Floor W. Kraaimaat

Biopsychosocial mediators and moderators of stress-health relationships in patients with recently diagnosed rheumatoid arthritis.

OBJECTIVE To investigate the mediating and moderating roles of social support, coping, and physiological variables in the relationship between life events and health status. METHODS Psychological and biological measurements were taken in 54 patients (38 women, 16 men, mean age +/- SD 56 +/-14.4 years) with recently diagnosed rheumatoid arthritis (RA). RESULTS Life events were correlated with psychological distress, but not with disease activity. No mediators for the relationship of life events with psychological well-being and disease activity were observed. In 40 tests, 4 moderators were found: Problem-focused coping, perceived support, diastolic blood pressure, and total number of lymphocytes were moderators of the relationship between daily hassles and health status (P < or = 0.05). CONCLUSION Our study provides limited support for the notion that the interactions of life stress with biopsychosocial variables have an impact on health. None of these variables were found to be crucial mediators of stress-health associations in recently diagnosed patients with RA, but some provocative evidence was given that biopsychosocial variables may have a minor impact on stress-health relationships.

Skin diseases in family medicine: prevalence and health care use.

PURPOSE Ongoing care for patients with skin diseases can be optimized by understanding the incidence and population prevalence of various skin diseases and the patient-related factors related to the use of primary, specialty, and alternative health care for these conditions. We examined the recent prevalence of skin diseases in a defined population of family medicine patients, self-reported disease-related quality of life, extent and duration of skin disease, and the use of health care by patients with skin diseases. METHODS We undertook a morbidity registry-based epidemiological study to determine the prevalence of various skin diseases, using a patient questionnaire to inquire about health care use, within a network of family practices in the Netherlands with a practice population of approximately 12,000 citizens. RESULTS Skin diseases accounted for 12.4% of all diseases seen by the participating family physicians. Of the 857 questionnaires sent to patients registered with a skin disease, 583 (68.0%) were returned, and 501 were suitable for analysis. In the previous year, 83.4% of the patients had contacted their family physician for their skin disease, 17.0% had contacted a medical specialist, and 5.2% had consulted an alternative health care practitioner. Overall, 65.1% contacted only their family physician. Patients who reported more severe disease and lower quality of life made more use of all forms of health care. CONCLUSION This practice population-based study found that skin diseases account for 12.4% of diseases seen by family physicians, and that some skin problems may be seen more frequently. Although patients with more extensive skin diseases also obtain care from dermatologists, most patients have their skin diseases treated mainly by their family physician. Overall, patients with more severe disease and a lower quality of life seek more treatment.

Aggression Control Therapy for violent forensic psychiatric patients: First results

Abstract Aggression Control Therapy (ACT), a treatment programme developed in the Netherlands for violent forensic psychiatric patients with a conduct disorder or antisocial personality disorder, was investigated in two studies. In the first study, the personality traits and problem behaviours of these patients and a normative Dutch population were compared, and then the traits and behaviours of patients who completed the ACT were compared with those who dropped out. In the second study, the ACT was evaluated by comparing pre-treatment, post-treatment, and follow-up data. Two control conditions were added: a waiting-list period for outpatients and a control group for inpatients. The patients who received ACT were psychologically unstable, egoistic, and prone to anger. They reported little social anxiety when exhibiting limit-setting behaviour (e.g. giving criticism) but tended to avoid approaching behaviour (e.g. giving a compliment). Results suggested that ACT diminished aggressive behaviour but did not change socially competent behaviour. The limitations of the two studies are mentioned and suggestions for further research into the effects of ACT are presented.

Anxiety/discomfort and handwashing in obsessive-compulsive and psychiatric control patients

Summary The effects of touching, a feared dirt stimulus and handwashing on subjective anxiety/distress and autonomic reactivity were investigated in 6 patients with fear of contamination and handwashing behavior and 12 psychiatric control patients. An increase in autonomic anxiety/discomfort was found during anticipation and the actual touching of a dirt stimulus of moderate intensity in both groups. Handwashing after touching the dirt stimulus only resulted in a reduction of subjective distress in both the experimental and control group.

