Cognitive therapy can be successful in promoting clinically meaningful improvements in functional outcome, motivation, and positive symptoms in low-functioning patients with significant cognitive impairment. Trial Registration clinicaltrials.gov Identifier: NCT00350883.
The deficit syndrome was proposed over 20 years ago as a separate negative symptom syndrome within schizophrenia with a distinct neurobiological pathophysiology and etiology. Recent research, however, has indicated that psychological factors such as negative attitudes and expectancies are significantly associated with the broad spectrum of negative symptoms. Specifically, defeatist beliefs regarding performance mediate between neurocognitive impairment and both negative symptoms and functional outcome. Additionally, asocial beliefs predict asocial behavior and negative expectancies regarding future pleasure are associated with negative symptoms. The present study explored whether these dysfunctional beliefs and negative expectancies might also be a feature of the deficit syndrome. Based on a validated proxy method, 22 deficit and 72 nondeficit patients (from a pool of 139 negative symptom patients) were identified and received a battery of symptom, neurocognitive, and psychological measures. The deficit group scored significantly worse on measures of negative symptoms, insight, emotion recognition, defeatist attitudes, and asocial beliefs but better on measures of depression, anxiety, and distress than the nondeficit group. Moreover, the deficit group showed a trend for higher scores on self-esteem. Based on these findings, we propose a more comprehensive formulation of deficit schizophrenia, characterized by neurobiological factors and a cluster of psychological attributes that lead to withdrawal and protect the self-esteem. Although the patients have apparently opted-out of participation in normal activities, we suggest that a psychological intervention that targets these negative attitudes might improve their functioning and quality of life.
Although racism persists as a significant public health issue that adversely impacts the mental health of people of color (U.S. Department of Health and Human Service, 2001), there has been very little systematic guidance for mental health professionals to address racism through practice (S. Harrell, 2000). Therefore, we conducted a content analysis of the peer reviewed counseling psychology literature-the first of its kind-to provide a summary and critique of the extant practice recommendations and facilitate the development and enhancement of practice efforts aimed at addressing racism. We reviewed racism-related articles published in the , and and identified 73 relevant articles, of which 51 provided practice recommendations. Based on our review of this literature, we identified eight general categories of recommendations for addressing racism: psychoeducation, validation, self-awareness and critical consciousness, critical examination of privilege and racial attitudes, culturally responsive social support, developing positive identity, externalize/minimize self-blame, and outreach and advocacy. We found that most recommendations within each category were at the individual level with far fewer at the group and systemic level. A critique of recommendations is provided along with suggestions for developing and bolstering practice, research, and consultation efforts aimed at addressing racism. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Objectives The objective of the study was to examine the trend of benzodiazepine prescribing under Medicare Part D formulary restriction. Methods A secondary data analysis was conducted using the National Ambulatory Medical Care Survey between 2005 and 2009. Subjects were identified from ambulatory physician office visits where the primary payment source was Medicare and at least one US Food and Drug Administration (FDA)‐approved benzodiazepine was prescribed. Data trend were graphically plotted and further analysed using segmented regression. Key findings An estimated 4.9 billion visits to office‐based physicians from 2005 to 2009 of which 1.2 billion (24.24%) were made by Medicare recipients. Of these, 86.9 million (7.38%) visits received at least one FDA‐approved benzodiazepine including alprazolam (33.3%), lorazepam (24.4%), clonazepam (16.2%), diazepam (12.1%), etc. One year after the passage of Medicare Part D benzodiazepine exclusion, benzodiazepine prescribing decreased 1.83%. However, it had dramatically increased (21.7%) in 2007. Results from segmented regression indicated that implementation of Medicare Part D drug benefits, with benzodiazepine exclusion, is significantly associated with benzodiazepine utilisation (P = 0.015). Conclusion The study findings indicated that benzodiazepine prescribing was not decreased by Medicare Part D formulary exclusion. Several factors could explain this phenomenon: (1) economic perspectives, (2) Medicare supplement programmes, (3) physician prescribing patterns/habits, (4) elderly dependence on benzodiazepines. Despite benzodiazepines having been allowed on Medicare Part D formularies in 2013, this amendment may lead to an even greater importance to healthcare professionals and policy makers by providing comprehensive patient care that ensures optional medication therapy outcomes.
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