William M. Womack

Sociocultural determinants of the help-seeking behavior of patients with mental illness

This descriptive study employed semistructured interviewing and questionnaire administration to delineate the sociocultural determinants of the help-seeking process in 48 psychiatric patients. The help-seeking process is considered in two stages. The first stage starts from the recognition of initial symptoms and ends in the first contact with a mental health professional. The second stage is defined as that time between the first contact and actual participation in a planned treatment program. In both stages, patients typically go through phases of lay consultation, nonpsychiatric professional consultation, and referral. The multiple steps which are usually involved in help seeking often result in significant delay of both mental health contact and treatment. The help-seeking process was found to correlate strongly with ethnicity. Both Asians and Blacks showed more extended family involvement, and the involvement of key family members tended to be persistent and intensive in Asians. Ethnicity was also associated with the length of delay, with Asians showing the longest delay and Caucasians the least. These ethnic differences were also reflected in help-seeking pathway assignment using Lins criteria. Although modernity and parochialism, as measured by the level of modernization and the cohesiveness of the social network system of the subjects, were also found to be correlated with delay, they appeared to exert an influence independent from that of ethnicity.

Hypnotic versus Active Cognitive Strategies for Alleviation of Procedural Distress in Pediatric Oncology Patients

This study provided a differential comparison of the efficacy of standardized instruction in hypnosis or active cognitive strategy for provision of relief from procedurally induced pain and anxiety. Subjects were instructed to self-direct in the use of strategies during medical procedures. Twenty pediatric oncology patients participated in the study. They were not informed that hypnosis was one of the strategies. Subjects were screened for hypnotizability and randomly assigned to treatments. Demographic data were collected. Pre-strategy training observations were made during a Bone Marrow Aspiration or Lumbar Puncture (BMA/LP) using visual analog scales, the McGill Pain Questionnaire, State-Trait Anxiety Inventory, pulse and temperature readings, and interview. Following strategy training, data were collected during a second BMA/LP using the same measures as employed pre-intervention. Results indicated that both strategies were effective in providing pain reduction. Neither technique provided for anxiety reduction. Hypnotizability scale scores failed to correlate with degree of pain reduction.

Factors related to school absenteeism in adolescents with recurrent headache.

Objective.—To examine possible risk and protective factors for school absenteeism among adolescents referred to a hospital‐based behavioral treatment program.

Recurrent Headache in Adolescents: Nonreferred Versus Clinic Population

Objective.—To compare headache activity, psychosocial measures, and cold pressor response between referred and nonreferred adolescents with frequent headache.

Memo Outlining Evidence for Change for Gender Identity Disorder in the DSM-5

IntroductionIn 2008, when the diagnostic Work Groups for the DSM-5 wereestablishedandformallyannouncedbytheAmericanPsychiatricAssociation,oneofthefirsttasks wastoreviewtheexistingdiag-nostic categories and to conduct literature reviews. The GenderIdentity Disorders (GID) subwor kgroup was one of three sub-workgroups of the Sexual and Ge nder Identity Disorders WorkGroup.Likeotherworkinggroups,itschargewastoevaluatewhatwas,ifanything,‘‘good’’abouttheexistingdiagnosisofGIDintheDSM-IV-TR and what, if anything, required changes. The sub-workgrouppublishedfourliteraturereviewsinwhichsomeinitialproposals and recommendations were made (Cohen-Kettenis PDrescher,2010; Meyer-Bahlburg, 2010; Zucker,2010). The subworkgroup had feedback from its advisors, fromother professionals, and from the public, including three periodsof APA-sponsored feedback on the DSM-5 website.Around mid-way during the DSM-5 preparation period,which ended on 1 December 2012, the Task Force added to thereview phase two additional committees. One was a ScientificReview Committee (SRC) and the second was a Clinical andPublic Health Committee (CPHC).The SRC was charged with providing feedback on all pro-posed changes to the diagnos tic criteria that were based onempirical evidence. The CPHC was charged with providingfeedback with regard to additional parameters, such as clinicalutility and public health concerns.EachWorkGrouporsubworkgroupoftheDSM-5TaskForcejustifiedtheproposedchangesofdiagnosticcategoriesinareportentitled Memo Outlining Evidence for Change (MOEC). Withthe permission of the American Psychiatric Association, wereproduce here the final version of the MOEC prepared by theGIDsubworkgroup(‘‘inpress’’referenceshavebeenupdatedandtypographical errors corrected). Publication of the MOEC thusmakestransparenttheargumen tationadvancedbythesubwork-group for interested readers. Comments on the proposal arewelcomeintheformofaLettertotheEditorofthisJournal.

