==================================HSR09================================== 9. Family in crisis. Acute illness and family therapy. Head injury and family/family intervention. 1 UI - 87120133 AU - Intagliata J ; Willer B ; Egri G TI - Role of the family in case management of the mentally ill. AB - This article provides a systematic discussion and assessment of the actual and potential contributions that families of the chronic mentally ill can make to the case management of their patient-relatives. It examines family members' involvement with six major case management functions including assessment, linkage, monitoring, assistance with daily problems, crisis intervention, and advocacy. For each function, the authors consider the potential of family members to make a contribution, specific activities that are more appropriately assumed by professional staff, and any limitations or caveats about family members' involvement with the given case management activity. The article points out that family members are clearly quite capable of making significant contributions in almost all aspects of managing their patient-relatives and that their potential contributions are too frequently ignored or underused by professionals. The authors recommend that professionals give greater acknowledgment to the case management efforts of family members, work to integrate the contributions of these natural helpers with formal case management systems, and provide family members with the encouragement and support they need to enhance their caring contributions. MH - Activities of Daily Living ; Crisis Intervention ; Family Therapy ; *Family ; Human ; Patient Advocacy ; Professional-Family Relations ; Schizophrenia/*REHABILITATION ; Schizophrenic Psychology ; Social Support SO - Schizophr Bull 1986;12(4):699-708 2 UI - 87066892 AU - Richmond TS ; Craig M TI - Family-centered care for the neurotrauma patient. AB - Nursing management of the family of the neurotrauma patient is a challenging experience. Whether the family is first encountered during their initial days of crisis or following discharge to the home, they require individualized, thoughtful nursing care. Indeed, according to Bond, the pattern of stresses the family encounters changes with time, with one of the most significant points being in the first days after discharge from the hospital when they realize and accept the full extent of the victim's deficits. It is to this end that nursing intervention throughout hospitalization is geared, and it is during this time that we cannot forget that nursing management may still be required. In the case of neurotrauma, the patient and family are not "cured: when they leave the hospital, for many their problems are just beginning. Let us develop mechanisms through which continued professional support can be made available to the families of neurologically impaired patients both during and following hospitalization. MH - Adaptation, Psychological ; Adolescence ; Adult ; Case Report ; Central Nervous System/*INJURIES ; Child ; Child, Preschool ; Crisis Intervention ; *Family ; Female ; Human ; Life Change Events ; Male ; Professional-Family Relations ; Social Identification ; Social Support SO - Nurs Clin North Am 1986 Dec;21(4):641-51 3 UI - 87058344 AU - Aspin J TI - Consulting to children's hearings in West Lothian. AB - This is an account of the application of consultation and family therapy teaching skills in a non-clinic setting. Adolescents and their families are observed in the context of children's hearings. The effect on the functioning and process of the hearing is then fed back at the end of the session to panel members in order to increase their sensitivity and improve the quality of decision taking. MH - Adolescence ; Crisis Intervention ; *Family Therapy ; Family ; Human ; Juvenile Delinquency/*LEGISLATION & JURISPRUD. ; *Referral and Consultation ; Scotland ; *Social Work, Psychiatric SO - J Adolesc 1986 Sep;9(3):257-69 4 UI - 87058340 AU - Bryce G ; Baird D TI - Precipitating a crisis: family therapy and adolescent school refusers. AB - This paper describes the use of family therapy with adolescent school refusers. School refusal is assessed and formulated from a family systems perspective, and therapy proceeds with the crisis precipitated by insisting on the adolescent's early return to school. Some of the common problems