ABSTRACT
BACKGROUND: Clinicians meet a variety of ethnicities among patients and families in hospice programs. This article focuses on Latino families. METHODS: Within a controlled trial of family therapy in the context of palliative care, 17 families identified as Hispanic. Five were examined qualitatively herein. RESULTS: A synopsis of each family's narrative is presented here. Patterns of strong family loyalty (Familismo), the gender roles of Machismo and Marianismo, the importance of family tradition, expectations about caregiving, and the place of faith and religion emerged as prominent and able potentially to impact on the therapy. CONCLUSIONS: Family therapists need to be thoughtful about cultural issues as they strive to support families.
Subject(s)
Hispanic or Latino/ethnology , Palliative Care , Adolescent , Adult , Caregivers/psychology , Child , Culture , Family/ethnology , Family/psychology , Family Therapy , Female , Gender Identity , Grief , Hispanic or Latino/psychology , Humans , Male , Middle Aged , Neoplasms/ethnology , Neoplasms/therapy , Religion and Medicine , Social ValuesABSTRACT
OBJECTIVE: The purpose of this paper is to present a review of research on the efficacy of psychotherapeutic interventions for children, adolescents and adults with social anxiety disorder. Data are presented on the relative efficacy of cognitive-behavioral therapies (CBTs), pharmacotherapy and combination treatments. We also discuss research on specific clinical conditions that are likely to influence treatment success. METHOD: Relevant studies were identified through literature searches, reference lists and research databases. RESULTS: Non-pharmacologic treatments for social anxiety disorder, particularly CBTs, have gained substantial empirical support over the last two decades. However, questions remain about how to maximize the benefit of available treatments. CONCLUSION: New directions for future research in this area are discussed.
Subject(s)
Cognitive Behavioral Therapy , Phobic Disorders/therapy , Adolescent , Adult , Anti-Anxiety Agents/therapeutic use , Child , Combined Modality Therapy , Humans , Treatment OutcomeABSTRACT
BACKGROUND: The clinical Global Impression Scale (CGI) is commonly used as a primary outcome measure in studies evaluating the efficacy of treatments for anxiety disorders. The current study evaluated the psychometric properties and predictors of clinicians' ratings on an adapted version of the CGI among individuals with social anxiety disorders. METHOD: An independent assessor administered the CGI Severity of Illness and Improvement ratings to 123 patients at baseline and the subset of treated patients again mid- and post-treatment. RESULTS: Improvement ratings were strongly related to both concurrent Severity of Illness and changes in Severity of Illness ratings from baseline. Additionally, both CGI ratings were positively correlated with both self-report and clinician-administered measures of social anxiety, depression, impairment and quality of life. Measures of social anxiety symptoms accounted for a large portion of the variance in Severity of Illness ratings, with significant additional variance accounted for by measures of impairment and depression. Changes in social anxiety symptoms from baseline accounted for significant variance in Improvement ratings, but no significant additional variance was accounted for by changes in impairment and depressive symptoms. CONCLUSIONS: Our findings support the utility of the CGI as an index of global severity and symptom-specific improvement among individuals with social anxiety disorder.
Subject(s)
Phobic Disorders/diagnosis , Psychiatric Status Rating Scales/standards , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Phobic Disorders/psychology , Phobic Disorders/therapy , Reproducibility of Results , Severity of Illness IndexABSTRACT
OBJECTIVE: This study investigates psychiatric comorbidity associated with eating disorder symptomatology among adolescents in the community. METHOD: Four hundred three adolescents in the community were administered structured clinical interviews to assess mood, anxiety, eating, substance use, and personality disorders. RESULTS: Adolescents with dysthymia, panic and major depressive disorder were significantly more likely than those without these disorders to have an eating disorder. After controlling for the effects of other Axis I disorders and personality disorders, only dysthymia independently predicted the presence of an eating disorder. Several personality disorders were also associated with eating disorder symptoms. However, only obsessive-compulsive personality disorder predicted eating disorder symptoms after controlling for other personality disorders. CONCLUSION: Although previous research on adults has focused on the association between major depressive disorder and eating disorders, dysthymia may be more strongly associated with eating disorders among adolescents in the community. This association is not accounted for by psychiatric comorbidity.
Subject(s)
Dysthymic Disorder/complications , Dysthymic Disorder/diagnosis , Feeding and Eating Disorders/complications , Feeding and Eating Disorders/diagnosis , Panic Disorder/complications , Panic Disorder/diagnosis , Personality Disorders/complications , Personality Disorders/diagnosis , Adolescent , Adolescent Behavior/psychology , Comorbidity , Female , Humans , Interview, Psychological , Logistic Models , Male , Predictive Value of Tests , Prevalence , Psychology, Adolescent , Risk Factors , Sampling Studies , Surveys and QuestionnairesABSTRACT
The increased risk of physical health problems in adult depressed patients has been shown in numerous studies. A recent study of the offspring of depressed parents found similar associations. The purpose of this study is to examine the strength and specificity of the association between depression and physical health problems in children and adolescents whose parents are dependent upon opiates. The sample consisted of offspring ages 6-17 (mean age 11 years) of opiate addicts who had a history of major depressive disorder (MDD; n = 28); other mood disorders (n = 31); no history of mood disorders but other psychiatric disorders (n = 92); or no history of psychiatric disorder (n = 127). Detailed psychiatric assessment and medical history of the offspring by direct interview with the offspring and an informant were obtained blind to parental diagnosis. After controlling for possible confounders, there was an increased risk of dermatological disorders, headache, other neurological/neuromuscular disorders, bronchitis, other respiratory disorders and hospitalizations for nonsurgical procedures in offspring with MDD, as compared to nonpsychiatrically ill controls. The offspring with other mood disorders had a slightly elevated risk. Major depression in children and adolescents whose parents are dependent on opiates is associated with increased risk of physical health problems. This finding is consistent with other reports and the timing of the physical health problems requires further study.