Stress Management Techniques in Childhood and Adolescence Relaxation Training, Meditation, Hypnosis, and Biofeedback: Appropriate Clinical Applications

Many childhood and adolescent stress-related symptoms have a psychophysiological component that involves muscular tension and/or autonomic nervous system dysfunction. Examples of this include recurrent headache, chest pain, abdominal pain, syncope, and dizziness. After a careful medical and psychosocial evaluation, the clinician may identify many patients who are appropriate for the application of stress reduction techniques such as progressive muscular relaxation, meditation, biofeedback, and relaxation/mental imagery (self-hypnosis). This review describes these techniques and their application with selected children and adolescents.

Behavioral management of childhood headache: a pilot study and case history report

Many chronically recurrent disorders of children and adolescents are often unresponsive to standard medical therapy. The Stress and Headache Management Clinic was established as a prototype behavioral medicine clinic to provide integrated therapeutic modalities. Using biofeedback and relaxation/mental-imagery techniques, 119 patients with the chief complaint of recurrent headache were evaluated. This paper describes the use, application, and efficacy of behavioral techniques for the management of headache in children and adolescents. Relevant treatment factors in behavioral treatment of pediatric headache are also discussed.

Variation in opioid use during PCA in adolescents

The objective of this investigation was to determine if the variability in the use of opioids for pain following surgery is related to variability in blood concentration of opioids used for pain relief. We measured morphine use and morphine blood concentration in a group of otherwise healthy adolescent girls following spinal surgery. There was considerable variability in morphine use and morphine blood levels as indicated by a large range of values and a moderately large standard deviation. Morphine blood concentration correlated with morphine use. Neither morphine use nor morphine concentration correlated with pain scores. The data indicate that there is considerable variability among patients in the amount of opioid needed to achieve comfort and in the blood concentration associated with comfort. The cause of this variability does not appear to be related to metabolism of opioid, but may be related to psychological differences, differences in pain tolerance and threshold, or differences in the way patients use PCA.

Anxiety and depression in the behavioral treatment of headache in children and adolescents.

Controlled studies have demonstrated that behavioral techniques are effective in the treatment of recurrent pediatric headache. The outcome of therapy may be influenced by factors that are intrinsic to the patient. We have reviewed the existing headache literature with particular emphasis on anxiety and depression and examined patient factors in our own series of 119 children and adolescents treated with biofeedback and relaxation-mental imagery. Patients with tension headache had significantly higher intake anxiety and depression scores than migraine or mixed headache patients. Anxiety and depression scores were significantly decreased from intake to end of treatment. Headache activity at the end of treatment was not significantly related to age, sex, headache type, hypnotizability or number of treatment sessions. Patients with higher intake anxiety scores had better clinical outcomes than those with lower scores. Intake depression scores showed no correlation with clinical outcome.

Transracial adoption and the black preschool child.

Abstract A pilot study to evaluate transracially adopted primary-school and preschool children in the areas of racial attitudes, intellectual functioning, and social, cognitive, and physical development. The authors conclude that the transracially adopted children were doing well socially and developmentally and at the time of the research were making evenly balanced racial preference choices. It would appear that transracial adoption is a viable option for black children who cannot be placed permanently in black homes.