A group social skills training program with psychiatric patients: Outcome, drop-out rate and prediction

Abstract The present study investigated the effectiveness of a social skills training program with 131 socially-anxious psychiatric inpatients and outpatients. Ninety-six patients were admitted to the treatment condition: 20 of them dropped out during treatment; 35 patients were randomly assigned to the control group. The social skills training resulted in a decrease in social anxiety and an increase in social skills. Treatment effects were maintained 3 months after treatment. Predictors of treatment outcome immediately after treatment and after a 3-month period of follow-up were investigated. The results are discussed with reference to extending the treatment targets to include a more active expansion of real-life situations and to the implementation of the therapy program in a clinical setting.

Aggression Control Therapy for Violent Forensic Psychiatric Patients: Method and Clinical Practice

Aggression control therapy is based on Goldstein, Gibbs, and Glicks aggression replacement training and was developed for violent forensic psychiatric in- and outpatients (adolescents and adults) with a (oppositional—defiant) conduct disorder or an antisocial personality disorder. First, the conditions for promoting “treatment integrity” are examined. Then, target groups, framework, and procedure are described in detail, followed by the most important clinical findings during the period 2002 to 2006. Finally, new programme developments are mentioned, with aggression control therapy as a starting point.

Violent Forensic Psychiatric Patients: Individual Differences and Consequences for Treatment

The literature on differences between aggressive individuals exhibiting reactive and proactive aggression raises the issue whether different treatment programs should be developed for violent forensic psychiatric patients with a conduct disorder or an antisocial personality disorder. In order to study this issue, aggressive behavior of 133 inpatients and of 176 outpatients was analyzed in detail for four subgroups, composed on the basis of the two factors of the Psychopathy Checklist-Revised. Contrary to expectations, there were no differences found in scores on self-report questionnaires for disposition to anger, hostility and aggressive behavior between the four subgroups. Minor differences were found, however, between these four subgroups in the relationship to aspects of aggressive behavior on the one hand, and neuroticism, social anxiety and social skills on the other hand. To some extent, this explorative study appears to confirm recommendations to distinguish between individuals who exhibit reactively aggressive behavior, and those who primarily display proactively aggressive behavior. In line with our clinical experiences and with our findings, it seems advisable to focus especially on anger management and social skills in the reactively aggressive group and on moral reasoning and prosocial thinking styles in the proactively aggressive group.

An evaluation of behavioural and personality differences between native and non-native male adolescents in the Netherlands ordered into treatment in a forensic psychiatric outpatient clinic, and their non-violent peers

BACKGROUND In a previous study of the dynamic criminogenic needs of violent outpatients we did not differentiate between native and non-native adolescents, but differences between personality traits and problem behaviours may require adaptations to any treatment programme. AIM To compare, in the Netherlands, native and non-native adolescents with and without a violence history on personality traits and problem behaviours. METHODS Forty-eight native and 71 non-native violent male adolescents were recruited from consecutive referrals to a forensic outpatient clinic after a violent offence and compared with randomly selected male youths in secondary vocational schools, but without a violent history, 82 of whom were from Dutch and 79 from non-Dutch descent. Each took part in an individual interview to complete a range of personality and behavioural rating scales. RESULTS Native and non-native adolescent outpatients did not differ from each other on any measure. Overall, the outpatients scored higher than the students on hostility but not aggressive behaviour, but there were differences within the student group according to descent, with the native students having higher agreeableness scores and lower hostility and aggressive behaviour scores than the students of non-Dutch descent. CONCLUSION Our study suggested that any differences in behavioural or personality traits seen in the general adolescent population according to descent are not reflected in a violent offender group of similar age. It therefore seems unlikely to be necessary to run different treatment programmes for native and non-native adolescent offenders.

Aggression Control Therapy for Violent Forensic Psychiatric Patients

Aggression control therapy is based on Goldstein, Gibbs, and Glicks aggression replacement training and was developed for violent forensic psychiatric in- and outpatients (adolescents and adults) with a (oppositional—defiant) conduct disorder or an antisocial personality disorder. First, the conditions for promoting “treatment integrity” are examined. Then, target groups, framework, and procedure are described in detail, followed by the most important clinical findings during the period 2002 to 2006. Finally, new programme developments are mentioned, with aggression control therapy as a starting point.