain. Correlation coefficients demonstrated significant relations between the components of psychological flexibility and the measures of health and GP visits. In regression analyses, including both pain intensity and psychological flexibility as potential predictors, psychological flexibility accounted for significant variance, DeltaR(2)=.039-.40 (3.9-40.0%). In these regression equations pain intensity accounted for an average of 9.2% of variance while psychological flexibility accounted for 24.1%. These data suggest that psychological flexibility may reduce the impact of chronic pain in patients with low to moderately complex problems outside of specialty care. Due to a particularly conservative recruitment strategy the overall response rate in this study was low and the generality of these results remains to be established.
Subject(s)
Activities of Daily Living/psychology , Adaptation, Psychological/physiology , Pain Threshold/psychology , Pain/nursing , Pain/psychology , Primary Health Care/methods , Adult , Aged , Aged, 80 and over , Analysis of Variance , Awareness/physiology , Chronic Disease , Disability Evaluation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain Measurement , Regression Analysis , Retrospective Studies , Surveys and QuestionnairesABSTRACT
BACKGROUND: There has been little research examining attitudes towards computerised therapy in young people. METHOD: A self-report survey of 37 young people and 31 parents using Child and Adolescent Mental Health Services (CAMHS). RESULTS: Young people reported high levels of computer usage and online help-seeking behaviour. Young people were cautious about computerised therapy whereas parents were more positive, identifying more benefits than concerns. CONCLUSIONS: Mental health professionals need to be aware of young people's online help-seeking behaviour in order to correct inaccuracies and maximise uptake of computerised therapy.