encountered in this approach are considered along with its results. MH - Adolescence ; Crisis Intervention ; *Family Therapy ; Family ; Female ; Human ; Male ; Phobic Disorders/PSYCHOLOGY/*THERAPY ; Problem Solving ; Professional-Family Relations SO - J Adolesc 1986 Sep;9(3):199-213 5 UI - 87043206 AU - Blazyk S ; Canavan MM TI - Managing the discharge crisis following catastrophic illness or injury. AB - Discharge from the acute care setting frequently represents a serious crisis for the catastrophically ill. Family members and the patient are expected to resume responsibility quickly for ongoing care while simultaneously coping with significant alterations in established role and behavior patterns. The dynamics of this transition are discussed and suggestions for helping the family cope with this crisis are offered. MH - Adaptation, Psychological ; After Care ; *Catastrophic Illness ; Continuity of Patient Care ; *Crisis Intervention ; *Family ; Hospitalization ; Human ; *Patient Discharge ; Professional-Family Relations ; Social Support ; Social Work Department, Hospital SO - Soc Work Health Care 1986 Summer;11(4):19-32 6 UI - 87034723 AU - Schwartz DA ; Reilly P TI - The choice not to be resuscitated. AB - We studied the use of the do not resuscitate (DNR) order among general medical patients. During the six-month study period, of 2431 admissions there were 95 patients (3.9%) declared DNR. Of 105 deaths, 69 (66%) occurred among DNR patients. Twenty-seven percent of the DNR patients left the hospital alive. In 90% of the cases the medical intern initiated the DNR discussion, and in 60% of the cases a decision was reached in less than 24 hours. Two-thirds of the DNR orders were consented to by family members, and one-third of all DNR orders had a discernible impact on nonresuscitative care. Less aggressive therapy accounted for 60% of these restrictions, whereas the remainder involved limitations in diagnostic evaluations. When compared with age- and sex-matched general adult inpatient control subjects, DNR patients were found to have longer hospitalizations (P = .01), be more likely to reside in a nursing home (RR = 4.2), have a metastatic neoplasm (RR = 3.6), and be admitted with an abnormal mental status (RR = 6.1) or urinary incontinence (RR = 2.9). These differences remained significant when we controlled for the presence of a metastatic neoplasm. Despite a high in-hospital mortality rate (73%), DNR patients were not admitted more frequently than controls to the intensive care unit. We conclude that the DNR decision is based on clinical prognostic indexes and that once established, this order serves to modify the allocation of medical resources. MH - Aged ; *Critical Care ; *Decision Making ; Family ; Female ; Hospitalization ; Human ; Male ; Medical Records ; Mental Disorders ; Neoplasm Metastasis ; Physician's Role ; Prognosis ; Questionnaires ; *Resuscitation SO - J Am Geriatr Soc 1986 Nov;34(11):807-11 7 UI - 87027228 AU - Livingston MG TI - Assessment of need for coordinated approach in families with victims of head injury. AB - Forty two men with severe head injury, and 41 with minor head injury, together with their families, were assessed at home after the injury. Despite significant impairment with respect to physical symptoms, personality difficulties, and occupational status in severely injured patients after one year, there was a very poor uptake of hospital rehabilitation facilities. In addition, patients' relatives showed significant psychosocial impairment throughout this period. There is a need for a specialist to coordinate rehabilitation services for patients with head injury and their relatives and, in particular, to integrate physical and psychological aspects of management with a multidisciplinary team approach. Although this task will require specialist hospital teams for future development, at present general practitioners have some specialised knowledge that would enable them to coordinate rehabilitation. MH - *After Care ; Family ; Head Injuries/PSYCHOLOGY/*REHABILITATION ; Human ; Male ; Rehabilitation Centers/*UTILIZATION ; Scotland ; Time Factors SO - Br Med J [Clin Res] 1986 Sep 20;293(6549):742-4 8 UI - 87025076 AU - Rao N ; Sulton L ; Young CL ; Harvey RF TI - Rehabilitation team and family assessment of the initial home pass. AB - Brain-injured individuals may have neurologic damage