The Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) published by the American Psychiatric Association (APA) in 1987 is currently the primary tool used by counselors in clinical settings for diagnosing clients' psychological and behavioral problems. Beginning with the third edition of the manual (DSM-III; APA, 1968) a multiaxial process for diagnosis was introduced to encourage a biopsychosocial perspective of client's problems.This study was designed to investigate if alterations in diagnosis on Axis IV and V could further encourage a biopsychosocial perspective. It was designed to imitate the rapid diagnostic process that takes place in many clinical settings. In the present study, the criterion for a biopsychosocial perspective was the maintenance of neutral perceptions and unbiased hypothesis-testing strategies following diagnosis of a client.Twenty-four counseling psychology trainees participated in the study. The counselor trainees diagnosed a client after listening to approximately 20 minutes of an audio-tape of an initial assessment interview. The 12 counselor trainees in the control group diagnosed the client using the standard multiaxial format for diagnosis. The 12 counselor trainees in the experimental group diagnosed the client using an alternative format which encouraged a focus on positive aspects of the client and the client's environment.The counselor trainees completed the Impression Formation Questionnaire to assess their perceptions of the client. They then wrote 12 questions they would ask the client in the next counseling session. These questions constituted their hypothesis-testing strategies for their diagnoses on Axis I and Axis II.The counselor trainees in both groups maintained primarily neutral perceptions of the client as measured by the IFQ. The counselor trainees in both groups favored confirmatory hypothesis-testing strategies when assigned to groups based on their hypothesis-testing strategy score (p < .05).The results of this study indicated that the standard and alternative multiaxial formats for diagnosis may encourage neutral perceptions of a client when counselors must diagnose the client based on very little information. Neither format for diagnosis was successful, however, in discouraging a biased, confirmatory search for information. / Department of Counseling Psychology and Guidance Services

This study examined the influence of social support on the relationship between posttraumatic stress disorder and comorbid psychopathology, suicidal behaviour, and mental and physical health functioning in the general population. Data came from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (N=34,653). Results showed a differential impact of posttraumatic stress disorder and social support depending on gender. For men, social support had a moderating effect, where social support had a greater influence on the prevalence of comorbid psychopathology for men with posttraumatic stress disorder compared to those without the disorder. In contrast, social support had an additive effect for women, where social support was associated with decreased psychopathology and posttraumatic stress disorder was associated with increased psychopathology. This study suggests that social support should be included in the treatment of men with posttraumatic stress disorder and encouraged among women regardless of mental disorder diagnosis.

Patienter med psykisk störning riskerar att få sämre behandling när de söker vård för somatiska sjukdomar. Patienter med psykisk störning upplever också att de blir sämre bemötta än patienter utan psykiska diagnoser inom den somatiska vården. Syftet med denna litteraturstudie var att beskriva sjuksköterskors attityder till patienter med psykiska störningar inom den somatiska vården. Syftet var också att som kvalitetsgranskning beskriva de utvalda studiernas undersökningsgrupp och bortfall. Studien är en litteraturstudie med beskrivande design där13 artiklar inkluderades från databaserna PubMed och Scopus. Studien pekar på att sjuksköterskor hade attityder till patienter med psykisk störning som krävande patienter som riskerade att skada sig själv och andra. Patienter med psykisk störning ansågs inte vara på rätt ställe inom vården när de behandlades på en somatisk avdelning. Avdelningarnas fysiska miljö och bemanning ansågs inte anpassade för denna patientgrupp. Sjuksköterskor hade attityden att deras förmåga var otillräcklig i vården av patienter med psykisk störning. De ansåg sig sakna kunskap och utbildning samt att de inte alltid såg det som att det låg i deras roll som sjuksköterskor på en somatisk vårdavdelning att vårda patienter med psykisk störning. Slutsatsen är att sjuksköterskor inom den somatiska vården många gånger har negativa attityder mot patienter med psykisk störning som leder till generaliseringar av patientgruppen. Brist på utbildning och tron på den egna förmågan pekar på att sjuksköterskor behöver ett bättre stöd vid vård av patienter med psykisk störning på somatiska avdelningar. Studien visar också på att en helhetssyn på omvårdnad inte är tydlig när det gäller vård av patienter med psykisk störning inom den somatiska vården. / Patients suffering from mental disorders receive worse treatment for their somatic illnesses than people in general. Patients with mental disorders believe they are treated differently from other people without psychiatric diagnosis in general hospitals. The aim of this review was to describe what attitudes nurses in somatic care have towards patients with mental disorders. The aim was also to examine the quality of the included articles by describing the sample and response rate. This review has a descriptive design and 13 articles were included from the databases PubMed and Scopus. The results imply that the attitude nurses had towards patients with mental disorders is that they were not only demanding but also a risk to themselves and to others. Somatic wards are not considered to be the right place for patients with mental disorders. The physical environment and the number of staff were not adjusted when caring for patients with mental disorders. Nurses perceived their own ability to care for these patients to be limited. They felt that they lacked knowledge and education and that they did not always consider the mental disorder to be their responsibility as nurses in somatic care. The conclusion is that nurses in somatic care many times have negative attitudes towards patients with mental disorders which may lead to generalizing about this group of patients. Lack of education and faith in their own ability shows that nurses need more support in caring for patients with mental disorders in somatic wards. The review also implies that an approach that treats the whole patient is not clear when it comes to the care of patients with mental disorders in somatic care.

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