Robert C. Rinaldi

Adolescents as victims of family violence

Adolescents as victims of family violence Cable Y.D. Jr.; Estes E.H. Jr.; Head C.A.; Karlan M.S.; Kennedy W.R.; Numann P.J.: Scheider K.A.; Scott W.C.; Skelton W.D.; Steinhilber R.M.; Strong J.P.; Wagner H.N. Jr.; Loeb J.M.; Rinaldi R.C.; Stewart B.; Voegtle K. USA J AM MED ASSOC 1993 270/15(1850-1856) Adolescents experience maltreatment at rates equal to or exceeding those of younger children. Recent increases in reported cases of maltreatment have occurred disproportionately among older children and adolescents. However, adolescents are less likely to be reported to child protective services and are more likely to be perceived as responsible for their maltreatment. Adolescent girls are reported as victims more often than boys, especially in sexual abuse. However, boys may be less likely to be identified or reported and often are abused by nonfamily members. Parents of adolescent victims have higher average income and educational levels and are less likely to have a parental history of abuse than parents of younger children. A wide range of serious adolescent risk behaviors is associated with maltreatment. These include increased risk of premature sexual activity, unintended pregnancy, emotional disorders, suicide attempts, eating disorders, alcohol and other drug abuse, and delinquent behavior. Incarcerated youth, homeless or runaway youth. and youth who victimize siblings or assault parents have been shown to have high rates of prior maltreatment. Signs of maltreatment are often ambiguous for adolescents. Screening questions have been effective in prompting self-disclosure of abuse. Adolescents also experience problems in the child welfare system that offers fewer and less appropriate services for this age group. Recommendations are made regarding screening of adolescents for maltreatment. the development of better services for adolescents, research on parenting to prevent maltreatment, and training of school staff to identify and refer victims of maltreatment.

Induced termination of pregnancy before and after Roe v Wade: Trends in the mortality and morbidity of women

The mortality and morbidity of women who terminated their pregnancy before the 1973 Supreme Court decision in Roe v Wade are compared with post-Roe v Wade mortality and morbidity. Mortality data before 1973 are from the National Center for Health Statistics; data from 1973 through 1985 are from the Centers for Disease Control and The Alan Guttmacher Institute. Trends in serious abortion-related complications between 1970 and 1990 are based on data from the Joint Program for the Study of Abortion and from the National Abortion Federation. Deaths from illegally induced abortion declined between 1940 and 1972 in part because of the introduction of antibiotics to manage sepsis and the widespread use of effective contraceptives. Deaths from legal abortion declined fivefold between 1973 and 1985 (from 3.3 deaths to 0.4 death per 100,000 procedures), reflecting increased physician education and skills, improvements in medical technology, and, notably, the earlier termination of pregnancy. The risk of death from legal abortion is higher among minority women and women over the age of 35 years, and increases with gestational age. Legal-abortion mortality between 1979 and 1985 was 0.6 death per 100,000 procedures, more than 10 times lower than the 9.1 maternal deaths per 100,000 live births between 1979 and 1986. Serious complications from legal abortion are rare. Most women who have a single abortion with vacuum aspiration experience few if any subsequent problems getting pregnant or having healthy children. Less is known about the effects of multiple abortions on future fecundity. Adverse emotional reactions to abortion are rare; most women experience relief and reduced depression and distress.

Psychiatric Assessment and Diagnosis

In psychiatry, as in any helping profession, effective clinical intervention depends on a comprehensive evaluation of the individual seeking treatment. The interrelated fields of psychiatric diagnosis and assessment constitute a wide and ever-expanding range of strategies designed to serve that purpose. Although an exhaustive survey of these methods would be impractical, this chapter details some of the more important and useful assessment techniques available to the practicing clinician. Our discussion of these techniques is divided into three main sections. The first concerns diagnosis and classification, including the use of structured diagnostic interviews. The second describes the growing use of convenient indirect measures of symptomatology, namely, self-report questionnaires and clinician rating scales. The third section reviews observation-based assessment techniques designed to measure abnormal behavior more directly in natural or in clinical or analogue settings. Because each of these methods has unique strengths and limitations, they are almost never used in isolation. Instead, the coordinated use of multiple assessment strategies, which allows for the identification of a consistent pattern of information, is generally the optimal approach.

Patient-therapist personality similarity and the therapeutic relationship

This study investigated personality similarities in the patient-therapist dyad to determine whether these similarities were conducive to the formation of a positive therapeutic relationship. The Edwards Personal Preference schedule was used to assess personality. The Barrett-Lennard Relationship Inventory and Truaxs Accurate Empathy Scale were used to measure therapeutic relationship. Fourteen PhD and non-PhD therapists participated. Twenty-two adult male and female patients participated. Multiple regression analysis was used to test the hypotheses. Results showed that therapeutic dyads rated as having similar personalities developed a therapeutic relationship at about the same rate as therapeutic dyads rated as having dissimilar personalities. Doctoral level therapists and non- PhD level therapists developed a therapeutic relationship with their patients at about the same rate, regardless of similarity or dissimilarity of personality.