resulting in physical, cognitive and personality sequelae. Rehabilitation promotes recovery for these patients by restoring cognitive and social functions and focusing attention on medical-physical and cognitive-social intervention. A major component in rehabilitation is to teach family members to understand the process of recovery and their role in teaching and reinforcing desired behaviors at home. To investigate the utility of the family's role, we studied the effects of allowing patients to return to the home/family environment for short stays (therapeutic pass). By comparing functional ratings obtained from family and rehabilitation team members, we found families rated brain-injured patients higher in medical-physical areas and more equally in cognitive-social areas. Although we do not control for the family's frame of reference regarding the patient's premorbid status, we conclude that impaired cognitive functioning has a profound impact on family members who, like the patient, must make adjustments because of the disability. We recommend therapeutic passes as a meaningful tool in the process of educating families about the disability, its scope and impact, as well as its accompanying effects on cognitive and social functioning. MH - Brain Injuries/*REHABILITATION ; *Family ; Home Nursing ; Human ; Patient Care Team ; *Patient Discharge ; *Rehabilitation Centers SO - Arch Phys Med Rehabil 1986 Oct;67(10):759-61 9 UI - 87017851 AU - Schroeder-Zwelling E ; Hock E TI - Maternal anxiety and sensitive mothering behavior in diabetic and nondiabetic women. AB - To evaluate the effects of a high-risk pregnancy on development of the maternal-infant relationship, the differences in anxiety, sensitive maternal behavior, and maternal separation anxiety in diabetic and nondiabetic mothers were examined. The findings imply that a high-risk pregnancy may not always be accompanied by increased anxiety or disturbances in sensitive maternal behavior. Questions are raised regarding the influences of demographic factors on maternal behavior and the differences that chronic versus sudden onset high-risk pregnancy factors might have on maternal anxiety and behavior. The findings also reinforce the influence of supportive medical and nursing care throughout a high-risk pregnancy. MH - Acute Disease ; Anxiety, Separation/PSYCHOLOGY ; Chronic Disease ; Diabetes Mellitus, Insulin-Dependent/*PSYCHOLOGY ; Facial Expression ; Female ; Human ; *Maternal Behavior ; Mothers/PSYCHOLOGY ; Pregnancy Complications/*PSYCHOLOGY ; Pregnancy ; Risk SO - Res Nurs Health 1986 Sep;9(3):249-55 10 UI - 87016059 AU - Michaels RH ; Oliver TK Jr TI - Human rights consultation: a 12-year experience of a pediatric bioethics committee. AB - For many years there has been a committee at the Children's Hospital of Pittsburgh to review research proposals to assure that the rights of children are protected. In 1974, its composition was changed and its mission broadened to include consultation and discussion of ethical issues in clinical care. The committee is called the Human Rights Committee to reflect this mission. Medical ethical consultations are performed by rotating on-call teams consisting of a physician and a nonphysician who are members of the committee. Selected cases from 48 consultations are presented to demonstrate the process and to illustrate some of the questions that were addressed. The clinical diagnoses were varied, but the commonest were congenital malformations. The most frequent reason for consultation was to question the advisability of assisted ventilation (27 cases), but other reasons concerned definitive surgery, intravenous hyperalimentation, cardiopulmonary resuscitation, and tracheostomy. Consultations are always optional and advisory. The recommendations of the consultation team are subsequently reviewed by the entire Human Rights Committee. The service has been well received by the medical staff. This method has some of the advantages of both the hospital ethics committee and the single consultant. Therefore, it should be considered when planning how to deal with these important problems. MH - Abnormalities/THERAPY ; Acute Disease ; Adolescence ; *Bioethics ; Case Report ; *Child Advocacy ; Comparative Study ; Critical Care ; Evaluation Studies ; Female ; Human ; Infant ; Infant, Newborn ; Infant, Premature, Diseases/THERAPY ; Informed