Counseling Clients with Dual Disorders: Information for Rehabilitation Counselors

1999 ◽  
Vol 30 (3) ◽  
pp. 3-10 ◽  
Author(s):  
Jhan D. Doughty ◽  
Brandon Hunt
Keyword(s):  
Substance Dependence ◽  
Psychotic Disorders ◽  
Rehabilitation Counseling ◽  
Chemical Dependency ◽  
Integrated Treatment ◽  
Future Research ◽  
Dual Disorders ◽  
Rehabilitation Programs ◽  
Dual Disorder ◽  
Counseling Clients

Persons with dual disorders of psychiatric illness and substance dependence represent a significant portion of clients in mental health, chemical dependency, and/or other rehabilitation programs. Several psychiatric disorders are commonly found in persons with coexisting substance dependence disorders, including anxiety and mood disorders, psychotic disorders, and personality disorders. In this paper, dual disorder classifications are discussed as well as information on the prevalence of each disorder. The differing views regarding dual disorders treatment are presented, as well as the models used in chemical dependency, psychiatric, and integrated treatment settings. Implications for rehabilitation counseling and future research needs are also addressed.

Integrated treatment of dual disorders in The Netherlands: a qualitative study of client experiences

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Anneke van Wamel ◽  
Ankie Lempens ◽  
Arjen Neven
Keyword(s):  
Mental Health Problems ◽  
Recovery Process ◽  
Integrated Treatment ◽  
Dual Disorders ◽  
Content Type ◽  
Client Experiences ◽  
Organisation Of Care ◽  
Qualitative Thematic Analysis ◽  
Treatment Models ◽  
Dual Disorder

Purpose Many clients who suffer from severe mental health problems also struggle with alcohol and drug use. And although there seems to be a consensus in most European countries that integrated treatment models (especially the integrated treatment of dual disorder clients model) are best fitted to help these clients, none of these have strong evidence, mostly owing to methodological limitations in the studies. This study aims to contribute to the knowledge of why integrated treatment is helpful by conducting in-depth interviews with dual disorder clients who are currently receiving integrated treatment. Design/methodology/approach This study is a qualitative thematic analysis using a timeline tool to elicit participants’ responses. In the interviews, dual diagnosis clients with severe problems reflected on their situation at admission, the care they received in integrated treatment and their opinions on positive and negative elements. The interviews were coded and analysed with MAXQDA. Findings In the analyses of the interviews, this study found three clusters of elements that clients indicated were the most helpful during their treatment and recovery process: trusting and meaningful relationship with the team, components of integrated treatment and organisation of care. Originality/value The findings emphasized the importance of working relationship in the treatment of complex and long-term problems. This has implications for the evaluation of these integrated treatment models which so far mainly focuses on specific interventions.

scholarly journals Cannabinoids, reward processing, and psychosis

2021 ◽  
Author(s):  
Brandon Gunasekera ◽  
Kelly Diederen ◽  
Sagnik Bhattacharyya
Keyword(s):  
Psychotic Disorders ◽  
Neural Substrates ◽  
Brain Regions ◽  
Reward Processing ◽  
Anterior Cingulate ◽  
Psychotic Symptoms ◽  
Dopamine Synthesis ◽  
Future Research ◽  
Drug Challenge ◽  
Psychotomimetic Effects

Abstract Background Evidence suggests that an overlap exists between the neurobiology of psychotic disorders and the effects of cannabinoids on neurocognitive and neurochemical substrates involved in reward processing. Aims We investigate whether the psychotomimetic effects of delta-9-tetrahydrocannabinol (THC) and the antipsychotic potential of cannabidiol (CBD) are underpinned by their effects on the reward system and dopamine. Methods This narrative review focuses on the overlap between altered dopamine signalling and reward processing induced by cannabinoids, pre-clinically and in humans. A systematic search was conducted of acute cannabinoid drug-challenge studies using neuroimaging in healthy subjects and those with psychosis Results There is evidence of increased striatal presynaptic dopamine synthesis and release in psychosis, as well as abnormal engagement of the striatum during reward processing. Although, acute THC challenges have elicited a modest effect on striatal dopamine, cannabis users generally indicate impaired presynaptic dopaminergic function. Functional MRI studies have identified that a single dose of THC may modulate regions involved in reward and salience processing such as the striatum, midbrain, insular, and anterior cingulate, with some effects correlating with the severity of THC-induced psychotic symptoms. CBD may modulate brain regions involved in reward/salience processing in an opposite direction to that of THC. Conclusions There is evidence to suggest modulation of reward processing and its neural substrates by THC and CBD. Whether such effects underlie the psychotomimetic/antipsychotic effects of these cannabinoids remains unclear. Future research should address these unanswered questions to understand the relationship between endocannabinoid dysfunction, reward processing abnormalities, and psychosis.

