By L. Jared. Iowa Wesleyan College.
Of the eight studies reviewed which assessed the relationship between illness symptom severity or global functioning and inpatient medication refusal or future outpatient non-adherence propranolol 40 mg overnight delivery, one reported an association between more severe psychopathology including disorganisation cheap 40 mg propranolol mastercard, hostility and suspiciousness and inpatient drug refusal and five studies linked symptom severity at or after discharge to poor outpatient adherence or poor attitudes towards medication. One study also linked the grandiosity score on the Brief Psychiatric Rating Scale to poor adherence. Whilst the authors did not find support for an association between memory or cognition on adherence, they acknowledged that a significant percentage of outpatients attributed non-adherence to forgetting or indicated that 47 reminders to take their medication would be of assistance. Poor insight, as measured by a variety of self-report instruments assessing illness awareness, was consistently linked with non-adherence. Three studies showed an association between poor insight at admission or during hospitalisation and non-adherence in inpatient settings. Four studies linked lack of insight at admission, discharge or post-discharge assessment to poor outpatient adherence. Poor insight, negative attitude or subjective response to medication, substance abuse, shorter illness duration, inadequate hospital discharge planning and poor therapeutic alliance were the risk factors found to be most consistently associated with non-adherence. There was an absence of support for relationships between illness-related factors, including neuro-cognitive impairment, severity of positive symptoms and the presence of mood symptoms and adherence. Furthermore, the severity of medication side effects, dose of medication, route of medication administration and family involvement were not found to be consistent predictors of non- adherence. However, a limitation of the review was that many of the studies included were retrospective, cross-sectional and conducted prior to the introduction of atypical antipsychotic medications. More recently, Compton (2007) reviewed relevant literature and developed a predictive model of risk factors for non-adherence to antipsychotic medications and follow-up appointments amongst people with schizophrenia. The model is comprised of eight independently significant predictors from diagnostic, clinical, psychosocial and treatment history domains: Substance use disorder diagnosis; medication side effects; moderate to severe psychotic symptoms; personality disorder diagnosis; economic problems; prior hospitalisation; current Global Assessment of Functioning scale score and duration of treatment from current psychiatrist (Compton, 2007). The summarised results of Compton’s (2007) review are featured in Table 1 (below). Table 1: Risk factors for non-adherence to antipsychotic medications and follow-up appointments amongst people with schizophrenia (from Compton, 2007). It is included in the print copy of the thesis held by the University of Adelaide Library. Although these factors are often labelled differently or grouped under different broad categories between studies, they are nonetheless referring to the same or similar phenomena. The factors that were consistently associated with adherence and/or assessed for their association with adherence are frequently classified as consumer factors, illness factors, medication factors, service factors and social factors. Consumer factors typically refer to demographic factors which are consistently tested despite limited support for their association with adherence (i. Other commonly raised consumer factors include consumer attitudes towards medication, previous substance abuse or dependence (although this is sometimes considered a social factor) and forgetfulness (although this is sometimes considered an illness factor related to the cognitive impairments associated with schizophrenia). Regarding illness factors, insight has consistently been found to be one of the strongest predictors of adherence. Other illness factors frequently assessed and sometimes associated with adherence include the severity of psychopathology generally, in addition to the severity of specific symptoms including paranoia, grandiosity and hostility. Medication factors included the consumer’s response to medication in addition to its tolerability and the presence of side effects and adverse reactions to medication. The dosage, route, regimen and administration of medication, in addition to the type of medication (typical or 50 atypical) are often assessed for associations with adherence. Service factors, including the therapeutic alliance between the prescriber and the consumer, have commonly been assessed. Social factors such as family support and stigma are also often assessed in relation to adherence. Thus, quantitative research has not shed any light on how various factors influence adherence and how factors may interact. This gap may reflect a perception that people with schizophrenia are irrational and, therefore, incapable of offering a valid viewpoint, despite research which has demonstrated that people with schizophrenia are able to make accurate assessments about the effects of their medication (e. Like the research presented in this thesis, the following studies (which represent the extant literature in the area) applied consumer-focussed approaches to understand medication adherence amongst people with schizophrenia. Qualitative data derived from the personal accounts of people diagnosed with schizophrenia were analysed and were sometimes triangulated with the views of relative caregivers and clinicians. Notably, some repetition of factors explored in some of the quantitative research that was discussed is apparent. The sample consisted of 34 people who had been diagnosed with