Consent ; Male ; Parents/PSYCHOLOGY ; Professional Staff Committees ; Prognosis ; Questionnaires ; *Referral and Consultation ; Respirators ; Resuscitation ; Tracheotomy SO - Pediatrics 1986 Oct;78(4):566-72 11 UI - 86312667 AU - Rieder MJ ; Schwartz C ; Newman J TI - Patterns of walker use and walker injury. AB - Infant walkers have been described as a cause of unexpected trauma in the first year of life. We conducted a prospective study to determine the mechanism and pattern of walker injuries presenting to an urban pediatric teaching hospital. We also studied the patterns of walker use. All injuries sustained by infants in baby walkers during a 1-year period were reviewed. The 139 injuries included 29 fractures. The most severe injuries were caused by falls down stairs; these falls accounted for 123 of the injuries. Stair gates were present in one third of all falls. At follow-up 2 months later, two thirds of the children had been in the walker subsequent to the injury. One third were still in the walker at 2 months after their initial injury. Less than half of the homes that had not had stair gates in place had acquired them at the time of follow-up. Baby walkers represent a cause of significant injury in the infant population; studies of warning labels and anticipatory guidance are needed. MH - Accidents, Home/PREVENTION & CONTROL ; Burns/ETIOLOGY ; Female ; Follow-Up Studies ; Head Injuries/ETIOLOGY ; Human ; Infant ; *Infant Care ; Locomotion ; Male ; Parents ; Prospective Studies ; Skull Fractures/ETIOLOGY ; Time Factors ; Wounds and Injuries/*ETIOLOGY SO - Pediatrics 1986 Sep;78(3):488-93 12 UI - 86306821 AU - Brooks N ; Campsie L ; Symington C ; Beattie A ; McKinlay W TI - The five year outcome of severe blunt head injury: a relative's view. AB - A close relative of each of 42 severely head injured patients was interviewed at 5 years after injury, following initial study at 3, 6, and 12 months. Persisting severe deficits, in some cases worse than at 1 year, were primarily psychological and behavioural, although minor physical deficits, for example in vision, were also common. Relatives were under great strain; significantly more so than at 1 year. The best predictor of strain in the relative was the magnitude of behavioural and personality change in the patient. MH - Adolescence ; Adult ; Behavior ; Brain Injuries/*DIAGNOSIS/PSYCHOLOGY ; Cognition ; Family ; Female ; Follow-Up Studies ; Human ; Interpersonal Relations ; Male ; Middle Age ; Personality ; Self Care ; Social Adjustment ; Support, Non-U.S. Gov't SO - J Neurol Neurosurg Psychiatry 1986 Jul;49(7):764-70 13 UI - 86289584 AU - Alonzo AA TI - The impact of the family and lay others on care-seeking during life-threatening episodes of suspected coronary artery disease. AB - To understand the impact of the family on care-seeking during a suspected episode of acute coronary artery disease (CAD) interviews were conducted with 1102 individuals hospitalized for a suspected myocardial infarction. Analyzing the care-seeking behavior of these individuals within life threatening illness behavior and situational perspectives, bivariate and multivariate analyses revealed that family members, especially a spouse, had both positive and negative influences on the duration of time between acute symptom onset and arrival at a hospital emergency room. To reduce both the morbid and mortal consequences of acute CAD it is recommended that we direct our intervention efforts toward warning the public of situational circumstances which contribute to extended self treatment and evaluation during acute episodes of CAD. MH - Acute Disease ; Comparative Study ; Emergencies ; *Family ; Female ; Human ; Male ; Middle Age ; Myocardial Infarction/*PSYCHOLOGY ; *Patient Acceptance of Health Care ; *Sick Role ; Support, U.S. Gov't, P.H.S. ; Time Factors SO - Soc Sci Med 1986;22(12):1297-311 14 UI - 86286410 AU - Weitzman M ; Alpert JJ ; Klerman LV ; Kayne H ; Lamb GA ; Geromini KR ; Kane KT ; Rose L TI - High-risk youth and health: the case of excessive school absence. AB - Excessive school absence is a major educational and social problem in the United States, yet very little is known about its etiology or how to prevent or ameliorate it. This paper reports results from a series of related studies conducted in seven Boston middle schools (grades 6, 7, and 8) to test the hypotheses that