scholarly journals Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review and meta-analysis

2017 ◽  
Vol 210 (5) ◽  
pp. 324-332 ◽  
Author(s):  
Danyael Lutgens ◽  
Genevieve Gariepy ◽  
Ashok Malla
Keyword(s):  
Systematic Review ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Meta Analysis ◽  
Psychosocial Interventions ◽  
Detailed Examination ◽  
Behavioural Therapy ◽  
Integrated Treatment ◽  
Treatment As Usual

BackgroundNegative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination.AimsTo conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders.MethodWe searched for randomised controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure.ResultsA total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive–behavioural therapy (pooled SMD −0.34, 95% CI −0.55 to −0.12), skills-based training (pooled SMD −0.44, 95% CI −0.77 to −0.10), exercise (pooled SMD −0.36, 95% CI −0.71 to −0.01), and music treatments (pooled SMD −0.58, 95% CI −0.82 to −0.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD −0.38, 95% CI −0.53 to −0.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity.ConclusionsSpecific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed.

scholarly journals Clinical Lycanthropy, Neurobiology, Culture: A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Sélim Benjamin Guessoum ◽  
Laelia Benoit ◽  
Sevan Minassian ◽  
Jasmina Mallet ◽  
Marie Rose Moro
Keyword(s):  
Systematic Review ◽  
Evaluation System ◽  
Psychotic Disorders ◽  
Right Hemisphere ◽  
Case Reports ◽  
Future Research ◽  
Patient Centered ◽  
Efficient Treatment ◽  
Cultural Aspects ◽  
Centered Care

Background: Culture can affect psychiatric disorders. Clinical Lycanthropy is a rare syndrome, described since Antiquity, within which the patient has the delusional belief of turning into a wolf. Little is known on its clinical or therapeutic correlates.Methods: We conducted a systematic review (PRISMA) on PubMed and Google Scholar, until January 2021. Case reports, data on neurobiological hypotheses, and cultural aspects were included. Language was not restricted to English.Results: Forty-three cases of clinical lycanthropy and kynanthropy (delusion of dog transformation) were identified. Associated diagnoses were: schizophrenia, psychotic depression, bipolar disorder, and other psychotic disorders. Antipsychotic medication may be an efficient treatment for this rare transnosographic syndrome. In case of depression or mania, the treatment included antidepressants or mood regulators. The neuroscientific hypotheses include the conception of clinical lycanthropy as a cenesthopathy, as a delusional misidentification of the self-syndrome, as impairments of sensory integration, as impairments of the belief evaluation system, and right hemisphere anomalies. Interestingly, there is a clinical overlap between clinical lycanthropy and other delusional misidentification syndromes. Clinical lycanthropy may be a culture-bound syndrome that happens in the context of Western cultures, myths, and stories on werewolves, and today's exposure to these narratives on cultural media such as the internet and the series. We suggest the necessity of a cultural approach for these patients' clinical assessment, and a narrative and patient-centered care.Conclusions: Psychiatric transtheoretical reflections are needed for complementaristic neurobiological and cultural approaches of complex delusional syndromes such as clinical lycanthropy. Future research should include integrative frameworks.

Influence of Cognitive Impairment on Rehabilitation Received and Its Mediating Effect on Functional Recovery

2021 ◽  
pp. 1-12
Author(s):  
Ilona Dutzi ◽  
Michael Schwenk ◽  
Marietta Kirchner ◽  
Eva Jooss ◽  
Jürgen M. Bauer ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Status ◽  
Mediating Effect ◽  
Future Research ◽  
Rehabilitation Outcome ◽  
Rehabilitation Outcomes ◽  
Rehabilitation Programs ◽  
Observational Cohort ◽  
The Relationship ◽  
State Examination

Background: Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited. Objective: To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and rehabilitation outcome are mediated by the provided amount of therapy. Methods: Observational cohort study in ward-based geriatric rehabilitation consecutively including 373 patients (mean age 82.0±6.69 years, mean MMSE 23.66±5.31). Outcome measures were amount, frequency, and type of multi-professional therapy sessions and rehabilitation outcome assessed with the Barthel Index (BI). Cognitive status was measured with the Mini-Mental-State Examination (MMSE) classifying three patient subgroups according to cognitive status were considered. Results: Patients with more severe CI received least total therapy hours (TTH) (MMSE <  17, 13.67±6.58 versus MMSE 17–26, 16.12±7.19 and MMSE >  26, 17.79±8.88 h, p = 0.014) and were less often included in occupational therapy (MMSE <  17, 48.9%versus MMSE 17–26, 65.5%and MMSE >  26, 71.4%, p = 0.019) and group-based physiotherapy (MMSE <  17, 73.3%versus MMSE 17–26, 88.5%and MMSE >  26, 81.2%, p = 0.027). Regression models showed that CI negatively impacted TTH (β= 0.24, p = 0.003) and rehabilitation outcome (β= 0.41, p = 0.008). In the mediation model, TTH accounted for 23.18%(p <  0.001) of the relationship between CI and rehabilitation outcome. Conclusion: Cognitive impairment negatively impacted rehabilitation received. The lower TTH partly mediated the negative association between CI and rehabilitation outcome. Future research should identify specific barriers to therapy provision and optimal length, intensity, and dosage of rehabilitation programs to optimize rehabilitation outcomes in CI.