schizophrenia or schizo affective disorder and prescribed a regimen of long-term antipsychotic medication (oral and depot) from the United Kingdom. Interviews focused specifically on conceptions of the cause and nature of schizophrenia, experience and knowledge about medications, the nature of medication practices used on a day-to-day basis, management strategies, the involvement of others in managing medication and attitudes towards professionals and although not articulated, the analysis appeared in line with a thematic analysis approach. For most participants, adherence was associated with recognition of the benefits of medication (such as symptom control and relapse and hospitalisation prevention) and/or the personal costs associated with non- adherence. The main utility of medication was seen as its ability to act directly on symptoms by stopping them or reducing them, rendering them more manageable. Participants identified one of the costs associated with taking antipsychotic medication as the experience of side effects, which at times, equalised or outweighed the positive gains associated with taking medication. There was evidence that participants had acquired knowledge regarding the levels of medication they needed to control their illness and, beyond those levels, had gained some freedom to adjust the medication to manage side effects and other problems involved.
Second buy propranolol 80mg with amex, we think that knowing what’s good about anxiety and what’s bad about it is good for you discount 80 mg propranolol visa. Finally, we cover what you’re probably most interested in — discovering the latest techniques for overcoming your anxiety and helping someone else who has anxiety. For example, if you really don’t want much information about the who, what, when, where, and why of anxiety and whether you have it, go ahead and skip Part I. However, we encourage you to at least skim Part I, because it contains fascinating facts and information as well as ideas for getting started. An Important Message to Our Readers Since the first edition of Overcoming Anxiety For Dummies, we’ve made a point of commenting on our use of humor in these books. Although topics like anxiety, depression, obsessive-compulsive disorder, and borderline per- sonality disorder are serious, painful subjects, we believe that laughter, like a little sugar, helps the medicine go down and the message come through. Introduction 3 This book is meant to be a guide to overcoming a mental state or disorder called anxiety. However, if your anxiety greatly interferes with your day-to-day life, restricts your activities, and robs you of pleasure, we urge you to seek professional mental healthcare. Conventions Used in This Book We use a lot of case examples to illustrate our points throughout this book. Please realize that these examples represent composites of people with vari- ous types of anxiety disorders. We bold the names of people in our examples to indicate that a case example is starting. We also use boldface text to indicate keywords in a bulleted list or to high- light action parts of numbered steps. Finally, when we direct you to a Web site for additional information, it’s printed in monofont. What You’re Not to Read Not only do you not have to read each and every chapter in order (or at all, for that matter), you don’t have to read each and every icon or sidebar (the text in the gray boxes). We assume, probably foolishly, that you or someone you love suffers from some type of problem with anxiety or worry. We imagine that you may be curious about a variety of helpful strategies to choose from that can fit your lifestyle and personality. Finally, you may be a mental-health professional who’s interested in finding a friendly resource for your clients who suffer from anxiety or worry. Part I: Detecting and Exposing Anxiety In the first two chapters, you find out a great deal about anxiety — from who gets it to why people become anxious. We explain the different kinds of anxiety disorders — they’re not all the same — and we tell you who is most susceptible and why. In Chapter 3, we review the biological aspects of anxiety disorders — from the toll they take on the body to the underlying biochemical processes involved. You discover the most common reasons that people resist working on their anxiety and what to do if you find yourself stuck. And you discover how the words that you use can increase anxiety and how simply changing your vocabulary decreases anxiety. In addition, we take a look at how medication can sometimes alleviate anxiety disorders. Changes in lifestyle such as staying connected with others, exercising, get- ting enough sleep, and maintaining a proper diet all help. Learning to relax through breathing exercises, muscle exercises, or conjuring up calm images can relieve anxiety passively. Mindfulness has emerged as a highly popular as well as empirically supported approach to improving emotional well-being. The chapters in this part focus on anxieties about finances, ter- rorism, natural disasters, and health. You can’t live a meaningful life without having some concern about issues such as these. This part gives you ways of preparing for unexpected calamities and ideas about how to accept uncer- tainty in an uncertain world. Part V: Helping Others with Anxiety What do you do when someone you love worries too much? As a coach or simply a cheerleader, you can help your friend or family member conquer anxiety. In this new, expanded portion of the book, we also give you the tools to understand the differences between normal fear and anxiety in children. In addition, we talk about who to go to for help with your child and what to expect. You can read about ten ways to stop anxiety in its tracks, ten ways to handle relapse, and ten signs that professional help is in order. Finally, the appendix lists books and Web sites for obtaining more informa- tion about the topics we cover in this book.