health problems and unmet health needs are major characteristics distinguishing excessively absent students from regular attenders and that a health-oriented approach using medically mediated interventions is effective in reducing absences among excessively absent students. There were no significant differences between regular attenders and excessively absent students on multiple measures of student and family health status, health habits, and health service utilization patterns in a case-control study. The intervention program was not associated with a significant decrease in absence school-wide or for participating students. We conclude that demographic and educational characteristics of students exert a greater effect on their behavior in regard to absence from school than do health status or receipt of health services and that a health-oriented approach, such as the one used here, will not have a major impact on what remains one of the most profound educational and social problems involving children in the United States today. MH - *Absenteeism ; Acute Disease ; Adolescence ; Alcohol Drinking ; Boston ; Child ; Chronic Disease ; Comparative Study ; *Health ; *Health Status ; Human ; Interviews ; Parents ; Risk ; School Health Services ; Smoking ; *Students ; Substance Abuse ; Support, Non-U.S. Gov't ; Urban Population SO - Pediatrics 1986 Aug;78(2):313-22 15 UI - 86285797 AU - Dawson KP ; Shannon FT TI - The pattern of acute medical admission to a children's unit. AB - A study of 607 consecutive acute medical admissions to a children's unit, revealed a dominance of acute asthma and acute respiratory infection. The patterns of illness reflected previous community based studies in the area. These patterns prevailed irrespective of whether the child came from a one or two parent family. Admission tended to be out of normal working hours. The significance of these findings is discussed. MH - Acute Disease/*OCCURRENCE ; Child ; Child, Preschool ; Ethnic Groups ; Female ; *Hospital Departments ; Human ; Infant ; Infant, Newborn ; Male ; New Zealand ; Parents ; Patient Admission/*TRENDS ; *Pediatrics ; Single Person ; Socioeconomic Factors SO - NZ Med J 1986 Jun 11;99(803):418-20 16 UI - 86283810 AU - Whitelaw A TI - Death as an option in neonatal intensive care. AB - Many paediatricians believe that there are circumstances in which infants should be allowed to die without having their lives prolonged by intensive care or surgery. During a four-year period, in a regional neonatal intensive-care unit, 75 infants were so seriously ill that withdrawal of treatment was discussed. 26 infants had severe acquired neurological damage, 26 had been born after extremely short gestation (25 weeks or less), and 23 had severe congenital abnormalities. The decision to withdraw treatment from a particular infant had to be unanimous among all the medical and nursing staff caring for that child and was based on a virtual certainty, not just of handicap, but of total incapacity--eg, microcephaly, spastic quadriplegia, and blindness. Of the 75 infants, the decision of the medical team was to withdraw treatment from 51. The parents of 47 infants accepted the decision and all these infants died. The parents of 4 infants chose continued intensive care, and 2 infants survived with disabilities. In the other 24 cases, the medical decision was to continue treatment. Of these, 17 survived and 7 died. When a thorough medical assessment had led to unanimous agreement among staff and parents that treatment should be withdrawn, its continuation on purely legal grounds is not justifiable. MH - Abnormalities/MORTALITY/THERAPY ; Critical Care ; *Euthanasia ; *Euthanasia, Passive ; Female ; Human ; Hydrocephalus/SURGERY ; Infant, Newborn ; Infant, Premature, Diseases/MORTALITY/THERAPY ; *Intensive Care Units, Neonatal ; Male ; Neonatology ; Parents/PSYCHOLOGY ; Patient Care Team ; Professional-Family Relations ; Prognosis ; Respiration, Artificial ; Spina Bifida/SURGERY SO - Lancet 1986 Aug 9;2(8502):328-31 17 UI - 86261868 AU - Shearn MA ; Shearn L TI - A personal experience with Guillain-Barr:e syndrome: are the psychologic needs of patient and family being met? AB - We present a dialogue that illustrates how difficult an episode of severe illness is for both the suffering patient and the confused family. The powerful emotions engendered can be successfully