scholarly journals Oral Cancer: A Historical Review

2020 ◽  
Vol 17 (9) ◽  
pp. 3168
Author(s):  
Francesco Inchingolo ◽  
Luigi Santacroce ◽  
Andrea Ballini ◽  
Skender Topi ◽  
Gianna Dipalma ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Cochrane Review ◽  
Integrated Treatment ◽  
Molecular Techniques ◽  
Future Research ◽  
Past Century ◽  
Medical Texts ◽  
Modern Times ◽  
Oral Cancers ◽  
Cancer Management

Aim: This historical medical literature review aims at understanding the evolution of the medical existence of oral cancer over times, particularly better comprehending if the apparent lower prevalence of this type of cancer in antiquity is a real value due to the absence of modern environmental and lifestyle factors or it is linked to a misinterpretation of ancient foreign terms found in ancient medical texts regarding oral neoplasms. Methods: The databases MedLne, PubMed, Web of Science, Elsevier’s EMBASE.com, Cochrane Review, National Library of Greece (Stavros Niarchos Foundation, Athens) and the Library of the School of Health Sciences of the National and Kapodistrian University of Athens (Greece) were extensively searched for relevant studies published during the past century on the history of oral cancer and its treatment from antiquity to modern times, in addition to the WHO website to analyse the latest epidemiological data. In addition, we included historical books on the topic of interest and original sources. Results: Historical references reveal that the cradle of the oral oncology was in ancient Egypt, the Asian continent and Greece and cancer management was confined to an approximate surgical practice, in order to remove abnormal masses and avoid bleeding with cauterization. In the Medieval Age, little progress occurred in medicine in general, oral cancers management included. It is only from the Renaissance to modern times that knowledge about its pathophysiological mechanisms and histopathology and its surgical and pharmacological treatment approaches became increasingly deep all over the world, evolving to the actual integrated treatment. Despite the abundant literature exploring oncology in past civilizations, the real prevalence of oral cancer in antiquity is much less known; but a literature analysis cannot exclude a consistent prevalence of this cancer in past populations, probably with a likely lower incidence than today, because many descriptions of its aggressiveness were found in ancient medical texts, but it is still difficult to be sure that each single description of oral masses could be associated to cancer, particularly for what concerns the period before the Middle Ages. Conclusions: Modern oncologists and oral surgeons must learn a lot from their historic counterparts in order to avoid past unsuccessful efforts to treatment oral malignancies. Several descriptions of oral cancers in the antiquity that we found let us think that this disease might be linked to mechanisms not strictly dependent on environmental risk factors, and this might guide future research on oral cavity treatments towards strategical cellular and molecular techniques.

scholarly journals Long-term Benzodiazepine Treatment in Patients with Psychotic Disorders Attending a Mental Health Service in Rural Greece

2016 ◽  
Vol 07 (S 01) ◽  
pp. S026-S030 ◽  
Author(s):  
Vaios Peritogiannis ◽  
Thiresia Manthopoulou ◽  
Venetsanos Mavreas
Keyword(s):  
Mental Health ◽  
Treatment Regimen ◽  
Psychotic Disorders ◽  
Population Based ◽  
First Episode ◽  
Future Research ◽  
History Of ◽  
The Mean ◽  
Mobile Mental Health

ABSTRACT Introduction: Long-term benzodiazepine (BZD) treatment in patients with mental disorders is widespread in clinical practice, and this is also the case of patients with schizophrenia, although the evidence is weak and BZD prescription is discouraged by guidelines and medical authorities. Data on BZD prescription are usually derived from national or regional databases whereas information on the use of BZD by patients with schizophrenia and related psychoses in general population-based samples is limited. Materials and Methods: Information for 77 patients with psychotic disorders who were regularly attending follow-up appointments with the multidisciplinary Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia, Northwest Greece, during 1-year period (2015) was obtained from our database. Results: From the total of 77 engaged patients, 30 (39%) were regularly prescribed BZDs in the long term, as part of their treatment regimen. Prescribed BZDs were mostly diazepam and lorazepam, in 43.3% of cases each. The mean daily dose of these compounds was 13 mg and 3.77 mg, respectively. Statistical analysis showed a correlation of long-term BZD use with the history of alcohol/substance abuse. Most patients were receiving BZD continuously for several years, and the mean dose was steady within this interval. Conclusions: A large proportion of patients with psychotic disorders were regularly prescribed BZD in long term. It appears that when BZDs are prescribed for some period in the course of a psychotic disorder, their use commonly exceeds the recommended interval and then becomes a regular part of the chronic treatment regimen. Future research should address the factors that may be related to the long-term BZD use by patients with psychotic disorders. Interventions for the reduction of regular BZD prescription should target the primary care setting and all those who treat first episode patients.