In a sense buy 40 mg propranolol mastercard, both the deflated balloon and the one close to the bursting point worry plenty about their own state: their condition discount 40 mg propranolol otc, worth, and vulnerability. The key to having just the right amount of ego — air in the balloon — is to have less concern with yourself (along with more concern for others) and less worry about how you stack up against others. When you can accept both your positive and negative qualities without being overly concerned for either, you’ll have the right amount of air in your ego balloon, but that isn’t always so easy to do. It takes a solid focus on learning, striving, and working hard — though not to excess. Chapter 13: Mindful Acceptance 209 The seductive power of positive thinking In the 1950s, self-help gurus began a movement Hardly. Today, school achievement lags sig- by encouraging everyone to pump up their self- nificantly behind where it was in 1960. School violence is cles were written on the topic of self-esteem in much higher than 50 years ago, and the rates professional journals; however, in the past ten of depression and anxiety among today’s youth years alone, more than 8,000 such articles have are higher than ever. An incredible number of recent research tion, literally thousands of self-help books have studies show a strong link between the over- promoted the unquestioned value of nurturing abundant focus on the self and violence, poor self-esteem. The self-esteem movement now school achievement, and emotional problems permeates parenting magazines, school cur- of all sorts. It seduced a gen- to be bad for you, but studies suggest that an eration of parents, teachers, and mental-health overly inflated self-esteem is even worse. The workers into believing that the best thing that answer appears to lie in having less focus on they could do for kids was to pump up their self- the almighty self. So has more than a half-century of promot- ing self-esteem (also known as ego) paid off? Appreciating your imperfections All too often, anxious people feel that they must be perfect in order for others to like and accept them. Kelly always wears exactly the right fashionable clothes, the right colors, and her accesso- ries always match. She always knows just what to say, never stumbling over a single word or swearing. Does she seem like someone you’d like to hang out at a pool with on a summer weekend? Picture that person in your mind and recall some of the good times that you’ve spent together. Think about how much you appreciate this person and how your life has been enriched by the relationship. Realize that you’ve always known about your friend’s negative qualities and imperfections, yet you’ve continued to appreciate your friend. In the second column, describe a couple of negative qualities or imperfections that your friend has. Following this exercise, realize that your friends probably have a similar pic- ture of you. Curtis fills in the “Appreciating Flawed Friends” exercise in Table 13-1 while thinking about his buddy Jack. In the respective columns, he writes about Jack’s positive qualities and imperfections. There’s no one that Curtis would rather spend time with, and Jack is the first person he would turn to in a crisis. If your friend filled out the same form on you, no doubt she would write about both wonderful qualities and some less-than-wonderful traits. And yet, your friend wouldn’t suddenly give up the friendship because of your imper- fections. Perhaps even more difficult is finding out how to drop defensive barriers in response to criticism from others. Instead of put- ting up barriers to communication and problem solving, admitting to some flaws brings people closer. Table 13-1 Appreciating Flawed Friends Positive Qualities Negative Qualities and Imperfections Jack is one of the funniest guys I know. Even though he’s smart, sometimes Jack makes stupid decisions, espe- cially about money. Jack will help me anytime I need it, no Jack’s a little overweight, and some- matter what. Connecting with the Here and Now In some ways, language represents the peak of evolutionary development. Language makes us human, gives us art, allows us to express complex ideas, and provides us with the tools for creating solutions to problems. At the same time, language lays the foundation for much of our emotional distress.