managed only when physicians and nurses are aware of and address this turbulence that the patient and family are experiencing. MH - Anxiety/ETIOLOGY ; Confusion ; Delusions/ETIOLOGY ; Emergencies ; *Family ; Female ; Human ; Male ; Marriage ; Polyradiculoneuritis/COMPLICATIONS/ DIAGNOSIS/*PSYCHOLOGY SO - South Med J 1986 Jul;79(7):800-3 18 UI - 86254538 AU - Bedell SE ; Pelle D ; Maher PL ; Cleary PD TI - Do-not-resuscitate orders for critically ill patients in the hospital. How are they used and what is their impact? AB - We studied compliance with do-not-resuscitate (DNR) orders at a university hospital where a DNR protocol has existed since 1979. Documentation of DNR status in patient progress notes and chart orders increased through 1983. During a 12-month period (March 1983 through April 1984), we studied in detail the medical records of 521 patients who had a cardiopulmonary arrest in the hospital. Seventy-five percent (389 of 521) of these patients were designated DNR. Patients who were designated DNR were significantly more likely to be older, to have malignancy or an abnormal mental status, and to be less likely to have acute myocardial infarction, stroke, or chronic obstructive pulmonary disease than patients in whom resuscitation was attempted. Eighty-six percent of families, but only 22% of patients, were involved in the decision to designate a patient DNR. The decision to designate a patient DNR occurred late in the course of a patient's illness, often when the patient was in coma. For 28% of patients, some form of medical care was withdrawn or withheld after they were designated DNR. These data suggest that use of the DNR protocol requires changes if patients are to participate in the decision not to undergo cardiopulmonary resuscitation. MH - Aged ; Boston ; *Critical Care ; Decision Making ; *Euthanasia ; *Euthanasia, Passive ; Family ; Female ; Hospitals, University ; Human ; Male ; Medical Records ; Nursing Staff, Hospital ; Patient Participation ; Physicians ; *Resuscitation ; Support, Non-U.S. Gov't ; Time Factors SO - JAMA 1986 Jul 11;256(2):233-7 19 UI - 86252690 AU - Sherburne E TI - A rehabilitation protocol for the neuroscience intensive care unit. AB - Because of modern technology, the rate of survival after neurologic injury has increased. The severity of patients' disabilities has also increased. Early rehabilitation intervention is beneficial from both a functional and an economic standpoint. This article describes a formal multidisciplinary protocol for comprehensive rehabilitation beginning with admission to the neurosurgical intensive care unit. A case study is also presented. MH - Adult ; Brain Injuries/REHABILITATION ; Case Report ; Family ; Human ; *Intensive Care Units ; Male ; *Neurosciences ; Patient Care Team ; Professional-Family Relations ; *Rehabilitation ; Spinal Cord Injuries/ REHABILITATION SO - J Neurosci Nurs 1986 Jun;18(3):140-5 20 UI - 86239778 AU - Shuchter SR ; Zisook S ; Kirkorowicz C ; Risch C TI - The dexamethasone suppression test in acute grief. AB - Nineteen recently widowed women and men were given diagnostic interviews, psychometric evaluations, and dexamethasone suppression tests (DSTs). While 58% of the subjects (N = 11) met Research Diagnostic Criteria for depression, only 16% (N = 3) were nonsuppressors on the DST. In this population, nonsuppression was related more to levels of anxiety than to depression. MH - Acute Disease ; Adult ; Anxiety/BLOOD/DIAGNOSIS ; Depression/BLOOD/ DIAGNOSIS ; Depressive Disorder/BLOOD/*DIAGNOSIS ; Dexamethasone/ *DIAGNOSTIC USE ; Female ; *Grief ; Human ; Hydrocortisone/BLOOD ; Male ; Middle Age ; Psychiatric Status Rating Scales ; Single Person/PSYCHOLOGY SO - Am J Psychiatry 1986 Jul;143(7):879-81 21 UI - 86189399 AU - LaRoche C TI - Prevention in high risk children of depressed parents. AB - Opportunities for prevention of psychopathology in children and families are often overlooked in the treatment of the depressed adult patient. Research and clinical findings are reviewed which highlight the impact on children and the family of depressed parents. They range from illness serious enough to require hospitalization to cases in which depression has not yet been diagnosed. These findings are used as guidelines for the development of preventive and therapeutic interventions for all family members. MH - Adjustment