Journal of clinical psychology in medical settings
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J Clin Psychol Med Settings · Jun 2010
What variables are associated with an expressed wish to kill a doctor in community and injured patient samples?
Working in a health care setting has been identified as a primary risk factor for violent assault, which is often perpetrated by patients. Patient dangerousness is a multidimensional phenomenon, which may include violent ideation, homicidal planning, a history of violent acts, or overt threatening behavior. Although the verbal report of thoughts of killing a doctor is only one of many risk factors for patient dangerousness, reports of homicidal ideation are widely regarded as being sufficient to warrant concern, and to indicate a need for further assessment of the patient. ⋯ Significant variables (p<.01) were then utilized in a logistic regression to generate a model for this wish. Three variables significantly predicted this wish: the Doctor Dissatisfaction (p<.001) and Borderline (p<.001) scales of the BHI 2, and injury-related litigation status (p=.002). The presence of one of these variables, especially Doctor Dissatisfaction, should prompt a more thorough assessment of potential danger to healthcare workers.
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J Clin Psychol Med Settings · Sep 2009
Randomized Controlled Trial Comparative StudyTelephone-administered cognitive behavioral therapy: a case study of anxiety and depression in Parkinson's disease.
Parkinson's disease (PD) is a chronic medical illness with a high incidence of psychiatric comorbidity, specifically depression and anxiety. Research on treatment of such psychiatric complications is scarce. Non-pharmaceutical treatment options are especially attractive. ⋯ A fairly large portion (67.5%) of patients screened in the outpatient clinic were identified as having symptoms of anxiety and/or depression. Results also indicated that CBT delivered via the telephone is a useful approach for targeting psychiatric symptoms in this population. A case example is given to illustrate the clinical considerations associated with delivering therapy via telephone to persons with PD.
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J Clin Psychol Med Settings · Jun 2009
Mindfulness meditation for symptom reduction in fibromyalgia: psychophysiological correlates.
Fibromyalgia, a chronic pain syndrome, is often accompanied by psychological distress and increased basal sympathetic tone. In a previous report it was shown that mindfulness-based stress-reduction (MBSR) reduced depressive symptoms in patients with fibromyalgia with gains maintained at two months follow-up (Sephton et al., Arthr Rheum 57:77-85, 2007). This second study explores the effects of MBSR on basal sympathetic (SNS) activation among women with fibromyalgia. ⋯ In this small sample, basal SNS activity was reduced following MBSR treatment. Future studies should assess how MBSR may help reduce negative psychological symptoms and attenuate SNS activation in fibromyalgia. Further clarification of psychological and physiological responses associated with fibromyalgia may lead to more beneficial treatment.
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J Clin Psychol Med Settings · Jun 2009
CBT for anxiety and associated somatic complaints in pediatric medical settings: an open pilot study.
To examine the initial feasibility and potential efficacy of a cognitive-behavioral intervention for youth with anxiety disorders and non-medical somatic symptoms. ⋯ Our modified cognitive-behavioral approach has promise for reducing anxiety and somatic symptoms in children seeking medical care.