A systematic review of longitudinal outcome studies of first-episode psychosis

2006 ◽  
Vol 36 (10) ◽  
pp. 1349-1362 ◽  
Author(s):  
N. M. MENEZES ◽  
T. ARENOVICH ◽  
R. B. ZIPURSKY
Keyword(s):  
Psychotic Disorders ◽  
First Episode Psychosis ◽  
First Episode ◽  
Future Research ◽  
Significant Heterogeneity ◽  
Chronic Patients ◽  
Psychosocial Therapy ◽  
Longitudinal Outcome ◽  
Episode Psychosis

Background. Existing outcome literature has had an over-representation of chronic patients and suggested a progressive course and poor outcome for schizophrenia. The current study aimed to recombine data of samples from longitudinal studies of first-episode psychosis (FEP) to describe outcome and its predictors.Method. A literature search (1966–2003) was conducted for prospective studies examining outcome in first-episode non-affective psychosis using the following key words: early, first, incident, episode, admission, contact, psychosis, schizophrenia, psychotic disorders, course, outcome, follow-up, longitudinal, cohort. These were pooled and analyzed using descriptive and regression analyses.Results. Thirty-seven studies met the inclusion criteria, representing 4100 patients with a mean follow-up of 35·1±6·0 months. Studies varied in the categories of outcome used, the most common being ‘good’ (54% of studies) and ‘poor’ (34% of studies), variably defined. In studies reporting these categories, good outcomes were reported in 42·2% (3·5%) and poor outcomes in 27·1% (2·8%) of cases. Predictors associated with better outcome domains were: combination of pharmacotherapy and psychosocial therapy, lack of epidemiologic representativeness of the sample, and a developing country of origin. Use of typical neuroleptics was associated with worse outcome. Stratification analyses suggested that populations with schizophrenia only, and those with prospective design, were associated with worse outcome domains.Conclusions. Outcome from FEP may be more favorable than previously reported, and treatment and methodological variables may be important contributors to outcome. Significant heterogeneity in definitions and methodology limited the comparison and pooling of data. A multi-dimensional, globally used definition of outcome is required for future research.

“Its About Relationships:” Perspectives of People with Cerebral Palsy on Belonging in Their Families, Schools, and Rehabilitation Counseling

1999 ◽  
Vol 30 (2) ◽  
pp. 7-18 ◽  
Author(s):  
James Schaller ◽  
Denise De La Garza
Keyword(s):  
Qualitative Research ◽  
Cerebral Palsy ◽  
Research Methodology ◽  
Service Provision ◽  
Rehabilitation Counseling ◽  
Future Research ◽  
Counseling Service ◽  
Major Theme ◽  
Qualitative Research Methodology ◽  
Anglo American

This study investigated perceptions of nine people with cerebral palsy about relationships in their families, schools, and rehabilitation counseling. One participant was Hispanic, all others were Anglo-American. Audio-taped interviews were transcribed and analyzed using qualitative research methodology. Findings indicated that feelings of belonging were a major theme for all participants across the contexts of family, school, and rehabilitation counseling. Aspects of belonging within each context, implications for rehabilitation counseling service provision, and suggestions for future research are discussed.

Steps for Evaluating and Interpreting Quantitative Research

1996 ◽  
Vol 27 (1) ◽  
pp. 57-61
Author(s):  
Mary J. McAweeney ◽  
Robert Heinrich
Keyword(s):  
Quantitative Research ◽  
Design Methodology ◽  
Rehabilitation Counseling ◽  
Future Research ◽  
Rehabilitation Professionals ◽  
Research Article ◽  
Statistical Validity ◽  
Basic Competencies ◽  
Published Research ◽  
Research Studies

All rehabilitation professionals should attain basic competencies in evaluating the design, methodology, and statistical validity of published or proposed research studies. Evaluation of rehabilitation counseling research is becoming more important as health care reform demands that rehabilitation professionals demonstrate the efficacy of their practices. This article presents fifteen criteria for use in critically evaluating rehabilitation research, and is intended for use in the evaluation of published research and in planning future research studies. The elements of a research article are discussed in detail, with examples provided. Several recommendations are made to improve the clinical usefulness of quantitative research conducted in rehabilitation counseling.

Sign in / Sign up

Export Citation Format

Share Document