Factors associated with the unresolved classification of the Adult Attachment Interview in women who have suffered stillbirth.

Abstract The "unresolved" state of mind with respect to loss or trauma as assessed in the Adult Attachment Interview is common in clinical and forensic groups, as well as in mothers whose infants are classified as disorganized in their attachment relationship to them. However, questions remain about what the unresolved state represents and what factors predict the unresolved state. This case controlled study reports on 64 women who had suffered stillbirth and who were pregnant with their next child. The study explores attachment, psychiatric, and social factors associated with the unresolved state or higher unresolved scores with respect to stillbirth. Women who had experienced stillbirth were more likely to be unresolved than control women. Although a similar number of stillbirth and control women had experienced childhood trauma, only women who had experienced stillbirth were unresolved with respect to this trauma, suggesting the unresolved state may be evoked or reevoked by subsequent traumatic loss. Higher unresolved scores in relation to stillbirth were predicted by childhood trauma, poor support from family after the loss, and having a funeral for the infant. The results are discussed in terms of the woman's sense of being causal in the loss

Group cognitive analytic music therapy: a quasi-experimental feasibility study conducted in a high secure hospital

This study conducted a feasibility patient preference quasi-experimental study of group cognitive analytic music therapy (G-CAMT) for mentally disordered offenders. Participants either chose or were randomised to 16 sessions of manualised G-CAMT (N = 10) plus treatment as usual (TAU) or TAU alone (N = 10). Self-rated and staff-rated outcomes were assessed at baseline, post-intervention and 8-weeks post-intervention. Residency was assessed at 2-year follow-up. Results indicate that G-CAMT was easily implemented; 9/10 participants completed G-CAMT and attendees had high satisfaction with the approach. Session attendance was high; 4/10 participants attended all sessions. At the 8-week follow-up, 3/9 G-CAMT participants had reliable reductions (i.e. statistically reliable pre to 8-week follow-up change results) in intrusive/possessive behaviours and fear of separation/abandonment. On the staff-rated outcome measure G-CAMT participants as a group were statistically significantly friendlier compared to TAU at 8-week follow-up (U = 0.50, p = 0.009, d = 1.92, CI 0.44 to 3.11). There were no differences between the arms in terms of residency outcomes at 2-year follow-up. The study is discussed in terms of G-CAMT’s theoretical grounding and high acceptability. The study is limited by its small sample size, but indicates the possibility of progressing onto a full trial

Understanding and meeting the needs of those using growth hormone injection devices

BACKGROUND: Recombinant human growth hormone (r-hGH) is used to treat: growth hormone deficiency in children and adults; children born small for gestational age; Turner's syndrome; and chronic renal failure. r-hGH is administered by daily subcutaneous injection and may be given using a number of different administration devices. The aim of this survey was, firstly, to identify which attributes of an r-hGH administration device are considered most important to physicians, teenage patients, parents of young children requiring GH and nurses who have experience of r-hGH administration, and, secondly, to determine how they rate existing devices in each of these key attributes. METHODS: The opinions of 67 individuals with experience in r-hGH administration were captured in discussion sessions. Parents, physicians and nurses were asked to rate 19 device attributes by completing a questionnaire, and to rank four different r-hGH administration devices (including a conceptual electronic device) in order of preference. RESULTS: Reliability, ease of use, lack of pain during injection, safety in use, storage, and number of steps in preparation before use, during use and after were considered to be the five most desirable attributes of an r-hGH administration device. An electronic device was preferred to an automatic, multi-dose injection device, a needle-free injection device or a manual, ready-to-use, disposable injection device. CONCLUSION: In the opinion of physicians, nurses and parents using r-hGH injection devices, an ideal device must combine reliability with simplicity, while delivering treatment with minimal pain. An electronic device, which combines many of the most useful features of existing devices with novel functions, was the preferred option for r-hGH administration

Forensic Psychotherapy in Forensic Mental Health

Forensic psychotherapy is a talking cure that aims to work with meaning making processes and defensive manoeuvres in offenders, in order to make them progress in their search for the meaning of the offence. An offence can be understood and contextualized once it is considered from the perspective of the life history of the offender. At the same time, the question of where the violent or sexual motives come from, are much more difficult to grasp. This paradox is problematic to society, that wants an answer from the criminal, but it is also problematic to the criminal him- or herself. The development of the embeddedness of forensic psychotherapy in English and Dutch forensic mental health institutions and the relevance of training are described and explained. For Belgium, two small scale projects are discussed that cater for mentally ill offenders who have difficulties to cope with more intensive psychiatric care. Within these projects, patients are offered the possibility to take part in therapeutic activities on a voluntary basis. The aim is to motivate people, who have difficulties to socialize, participate in group and reconnect with other

Impaired social status of growth hormone deficient adults as compared to controls with short or normal stature

Summary OBJECTIVES In adults with growth hormone deficiency (GHD) social problems have been reported, but so far the relative contributions of GHD, additional pituitary deficiencies and short stature have not been distinguished. We therefore compared social data from GHD patlents wlth soclal date from controls wlth short or normal stature. Furthermore we Investigated whether social problems are caused solely by the deficiency of OH or also by the associated absence of other pitultary hormones. DESIGN A questionnaire was sent to patient8 and controls with items on education, profession, income, partner and living situation. PATIENTS Two hundred and ten GHD patients treated in chlldhood but not in adulthood wlth GH (93 isolated GHD (IGHD), 111 patients with multiple pltultary deficiency (MPD)) were compared wlth 53 short controls (helght In chlldhood <third percentile for population) and 39 normal stature controls. RESULTS There were no differences between short and normal controls. There were also no differences between IGHD and MPD patients in any of the Investigated Items. GHD patients did not differ from controls on education level, but scored lower on the profession scale, had a lower Income and had a partner less often; If they had a partner they less often had children; also, more of them lived with their parents