Disorders/THERAPY ; Adult ; Ambulatory Care ; Bipolar Disorder/ FAMILIAL & GENETIC ; Child ; Comparative Study ; Crisis Intervention ; Death ; Depressive Disorder/OCCURRENCE/*THERAPY ; Female ; Fetal Death ; Grief ; Hospitalization ; Human ; Male ; Marriage ; Maternal Behavior ; Mental Disorders/*PREVENTION & CONTROL ; Parent-Child Relations ; Pregnancy ; Puerperal Disorders/THERAPY ; Risk SO - Can J Psychiatry 1986 Mar;31(2):161-5 22 UI - 86212736 AU - von Broembsen F TI - Separation crisis in a family with a borderline adolescent. AB - The case discussed illustrates the crisis value of separation strivings in borderline families. Dynamic and interpersonal issues were approached from a focus on (a) patterns of projective identification; (b) parental definitions interfering with the child's ego structure formation; and (c) the deterioration of a borderline personality toward frankly schizophrenic functioning under the double pressure of the developmental task of separation and binding parental maneuvers. MH - Adult ; Borderline Personality Disorder/*PSYCHOLOGY/THERAPY ; Case Report ; Crisis Intervention ; *Family ; Father-Child Relations ; Female ; Gender Identity ; Human ; *Individuation ; Mother-Child Relations ; Object Attachment ; *Personality Development ; Personality Disorders/ *PSYCHOLOGY ; Psychoanalytic Therapy ; Self Concept SO - Am J Psychoanal 1986 Spring;46(1):62-75 23 UI - 86186083 AU - Williams SE ; Freer CA TI - Aphasia: its effect on marital relationships. AB - The primary purpose of this study was to determine if a relationship exists between marital satisfaction and knowledge of aphasia of the spouse of a stroke patient. Other factors such as the severity of the aphasia, length of time poststroke, and length of marriage were also examined. The subjects, 16 spouses of aphasic patients, were grouped according to severity of the aphasia (mild, moderate, severe). Spouses completed a Knowledge of Aphasia questionnaire and pre/poststroke forms of a Marital Satisfaction Scale (MSS). The questionnaire measured spouse understanding of aphasia, while the MSS examined changes in spouse attitudes toward their marriages after the patients became aphasic. Neither spouses' knowledge of aphasia nor its severity was related to their marital satisfaction. However, there was a significant negative change between the pre/poststroke MSS scores. Spouses of mildly impaired patients were less knowledgeable about aphasia than were those of severely impaired patients. Results are discussed in terms of the counseling needs of families of aphasic patients. MH - Acute Disease ; Aged ; Analysis of Variance ; Aphasia/*PSYCHOLOGY/ REHABILITATION ; Attitude ; Cerebrovascular Disorders/REHABILITATION ; Communication ; Comparative Study ; Family ; Female ; Human ; Male ; *Marriage ; Middle Age ; Perception ; Questionnaires ; Time Factors SO - Arch Phys Med Rehabil 1986 Apr;67(4):250-2 24 UI - 86167702 AU - Kaplan SL ; Grossman P ; Landa B ; Shenker IR ; Weinhold C TI - Depressive symptoms and life events in physically ill hospitalized adolescents. AB - To study life events and depressive symptoms in adolescents hospitalized for physical illness, we administered the Coddington Life Events Survey and the Beck Depression Inventory (BDI) to 43 acutely ill adolescents, 42 chronically ill adolescents, and 140 adolescents from a general population. There were no differences between the three groups in total BDI, Psychological BDI, and Coddington Life Change Categories adjusted for hospitalization. The Somatic BDI was significantly greater in the acutely ill and chronically ill than in the general population sample (p less than 0.01). In the chronically ill, the Family Life Change score correlated with the psychological BDI (r = 0.44, p less than 0.01) but the Undesirable Life Change score did not. In the acutely ill and the general population, the Undesirable Life Change Score correlated with the Psychological BDI (r = 0.44, p less than 0.01), (r = 0.43, p less than 0.01) but the Family Life Change Score did not. MH - Acute Disease/PSYCHOLOGY ; Adolescence ; Chronic Disease/PSYCHOLOGY ; Depression/*PSYCHOLOGY ; Disease/*PSYCHOLOGY ; Family ; Female ; Human ; *Life Change Events ; Male SO - J Adolesc Health Care 1986 Mar;7(2):107-11 25 UI - 86160739 AU - Dove AF ; Dave SH TI - Elderly patients in the accident department and their problems. AB - During two months in the winter and two in the summer information was gleaned about all patients aged 70 and over attending a large accident and emergency department. Comparative figures for the same periods over the previous 20 years showed an increasing number of elderly attenders, the increase being closely related to the increasing proportion of elderly in the population. Using national census data, attendance rates were shown to increase dramatically with age. With increasing age more elderly attended as a result of accidents in the home. The information suggested that social isolation and paucity of support in the community may be responsible for the decision to come to hospital rather than to consult the general practitioner. The elderly attend accident and emergency departments for a wide range of problems but some do so solely for socioeconomic reasons and are particularly difficult to help. MH - Accidents, Home ; *Aged ; Comparative Study ; Divorce ; *Emergencies ; Emergency Service, Hospital ; England ; Female ; Human ; Male ; Marriage ; Referral and Consultation ; Sex Factors ; Single Person SO - Br Med J [Clin Res] 1986 Mar 22;292(6523):807-9 26 UI - 86148178 AU - Hansen M ; Young DA ; Carden FE TI - Psychological evaluation and support in the pediatric intensive care unit. AB - This article has discussed the role of the psychological consultant in the PICU. New advances in critical care treatment have created the need for a greater awareness of psychological issues that affect the medical management of children, and the emotional impact on their families. Psychological consultation can assist in clarifying and addressing these issues by identifying and evaluating the stressors impinging on the patient, and implementing or directing appropriate interventions. This intervention may also entail assistance to the family and care providers in coping with intense and emotionally sensitive issues. MH - Child ; Child Abuse ; Critical Care/*PSYCHOLOGY ; Family Therapy ; Female ; Human ; Incest ; Intensive Care Units/*MANPOWER ; Male ; Mental Disorders/*THERAPY ; Neoplasms/PSYCHOLOGY ; Nursing Staff, Hospital/ PSYCHOLOGY ; Parents/PSYCHOLOGY ; *Psychology, Clinical ; Psychotherapy SO - Pediatr Ann 1986 Jan;15(1):60-9 27 UI - 86127633 AU - Rhodes RM ; Zelman AB TI - An ongoing multifamily group in a women's shelter. AB - A mental health clinic's consultation to a spouse abuse center led to formation of an ongoing multifamily group that included all residents of the shelter and their children of all ages. The theoretical framework is outlined and group dynamics are highlighted by case material focused on illustrating specific intervention techniques. MH - Adaptation, Psychological ; Adolescence ; Adult ; Case Report ; Child ; Child Reactive Disorders/THERAPY ; Child Rearing ; Child, Preschool ; Community Mental Health Services ; Crisis Intervention ; Family Therapy/ *METHODS ; Female ; Group Processes ; Group Structure ; Human ; Infant ; Infant, Newborn ; Male ; Mother-Child Relations ; Pregnancy ; Psychotherapy, Group/*METHODS ; *Spouse Abuse ; Stress, Psychological/ COMPLICATIONS ; Violence SO - Am J Orthopsychiatry 1986 Jan;56(1):120-30 28 UI - 86120095 AU - Jacobson MS ; Rubenstein EM ; Bohannon WE ; Sondheimer DL ; Cicci R ; Toner J ; Gong E ; Heald FP TI - Follow-up of adolescent trauma victims: a new model of care. AB - A comprehensive model of service delivery for the rehabilitative care of adolescents with closed head injuries is presented. Our data show that the Glasgow Coma Scale score on hospital admission correlates with the length of time required for follow-up. Adolescents with mild closed head injuries require more follow-up than adults with comparable injuries because of adolescent developmental stages that complicate the recovery process. Anticipatory guidance has helped the patient and family cope with stresses. Finally, we have identified a typical pattern of difficulties during the recovery process including: impaired judgment, reduced attention span, irritability, short-term memory loss, and ongoing memory deficits. MH - Adaptation, Psychological ; Adolescence ; Case Report ; Family ; Female ; Follow-Up Studies ; Head Injuries/PSYCHOLOGY/*REHABILITATION ; Human ; Learning Disorders/THERAPY ; Male ; Remedial Teaching ; Self Concept ; Support, U.S. Gov't, P.H.S. SO - Pediatrics 1986 Feb;77(2):236-41